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Although previous studies have underlined the protective role of social support for physical and psychological health, no self-report questionnaires are validated for measuring social support in large-scale psychiatric epidemiological studies. In the current study, we aim to validate the shortened version of the Close Persons Questionnaire (CPQ), a self-report questionnaire that is administered twice to measure social support received from the partner (CPQ-p) as well as from a close friend/family member (CPQ-f). Data of psychiatric patients (n = 1891) and controls (n = 1872) from three Dutch epidemiological studies that assessed determinants of psychopathology were used to validate the shortened CPQ. This included determining factor structure and reliability for the different scales. Using multigroup confirmatory factor analyses, a four-factor model proved to be the best fitting model for both the CPQ-p and CPQ-f. The resulting subscales -emotional support, practical support, negative support experiences, inadequacy of support-showed moderate to good reliability for both the CPQ-p and the CPQ-f, and were all correlated with other social measures in the expected directions. The shortened version of the CPQ proves to be a valid and reliable measure of social support for both psychiatric patients and controls. Further research is needed to assess usability of the shortened version of the CPQ for clinical practice., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Brain-derived neurotrophic factor (BDNF) levels decline during depression and normalise after remission, although studies in older patient samples are inconsistent. Whether BDNF serum levels predict depression remission is unclear. We hypothesize that the predictive value of serum BDNF levels in late-life depression is moderated by selective serotonin reuptake inhibitors (SSRI) usage and early traumatization., Methods: Our study sample was a subset of the Netherlands Study of Depression in Older persons (NESDO), a prospective cohort study. It consisted of 267 older persons with a diagnosis of depression, for which follow-up data were available. Depression diagnosis was assessed at baseline and follow up using a structured diagnostic interview (Composite International Diagnostic Interview (CIDI), volume2.1). Logistic regression was performed (adjusted for covariates) with remission of depression after two years as the dependent variable and baseline BDNF serum levels, childhood traumatization and SSRI use as independent variables. Results - The mean age of the subjects was 70.7 years, 65.6% of them were female, their mean BDNF level was 7.7 ng/ml, 80 (30.0%) of them were traumatised in their childhood,71 (26.6%) used SSRIs and 136 (50.9%) no longer had a depressive disorder at the two year follow up. The predictive value of BDNF serum levels was conditional on traumatization and SSRI usage (threeway interaction p = .010). Higher BDNF serum levels predicted remission in traumatized depressed patients without SSRI usage (OR = 1.17, 95% C.I.: 1.00-1.36; p = .048) and in non-traumatized depressed patients who used SSRIs (OR = 1.17, 95% C.I.: 1.00-1.36; p = .052), but not in the other two subgroups., Conclusion: The association between BDNF serum levels and the course of late-life depression seems to depend on SSRI use and childhood trauma. Based on these results, we hypothesize that childhood trauma may permanently reduce ('blunt') the responsiveness of the neurotrophic system to SSRI usage, and that this responsiveness might be more important for depression course than the actual BDNF serum levels., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: Different biological mechanisms may underlie depression beginning in early life (early-onset) and depression beginning later in life (late-onset). Although the relation between inflammation and depression has been studied extensively, the distinct role of inflammation in early and late-onset depression in older patients has not been addressed before. In the cross-sectional part of this study, we explored differences in levels of circulating inflammatory markers and cytokine levels in lipopolysaccharide (LPS) stimulated whole blood between older subjects with a late-life onset depression (≥60 years) and older subjects with an early-onset depression (<60 years). Secondly, in a 2-year follow-up study, we examined if circulating and stimulated inflammatory markers influenced the change in Inventory of Depressive Symptomatology (IDS) scores, and if this relation was different for early- and late-onset depression., Methods: The study was part of the Netherlands Study of Depression in Older Persons (NESDO). We included 350 patients, all aged 60 and older, with a depressive episode in the previous 6 months: 119 with a late-onset depression and 231 with an early-onset depression. Blood samples were collected and CRP, IL-6, NGAL, GDF15, and, LPS plasma levels were determined and whole blood was LPS stimulated and cytokine levels IL-1β, IL-6, TNFα, IFNγ, IL-10, and IL-1 receptor antagonist (IL-1ra) were determined., Results: After adjustment for demographics, health indicators, and medication use, increased plasma CRP levels were more strongly associated with late-onset depression than early-onset depression (OR [95% CI]: 1.43 [1.05-1.94]). In the longitudinal analyses, higher circulating IL-6 levels were associated with a significantly slower decline in IDS scores in the crude and the adjusted models (p ≤ 0.027). This relation was not different between late- and early-onset depression. Other circulating and stimulated inflammatory markers were not associated with late- and/or early-onset depression., Conclusions: This study provides preliminary evidence that low-grade inflammation is more strongly associated with late-onset than early-onset depression in older adults, suggesting a distinct inflammatory etiology for late-onset depression. Cytokine production capacity did not distinguish between early- and late-onset depression., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objective: To systematically review of the available literature to (1) examine the association between death anxiety and hypochondriasis and (2) examine the association between death anxiety and medically unexplained symptoms (MUS)., Methods: A systematic literature search was conducted in Embase, PsycINFO, Pubmed and Ovid databases and reference lists of selected articles. Articles were included when the research population concerned people with hypochondriasis and/or MUS in who death anxiety was assessed by a validated research method. Two independent reviewers verified that the studies met the inclusion criteria, assessed the quality of the studies and extracted relevant characteristics and data. The data were descriptively analysed., Results: Of the 1087 references identified in the search, six studies on the association between death anxiety and hypochondriasis and three studies on the association between death anxiety and MUS met inclusion criteria. All studies found a positive association of death anxiety with hypochondriasis and/or MUS. The design of all studies was cross-sectional and the overall quality of the studies was low. The influence of age or sex on these associations was not analysed in any of the studies. Given the diversity in setting, population, study design, and methods used, a meta-analysis was not possible., Conclusion: All studies found a positive association of death anxiety with hypochondriasis and/or MUS. Acknowledging that death anxiety may play a prominent role in hypochondriasis/MUS populations, future research should address (potentially modifiable) determinants of death anxiety in these populations., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: Aging societies will bring an increase in the number of long-term care residents with mental-physical multimorbidity. To optimize care for these residents, it is important to study their care needs, since unmet needs lower quality of life. To date, knowledge about care needs of residents with mental-physical multimorbidity is limited. The aim of this study was to explore (un)met care needs of residents with mental-physical multimorbidity and determinants of unmet needs., Methods: Cross-sectional cohort study among 141 residents with mental-physical multimorbidity without dementia living in 17 geronto-psychiatric nursing home units across the Netherlands. Data collection consisted of chart review, semi-structured interviews, (brief) neuropsychological testing, and self-report questionnaires. The Camberwell Assessment of Need for the Elderly (CANE) was used to rate (un)met care needs from residents' and nursing staff's perceptions. Descriptive and multivariate regression analyses were conducted., Results: Residents reported a mean number of 11.89 needs (SD 2.88) of which 24.2% (n = 2.88, SD 2.48) were unmet. Nursing staff indicated a mean number of 14.73 needs (SD 2.32) of which 10.8% (n = 1.59, SD 1.61) were unmet. According to the residents, most unmet needs were found in the social domain as opposed to the psychological domain as reported by the nursing staff. Different opinions between resident and nursing staff about unmet needs was most common in the areas accommodation, company, and daytime activities. Further, nearly half of the residents indicated 'no need' regarding behavior while the nursing staff supposed that the resident did require some kind of support. Depression, anxiety and less care dependency were the most important determinants of unmet needs., Conclusions: Systematic assessment of care needs showed differences between the perspectives of resident and nursing staff. These should be the starting point of a dialogue between them about needs, wishes and expectations regarding care. This dialogue can subsequently lead to the most optimal individually tailored care plan. To achieve this, nurses with effective communication and negotiation skills, are indispensable., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objectives: Growth differentiation factor-15 (GDF-15) is an inflammatory molecule that reacts to cell stress. Since major depression is associated with inflammation, we examined whether GDF-15 levels are elevated in patients with late-life depression., Methods: Plasma GDF-15 levels were analyzed in 350 patients diagnosed with major depressive disorder in the last six months and 128 non-depressed controls from the Netherlands Study of Depression in Older persons (age ≥ 60 years). Major depressive disorder and age of onset were assessed with the Composite International Diagnostic Interview. Severity of depressive symptoms was measured with the Inventory of Depressive Symptoms (IDS-30). Multiple linear regression models were applied to study depression (diagnosis, onset age, severity, antidepressant drug use) as determinant of GDF-15 level, adjusted for demographic and clinical variables., Results: Plasma GDF-15 levels were 22% higher in patients with major depression compared to controls. Within the depressed group, levels were higher in patients with older age of onset. GDF-15 levels showed a small, positive correlation to the levels of the inflammatory mediators IL-6 and C-reactive protein (r=0.23, and 0.24, p<0.05). This increase was independent from comorbidities, such as cardiovascular disease, rheumatism and diabetes, and anti-inflammatory drugs. However, this increase was dependent on lifestyle factors as smoking, physical activity and alcohol use. Within the depressed subgroup, neither depression severity or antidepressant drug use was associated with GDF-15 levels in the fully adjusted models., Conclusion: The inflammatory factor GDF-15 does not seem to be an independent inflammatory marker for late-life major depressive disorder., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: To study the effect of vitamin D levels on depression course and remission status after two years, as well as attrition and mortality, in an older cohort., Methods: This study was part of the Netherlands Study on Depression in Older persons (NESDO), a prospective cohort study. 367 depressed older persons (≥ 60 years) were included. Baseline vitamin D status, reasons for loss to follow up, clinical depression diagnosis at two-year follow up, and six-monthly symptom scores were obtained. Data were analyzed by logistic regression and random coefficient models and adjusted for confounders of vitamin D status., Results: Vitamin D had no effect on the course of depression or remission, except for a trend towards lower remission rates in the severely deficient subgroup (25-(OH) vitamin D<25 nmol/l). Patients who died during follow up had significantly lower 25-(OH) vitamin D and 1,25-(OH)2 vitamin D levels than patients with continued participation., Conclusions: For the total sample we found no effect of vitamin D levels on the course of depression or remission rates. However, we did find an effect of lower vitamin D levels on mortality. This strengthens the interpretation of vitamin D deficiency being a marker for poor somatic health status. The trend towards lower remission rates in the severely deficient subgroup raises the question whether this group could benefit from supplementation. Randomized controlled trials are necessary to study this., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Depression and physical frailty in older persons are both associated with somatic diseases, but are hardly examined in concert., Objectives: To examine whether depression and physical frailty act independently and/or synergistically in their association with somatic diseases., Design: Baseline data of an ongoing observational cohort study including depressed cases and non-depressed comparison subjects., Settings: Netherlands Study of Depression in Older persons (NESDO)., Participants: 378 depressed older persons confirmed by the Composite International Diagnostic Interview (CIDI), version 2.1, and 132 non-depressed comparison subjects., Methods: Multiple linear regression analyses adjusted for socio-demographic and life-style characteristics were conducted with the number of somatic diseases as the dependent variable and depression and physical frailty as independent variables. Physical frailty was defined as ≥3 of the following characteristics, slowness, low physical activity, weight loss, exhaustion, and weakness., Results: Depression and physical frailty did not interact in explaining variance in the number of somatic diseases (p=.57). Physical frailty, however, partly mediated the association between depression and somatic diseases, as the strength of this association decreased by over 10% when frailty was added to the model (B=0.47, p=.003, versus B=0.41, p=.01). The mediation effect was primarily driven by the frailty criterion exhaustion. Of the remaining frailty components, only slowness was associated with the number of somatic diseases; but this association was fully independent of depression., Conclusions: Our results suggest that depression and physical frailty have common pathways towards somatic diseases, as well as unique pathways. As no high-risk group was identified (no significant interaction), mental health nurses should regularly monitor for physical frailty within their caseload of depressed patients., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: Although it is well established that late-life depression is associated with both systemic low-graded inflammation and cognitive impairment, the relation between inflammation and cognition in depressed older persons is still equivocal. The objective of this study is to examine the association between plasma Neutrophil Gelatinase-Associated Lipocalin (NGAL) concentrations and cognitive functioning in late-life depression, including the potentially moderating role of sex., Methods: A total of 369 depressed older persons (≥60 years) from The Netherlands study of Depression in Older persons (NESDO) were included. Four cognitive domains, i.e. verbal memory, processing speed, interference control and attention were assessed with three cognitive tests (Stroop test, Wais Digit span test, and Rey's verbal learning test). Multiple linear regression analyses were applied with the four cognitive domains as dependent variables adjusted for confounders., Results: The association between NGAL levels and specific cognitive domains were sex-specific. In women, higher NGAL levels were associated with impaired verbal memory and lower processing speed. In men, higher NGAL levels were associated with worse interference control. Higher NGAL levels were not associated with attention. No sex-specific associations of either high sensitivity C-reactive protein (hsCRP) or interleukin-6 (IL-6) with cognitive functioning were found., Conclusion: This study shows sex-specific association of NGAL with cognitive functioning in late-life depression., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Brain-Derived Neurotrophic Factor (BDNF) serum levels are abnormally low in depressed patients as compared to healthy controls and normalize with SSRI treatment. The aim of this study is to examine serum BDNF levels in late-life depression, stratified for SSRI usage, and to explore the relation between BDNF levels and specific depression characteristics as well as between BDNF levels and early and recent life stressors in late-life depression. We assessed serum BDNF levels in 259 depressed patients not using an SSRI, 99 depressed patients using an SSRI and 119 non-depressed controls (age range 60-93 years). Depressive disorders were diagnosed with the Composite International Diagnostic Interview (CIDI, version 2.1). Serum BDNF levels were significantly higher in depressed patients who used an SSRI compared to depressed patients not using SSRIs and compared to non-depressed controls, when adjusted for age, sex, life style characteristics, cognitive functioning and somatic comorbidity. Recent life-events, assessed with the List of Threatening Events-Questionnaire, were significantly associated with lower BDNF levels in non-depressed subjects only. Although a summary score of early traumatization (before the age of 16 years) was not associated with serum BDNF levels in any of the three groups, we found an interaction between a history of severe physical abuse and SSRI usage in the depressed group. Interestingly, higher serum levels of BDNF in depressed patients using SSRIs were only found in those patients without a history of severe childhood abuse and not in those with a history of severe childhood abuse., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: The Health of the Nation Outcome Scales (HoNOS) is widely used to evaluate mental health care outcomes. For appropriate use and interpretation in routine clinical practice, further validation of the adapted version for older clients (HoNOS 65+) is needed., Objective: The aim of this study is to compare scoring profiles produced by different categories of professionals, assess the internal consistency of the sum score and proposed subscales, and concurrent validity of the total sum score of the Dutch version of HoNOS 65+., Methods: We used baseline data from fourteen mental health care organizations participating in the MEntal health care Monitor Older adults (MEMO), a nationwide routine outcome monitoring system. A total of 767 older clients, referred for gerontopsychiatric disorders, were administered HoNOS 65+ by non-academic (primarily nurses, n=430) or academic professionals (psychologists/physicians, n=337). Demographics and full DSM-IV classification, including the Global Assessment of Functioning (GAF), were derived from the electronic medical dossier., Results: HoNOS 65+ seemed to discriminate between clients with and without a depressive disorder, adjustment disorder, anxiety disorder and psychotic disorder on the items expected. In clients suffering from a depressive or psychotic disorder, nurses/social workers and physicians/psychologists did not differ in scoring on all items of HoNOS 65+. In clients with an adjustment disorder or anxiety disorder, professions differed in rating on two items. Confirmatory Factor Analyses supported neither the factor structure of the original HoNOS nor the initially reported structure of HoNOS 65+ version. Cronbach's alpha of the total sum score was 0.60. Internal consistency of previously identified subscales was low. A new set of subscales could not be identified satisfactorily. A medium-sized correlation of the HoNOS 65+ sum score and the GAF was found (r=-.30, p<.001)., Conclusions: It is preferable to use individual HoNOS 65+ items, to evaluate care outcomes. The HoNOS 65+ items discriminate between clients with and without a particular diagnosis. Nonetheless, in some of the most prevalent gerontopsychiatric disorders rating differs between professionals with different educational backgrounds., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Objective: Systemic low graded inflammation has been identified as a possible biological pathway in late-life depression. Identification of inflammatory markers and their association with characteristics of depression is essential with the aim to improve diagnosis and therapeutic approaches. This study examines the determinants of plasma Neutrophil Gelatinase-Associated Lipocalin (NGAL), which is selectively triggered by TNFα receptor 1 signaling within the central nervous system, and its association with late-life depressive disorder., Methods: Baseline data were obtained from a well-characterized prospective cohort study of 350 depressed and 129 non-depressed older persons (≥60years). Past 6month diagnosis of major depressive disorder (MDD) according to DSM-IV-TR criteria was assessed with the Composite International Diagnostic Interview (CIDI 2.0). Potential determinants of plasma NGAL included sociodemographic characteristics, lifestyle and psychiatric and physical comorbidity., Results: Plasma NGAL concentrations were significantly associated with age, male gender, smoking and waist circumference. Adjusted for these determinants, depressed patients had significantly higher NGAL plasma levels compared to non-depressed comparison group. Depressed patients who did not meet full criteria for MDD in the month before sampling (partially remitted) had lower plasma NGAL levels compared with those who did. Subjects with a recurrent depression had higher plasma NGAL levels compared to those with a first episode. NGAL levels were neither related with specific symptom profiles of depression nor with antidepressant drug use., Conclusion: Adjusted for confounders, NGAL plasma levels are increased in depressed older persons, without any effect of antidepressant medication and age of onset., (© 2013.)