Predictors in geriatric psychiatry hospital length of stay.

This paper examined predictors of length of stay in a freestanding geriatric psychiatry hospital. Data on patient and treatment characteristics of geriatric inpatients (N = 1,593) were extracted from an archival administrative tracking database from Mary Starke Geriatric Harper Center. Five independent variables (length of time between last discharge and most recent admission, number of previous admissions, number of assaults, co-morbid medical condition, and admitting psychiatric diagnosis) were entered into a hierarchical regression model as potential predictors of length of stay in a geriatric psychiatry hospital. Number of assaults committed by the patient was the only significant predictor of length of stay, such that patients that had a greater number of assaults were more likely to have longer lengths of stay than those with fewer assaults. These findings highlight the importance of identifying patients at risk for assaultive behavior and developing effective interventions for aggression in geriatric psychiatry hospitals.

Do manualized treatments for depression reduce insomnia symptoms?

OBJECTIVE: Researchers evaluated the effect of manualized treatments for depression on comorbid symptoms of insomnia. METHOD: Hierarchical linear modeling was used to analyze archival data collected from 14 studies (N = 910) examining the efficacy of psychological treatments for depression in adults. RESULTS: Participants receiving a psychological treatment for depression experienced significantly more relief from symptoms of insomnia with overall, early-, middle-, and late-night sleep than those not receiving such treatment. CONCLUSION: Symptoms of insomnia in those with an average (or lower) level of depression can be reduced through psychological treatment for depression. However, more severe depressive symptoms do not receive great relief from sleep disturbance and may require an additional treatment component targeting symptoms of insomnia.

The structure of affective symptomatology in older adults with osteoarthritis.

OBJECTIVE: To examine the structure of symptoms of affective disorder among older adults with a chronic health problem (osteoarthritis) and to explore cross-sectional and longitudinal associations of obtained affective symptom clusters with key health outcomes (pain, functional disability, perceived health). METHODS: One-year longitudinal study of older adults with diagnosed osteoarthritis of the knee. Symptoms of DSM depression and anxiety were assessed in a research diagnostic interview by using a DSM-IV symptom checklist; self-reports captured demographic characteristics, objective health, pain, disability, and perceived health. Confirmatory factor analysis tested comparability of affective symptom structure in this sample to findings of previous research; ordinary least squares regression examined cross-sectional and longitudinal associations of affective symptoms with health outcomes, controlling for demographics and objective health. RESULTS: The current sample displayed an affective symptom structure comparable with that observed in previous research, with symptoms clustering into depressed mood (DM), somatic symptoms (SS), and psychic anxiety (PA) factors. DM was cross-sectionally associated with pain and disability and marginally with perceived health; SS predicted current pain and perceived health. Only DM predicted 1 year change in disability and perceived health (but not pain). CONCLUSIONS: This research confirms the role of SS of distress in fueling disability and perceived ill health among older adults who are chronically ill. However, it is DM that drives changes in perceived health and functional ability.

Pain, disability, and depression in osteoarthritis: effects of race and sex.

OBJECTIVES: A cross-sectional study examined how race and sex affect associations among osteoarthritis (OA) pain, disability, and depression in 363 older adults with diagnosed knee OA. METHOD: African American (Black; N = 94) and non-Hispanic White (White; N = 269) men and women self-reported pain, disability, depressive symptoms, arthritis history, general health, and demographic information. RESULTS: Women experienced greater pain and marginally greater disability than men; African Americans reported greater disability and marginally greater pain than non-Hispanic Whites. These effects varied with education, health, and arthritis history. In ordinary least squares regression analyses, race and pain independently predicted depression. Significant interactions of race, sex, and disability were driven by a lack of relationship between depression and disability among African American men. DISCUSSION: Race and sex influence affective response to OA pain and disability in complex ways, with African American men showing paradoxical effects. Further research is needed to elucidate mechanisms of this moderation effect.

A comparison of the frequencies of risk factors for depression in older black and white participants in a study of indicated prevention.

BACKGROUND: To compare the frequencies of risk factors, we describe risks for depression as a function of race among consecutively admitted participants in a randomized clinical trial of indicated depression prevention in later life. METHODS: Seventy-two black and 143 white participants were screened for risk factors for depression. RESULTS: Black participants were more likely to have fewer years of education and lower household income. They were more likely to be obese, live alone, experience functional disability, have a history of alcohol and drug abuse, and have lower scores on the Mini-mental State Examination and the Executive Interview (EXIT). White participants were not found to have greater prevalence or higher mean score on any risk factor. On average, black participants experienced approximately one more risk factor than white participants (t(213) = 3.32, p = 0.0011). CONCLUSIONS: In our sample, black participants had higher frequencies of eight risk factors for depression and a greater mean number of risk factors compared to white participants.