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Background: Female older workers generally leave the work force earlier than men. Depressive symptoms are a risk factor of early work exit and are more common in women. To extend working lives, pathways leading to these sex inequalities need to be identified. The aim of this study was to investigate the association of sex and gender with depressive symptoms in older workers, and the role of working conditions in this association., Methods: We used data from the Longitudinal Aging Study Amsterdam (2012-2013/2015-2016, n = 313). Our outcome was depressive symptoms, measured by the Center for Epidemiologic Studies Depression Scale. We included biological sex, a gender index ranging from masculine to feminine (consisting of six items measuring gender roles: working hours, income, occupation segregation, education, informal caregiving, time spent on household chores), and working conditions (physical demands, psychosocial demands, cognitive demands, autonomy, task variation, social support) in our models. We examined the differential vulnerability hypothesis, i.e., sex/gender moderates the association between working conditions and depressive symptoms, and the differential exposure hypothesis, i.e., working conditions mediate the association between sex/gender and depressive symptoms., Results: Female sex and feminine gender were both associated with more depressive symptoms. The differential vulnerability hypothesis was not supported by our results. We did find that femininity was negatively associated with autonomy and task variation. In turn, these working conditions were associated with fewer depressive symptoms. Thus, autonomy and task variation partially mediated the association between gender and depressive symptoms, supporting the differential exposure hypothesis. Mediation effects for sex inequalities were not significant., Conclusions: Older female workers and older feminine workers have more depressive symptoms than their male/masculine counterparts. Autonomy and task variation appeared to be important in - partially - explaining gender differences in depressive symptoms rather than sex differences. By improving these conditions, gender inequality in mental health among older workers can be reduced, so that both genders have similar chances to reach the retirement age in good mental health., (© 2022. The Author(s).)

Background: Studying secular trends in the exposure to risk and protective factors of depression and whether these trends are associated with secular trends in the prevalence of depression is important to estimate future healthcare demands and to identify targets for prevention., Methods: Three birth cohorts of 55-64-year olds from the population-based Longitudinal Aging Study Amsterdam were examined using identical methods in 1992 (n = 944), 2002 (n = 964) and 2012 (n = 957). A two-stage screening design was used to identify subthreshold depression (SUBD) and major depressive disorder (MDD). Multinomial logistic regression analyses were used to identify secular trends in depression prevalence and to identify factors from the biopsychosocial domains of functioning that were associated with these trends., Results: Compared with 1992, MDD became more prevalent in 2002 (OR 1.90, 95% CI 1.10-3.28, p = 0.022) and 2012 (OR 1.80, 95% CI 1.03-3.14, p = 0.039). This was largely attributable to an increase in the prevalence of chronic diseases and functional limitations. Socioeconomic and psychosocial improvements, including an increase in labor market participation, social support and mastery, hampered MDD rates to rise more and were also associated with a 32% decline of SUBD-rates in 2012 as compared with 2002 (OR 0.68, 95% CI 0.48-0.96, p = 0.03)., Conclusions: Among late middle-aged adults, there is a substantial net increase of MDD, which is associated with deteriorating physical health. If morbidity and disability continue to increase, a further expansion of MDD rates may be expected. Improving socioeconomic and psychosocial conditions may benefit public health, as these factors were protective against a higher prevalence of both MDD and SUBD.

Objective: This study investigates the independent and combined potential of slowed gait speed and slowed processing speed as predictors of adverse health outcomes. The role of depressive symptoms in these associations is also investigated., Methods: In the prospective cohort study, using the Longitudinal Aging Study Amsterdam database, three study samples for each outcome variable were defined: persistent cognitive decline (PCD; N = 1,271, 13 years of follow-up), falls (N = 1,282, 6 years of follow-up), and mortality (N = 1,559, age 74.9 ± 5.8, 21 years of follow-up). At baseline, gait speed (6-m walk with a turn at 3 m), processing speed (coding task), depressive symptoms (Center for Epidemiologic Studies Depression Scale), and basic demographic data were assessed. Also, time to PCD, falls, and mortality were assessed. Cox (for PCD and mortality) and stratified Cox (for falls) regression models were used., Results: Slowed processing speed predicted PCD (HR: 7.8; 95% CI: 3.3-18.8), slowed gait speed predicted falls (HR: 1.3; 95% CI: 1.0-1.5), and both measures predicted mortality (gait speed HR: 2.1; 95% CI: 1.6-2.6; processing speed HR: 1.9; 95% CI: 1.6-2.4). Each association remained significant after adjusting for the other slowing symptom. Slowed processing speed only predicted falls in the presence of slowed gait (interaction). A slowing sum score that combines both slowing symptoms predicted all three outcomes. The associations were not influenced by depressive symptoms., Conclusion: Slowing of thought is as relevant as slowing of movement to predict adverse health outcomes, because they seem to represent separate underlying pathologies., (Copyright © 2017 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.)

Background: Loneliness is highly prevalent among older people, has serious health consequences and is an important predictor of mortality. Loneliness and depression may unfavourably interact with each other over time but data on this topic are scarce., Aims: To determine whether loneliness is associated with excess mortality after 19 years of follow-up and whether the joint effect with depression confers further excess mortality., Method: Different aspects of loneliness were measured with the De Jong Gierveld scale and depression with the Centre for Epidemiologic Studies Depression Scale in a cohort of 2878 people aged 55-85 with 19 years of follow-up. Excess mortality hypotheses were tested with Kaplan-Meier and Cox proportional hazard analyses controlling for potential confounders., Results: At follow-up loneliness and depression were associated with excess mortality in older men and women in bivariate analysis but not in multivariate analysis. In multivariate analysis, severe depression was associated with excess mortality in men who were lonely but not in women., Conclusions: Loneliness and depression are important predictors of early death in older adults. Severe depression has a strong association with excess mortality in older men who were lonely, indicating a lethal combination in this group., (© The Royal College of Psychiatrists 2016.)

Introduction: Psychomotor slowing is a core feature of depression in late life, but its prognostic value with respect to course and chronicity is unclear. We investigated whether gait speed can predict chronicity of depressive symptoms. Furthermore, we tested whether (1) cognitive slowing and (risk factors for) vascular diseases, (2) a marker of chronic inflammation, and (3) specific somatic conditions could explain this association., Methods: In the population-based Longitudinal Aging Study Amsterdam, 271 aged participants with clinically relevant depressive symptoms (Center for Epidemiologic Studies Depression Scale ≥16) were followed during a period of 6 years. With 14 successive Center for Epidemiologic Studies Depression Scale observations, 3 clinical course types of depressive symptoms were defined., Results: Remission, fluctuating course, and chronic course of depressive symptoms were seen in 21%, 48%, and 30%, respectively. Slowed gait speed at baseline was associated with a chronic course of depressive symptoms using remission as the reference (odds ratio 0.56, 95% confidence interval 0.41-0.77). Processing speed and vascular risk factors explained this association only for 2%. Specific somatic comorbidity (number of chronic diseases, chronic obstructive pulmonary disease, osteoarthritis) or inflammation influenced the odds ratio., Limitation: Some variables were not measured with as much detail as would be possible in a clinical study setting., Conclusions: Slowed gait speed is a robust predictor of chronicity of depressive symptoms in late life, independent of somatic comorbidity and partly in concert with a slowed processing speed. Results suggest that slowed gait speed is an integral part of the depressive syndrome, probably a subtype associated with chronic course, independent of somatic comorbidity., (Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: The authors wanted to examine the association between attention deficit hyperactivity disorder (ADHD) and personality characteristics and the potential mediating role of these characteristics in the relationship between ADHD and depression in older adults in the general Dutch population., Methods: Data from the Longitudinal Aging Study Amsterdam in 2008/2009 were used in a cross-sectional design on 231 participants with and without ADHD aged 60-94 years. Questionnaires assessing self-esteem, self-efficacy, mastery, neuroticism, and social inadequacy were administered. ADHD was measured by means of ADHD diagnosis and level of ADHD symptoms. Linear regression analyses were performed to assess the association between ADHD (symptoms) and personality characteristics. Single and multivariate mediation analyses were performed to examine the mediating role of personality characteristics in the relationship between ADHD (symptoms) and depressive symptoms., Results: ADHD was significantly negatively associated with sense of mastery (B = -2.44, t = -3.14, df = 228, p = 0.002), self-esteem (B = -1.16, t = -2.27, df = 228, p = 0.02), and self-efficacy (B = -2.33, t = -2.02, df = 228, p = 0.045) and positively associated with neuroticism (B = 0.99, t = 4.90, df = 228, p <0.001) and social inadequacy (B = 0.65, t = 3.32, df = 229, p = 0.001). In the single mediation analyses, all personality characteristics were mediators in the relationship between ADHD symptoms and depressive symptoms. In the multivariate analysis only mastery and self-esteem were mediators., Conclusion: Older adults with ADHD reported lower self-esteem and sense of mastery and higher levels of neuroticism and social inadequacy than older adults without ADHD. Mastery and self-esteem partly explained the association between ADHD and depressive symptoms in old age. The results implicate that in treatment clinicians should pay attention to the personality characteristics of older adults with ADHD., (Copyright © 2014 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.)

Objectives: Growing evidence shows several possible relations between religiousness and late-life depression. Emotional aspects of religiousness such as facets of the perceived relationship with God can be crucial in this connection. The aim of the current study was to examine the association between the course of late-life depression and feelings about God and religious coping., Design: Longitudinal survey study; naturalistic; 12-year follow-up., Setting: Longitudinal Aging Study Amsterdam; population-based, in three regions in The Netherlands., Participants: A subsample of 343 respondents (mean age: 77.2 years), including all respondents with high levels of depressive symptoms at any measurement cycle between 1992 and 2003 (assessed by using the Center for Epidemiologic Studies Depression Scale and the Diagnostic Interview Schedule) and a random sample of nondepressed respondents who completed a postal questionnaire in 2005., Measurements: Scales on God Image and Religious Coping. Twelve-year depression course trajectories serve as predicting variables and are specified according to recency and seriousness., Results: Persistent and emergent depression are significantly associated with fear of God, feeling wronged by God, and negative religious coping. In terms of negative religious coping, significant associations were observed after adjustment for concurrent depression with a history of repeated minor depression and previous major depression., Conclusions: Late-life depression seems to maintain a pervasive relationship over time with affective aspects of religiousness. Religious feelings may parallel the symptoms of anhedonia or a dysphoric mood and could represent the experience of an existential void., (Copyright © 2014 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.)

Background: Late-life depression is a heterogeneous disorder, whereby cognitive impairments are often observed. This study examines which clinical characteristics and symptom dimensions of late-life depression are especially impacting on specific cognitive domains., Methods: Cross-sectional data of 378 depressed and 132 non-depressed older adults between 60-93 years, from the Netherlands Study of Depression in Older adults (NESDO) were used. Depressed older adults were recruited from both inpatient and outpatient mental healthcare institutes and general practices, and diagnosed according to DSM-IV-TR criteria. Multivariable associations were examined with depression characteristics (severity, onset, comorbidity, psychotropic medication) and symptom dimensions as independent variables and cognitive domains (episodic memory, processing speed, interference control, working memory) as dependent variables., Results: Late-life depression was associated with poorer cognitive functioning. Within depressed participants, higher severity of psychopathology and having a first depressive episode was associated with poorer cognitive functioning. The use of tricyclic antidepressants, serotonergic and noradrenergic working antidepressants, and benzodiazepines was associated with worse cognitive functioning. Higher scores on the mood dimension were associated with poorer working memory and processing speed, whereas higher scores on a motivational and apathy dimension were associated with poorer episodic memory and processing speed., Conclusions: Heterogeneity in late-life depression may lead to differences in cognitive functioning. Higher severity and having a first depressive episode was associated with worse cognitive performance. Additionally, different domains of cognitive functioning were associated with specific symptom dimensions. Our findings on the use of psychotropic medication suggest that close monitoring on cognitive side effects is needed.

Objective: To examine whether persons who experienced adverse childhood events or recent negative life events have a worse cognitive performance and faster cognitive decline and the role of depression and apolipoprotein E-∊4 in this relationship., Methods: The community-based sample consisted of 10-year follow-up data of 1312 persons participating in the Longitudinal Aging Study Amsterdam (age range 65-85 years)., Results: Persons who experienced adverse childhood events showed a faster 10-year decline in processing speed but only when depressive symptoms were experienced. Persons with more recent negative life events showed slower processing speed at baseline but no faster decline., Conclusions: Childhood adversity may cause biological or psychological vulnerability, which is associated with both depressive symptoms and cognitive decline in later life. The accumulation of recent negative life events did not affect cognitive functioning over a longer time period., (© The Author(s) 2014.)

Purpose: In this study, the authors' aims were to (a) determine the longitudinal relationships between baseline hearing status and 4-year follow-up depression and loneliness in an older population and (b) investigate possible differences across subgroups in these relationships., Method: The authors used data from 2 waves of the Longitudinal Aging Study Amsterdam (4-year follow-up, baseline ages 63-93 years). Sample sizes were 996 (self-report analyses) and 830 (speech-in-noise test analyses). The authors used multiple linear regression analyses to assess the associations between baseline hearing status and 4-year follow-up of depression, social loneliness, and emotional loneliness. Hearing was measured by self-report and by a speech-in-noise test. Age, gender, hearing aid use, baseline depression or loneliness, and relevant confounders and effect modifiers were incorporated., Results: Both hearing measures showed significant associations with loneliness (p < .05), but these effects were confined to specific subgroups of older persons. For instance, adverse effects were confined to nonusers of hearing aids (self-report, social loneliness model) and men (self-report and speech-in-noise test, emotional-loneliness model). No significant effects appeared for depression., Conclusion: Significant adverse effects of poor hearing on loneliness were found for specific subgroups of older persons. In future research, investigators should further examine the subgroup effects observed. Eventually, this may contribute to the development of tailored prevention programs.

Background: Comorbidity between Attention-Deficit/Hyperactivity Disorder (ADHD) and depression and anxiety disorders in children and young to middle-aged adults has been well documented in the literature. Yet, it is still unknown whether this comorbidity persists into later life. The aim of this study is therefore to examine the comorbidity of anxiety and depressive symptoms among older adults with ADHD. This is examined both using cross-sectional and longitudinal data., Methods: Data were used from the Longitudinal Aging Study Amsterdam (LASA). Participants were examined in three measurement cycles, covering six years. They were asked about depressive and anxiety symptoms. To diagnose ADHD, the DIVA 2.0, a diagnostic interview was administered among a subsample (N=231, age 60-94). In addition to the ADHD diagnosis, the association between the sum score of ADHD symptoms and anxiety and depressive symptoms was examined. Data were analyzed by means of linear regression analyses and linear mixed models., Results: Both ADHD diagnosis and more ADHD symptoms were associated with more anxiety and depressive symptoms cross-sectionally as well as longitudinally. The longitudinal analyses showed that respondents with higher scores of ADHD symptoms reported an increase of depressive symptoms over six years whereas respondents with fewer ADHD symptoms remained stable., Limitations: The ADHD diagnosis is based on the DSM-IVcriteria, which were developed for children, and have not yet been validated in (older) adults., Conclusions: It appears that the association between ADHD and anxiety/depression remains in place with aging. This suggests that, in clinical practice, directing attention to both in concert may be fruitful., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Objectives: To disentangle the reciprocal effects between depressive symptoms and cognitive functioning over time and to study the association between changes in their trajectories using 13 years of follow-up., Design and Participants: Data were used from five waves of the population-based Longitudinal Aging Study Amsterdam. Subjects were included if data was present on depressive symptoms and cognitive performance on at least two occasions, which resulted in a study sample of N = 2,299., Measurements: Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression Scale. Cognitive functioning was assessed using the Mini-Mental State Examination (general cognitive functioning) and timed coding task (speed of information processing)., Results: Cross-domain latent change analyses showed that depression at baseline predicted both decline of general cognitive functioning and information processing speed, independent of relevant covariates. Conversely, information processing speed at baseline, but not general cognitive functioning was related to the course of depressive symptoms. The course of cognitive functioning was not significantly associated with the course of depressive symptoms., Conclusion: Depressive symptoms in older patients flag an increased likelihood of cognitive decline. This effect is considerable and may be due to several underlying mechanisms. The likelihood of the relationship reflecting either a causal effect of depression on cognitive decline, or a common cause, or both, should be estimated. Likewise, older persons with more limitations in information processing speed specifically are more vulnerable to increases in depression., (Copyright © 2013 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.)

Objectives: To investigate whether gait speed predicts incident depressive symptoms and whether depressive symptoms predict incident gait speed impairment; to ascertain the presence of shared risk factors for these associations., Design: The Longitudinal Aging Study Amsterdam, a prospective cohort study with five follow-up cycles over 16 years., Setting: Population based., Participants: One thousand nine hundred twenty-eight respondents for incident depressive symptoms (mean age 68.9 ± 8.5) and 1,855 respondents for incident gait speed impairment (mean age 68.0 ± 8.2)., Measurements: Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale; gait speed was measured, back and forth, during a 3-m walk as quickly as possible, with a 180° turn. Multivariate analyses were performed for both sexes using Cox regression., Results: Incident depressive symptoms occurred in 24% of respondents. In univariate analyses, gait speed at baseline predicted incident depressive symptoms in men and women; after adjustment for covariates, this association persisted in men only. Examining the reverse association, 34% of respondents developed gait speed impairment. Depressive symptoms at baseline were univariately associated with incident gait speed impairment in women but not in men; this association did not persist after adjustment. The bidirectional associations did not share the same explanatory variables., Conclusion: Gait speed predicts depressive symptoms in men. The geriatric giants of depressive symptoms and slowed gait speed in late life appear to result from different pathologies, both of which therefore require their own treatment strategies., (© 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.)

Objective: To determine the possible longitudinal relationships between hearing status and depression, and hearing status and loneliness in the older population., Design: Multiple linear regression analyses were used to assess the associations between baseline hearing and 4-year follow-up of depression, social loneliness, and emotional loneliness. Hearing was measured both by self-report and a speech-in-noise test. Each model was corrected for age, gender, hearing aid use, baseline wellbeing, and relevant confounders. Subgroup effects were tested using interaction terms., Study Sample: We used data from two waves of the Longitudinal Aging Study Amsterdam (2001-02 and 2005-06, ages 63-93). Sample sizes were 996 (self-report (SR) analyses) and 830 (speech-in-noise test (SNT) analyses)., Results: Both hearing measures showed significant adverse associations with both loneliness measures (p < 0.05). However, stratified analyses showed that these effects were restricted to specific subgroups. For instance, effects were significant only for non-hearing aid users (SR-social loneliness model) and men (SR and SNT-emotional loneliness model). No significant effects appeared for depression., Conclusions: We found significant adverse effects of poor hearing on emotional and social loneliness for specific subgroups of older persons. Future research should confirm the subgroup effects and may contribute to the development of tailored prevention and intervention programs.

Objectives: The study examined the accumulated as well as the differential influence of negative life events on cognitive decline in older persons, and whether this association was different for persons with normal and poor cognitive functioning, and for ApoE ε4 carriers and noncarriers., Methods: We used data from the Longitudinal Aging Study Amsterdam (N = 1,356). Data were analyzed using linear mixed models., Results: We found differential associations for different negative life events with cognitive decline none of which were mediated by depressive symptoms. The death of a child or grandchild, which may be considered a highly stressful event, was associated to a higher rate of cognitive decline, whereas more chronic stressors, such as the illness of a partner or relative, or serious conflicts, were associated with better cognitive function. The associations between life events and cognitive function were stronger in ApoE ε4 carriers compared with noncarriers, suggesting that this gene plays a role in the association between stress and cognitive function., Discussion: Highly stressful events seem to be associated with a higher rate of cognitive decline, whereas mild chronic stressors may have an arousing function that stimulates cognitive performance.

Objectives: To investigate whether specific domains of cognitive functioning predict the natural course of depressive symptoms in older people., Design and Participants: Using the nationally representative, population-based cohort of the Longitudinal Aging Study Amsterdam, 281 participants with clinically relevant depressive symptoms (Center for Epidemiological Studies Depression Scale ≥16) aged 55 years and older were followed longitudinally during a period of 6 years., Measurements: Using a maximum of 14 successive Center for Epidemiological Studies Depression Scale observations, three clinical course types of depressive symptoms were defined. At baseline, general cognitive functioning was assessed using the Mini-Mental State Exam, memory performance (immediate recall and retention) by means of the auditory verbal learning test, and processing speed by means of a timed coding task., Results: Remission, fluctuating course, and chronic course were seen in 22%, 50%, and 28%, respectively. In univariate analyses, a slowed processing speed was associated with a chronic course of depressive symptoms, as compared with remission (mean: 21.5, SD: 6.6, versus mean: 24.6, SD: 6.8, t = 2.78, df = 139, p < 0.001). Using multivariate regression techniques, this association remained significant after correcting for potential confounders and a number of risk factors for vascular brain damage (odds ratio: 1.08, 95% confidence interval: 1.01-1.14). Neither global cognitive functioning nor memory performance was associated with any course type of depressive symptoms., Conclusion: We found an independent association of a slowed processing speed with a poor natural course of depressive symptoms in older people. In clinical practice, when dealing with an older depressed person with comorbid cognitive decline, processing speed might be a more useful tool than the Mini-Mental State Exam in predicting the prognosis.

Objectives: High-cortisol levels in depressed persons could possibly give rise to the metabolic syndrome. This study investigated cross-sectionally whether depression and high-cortisol levels increased the odds of metabolic syndrome in an older community-based sample., Methods: In 1,212 participants, aged > or =65 years, enrolled in the Longitudinal Aging Study Amsterdam, depression (major [1-month diagnosis] or subthreshold [no 1-month diagnosis, but symptoms]), metabolic syndrome (modified Adult Treatment Panel III criteria), and free cortisol index (total serum cortisol/cortisol binding globulin) were assessed., Results: Major depression was not associated with the metabolic syndrome (odds ratio [OR] = 1.16, 95% confidence interval [CI] = 0.54-2.49), but subthreshold depression was associated with a decreased odds (OR = 0.55, 95% CI = 0.37-0.82). Persons with higher levels of free cortisol index showed a higher odds of metabolic syndrome (OR per standard deviation increase = 1.21, 95% CI = 1.06-1.39)., Conclusions: As persons with high-cortisol levels more often had metabolic syndrome, hypercortisolemia within depressed persons may increase the risk of metabolic syndrome.

Objectives: To study the onset and compare risk factors for pure depression (DEP), pure anxiety (ANX), and comorbid anxiety-depression (ANXDEP) in the aging population., Design: Prospective study with 3-year intervals over a 9-year period., Setting: Data of the Longitudinal Aging Study Amsterdam were used, which is a population-based study among older adults (55-85 years at baseline)., Participants: Older adults free of depression and anxiety at baseline (N = 1,712)., Measurements: Clinically relevant levels of depression and anxiety were measured with the Center for Epidemiologic Studies Depression scale> or =16 and Hospital Anxiety and Depression Scale > or =7, respectively. A broad range of potential sociodemographic, health, and psychosocial risk factors for anxiety and/or depression were examined by using polytomous logistic regression analyses., Results: Within 9 years, 184 subjects (10.8%) developed DEP, 93 (5.4%) ANX, and 103 (6.0%) ANXDEP. Concerning sociodemographics, higher age and lower educational level were predictors for DEP. Health indicators were predictive for DEP and ANXDEP but not for ANX. Depressive symptoms at baseline were predictive for DEP, whereas initial anxiety symptoms were predictive for ANX and ANXDEP. Neuroticism increased the risk of DEP and ANXDEP. Mixed effects of psychosocial variables were found: DEP was associated with recent widowhood, whereas ANX and ANXDEP were associated with other life events such as having an ill partner., Conclusion: Although onset of ANXDEP demonstrated communality in risk factors, comparing risk factors associated with DEP and ANX revealed more differences than similarities. This underlines the need to distinguish anxiety from depression in preventive strategies.

The hypothalamic-pituitary-adrenal (HPA)-axis regulates the response to stressful events and is expected to be involved in the pathogenesis of depression. The glucocorticoid receptor (GR) regulates the activity of the HPA-axis. Both GR gene polymorphisms and childhood adversity are known to be associated with increased risk for depression. In the Longitudinal Aging Study Amsterdam, a large population based sample of older men and women, 906 subjects were genotyped. An association study was performed to determine the relationship between GR gene polymorphisms, childhood adversity, HPA-axis markers and depressive symptoms. A gene-environment interaction between the GR polymorphisms 22/23EK and 9beta and childhood adversity resulted in an increased risk of clinically relevant depressive symptoms. Without childhood adversity no increased risk was present. The 22/23EK variant was also associated with a lower Free Cortisol Index in the presence of childhood adversity. Persons that are heterozygous for the BclI variant, in contrast with wild-type and BclI-homozygotes, had lower serum levels of cortisol binding globulin and had no increased risk of recurrent depressive symptoms in the presence of childhood adversity. We found a gene-environment (G x E) interaction between common variants of the GR gene and childhood adversity, demonstrating a vulnerable phenotype for developing clinically relevant depressive symptoms at old age. This G x E interaction also influenced HPA-axis markers providing support for the involvement of the HPA-axis in both stress regulation and the pathogenesis of depression., (2008 Wiley-Liss, Inc.)

Objective: Prayer is generally recognized as an important aspect of religiousness. Relatively few empiric studies examined the relation between prayer and depressive symptoms in later life, and findings so far are mixed., Method: Respondents, aged 60-91 years, participated in the third (N = 1,702) and fourth (N = 1,346) assessment cycles, with three-year intervals, of the Longitudinal Aging Study Amsterdam. Data were collected on frequency of prayer, perceived meaningfulness of prayer, religious affiliation, church attendance, salience of religion, demographics, and health variables. Depressive symptoms were assessed with the Center for Epidemiologic Studies-Depression Scale., Results: In the total sample, there was no significant association between frequency of prayer and depressive symptoms. Among those who were not religiously affiliated, prayer was associated with higher levels of depressive symptoms. The results were particularly pronounced among nonaffiliated widowed respondents; odds ratio for praying daily associated with having Center for Epidemiologic Studies-Depression Scale scores of 16 and higher amounted to 3.59 (99% confidence interval: 1.01-11.79). At three-year follow up, prayer did not predict change of depressive symptoms., Conclusions: As secularization in Western Europe progresses, the current results suggest that clinical exploration of private religiousness among older patients remains relevant, also among people who seem to be less religious.

Background: The association between depression and an increased risk of death in elderly persons has been established in both clinical and community studies. Co-occurrence of depression and generalized anxiety has been shown to represent more severe and more chronic psychopathology. However, little is known about the relation between generalized anxiety disorder, mixed anxiety-depression (generalized anxiety disorder and depression) and excess mortality in the elderly., Objective: To investigate whether generalized anxiety and mixed anxiety-depression are associated with mortality., Method: Generalized anxiety disorder, mixed anxiety-depression and depression were assessed in 4051 older persons with a ten-year follow-up of community death registers. The mortality risk of generalized anxiety, depression and mixed anxiety-depression was calculated after adjustment for demographic variables, physical illness, functional disabilities and social vulnerability., Results: In generalized anxiety disorder and mixed anxiety-depression no significant excess mortality was found. In depression a significant excess mortality was found in men [HR 1.44 (1.09-1.89)] but not in women [HR 1.04 (0.87-1.24)] after adjustment for the different variables., Conclusions: In elderly persons depression increases the risk of death in men. Neither generalized anxiety nor mixed anxiety-depression are associated with excess mortality. Generalized anxiety disorder may even predict less mortality in depressive elderly people. The relation between generalized anxiety disorder and its possibly protective effect on mortality has to be further explored., ((c) 2006 John Wiley & Sons, Ltd.)

Purpose: The aim of this study was to estimate the longitudinal relationship between transitions in the use of long-term care and older adults' depressive symptoms and to investigate whether this relationship could be explained by markers of older adults' underlying health, or other variables including demographics, personality, and partner status., Design and Methods: Data were from the Longitudinal Aging Study Amsterdam, which consists of a random, community-based sample of 3,107 older Dutch people (55-85 years of age) stratified by age and gender. The use of informal care, professional home care, and institutional care was recorded, and respondents were screened on depressive symptoms. Follow-up measurements took place at 3 and 6 years., Results: Longitudinal analyses showed significant associations between the enduring use of professional long-term care and an increase in depressive symptoms. Transitions to professional home care or institutional care were also associated with considerably more depressive symptoms after 3 years, whereas transitions from professional home care or institutional care to no care or informal care only were not associated with a change in depressive symptoms. Most of the associations remained significant after indicators of underlying health and other covariates were adjusted for, and also after the data were reanalyzed for respondents with and without functional limitations., Implications: This study does not involve a controlled experiment of professional long-term care among older adults. However, the findings suggest the possibility that receiving professional long-term care could introduce new stressors and increase the risk of depressive symptoms. Our analyses illuminate the concerns of elders regarding their use of professional long-term care and may help in planning for more effective delivery of this type of care.

The main pathway of the disablement process consists of four consecutive phases: Pathology (presence of disease/injury), Impairments (dysfunctions/structural abnormalities), Functional Limitations (restrictions in basic physical/mental actions), and Disability (difficulty doing activities of daily life, ADL). This study determines the presence of the main pathway of disablement in a cohort aged 55 years and older and examines whether progression of the main pathway of disablement is accelerated in the presence of depression. Based on baseline (T1) and two three-year follow-up interviews (T2 and T3) from the Longitudinal Aging Study Amsterdam (LASA) in a population-based cohort of 1110 Dutch persons, we first analysed the intermediate effect of the different consecutive phases of the disablement process by means of multiple regression, adjusted for covariates. Then, depression was used as interaction term in multiple regression analyses linking the consecutive phases of the disablement process. We found that Impairments mediated the association between Pathology and Functional Limitations, and that Functional Limitations mediated the association between Impairments and Disability. Depression significantly modified the associations between Pathology and subsequent Impairments, and between Functional Limitations and subsequent Disability. In sum, the main pathway of the disablement process was identified in our sample. In addition, we found an accelerating effect of depression, particularly in the early and late stages of the model. Reduction of depression may help slow down the process of disablement for persons who find themselves in those stages of the model.

Psychosocial coping resources have been found to protect against depressive symptoms in people with and without chronic diseases. It has not been established, however, whether these resources have the same effects across patients with different diseases. Therefore, the aim of the study was to estimate the direct and buffer effects of psychosocial resources on depression, and to examine whether these effects are different for various chronic diseases. Data were obtained from the Longitudinal Aging Study Amsterdam. In all, 2288 community-dwelling respondents (age 55-85) were included and followed for a maximum of 6 years. Depressive symptoms (using the Center for Epidemiologic Studies-Depression scale), the presence of seven frequently occurring chronic diseases, social support and personal coping resources, physical functioning and sociodemographic variables were assessed by structured interviews. Generalized estimating equation models were estimated for each disease, social support and personal coping resources. All resources, except social network size, showed a direct effect on depressive symptoms regardless of the presence of chronic diseases. Having a partner, high self-esteem, mastery, self-efficacy and feeling less lonely additionally buffered the negative effect of some, but not all, specific chronic diseases. Unexpectedly, in patients with cardiac disease, none of the psychosocial resources exerted a buffer effect on depressive symptoms. For instrumental and emotional support only direct (unfavorable) effects and no buffer effects could be observed. In conclusion, our study provides evidence that buffer effects of psychosocial resources are different across various chronic diseases. This suggests that interventions to enhance specific resources may ameliorate depressive symptoms in specific chronic patients groups.

Background and Aims: Some prospective studies show that depression is a risk factor for cognitive decline. So far, the explanation for the background of this association has remained unclear. The present study investigated 1) whether depression is etiologically linked to cognitive decline; 2) whether depression and cognitive decline may be the consequence of the same underlying subcortical pathology, or 3) whether depression is a reaction to global cognitive deterioration., Methods: A cohort of 133 depressed and 144 non-depressed older persons was followed at eight successive observations over 3 years. All subjects were participants in the Longitudinal Aging Study Amsterdam (LASA). Depression symptoms were measured by means of the CES-D at eight successive waves. Cognitive function (memory function, information processing speed, global cognitive functioning) was assessed at baseline and at the last CES-D measurement., Results: The severity and duration of depressive symptoms were not associated with subsequent decline in memory functioning or global cognitive decline. There was an association between both chronic mild depression and chronic depression, and decline in speed of information processing., Conclusions: These results support the hypothesis that, in older persons, chronic depression as well as cognitive decline may be the consequence of the same underlying subcortical pathology.

Objective: The purposes of this study were to examine the differences in influence of various chronic diseases on depressive symptomatology over time and to determine whether there were differences in such influence depending on physical limitations and time of onset of disease., Study Design and Setting: Data for this study were obtained from the Longitudinal Aging Study Amsterdam. Two thousand two hundred eighty-eight respondents (age 55-85) were included and followed for a maximum of 6 years. Depressive symptoms (using the CES-D scale), the presence of seven frequently occurring chronic diseases, physical limitations, and sociodemographic variables were assessed by structured interviews. Generalized estimating equation models were estimated for each disease and compared with each other., Results: Lung disease, arthritis, cardiac disease, and cancer were all positively associated with increased depressive symptoms over time. Stroke was associated with depressive symptoms, but these associations were not found when adjusted for physical limitations. For atherosclerosis and diabetes mellitus only weak or no associations with depressive symptoms were found. Recent onset of disease resulted in less strong associations for in cancer, lung disease, and arthritis., Conclusion: The results demonstrate that the level of depressive symptoms varies across type of chronic disease. In cardiac disease, arthritis, cancer, and lung disease increased depressive symptoms could not be attributed to physical limitations, but in stroke the association found with depressive symptoms was to a large extent attributable to physical limitations.

Objectives: Expanding on cross-sectional studies, associations are examined between religious involvement and the 6-year course of depressive symptoms in older adults., Methods: Subjects are 1,840 community-dwelling older adults (aged 55 to 85) participating in three measurement cycles of the Longitudinal Aging Study, Amsterdam. Assessments include aspects of religious involvement, depressive symptoms, physical health, self-perceptions, social integration, urbanization, and alcohol use., Results: Church attendance is negatively associated with the course of depressive symptoms, also after adjustment for explanatory variables. Among respondents with functional limitations, lower depression scores are found for those who attend church on a regular basis. For respondents who are bereaved or nonmarried, however, slightly higher depression scores are found for those with high levels of orthodox beliefs., Discussion: There is a consistent negative association over time between church attendance and depressive symptoms in older Dutch citizens. Both stress-buffering as well as depression-evoking effects of religious involvement are found.

Background: depressed mood is common in late life, more prevalent among the chronically diseased than in the general population, and has various health-related consequences. So far, the association between depression and unhealthy lifestyles among chronically diseased has not been examined longitudinally in older persons., Primary Objective: to determine if depressed mood is associated with unhealthy lifestyles in late middle aged and older people, with or without chronic somatic diseases., Methods: in a sample of 1,280 community-dwelling people from the Netherlands, the associations between depressive symptoms and lifestyle domains were analysed cross-sectionally and longitudinally - using logistic regression analyses and multivariate analyses of variance., Results: after controlling for confounders, depressed people (n=176 at baseline) were more likely to be smokers (odds ratio 1.71; 95% confidence interval 1.17-2.52). A persistent depression was associated with an increase in cigarette consumption (P=0.036). Having an emerging depression (n=155) was most likely to co-occur with a person's change from being physically active to being sedentary (relative risk-ratio 1.62; 95% confidence interval 1.05-2.52), and was associated with the largest decrease in minutes of physical activity (P=0.038). This effect was not modified or confounded by chronic somatic disease. A persistent depression tended to be associated with incident excessive alcohol use (relative risk-ratio 4.04; 95% confidence interval 0.97-16.09; P=0.056)., Conclusions: depression is associated with smoking behaviour, and with an increase in cigarette consumption. An emerging depression is associated with becoming sedentary, irrespective of a person's disease status at baseline, and is associated with decrease in minutes of physical activity.

Objectives: This study examines the association of hearing impairment and chronic diseases (diabetes mellitus, lung disease, cardiac disease, stroke, cancer, peripheral artery disease, osteoarthritis, rheumatoid arthritis) with psychosocial status (depression, self-efficacy, mastery, loneliness, social network size) in older persons., Methods: The sample consists of 3,107 persons (55 to 85 years) participating in the Longitudinal Aging Study Amsterdam. MANOVA, adjusted for covariates, was used to test the effect of hearing impairment on the combined outcomes. The association of hearing impairment and chronic diseases with psychosocial status was studied using multivariate regression analyses., Results: Hearing impaired elderly report significantly more depressive symptoms, lower self-efficacy and mastery, more feelings of loneliness, and a smaller social network than normally hearing peers. Whereas chronic diseases show significant associations with some outcomes, hearing impairment is significantly associated with all psychosocial variables., Discussion: The findings emphasize the negative effect of hearing impairment on quality of life.

Objective: Better understanding of the relationship between pain and depression in older adults in the community is of particular importance considering the high prevalence of both conditions in these adults. In the present study, the longitudinal relationship between pain and depression in older adults was examined, thereby taking into account the role of physical disability and the possibly modifying effect of sex and age., Methods: The study is based on a sample which at the outset consisted of 325 non-depressed and 327 depressed persons (55-85) drawn from a larger random community-based sample in the Netherlands. Depression (CES-D) and pain (subscale of the Nottingham Health Profile) were measured at eight successive waves over 3 years., Results: Pain was very persistent over time as was to a lesser extent depression. The prognosis of comorbid pain and depression was poor. In longitudinal analyses (Generalized Estimating Equations), pain and depression were strongly associated. At the symptom level, the pain-depression relationship was found to be stronger in men than in women. There was no effect of age on the pain-depression relationship. No support was found for the hypothesis that the pain-depression relationship is mediated by disability., Conclusion: The persistent nature of pain and to a lesser extent depression and the intimate and probably reciprocal association between them stress the need for adequate treatment strategies.

Purpose Although the prevalence of depression in visually impaired older persons is high, the association between vision loss and depression seems to be influenced by factors other than visual impairment. In this study, the role of vision loss, functional limitations and social network characteristics in relation to depressive symptoms was investigated. Methods Cross-sectional data ( N = 1237) from the Longitudinal Aging Study Amsterdam were used to investigate the prevalence of depression (Center of Epidemiological Studies-Depression scale) within subgroups with increasing vision loss. In linear regression models, functional limitations and social network characteristics were examined as possible mediators in the association between vision loss and depression. Having a partner was considered to be a potential moderator. Results Although a significant linear trend was found in the presence of depressive symptoms with 14% in normally sighted, 23% in mild and 37% in severe vision loss ( χ2(1) = 14.9; p < 0.001), vision loss was not an independent determinant of depression. Mediators were functional limitations (p < 0.001) and social network size (p = 0.009). No interaction with partner status was found. Conclusion In the presence of depression, a trend was found with increasing severity of vision loss, indicating the need for more attention in (mental) health care and low-vision rehabilitation. In the general older population, vision loss was not an independent determinant of depression but was mediated by functional limitations and social network size. Rather than receiving actual social support, the idea of having a social network to rely on when needed seemed to be associated with lower levels of depression. [ABSTRACT FROM AUTHOR]

Objectives Although it is well known that recurrence of late-life depression is very common, little is known about the characteristics of older people who are vulnerable for recurrence. In order to identify characteristics of those who are at risk, the present study aimed to investigate the strength of the associations of the big five personality factors with recurrence in later life. Secondly, we studied whether there are gender and age differences in the strength of these associations. Methods Using data from the longitudinal aging study Amsterdam (LASA) a subsample with clinically relevant depressive symptoms at one or more of the first three LASA-cycles, but who had recovered at the fourth cycle, was approached to participate in a fifth cycle to determine recurrence (n = 92). Respondents completed self-report questionnaires on personality (NEO-FFI) and depression (CES-D). By means of logistic regression analyses the associations between the Big Five and recurrence of depression at fifth cycle was investigated. Results 58 (63%) had a recurrence of depressive symptoms. A high level of neuroticism was significantly associated with recurrence. No gender differences or age-related differences in strength of the associations of personality with recurrence were found. Conclusion In later life, neuroticism still is associated with the recurrence of depression. Efforts to prevent recurrence of late-life depression should focus on those with high levels of neuroticism and future research should aim at further unravelling the association between depression and personality in later life. Copyright © 2009 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective: The authors examined whether personality characteristics such as mastery, self-efficacy, and neuroticism predict the likelihood of recovery of depression among elderly in the community. It was hypothesized that these personality characteristics do predict recovery but that their effect is overwhelmed by the effect of deteriorations in physical health, cognitive decline, and loss of social resources. The second research question investigated whether these personality characteristics moderate the negative impact of the other prognostic factors on the chance of recovery. Methods: A prospective (nine-year) follow-up study of 206 depressed elderly (55-85 years at baseline) participants of the Longitudinal Aging Study Amsterdam. Data on chance of recovery were analyzed using Cox proportional regression analyses. Results: Both in the univariate and in the multivariate model, the personality characteristics, especially neuroticism, predicted recovery of depression. The effect of neuroticism was similar to that of physical health and stronger than the impact of cognitive decline or social resources. No support was found for personality as a moderator of the negative impact of age-related stressors. Conclusions: Personality characteristics, i.e., neuroticism and physical health-related variables are separate but equally important domains for the chance of recovery of depression in later life. [ABSTRACT FROM AUTHOR]

Objectives In older people, a diagnosis of depression is frequently missed, and proper treatment is subsequently hampered. We investigated antidepressant and benzodiazepine use in an older community sample, and assessed possible risk factors associated with non-treatment in depressed elderly. Methods Data were used from the baseline measurements of the Longitudinal Aging Study Amsterdam (LASA). In a random, age and sex stratified community sample of 3107 older Dutch people (55 to 85 years), respondents were screened on depression with the Center for Epidemiologic Studies Depression Scale (CES-D). In the depressed subsample depressive disorder according to DSM-III was assessed using the Diagnostic Interview Schedule (DIS). The use of antidepressants and anxiolytics (benzodiazepines) in the depressed subsample was measured, and associations with age, sex, cognitive impairment, physical health and anxiety symptoms were investigated. Results Only 16% of the respondents with a major depressive disorder used antidepressants. More than half of them used non-therapeutic dosages. Lower antidepressant use was associated with cognitive impairment. Benzodiazepine use was more likely than antidepressant use, which was especially evident in females in the major depressive disorder group. Conclusions Depressed older people were undertreated, particularly when they were cognitively impaired. A high rate of benzodiazepine use was found, particularly in females. Copyright © 2003 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective: To study the impact of depression on the wellbeing, disability and use of health services of older adults. Method: Prospective community-based study, using a large (n =2200) sample of the elderly (55–85) in the Netherlands. Using a 3-year follow-up, the effect of depressive symptoms (CES-D) on disability, wellbeing and service utilization was assessed, controlling for competing need-for-care (chronic physical illness, functional limitation and cognitive decline), enabling (partner status, size of the social network, social support and locus of control), and predisposing factors (age, sex and level of education). Results: Depressive symptoms have considerable impact on the wellbeing and disability of older people and clear economic consequences caused by inappropriate service utilization. Compared with other need-for-care variables the impact of depression is weaker (service utilization), similar (disability) or stronger (wellbeing). Conclusion: The steeply rising prevalence of competing health risks in later life does not influence the significance of depression. [ABSTRACT FROM AUTHOR]

Objective To investigate whether depressive symptoms predict specific types of cognitive decline in order to elucidate the association between late life depression and cognitive decline. Background Mechanisms underlying the association between late life depression and cognitive decline are still unclear. Method Six hundred and forty-one elderly persons of the Longitudinal Aging Study Amsterdam (LASA) aged 70–85 were examined by means of two measurement occasions over a period of 3 years. Depressive symptoms were assessed by means of the CES-D. Various cognitive functions were examined using neuropsychological tests. Results Depressive symptoms were associated with decline in speed of information processing over a 3-year period, whereas there was no association between depression and increasing memory impairment or global mental deterioration. Conclusion These findings suggest that depressive symptoms are associated with subcortical pathology, most probable white matter lesions. Copyright © 2001 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

AbstractObjectivesMethodResultsConclusionTo gain insight into the longitudinal, reciprocal associations between depressive symptoms and sexual satisfaction as well as the potential moderating roles of gender and perceived importance of sexuality.We analyzed longitudinal data from 2113 participants of the Longitudinal Ageing Study Amsterdam (LASA) with an initial age range of 54–93 years, using Generalized Estimating Equations (GEE).There were no significant associations between baseline depressive symptoms and change in sexual satisfaction, nor between baseline sexual satisfaction and change in depressive symptoms. Gender and perceived importance of sexuality were moderators: in men higher depression scores were associated with a decrease in sexual satisfaction, whereas in women higher depression scores were associated with an increase in sexual satisfaction. In participants for whom sexual life was important, higher depression scores were associated with a decrease in sexual satisfaction. In participants for whom sexual life was not important, higher depression scores were associated with an increase in sexual satisfaction.The associations between baseline depressive symptoms and change in sexual satisfaction as well as between baseline sexual satisfaction and change in depressive symptoms varied according to gender and importance ascribed to sexuality. Potential explanations might lie in the different roles sexual activity plays in sexual satisfaction in men and women. [ABSTRACT FROM AUTHOR]