Attitudes towards depression and its treatment among white, hispanic, and multiracial adults.

BACKGROUND: Depression is present in all societies and affects members of all racial and ethnic groups. However, attitudes about depression differ across groups and have been shown to impact help-seeking behaviors, preferences for treatments, and compliance with treatments. METHODS: Taking a cross-cultural approach, this project used a case vignette of depression to examine race/ethnic group differences in attitudes about depression and its treatment among young adults in the U.S. RESULTS: Data analyses revealed significant racial/ethnic group differences in attitudes as well as the treatments/strategies participants reported they would use. Gender x race/ethnicity interactions revealed that White and Multiracial/ethnic men were more likely to believe the vignette character should find a partner to help with symptoms, while White and Multiracial/ethnic women did not endorse those strategies. Hispanic men and women did not show a gender difference in that strategy, but gender differences were observed in other strategies. In a rare comparison, majority-minority Multiracial/ethnic participants (i.e., White selected as one of their races/ethnicities) rated identified helpers and treatments similarly to White participants and significantly higher than multiple-minority Multiracial participants (i.e., White not selected as one of their races/ethnicities). CONCLUSIONS: Findings supported previous research that indicates different U.S. racial/ethnic group ideas of depression and its treatment are potentially linked with cultural values, and we suggest that investigating these more fine-grained group differences can help to inform treating professionals as well as public health messages.

Psychological and physical health behavior deviations in students amidst the COVID-19 pandemic.

Objective: This study sought to understand how the pandemic impacted mental and physical health behaviors in University students. Methods: Undergraduate and graduate students were asked to answer questions on depression, anxiety, stress, sleep quality, and physical activity "prior to" and "during" the shutdown. Results: 457/960 (47.6%) completed the entire survey. Paired samples t-tests showed significant change in mental and physical health behaviors over time. Hierarchical regression models indicated that negative experiences during the shutdown were associated with depression, anxiety, stress, and sleep quality (all p's < .001), but not time spent exercising or sedentary behavior. In addition, positive experiences during the shutdown acted as a buffer. Conclusion: The COVID-19 pandemic shutdown negatively impacted University students. Significant mental and physical health consequences were observed. These effects may linger long past the re-opening of society, and it may be prudent to prepare for additional demand on campus resources.

Students in undergraduate and graduate programs experience daily stress related to finances, workload, and time management, as well as the entry into emerging adulthood. This period of transition and its corresponding stressors are especially concerning when looking at the impact of a global pandemic on public health. The present study substantiates previous research concluding that college student health negatively changed during COVID-19 and extends it to include graduate students and a more extensive view of health behaviors.

Predictors of depression among middle-aged and older men and women in Europe: A machine learning approach.

Background: The high prevalence of depression in a growing aging population represents a critical public health issue. It is unclear how social, health, cognitive, and functional variables rank as risk/protective factors for depression among older adults and whether there are conspicuous differences among men and women. Methods: We used random forest analysis (RFA), a machine learning method, to compare 56 risk/protective factors for depression in a large representative sample of European older adults (N = 67,603; ages 45-105y; 56.1% women; 18 countries) from the Survey of Health, Ageing and Retirement in Europe (SHARE Wave 6). Depressive symptoms were assessed using the EURO-D questionnaire: Scores ≥ 4 indicated depression. Predictors included a broad array of sociodemographic, relational, health, lifestyle, and cognitive variables. Findings: Self-rated social isolation and self-rated poor health were the strongest risk factors, accounting for 22.0% (in men) and 22.3% (in women) of variability in depression. Odds ratios (OR) per +1SD in social isolation were 1.99x, 95% CI [1.90,2.08] in men; 1.93x, 95% CI [1.85,2.02] in women. OR for self-rated poor health were 1.93x, 95% CI [1.81,2.05] in men; 1.98x, 95% CI [1.87,2.10] in women. Difficulties in mobility (in both sexes), difficulties in instrumental activities of daily living (in men), and higher self-rated family burden (in women) accounted for an additional but small percentage of variance in depression risk (2.2% in men, 1.5% in women). Interpretation: Among 56 predictors, self-perceived social isolation and self-rated poor health were the most salient risk factors for depression in middle-aged and older men and women. Difficulties in instrumental activities of daily living (in men) and increased family burden (in women) appear to differentially influence depression risk across sexes. Funding: This study was internally funded by Colorado State University through research start-up monies provided to Stephen Aichele, Ph.D.

A Virtual Reality Intervention to Reduce Dementia-Related Agitation Using Single-Case Design.

OBJECTIVES: The primary objective of this study was to use a single-case design to evaluate the utility of a VR intervention to reduce agitation behaviors in two female participants with a diagnosis of dementia. METHODS: A single-case research design with an ideographic approach was selected given the novelty of this intervention. A blended single case experimental design was used combining the Multiple-baseline design across individuals with a reversal design to examine the effects of VR nature scenes on agitation. Visual analysis was used to determine changes in mean, level, and latency of the behaviors. RESULTS: For both participants, a significant decrease in their respective agitation behaviors was observed during intervention phases. CONCLUSIONS: This study provides preliminary evidence of the utility of VR as a brief and effective intervention to decrease agitation in individuals with dementia. CLINICAL IMPLICATIONS: These initial, promising results may help caregivers improve the quality of life for dementia patients. Further, the brevity of the intervention makes this a practical tool for care providers working in clinical settings. The primary objective of this study was to use a single-case design to evaluate the utility of a VR intervention to reduce agitation behaviors in two female participants with a diagnosis of dementia.

Impacts of the Coronavirus Pandemic on the Emotional and Physical Health of Older Adults Compared with Younger Cohorts.

OBJECTIVES: This study compared emotional and physical health and overall well-being related to social restrictions during the pandemic among older, middle-aged, and younger adults in the United States (n = 276). METHODS: Online surveys collected information on mental and physical health, as well as positive and negative impacts of the pandemic. One-way MANOVAs and hierarchical regressions were used to analyze data. RESULTS: Depressive symptoms and coronavirus anxiety differed significantly by age, with older adults reporting less depressive and anxious symptoms than younger cohorts. Negative COVID experiences significantly predicted higher levels of stress, anxiety, and insomnia symptoms in younger adults as compared to older cohorts. CONCLUSIONS: Findings indicate that social restrictions had a more substantial negative impact amongst younger adults compared to older adults, particularly in terms of mental health and well-being. CLINICAL IMPLICATIONS: Older adults may be more resilient to the impacts of the pandemic than younger cohorts and thus may serve as a critical resource for how to navigate crisis situations of this nature. Future studies should continue to monitor health outcomes as the pandemic subsides in conjunction with the vaccine rollout, as the long-term effects of social distancing and stay-at-home measures are yet to be determined.

Comparison of longitudinal diary and actigraphy-assessed sleep in pregnant women.

STUDY OBJECTIVES: Various methods are employed to assess sleep in pregnant women, including self-report, sleep diary, and actigraphy. Unfortunately, the data are often contradictory, and interpretations are often inconsistent. The current aims are to compare subjective and objective sleep data in pregnant women collected longitudinally in early pregnancy. METHODS: In this secondary analysis of 104 pregnant women, sleep was collected via diary and actigraphy for 14 days during three separate occasions (10-12 weeks; 14-16 weeks; and 18-20 weeks). Sleep variables included wake after sleep onset (WASO), sleep efficiency (SE), bedtime/lights out, sleep onset latency (SL), and total sleep duration (TST). Repeated measures ANOVAs compared each sleep variable across Time and by Method of data collection, while controlling for parity and daytime naps. RESULTS: Significant differences were noted for only the method of data collection for sleep component studied for WASO, F (1, 98) = 147.20, p < 0.001; SE, F (1, 98) = 129.41, p < 0.001); bedtime/lights out, F (1, 103) = 5.33, p < 0.05); and sleep duration, F (1, 104) = 182.75, p < 0.001). Significant variation was not seen in any variable across time-period. CONCLUSIONS: There are substantial discrepancies between diary- and actigraphy-assessed sleep measures in pregnant women which is in alignment with previous literature. These data highlight that these methodologies assess different constructs. We contend that these data may be useful as a reference to compare high-risk women or those with sleep disorders. Using a multi-modal approach to identify sleep disturbance in pregnancy is likely a more clinically useful option.

Sleep Disturbance in Early Pregnancy, but Not Inflammatory Cytokines, May Increase Risk for Adverse Pregnancy Outcomes.

BACKGROUND: It is unclear whether subjective or objective measures of sleep during pregnancy are more pertinent to pregnancy outcomes. Moreover, it is unclear as to whether subjective indices (i.e., those likely influenced by psychological thoughts and emotions) are more likely than objective measures to modify inflammatory cytokines. METHOD: Subjective and objective measures of sleep were collected from 166 pregnant women. Sleep data, both aggregate and variability measures, from diary and actigraphy, were ascertained for three 2-week periods during early gestation (10-20 weeks). A fasting morning blood sample was assayed for the cytokines (IL-6, IFN-γ, and TNF-α). Sleep, stress, and depression questionnaires were also collected. Repeated measures ANOVAs, regression models, and independent t tests were used to analyze the data. RESULTS: Diary-assessed total sleep time (p < .05) and actigraphy-assessed sleep latency (p = .05) were negatively associated with gestational age. Variability in actigraphy-assessed sleep latency (p < .01) was negatively associated with infant weight. None of the cytokines was associated with any of the outcomes. t tests revealed that those with a complication were older (p < .05) and had higher pre-pregnancy BMI (p < .05), higher self-reported stress (p < .05), and lower IFN-γ (p < .05). CONCLUSION: Findings suggest that longer and more variable sleep latency, as well as shorter sleep duration, is associated with shorter gestational age or a lower birth weight infant. Overall, the findings suggest that among a low-risk, healthy sample of pregnant women, sleep disturbance does not pose a substantial risk for adverse delivery outcomes.

Understanding the Impacts of Caregiver Stress.

PURPOSE/OBJECTIVES: Identifying risk factors associated with caregiver stress and suggesting methods for systematic caregiver screening for caregiver strain, depression, and anxiety. PRIMARY PRACTICE SETTING: Emergency department, primary care, and other health care settings. FINDINGS/CONCLUSIONS: Caregiver stress can lead to multiple negative outcomes including declines in physical health, increased mental health concerns, and overall decreased quality of life. Caregiver stress also leads to increased financial costs to the person, family, and health care systems, making it a public health issue. Recognizing caregiver stress is the initial step to identifying those in need of support and to providing quality care. Fortunately, caregiver stress can be prevented or reduced using a culturally competent multidimensional approach to addressing social determinants of health and unmet physical, psychological, and social/emotional needs of caregivers. IMPLICATIONS FOR CASE MANAGEMENT: Case management plays a critical role in assessing, educating, advocating, creating care plans, and advocating for both the caregiver and the care recipient.

Comorbidity of depressive symptoms among primary care patients with diabetes in a federally qualified health center.

Depression is frequently comorbid with diabetes; however, less is known about this comorbidity in socially disadvantaged populations. This cross-sectional study examined depressive symptomatology among 424 patients with prediabetes or type 2 diabetes mellitus at a federally qualified health center. Prevalence of clinically significant depressive symptoms was assessed using the World Health Organization Five-Item Well-Being Index. The majority (67.7%) endorsed depressive symptoms, with greater prevalence among middle-aged adults (45-64 years) than younger or older counterparts. More women than men endorsed depressive symptoms. Findings suggest the need for routine depression screening in both prediabetes and type 2 diabetes mellitus, particularly among middle-aged and low-income individuals.

Utility of the SLUMS as a cognitive screening tool among a nonveteran sample of older adults.

OBJECTIVES: To investigate the concurrent validity of the Saint Louis University Mental Status examination (SLUMS) by comparing the ability of the Mini-Mental State Examination (MMSE) and the SLUMS to predict performance on standard neuropsychological measures of memory and executive functioning. DESIGN: Cross-sectional. SETTING: University-based research clinic. PARTICIPANTS: Community-dwelling adults (N = 170) age 60 years and older (Mage = 73.08; SD = 8.18). MEASUREMENTS: The Trail Making Test (TMT), Rey Auditory Verbal Learning Test, Wisconsin Card Sorting Test (WCST), MMSE, and SLUMS. RESULTS: The distributional properties of the SLUMS and the MMSE were directly compared. The SLUMS showed statistically a smaller mean, lower rank scores, and less skewness than the MMSE. Comparisons of the correlations of the screening tests with the neuropsychological measures indicated that the SLUMS demonstrated stronger relationships with the TMT compared with the MMSE. Multiple regression analyses were conducted to determine the ability of the SLUMS and the MMSE to predict scores on common neuropsychological tests after controlling for demographic variables. Results demonstrated that the SLUMS significantly predicted performance across all measures over the MMSE and demographic variables, with the exception of the WCST's perseverative errors. However, the MMSE does not add to the prediction of neuropsychological functioning over the SLUMS. CONCLUSION: Although the SLUMS and the MMSE are strongly correlated, the SLUMS significantly adds to the prediction of neuropsychological measures beyond the MMSE scores. Our findings suggest that the SLUMS may be an appropriate measure to use as a screening tool among older adults and may have fewer ceiling effects than the MMSE.

The bidirectional relationship of depression and diabetes: a systematic review.

Depression and diabetes are both serious chronic conditions common in Western cultures. These conditions impart a significant burden on the patients and society. Depression is often comorbid with chronic illness, and past research has found an increased prevalence of depressive symptoms in patients with Type 2 Diabetes Mellitus (T2DM). However, the exact nature and direction of this relationship are unknown. Depression is often thought to be a consequence of diabetes, perhaps due to the burden of chronic illness. Research has also suggested that depression may be a risk factor for development of diabetes, in part due to biochemical changes in depression and in part because of a reduction of health care behaviors in individuals with depression. This paper reviews the literature behind both lines of investigation and includes special diagnostic and clinical considerations for at risk populations. We discuss clinical implications, limitations of current research, and areas of interest for future research.

Concurrent Validity of the Cognitive Assessment of Minnesota in Older Adults with and without Depressive Symptoms.

Cognitive impairment represents a common mental health problem in community-dwelling and institutionalized older adults, and the prevalence increases with age. Multidisciplinary teams are often asked to assess cognitive and functional impairment in this population. The Cognitive Assessment of Minnesota was created by occupational therapists for this purpose and is frequently used, but has not been extensively validated. This study examined the performance of the CAM and compared it to the MMSE with 113 outpatient clinic patients over the age of 60. Subgroups were established based on scores on a depression inventory to determine if the presence of depressed mood altered the relationship between the measures. Both measures demonstrated good internal consistency. The overall correlation between the two measures was high, statistically significant and remained high regardless of depression status. We offer recommendations about the utility of each measure in screening cognitive functioning for older adults.

The Palisades: an interdisciplinary wellness model in senior housing.

PURPOSE: The conceptual model and implementation strategies for a university-private housing collaboration in a multilevel housing campus for older adults are described. The faculty and private developers viewed senior housing as an opportunity for people to downsize their space in order to upsize their lives within a community rich with resources to support their developmental needs. METHODS: A wellness program that includes assessments developed and performed by a multidisciplinary team provides the basis for the development of resources and interventions aimed at upsizing residents' lives. Semi-annual assessments and feedback sessions provide the residents with opportunities to set and revise goals and to work with members of the team to identify resource needs. RESULTS: After the first year, the wellness assessment scheduling and protocol were streamlined and recruitment barriers were addressed. The addition of a system for providing feedback to residents about their assessment results enhanced the meaning and value of the process. IMPLICATIONS: The Palisades team hopes to assist in promoting similar projects designed to positively impact wellness in older adults.

The sensitivity and specificity of cognitive screening instruments to detect cognitive impairment in older adults with severe psychiatric illness.

BACKGROUND: Older adults with severe psychiatric illness are often treated at community mental health centers (CMHCs) and these individuals commonly have numerous risk factors for cognitive impairment (CI). Brief cognitive screening instruments are frequently used to evaluate cognitive functioning in CMHCs, but the validity of these measures for detecting CI has not been adequately evaluated in this patient population. OBJECTIVES: To determine the sensitivity and specificity of 2 cognitive screening measures (the Mini-Mental Status Examination [MMSE] and the Stroop Color and Word Test [SCWT]) for detecting CI in a sample of older adults with severe psychiatric illness. METHODS: Data were collected from 52 older adults receiving services at a CMHC. Diagnosis of CI was made by a neuropsychologist. Sensitivity and specificity coefficients for 2 cutoff scores for the MMSE and the SCWT were calculated. RESULTS: A cutoff score of 25 on the MMSE yielded a sensitivity of 43.3% and a specificity of 90.4% for detecting CI, whereas a cutoff score of 21 yielded sensitivity of 13.1% and 100% specificity. Using an age- and education-corrected scaled score (SS) on the SCWT falling at or below 7 as the criterion the SCWT had 88.8% sensitivity and 36.8% specificity, whereas a cutoff score of 5 or below yielded sensitivity of 59.2% and specificity of 57.8%. CONCLUSIONS: Overall, the MMSE was found to be the more clinically useful cognitive screening tool for use in CMHC. Yet, because of the poor sensitivity of the MMSE for detecting CI in this patient population, alternative screening methods should be explored.

Applications of Preference Assessment Procedures in Depression and Agitation Management in Elders with Dementia.

Low levels of engagement with leisure activities are commonly seen in older adults with dementia and may lead to decreased social contact, depressed affect, and agitated behaviors. Adults with dementia often have difficulty choosing activities when asked directly about preferences due to cognitive decline, which makes it more difficult to increase their engagement levels. However, simply presenting leisure items without prior knowledge of preferences may be inefficient and may not yield desired results. Long-term care staff need more structured and efficient ways to determine individual preferences and preference assessments (structured choice making opportunities) may offer a solution. Preference assessments have been used to identify effective reinforcers for both individuals with developmental disabilities and older adults with dementia and can provide staff with a brief method for identifying enjoyable activities. This study examined the utility of using stimuli (identified from preference assessments) in behavioral management protocols with 11 elders (mean age = 85.6 years) with dementia in a long-term care setting. Behavioral outcomes of depression and agitation were evaluated at baseline and throughout the intervention. Results indicated positive improvement in behavioral symptoms in 8 of 11 participants. The utility of using preferred items in behavioral management protocols was supported for reducing agitated behaviors but was only partially supported for decreasing depressive symptoms in individuals with dementia.

Effectiveness of nonpharmacological interventions for the management of neuropsychiatric symptoms in patients with dementia: a systematic review.

BACKGROUND: Recent reports documenting limited evidence supporting the use of pharmacological interventions for neuropsychiatric symptoms (NPS) and increased risk of death, the black box warnings against the use of atypical antipsychotic drugs in older adults, and Omnibus Budget Reconciliation Act regulations suggest the need to evaluate the usefulness of nonpharmacological interventions in the management of NPS of dementia. METHODS: To determine the evidence base of nonpharmacological interventions for the management of NPS in patients with dementia, we reviewed MEDLINE, PsycINFO, the Cochrane library, and relevant bibliographies published from January 1966 to December 2005, using the American Psychological Association Guidelines. RESULTS: Three randomized controlled trials (RCTs) and 6 single-case designs (SCDs; N of 1 trials) met inclusion criteria. Under unmet needs interventions, 1 SCD found a moderate reduction in problem behaviors. Under behavioral interventions, based on observational data, all 4 SCDs reported a relative reduction of 50% to 100% in neuropsychiatric symptoms. Under caregiving interventions, there were 3 RCTs. At the 6-month follow-up, 1 RCT found a reduction in 4 neuropsychiatric symptom subscales: ideation disturbance score (0.3 vs 0.5; range, 0-8; P = .005); irritability score (18.8 vs 23.0; range, 8-38; P = .008); verbal agitation, as measured by mean frequency of 20-minute outbursts (0.5 vs 0.8; P = .005); and physical aggression score (11.4 vs 12.9; range, 6-42; P<.001). Another RCT found a significant improvement in frequency (2.3 vs 3.1; range, 0-4; P<.001) and severity (2.2 vs 2.8; range, 0-4; P<.001) of target behaviors associated with the intervention arm. The third RCT found no effect. Under bright light therapy, 1 SCD found short-term improvements on the Agitated Behavior Rating Scale (9.7 vs 19.9; P<.001). CONCLUSIONS: The cumulative research to date on the impact of nonpharmacologic interventions for NPS among patients with dementia indicates that interventions that address behavioral issues and unmet needs and that include caregivers or bright light therapy may be efficacious. More high-quality research is necessary to confirm these findings.

Using choice-making opportunities to increase activity engagement in individuals with dementia.

Structured choice-making procedures, referred to as preference assessments, have been frequently used to identify reinforcers for individuals with developmental disabilities; however, few studies have examined the use of preference assessments with older adults with dementia. This study evaluated the utility of 4 versions of a 2-choice preference assessment for identifying items and activities associated with high levels of engagement in clients at an adult day care program. The same 8 items were presented in 4 formats (ie, verbal, pictorial, textual, tangible), and items from each assessment were ranked with respect to the subsequent level of participant engagement with each item. Correlations were computed between the preference hierarchy and subsequent engagement levels for each format. The format with the highest correlation coefficient was subsequently used in interventions in which frequent structured choice opportunities were presented throughout the day to increase engagement. For 3 of 4 participants, the vocal modality was optimal, while the tangible modality was optimal for the fourth. Moderate to substantial increases in engagement were observed for all participants when structured choices were offered. Implications for activity engagement in adult day care programs are discussed.

Decreasing entry into a restricted area using a visual barrier.

Wandering is a difficult-to-manage behavior problem for individuals with cognitive impairments that can jeopardize safety if an individual enters a hazardous area or becomes lost. This study investigated the effects of a cloth barrier on entry into an unsafe area. The cloth barrier reduced entry into the restricted area and had high treatment acceptability.