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Objective: Research has shown an association between depression and functional limitations in older adults. Our aim was to explore the latent traits of trajectories of limitations in mobility and instrumental activities of daily living (IADL) tasks in a sample of older adults diagnosed with major depression.Methods: Participants were 248 patients enrolled in a naturalistic depression treatment study. Mobility/IADL tasks included walking one-fourth mile, going up/down stairs, getting around the neighborhood, shopping, handling money, taking care of children, cleaning house, preparing meals and doing yardwork/gardening. Latent class trajectory analysis was used to identify classes of mobility/IADL function over a 4-year period. Class membership was then used to predict functional status over time.Results: Using time as the only predictor, three latent class trajectories were identified: (1) Patients with few mobility/IADL limitations (42%), (2) Patients with considerable mobility/IADL limitations (37%) and (3) Patients with basically no limitations (21%). The classes differed primarily in their initial functional status, with some immediate improvement followed by no further change for patients in Classes 1 and 2 and a stable course for patients in Class 3. In a repeated measures mixed model controlling for potential confounders, class was a significant predictor of functional status. The effect of baseline depression score, cognitive status, self-perceived health and sex on mobility/IADL score differed by class.Conclusions: These findings show systematic variability in functional status over time among older patients with major depression, indicating that a single trajectory may not reflect the pattern for all patients. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To examine the course of depressive symptoms in older patients with comorbid major depression and dysthymia. DESIGN: Secondary data analysis using both proportional hazards modeling and a repeated measures mixed model. SETTING: Clinical Research Center for the Study of Depression in Later Life conducted at Duke University. PARTICIPANTS: Two hundred fifty inpatients and outpatients age 60 and older with major depression enrolled in a naturalistic treatment study and followed up for 10 years. MEASUREMENTS: The Diagnostic Interview Schedule was used to confirm a clinical diagnosis of major depression and to identify patients with comorbid dysthymia at the time of study enrollment. Patients were administered the Montgomery-Asberg Depression Rating Scale (MADRS) every 3 months. For the proportional hazards models, partial remission was defined as a MADRS score <16 and full remission as a score <7. RESULTS: A total of 34.8% of the patients had comorbid major depression and dysthymia at baseline enrollment. Compared with those with major depression alone, they had longer time to both partial (median number of days = 175 versus 106) and full remission (median number of days = 433 versus 244) from major depression. In the repeated measures mixed model predicting MADRS score over 3 years of follow-up and controlling for the effects of potential confounders, the effect of having comorbid dysthymia was not consistent over time, with patients with both disorders having higher predicted scores after initial response. CONCLUSIONS: Older patients with comorbid major depression and dysthymia have a less favorable trajectory of recovery compared with those with major depression alone. [ABSTRACT FROM AUTHOR]

BACKGROUND: Despite the burden of depression in late life, its origins present a paradox to investigators and clinicians alike. METHOD: We review biological (genetics and heredity factors, neurotransmitter dysfunction, endocrine changes, vascular disorders, and medical co-morbidities), psychological (personality attributes, neuroticism, cognitive distortions, and the lack of emotional control and self-efficacy) and social (stressful life events, bereavement, chronic stress or strain, socio-economic disadvantage and impaired social support) origins of late-life depression based upon an extensive though not exhaustive review of the extant literature. In addition, modifying psychological and social factors are discussed. RESULTS: Older adults appear to be at greater risk for major depression biologically, such as depression resulting from vascular changes, yet the frequency of depression is lower compared to younger adults. Older adults may be protected psychologically due to factors such as socio-emotional selectivity and wisdom, compared to younger adults, and perhaps relatively protected from social risks. CONCLUSIONS: A biopsychosocial approach to evaluating the origins of late-life depression is heuristically valuable, a continual reminder of the many factors that contribute to the onset and persistence of clinically significant symptoms in late life. [ABSTRACT FROM AUTHOR]

Background: The evidence for an association between depression and mortality among community-dwelling elderly persons remains inconclusive, although it is well established for younger individuals. Extant studies suggest that this association weakens when adjusted for potential confounding factors, especially functional impairment. A cohort of elderly subjects followed for 3 years was analyzed to determine the association of depression and 3-year mortality, controlling for the major known risk factors for mortality in the elderly population.Methods: Information on depression (CES-D scores), mortality, demographics, body mass index, chronic disease, smoking history, cognitive impairment, functional impairment, self-rated health, and social support was obtained from a stratified probability-based sample of community-dwelling elderly persons, with equal distribution between African Americans and whites in the Piedmont of North Carolina. Descriptive statistics were calculated, and logistic regression was used for a series of models with progressively more control variables.Results: The unadjusted relative odds of mortality among depressed subjects at baseline was 1.98 over 3 years of follow-up. Inclusion of age, gender, and race into the model did not reduce the relative odds. When chronic disease and health habits, cognitive impairment, functional impairment, and social support were added to the model, the odds ratios for mortality with depression were 1.74, 1.69, 1.29, and 1.21, respectively. This decrease in odds ratios was not observed for other variables in the model when additional variables were added.Conclusions: The estimated odds of dying if depressed moved toward unity as other risk factors for mortality were controlled. Unlike other known risk factors for mortality in the elderly population, depression appears to be associated with mortality through a number of independent mechanisms, perhaps through complex feedback loops. [ABSTRACT FROM AUTHOR]

Maintaining healthy behaviors is challenging. Based upon previous reports that in North Carolina (NC), USA, overweight/obese clergy lost weight during a two-year religiously tailored health intervention, we described trajectories of diet, physical activity, and sleep. We investigated whether behavior changes were associated with weight and use of health-promoting theological messages. Improvements were observed in sleep, calorie-dense food intake, and physical activity, with the latter two associated with weight loss. While theological messages were well-retained, their relationship with behaviors depended on the specific message, behavior, and timing. Findings offer insights into weight loss mechanisms, including the role of theological messages in religiously tailored health interventions., (© 2023. The Author(s).)

Clergy are tasked with multiple interpersonal administrative, organizational, and religious responsibilities, such as preaching, teaching, counseling, administering sacraments, developing lay leader skills, and providing leadership and vision for the congregation and community. The high expectations and demands placed on them put them at an increased risk for mental distress such as depression and anxiety. Little is known about whether and how clergy, helpers themselves, receive care when they experience mental distress. All active United Methodist Church (UMC) clergy in North Carolina were recruited to take a survey in 2019 comprising validated depression and anxiety screeners and questions about mental health service utilization. Bivariate and Poisson regression analyses were conducted on the subset of participants with elevated depressive and anxiety symptoms to determine the extent of mental health service use during four different timeframes and the relationship between service use and sociodemographic variables. A total of 1,489 clergy participated. Of the 222 (15%) who had elevated anxiety or depressive symptoms or both, 49.1% had not ever or recently (in the past two years) seen a mental health professional. Participants were more likely to report using services currently or recently (in the past two years) if they were younger, had depression before age 21, or "very often" felt loved and cared for by their congregation. The rate of mental health service use among UMC clergy is comparable to the national average of service use by US adults with mental distress. However, it is concerning that 49% of clergy with elevated symptoms were not engaged in care. This study points to clergy subgroups to target for an increase in mental health service use. Strategies to support clergy and minimize mental health stigma are needed., (© 2022. The Author(s).)

Objectives: Work in occupations with higher levels of occupational stress can bring mental health costs. Many older adults worldwide are continuing to work past traditional retirement age, raising the question whether older adults experience depression, anxiety, or burnout at the same or greater levels as younger workers, and whether there are differences by age in these levels over time., Design/setting/participants: Longitudinal survey of 1161 currently employed US clergy followed every 6-12 months for up to 66 months., Measurements: Depression was measured with the 8-item Patient Health Questionnaire (PHQ-8). Anxiety was measured using the anxiety component of the Hospital Anxiety and Depression Scale (HADS). Burnout symptoms were assessed using the three components of the Maslach Burnout Inventory: emotional exhaustion (EE), depersonalization (DP), and sense of personal accomplishment (PA)., Results: Older participants had lower scores of depression, anxiety, EE, and DP and higher levels of PA over time compared to younger adults. Levels of EE decreased for older working adults, while not significantly changing over time for those younger. DP symptoms decreased over time among those 55 years or older but increased among those 25-54 years., Conclusions: Older working adults may have higher levels of resilience and be able to balance personal life with their occupation as well as may engage in certain behaviors that increase social support and, for clergy, spiritual well-being that may decrease stress in a way that allows these older adults to appear to tolerate working longer without poorer mental health outcomes.

This paper investigates the mental health promotion and protection (MHPP) model of reducing depression. Data are from the Clergy Health Initiative Longitudinal Survey of United Methodist ministers in North Carolina that included the Mental Health Continuum Short Form (MHC-SF) for positive mental health and the Patient Health Questionnaire (PHQ-9) for depression in 2014 and 2016 (N = 955). The promotion hypothesis predicts reduced risk of depression in 2016 among clergy whose mental health increased to flourishing and the increased risk of depression in 2016 for clergy who stayed not flourishing. The protection hypothesis predicts increased risk of depression in 2016 for clergy who were flourishing in 2014 but went down to 'not flourishing' in 2016. The reference group is clergy who stayed flourishing. We used modified Poisson regression models for binary outcomes to estimate Prevalence Ratios (PR) and to estimate Incidence Rate Ratios (IRR) of depression in 2016 associated with changes in mental health status. Results support both hypotheses. Compared to clergy who stayed flourishing, clergy who improved to flourishing were as likely, while clergy who stayed not flourishing were nearly seven times more likely, to have depression in 2016. Clergy who declined to not flourishing were six times more likely to have depression in 2016 compared to those who stayed flourishing. Similar patterns were observed when the sample was restricted to clergy without depression in 2014. These findings suggest focusing on MHPP as a complementary approach to treatment to reduce the incidence, prevalence and burden of depression., Competing Interests: Declaration of Competing Interest The authors declare that there is no conflict of interest regarding the publication of this article., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Religious participation and spirituality are linked to good mental health. However, clergy may experience more depression than is observed in the general population, which may be due in part to high job strain. The objectives of this study were to identify distinct longitudinal trajectories of depressive symptoms in clergy and to identify variables associated with each course. The sample was 1172 clergy who were followed for up to 66 months. Depressive symptoms were measured using the Patient Health Questionnaire (PHQ-8), which was administered approximately every 6 months. Latent class trajectory analysis was conducted for group identification, and a 3-class trajectory model fit the data best. Class 1 (38% of the sample) had minimal or no depressive symptoms over time, class 2 (47%) had chronic mild symptoms, and class 3 (15%) had persistent moderate/severe symptoms. Occupational distress was significantly associated with trajectory class. The odds of being in either the chronic mild or the persistent moderate/severe depressive symptom class were significantly higher for those who were female, for those with fair/poor self-rated health, for those with more perceived financial or occupational stress, for those with lower levels of perceived emotional support, and/or for those with lower levels of spiritual well-being. The class exhibiting resilience to depressive symptoms had higher levels of perceived support and spiritual well-being as well as lower levels of perceived financial and occupational stress. A substantial percentage of clergy, and possibly people in similar helping occupations, may experience significant levels of depressive symptoms that do not remit over time. These individuals may benefit from treatments that address work-related coping.

Objectives: The objectives were to describe the oral health status of immigrants in the USA, describe the association between acculturation and oral health by accounting for the effects of depression and to explore the effects of interaction between acculturation and depression on the oral health of immigrants., Methods: Data were from the 2011-2012 National Health and Nutrition Examination Survey (NHANES). Oral health status was assessed by both self-rated oral health and clinically diagnosed periodontitis, each coded as a binary outcome. Acculturation was operationalised as length of stay in the USA and speaking English at home. Depression was assessed using the Patient Health Questionnaire-9. Multiple logistic regression models were used to examine the association of acculturation and depression status with oral health., Results: In 2011-2012, 36.6% immigrants reported poor oral health and 53.0% were diagnosed with periodontitis. A length of stay in the USA of 30+ years (adjusted odds ratio [AOR] = 0.43, 95% confidence interval [95% CI]: 0.21-0.89) reduced the odds of having periodontitis in comparison with a length of stay in the USA of fewer than 5 years. Speaking English at home (AOR = 0.64, 95% CI: 0.43-0.96) reduced the odds of having periodontitis compared with speaking other languages. Depression was negatively associated with self-reported good oral health (AOR = 0.43, 95% CI: 0.20-0.92) and positively associated with clinically diagnosed periodontitis (AOR = 1.89, 95% CI: 1.18-3.04). The effects of acculturation did not differ according to depression status., Conclusion: A longer stay in the USA and speaking English at home were associated with less periodontitis among the immigrants., (© 2017 FDI World Dental Federation.)

Objectives: While trends in tooth loss among older adults have been well documented and show a decline over the last few decades, little is known about trends in tooth decay which may lead to tooth loss. The study aim was to examine trends in tooth decay among adults ages 50 years and older in the United States and determine whether these trends were consistent across demographic and socioeconomic subgroups of middle-aged and older adults., Methods: Secondary analysis of data collected through detailed oral health examinations in the National Health and Nutrition Examination (NHANES) surveys 1988-1994 and 1999-2004. Tooth decay was measured as active caries. Multivariable associations were estimated using negative binomial regression models., Results: Averaged over time, the mean number of decayed teeth was 0.54. Rates of decay remained stable over time. Males, non-Hispanic Blacks, Mexican-Americans, and those of other race/ethnicity as well as those with fewer years of education and lower levels of income had more decayed teeth. The increased number of decayed teeth for Mexican-Americans and those of other race/ethnicity was due in part to differing levels of education and income. Trends over time did not vary by any of these demographic and socioeconomic characteristics. Trends in the number of decayed teeth did not meaningfully change when the numbers of missing and filled teeth were controlled., Conclusions: Although studies have shown the number of middle-aged and older Americans experiencing tooth loss has decreased over time, trends in tooth decay have remained relatively stable, with socioeconomic disparities persisting over time., Competing Interests: The authors did not report any conflicts of interest., (© 2016 American Association of Public Health Dentistry.)

Objective: The objective of this research was to identify distinct trajectories of recovery in older depressed patients in order to identify optimal samples and points for interventions., Methods: The sample was 368 patients ages 60 years and older diagnosed with major depression and enrolled in a naturalistic treatment study and followed for up to 3 years., Results: A model with four trajectory classes fit the data best: a quick recovery class (43%), a persistent moderate symptom class (27%), a persistent high symptom class (15%), and a slow recovery class (15%). Compared with patients in the quick recovery class, patients in the persistent moderate symptom class had more instrumental activities of daily living/mobility limitations and lower levels of subjective social support. Patients in the persistent high symptom class had higher levels of perceived stress and lower levels of social support compared with those with a quick recovery. Patients in the slow recovery class had a younger age of onset compared with those in the quick recovery group. In multinomial logistic regression, levels of perceived stress and social support at baseline significantly differed across classes controlling for demographic and health variables., Conclusions: Older patients diagnosed with major depression can have varying patterns of response to treatment. Interventions targeting those patients with higher levels of perceived stress and lower levels of subjective social support at the time of the index episode may lead to more favorable long-term trajectories. Copyright © 2015 John Wiley & Sons, Ltd., (Copyright © 2015 John Wiley & Sons, Ltd.)

Objective: Adverse outcomes associated with chronic depressive symptoms are of clinical importance. The objective was to identify subgroups of older adults based on their trajectories of depressive symptoms over a 10-year period and determine if these subgroups predicted oral health outcomes., Methods: The sample was 944 adults aged 65+ who participated in the oral health module of the the Health and Retirement Survey in 2008. Depressive symptoms were measured with a modified version of the Center for Epidemiologic Studies-Depression (CES-D) scale. Latent class trajectory analysis was used to identify distinct subgroups of elders based on their CES-D scores from 1998-2008. Group membership was used to predict self-rated oral health, overall mouth condition (problems with bleeding gums, gum sensitivity, and food avoidance), and edentulism in 2008., Results: Three distinct subgroups were identified using zero-inflated Poisson regression models: (i) minimal depressive symptoms over the study period (43%), (ii) low but generally stable level of depressive symptoms (41%), and (iii) moderate symptoms and higher CES-D scores than the other groups over the 10 years (16%). Controlling for demographic and health variables and edentulism status, having a trajectory of moderate symptoms was associated with poorer mouth condition (p < 0.0001) and poorer self-rated oral health (p = 0.0003) compared with those with minimal symptoms. Having low levels of depressive symptoms was not significantly associated with these two outcomes. Group membership was not significantly associated with the probability of edentulism., Conclusions: Chronic moderate depressive symptoms are associated with poorer oral health in older adults., (Copyright © 2015 John Wiley & Sons, Ltd.)

Objective: Vascular lesions seen through brain imaging as hyperintensities are associated with both depression and functional impairment in older adults. Our objective was to determine if the relationship between the volume of cerebral white matter hyperintensities (WMHs) and functional decline differed in the presence of late life depression., Design: Secondary analysis of data collected through the Neurocognitive Outcomes of Depression Study. Analysis techniques included general linear mixed models examining trajectories of functional change predicted by lesion volume at baseline., Participants: 381 participants (244 patients diagnosed with major depression and 137 never depressed comparison participants) ages 60 years and older followed for up to 16 years., Measurements: WMH volume was measured through analysis of brain magnetic resonance imaging data. Functional limitations included difficulties with basic activities of daily living tasks, instrumental activities of daily living tasks, and mobility., Results: Those participants who were both depressed and had a higher volume of WMHs at baseline were most at risk for functional decline across all measures of function. Among the never depressed, those with a higher WMH volume at baseline had a more accelerated rate of functional decline than those with lower WMH volume, and those who were depressed with lower volume of WMH started with more limitations than the never depressed but appeared to progress at a rate similar to those who were never depressed with lower WMH., Conclusion: Older patients with both cerebrovascular risk factors and depression are at an increased risk for functional decline, and may benefit from the treatment of both conditions., (Copyright © 2016 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.)

Background: The association between disability and depression is complex, with disability well established as a correlate and consequence of late life depression. Studies in community samples report that greater volumes of cerebral white matter hyperintensities (WMHs) seen on brain imaging are linked with functional impairment. These vascular changes are also associated with late life depression, but it is not known if depression is a modifier in the relationship between cerebrovascular changes and functional impairment., Methods: The study sample was 237 older adults diagnosed with major depression and 140 never depressed comparison adults, with both groups assessed at study enrollment. The dependent variable was the number of limitations in basic activities of daily living (ADL), instrumental ADLs, and mobility tasks. The independent variable was the total volume of cerebral white matter lesions or hyperintensities assessed though magnetic resonance imaging., Results: In analyses controlling for age, sex, race, high blood pressure, and cognitive status, a greater volume of WMH was positively associated with the total number of functional limitations as well as the number of mobility limitations among those older adults with late life depression but not among those never depressed, suggesting the association between WMH volume and functional status differs in the presence of late life depression., Conclusions: These findings suggest older patients with both depression and vascular risk factors may be at an increased risk for functional decline, and may benefit from management of both cerebrovascular risk factors and depression.

Objective: The aim of this study was to examine inflammation and coagulation, which are positively linked to disability and inversely linked to increased religious attendance, as mediators in the cross-sectional relationships between religious attendance and functional status., Method: Frequency of attendance and limitations in basic activities of daily living (ADLs), instrumental activities (IADLs), and mobility were assessed in 1,423 elders., Results: More frequent attendance was associated with fewer ADL, IADL, and mobility limitations, and with lower levels of inflammation and coagulation including interleukin-6, soluble vascular cell adhesion molecule, and D-dimer. Inflammation and coagulation partially mediated the associations between attendance and function. Eight percent of the effect of attendance on ADL (p = .014), 5% of the effect on IADL (p = .003), and 8% of the effect on mobility (p = .001) limitations were due to inflammation and coagulation., Discussion: Relationships between attendance and function may be due in part to lower levels of inflammation and coagulation among elders who attend services., (© The Author(s) 2014.)

Identifying sources of heterogeneity in late life depression remains an important focus of psychiatric investigation. Community samples are particularly informative since many older adults have clinically significant depressive symptoms but fail to meet criteria for major depression and older adults generally do not seek treatment for their depressive symptoms. The primary data used for these analyses were those collected in a community-based survey of over 3000 adults age 65 or older followed for up to ten years. Depressive symptoms were measured by the Center for Epidemiologic Studies-Depression scale (CES-D). Latent class analysis was used to identify clusters of participants based on their symptom profiles at baseline. Mixed models were used to examine trajectories of CES-D scores based on cluster assignment. A model with three unique clusters best fit the data. Cluster 1 (59%) had a low probability of any symptom endorsement. Cluster 2 (31%) endorsed as a group some negative affect and somatic symptoms but their endorsement of low positive affect did not differ from Cluster 1. Participants in Cluster 3 (10%) had a higher probability of endorsement of all symptoms compared to Clusters 1 and 2. The results did not appreciably differ when symptom severity was included. Cluster assignment was a significant predictor of change in CES-D score over the ten-year follow-up period, and the effects over time differed by sex. Depressive symptom profiles predict the longitudinal course of depression in a community sample of older adults, findings that are important especially in primary care settings., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Purpose of the Study: To examine the longitudinal associations between 3 dimensions of religious involvement-religious attendance, use of religious media, and private religious activities-and 3 domains of functional status-limitations in basic activities of daily living (ADL), instrumental activities of daily living (IADL), and mobility in older adults., Design and Methods: Using the data from a survey of 2,924 adults aged 65+, with self-reported religious involvement and functional status collected at baseline, 3, 6, and 10 years postbaseline, we used repeated measures mixed models to predict functional change by religious status at the prior interview., Results: Increased religious attendance was associated with fewer ADL, IADL, and mobility limitations 3-4 years later, controlling for demographic, health, and social variables as well as prior functional status. Neither use of religious media nor private religious activities was associated with functional change in controlled analyses. Use of religious media, however, was associated with developing more IADL and mobility limitations in uncontrolled analysis, suggesting a potential indirect association., Implications: Religious attendance may protect against decline in functional limitations in older adults. Clinicians may wish to consider the importance of attendance at services in preventing disability for those patients for whom religious involvement is important. Gerontologists may wish to include religious participation in their conceptual framework outlining risk factors for functional decline.

Objective: To identify trajectories of depressive symptoms in older community residents., Method: Depressive symptomatology, based on a modified Center for Epidemiological Studies-Depression scale, was obtained at years 0, 3, 6, and 10, in the Duke Established Populations for Epidemiologic Studies of the Elderly (n = 4162). Generalized growth mixture models identified the latent class trajectories present. Baseline demographic, health, and social characteristics distinguishing the classes were identified using multinomial logistic regression., Results: Four latent class trajectories were identified. Class 1 - stable low depressive symptomatology (76.6% of the sample); class 2 - initially low depressive symptomatology, increasing to the subsyndromal level (10.0%); class 3 - stable high depressive symptomatology (5.4%); class 4 - high depressive symptomatology improving over 6 years before reverting somewhat (8.0%). Class 1 was younger, male gender, with better education, health, and social resources, in contrast to class 3. Class 2 had poorer cognitive functioning and higher death rate. Class 4 had better health and social resources., Conclusion: Reduction in high depressive symptomatology is associated with more education, better health, fewer stressful events, and a larger social network. Increasing depressive symptomatology is accompanied by poorer physical and cognitive health, more stressful life events, and greater risk of death., (© 2011 John Wiley & Sons A/S.)

Objective: The aim of the study was to compare symptom expression in primarily middle-aged (<60) and older (60+) patients who were depressed and determine if symptom profiles differed by age., Methods: Patients diagnosed with major depression (N = 664) were screened using the Center for Epidemiologic Studies--Depression scale and sections of the Diagnostic Interview Schedule. Patients were separated into homogeneous clusters based on symptom endorsement using latent class analysis., Results: Older patients were less likely to endorse crying spells, sadness, feeling fearful, being bothered, or feeling life a failure but were more likely to endorse poor appetite and loss of interest in sex. Older patients were also less likely to report enjoying life, feeling as good as others, feeling worthless, wanting to die, and thinking about suicide. In two latent class models with depressive symptoms as indicators, three-class models best fit the data. Profiles supported heterogeneity in symptom expression. Clusters differed by age when other demographic, clinical, health, and social variables were controlled but did not support age-specific symptom profiles. Overall, older patients had later age of onset, had fewer lifetime spells, were more likely to have ever received electroconvulsive therapy (ECT), and were less likely to have comorbid anxiety. Older patients also had more cognitive impairment, health conditions, and mobility limitations but had higher levels of subjective social support and had experienced fewer stressful life events., Conclusions: There are age differences in symptom endorsement between younger/middle-aged and older patients with major depression. The data, however, did not identify a symptom profile unique to late-life depression., (Copyright © 2011 John Wiley & Sons, Ltd.)

Objective: The relationship between stress, social support, and cognition in geriatric depression is complex. In this study, we sought to examine whether an increase in stressful life events or a decrease in social support would lead to subsequent cognitive decline among older adults with and without depression., Methods: The sample consisted of 112 depressed and 101 non-depressed older adults who enrolled in the Neurocognitive Outcomes of Depression in the Elderly (NCODE) study. Participants were assessed clinically, agreed to interviews focusing on stressful life events and social support, and underwent a battery of neuropsychological tests annually. Our global measure of cognition was the Consortium to Establish a Registry in Alzheimer's disease Total Score (CERAD TS)., Results: We found that a decline in the total number of stressors was associated with a subsequent improvement on CERAD TS. In terms of social support, decreased social interaction, and instrumental social support predicted decline in cognitive performance. These relationships were significant even after controlling for depression status, age, education, and sex., Conclusions: These findings extend prior research on the importance of social factors in aging and depression which have largely focused on mood-related outcomes. Future confirmatory studies are needed. In addition, biological and other studies should be conducted to further our understanding of the relationship between stress, social support and cognition in older adults with and without depression., (Copyright © 2011 John Wiley & Sons, Ltd.)

Background: Late-life depression may be undiagnosed due to symptom expression. These analyses explore the structure of depressive symptoms in older patients diagnosed with major depression by identifying clusters of patients based on their symptom profiles., Methods: The sample comprised 366 patients enrolled in a naturalistic treatment study. Symptom profiles were defined using responses to the Center for Epidemiologic Studies Depression Scale (CES-D), the Hamilton Rating Scale for Depression (HAM-D) and the depression section of the Diagnostic Interview Schedule (DIS) administered at enrollment. Latent class analysis (LCA) was used to place patients into homogeneous clusters. As a final step, we identified a risk profile from representative items across instruments selected through variable reduction techniques., Results: A model with four discrete clusters provided the best fit to the data for the CES-D and the DIS depression module, while three clusters best fit the HAM-D. Using LCA to identify clusters of patients based on their endorsement of seventeen representative symptoms, we found three clusters of patients differing in ways other than severity. Age, sex, education, marital status, age of onset, functional limitations, level of perceived stress and subjective social support were differentially distributed across clusters., Conclusions: We found considerable heterogeneity in symptom profiles among older adults with an index episode of major depression. Clinical indicators such as depression history may play less of a role differentiating clusters of patients than variables such as stress, social support, and functional limitations. These findings can help conceptualize depression and potentially reduce misdiagnosis for this age group.

Objective: To explore the relationship between personality, social support, and depression in older adults, identify the personality trait and social support dimension most closely associated with depression, and determine whether the relationship between personality and depression varies by level of social support., Design: Cross-sectional analysis within longitudinal study., Participants: Older patients originally diagnosed with major depression (n = 108) and never-depressed comparison group of older adults (n = 103)., Measurements: Patients sufficiently recovered from major depression and comparison participants were administered the NEO Personality Inventory. Social support was measured annually for both groups. Patients were administered the Montgomery-Asberg Depression Rating Scale (MADRS) every 3 months., Results: Patients and comparison participants differed on four of the five NEO domains and all four social support dimensions, but personality did not significantly predict depression status (patient/comparison) in controlled analyses. Within the patient group, subjective social support was the only dimension correlated with MADRS score. In separate linear regression analyses among the patients, controlling for age, sex, and subjective social support, the domains of Neuroticism, Openness to Experience, Conscientiousness, and Extraversion were associated with MADRS score. For Neuroticism and Openness, the association varied by level of subjective social support., Conclusions: Our research confirmed that older patients differed from never-depressed older adults in dimensions of personality and social support, and the relationship between these variables differed by depression status. The relationship between personality, social support, and depressive symptoms in older adults recovering from depression is also complex, with subjective social support modifying the association between personality and depression.

Objectives: Physical symptoms are known to be associated with late life depression both cross-sectionally and over time. We attempted to determine if self-reported shortness of breath (SoB) is associated with depressive symptoms at long-term (3-year) follow-up in a community sample of older (65+) adults., Methods: A sample of 2926 elderly subjects from the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE) were evaluated at baseline and at 3-year follow-up. Depressive symptoms were assessed by a modified version of the Center for Epidemiologic Studies-Depression Scale (CES-D) and SoB was assessed by a three-item scale administered at baseline. The analyses were controlled for factors known to be associated with depressive symptoms and SoB. Both bivariate and multivariate analyses were performed., Results: Eighty-three percent of subjects who experienced SoB survived for three years. Within the analysis sample of those participating at follow-up, 36 percent experienced SoB at baseline. In bivariate analyses, SoB, older age, female sex, history of a heart attack, higher body mass index (BMI), depressive symptoms at baseline, cognitive impairment, and functional impairment were associated with follow-up depressive symptoms. When controlled variables were included in a linear regression model, SoB was a significant predictor of depressive symptoms at follow-up (p < 0.0001) as well as baseline depressive symptoms, sex, BMI, and functional status. No two-way interaction terms with SoB were significant., Conclusions: SoB is a significant predictor of depressive symptoms at 3-year follow-up. Given that SoB is a symptom that is responsive to therapeutic intervention, active intervention to relieve the symptom when identified could reduce the incidence of depressive symptoms., (Copyright © 2010 John Wiley & Sons, Ltd.)

Background: Depressive symptoms above screening thresholds have been shown to predict functional decline in older adults. Less is known about the impact of subthreshold depression, and whether more symptoms confer significantly greater risk compared to fewer symptoms., Method: Using data from the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE) collected over 10 years, we used repeated-measures mixed models to predict functional change by depression status at the prior (index) in-person interview. Depressive symptoms were measured using a modified version of the Center for Epidemiologic Studies Depression Scale (CES-D). Subthreshold depression was operationalized as 6-8 symptoms and CES-D-defined depression as 9-20 symptoms in the previous week. Three domains of functional status were assessed at the subsequent in-person interview: limitations in basic activities of daily living (ADL), instrumental ADL (IADL) and mobility., Results: Controlling for race, sex, age, education, marital status, cognitive status, health status, self-perceived health, perceived social support and functional status at the index interview, having 6 depressive symptoms predicted an increase of 0.12 IADL limitations 3-4 years later (p=0.03). The incremental effect of CES-D-defined depression (9 symptoms compared to 6-8 symptoms) was not significant, suggesting that the effect of more symptomatic depression did not add to that of subthreshold depression. CES-D score modeled as a continuous variable predicted functional change for all domains, but the relationship was not linear, supporting a possible threshold effect., Conclusions: The relationship between depressive symptoms and functional change is complex, not necessarily linear, and may vary by tasks assessed.

Objective: To explore the underlying structure of symptom presentation in older adults with major depression by identifying homogeneous clusters of individuals based on symptom profiles., Design: Secondary data analysis using latent class cluster analysis., Setting: Clinical Research Center for the Study of Depression in Later Life conducted at Duke University., Participants: Three hundred sixty-six patients age 60+ who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for major depression and were enrolled in a longitudinal naturalistic treatment study., Measurements: Responses to the 10 items of the Montgomery-Asberg Depression Rating Scale at the time of study enrollment., Results: The authors identified four latent clusters of older adults with major depression. Patients in Cluster 1 (47.2%) had mean scores of average severity for reported and apparent sadness and lassitude and low mean scores for reduced appetite. Patients in Cluster 2 (27.1%) had higher mean scores compared with Cluster 1 for all items, and particularly for apparent sadness. Patients in Cluster 3 (18.9%) had the lowest mean scores for both apparent and reported sadness, but a similar profile compared with Cluster 1 for inner tension, reduced sleep, reduced appetite, and concentration difficulties. Cluster 4 (6.8%) had the highest mean scores for each item. Both apparent and reported sadness accounted for a large amount of variance among the four clusters. Patients in Cluster 4 were more likely to have 12 or less years of education and/or one or more functional limitations., Conclusion: The heterogeneity in symptom presentation among older adults diagnosed with major depression can potentially inform the development of DSM-V.

Objectives: To determine the risk of disability in individuals with coexisting visual and cognitive impairment and to compare the magnitude of risk associated with visual impairment, cognitive impairment, or the multimorbidity., Design: Prospective cohort., Setting: North Carolina., Participants: Three thousand eight hundred seventy-eight participants in the North Carolina Established Populations for the Epidemiologic Studies of the Elderly with nonmissing visual status, cognitive status, and disability status data at baseline, Measurements: Short Portable Mental Status Questionnaire (cognitive impairment defined as > or =4 errors), self reported visual acuity (visual impairment defined as inability to see well enough to recognize a friend across the street or to read newspaper print), demographic and health-related variables, disability status (activities of daily living (ADLs), instrumental activities of daily living (IADLs), mobility), death, and time to nursing home placement., Results: Participants with coexisting visual and cognitive impairment were at greater risk of IADL disability (odds ratio (OR)=6.50, 95% confidence interval (CI)=4.34-9.75), mobility disability (OR=4.04, 95% CI=2.49-6.54), ADL disability (OR=2.84, 95% CI=1.87-4.32), and incident ADL disability (OR=3.66, 95%, CI=2.36-5.65). In each case, the estimated OR associated with the multimorbidity was greater than the estimated OR associated with visual or cognitive impairment alone, a pattern that was not observed for other adverse outcomes assessed. No significant interactions were observed between cognitive impairment and visual impairment as predictors of disability status., Conclusion: Individuals with coexisting visual impairment and cognitive impairment are at high risk of disability, with each condition contributing additively to disability risk. Further study is needed to improve functional trajectories in patients with this prevalent multimorbidity. When visual or cognitive impairment is present, efforts to maximize the other function may be beneficial.

Background: In previous studies we found that, among older adults (>64 years), perception that basic needs were not being met increased mortality risk and risk for functional decline. In this study, we determined, controlling for reported income and functional status, if perceived inadequate basic needs predicted depressive symptoms., Methods: Repeated-measures analysis was used to determine, during three intervals in a 10-year longitudinal study (the Duke Established Populations for Epidemiologic Studies of the Elderly, n = 4162 at baseline), if perceived inadequate basic needs at the beginning of each interval predicted more depressive symptoms at the end of the interval. We included time invariant covariates known to be associated with depressive symptoms--age, sex, race, and education. We also included time-varying covariates at the beginning of the three intervals--income, cognitive status, functional status, depressive symptoms, and interval., Results: In the repeated-measures controlled analyses, the perception of inadequate basic needs was a highly significant predictor of future depressive symptoms (p <.0001). Race, education, baseline depression, baseline function, interval, and income were also significant predictors of depression. The interaction between interval and depression was not significant., Conclusions: The perception that one's basic needs are not being met predicted future depressive symptoms in a highly controlled analysis. These results suggest that perception of inadequate basic needs, even when income and other known correlates of depression are controlled, is a strong predictor of future depressive symptoms.

Objective: The authors sought to examine the association of vascular nutritional factors and depression in an elderly cohort of depression (currently and recently depressed) and comparison (never depressed) subjects., Method: Nutrient intake over the past year was assessed in 196 elderly depression and comparison individuals with a Block 1998 food-frequency questionnaire. Nutrient intake, body mass index, and Keys score (a measure of the serum cholesterol-raising capacity of the diet) were determined. Subjects were age 60 and over and were participants in a longitudinal study of major depression. All subjects received psychiatric and medical comorbidity assessments; depression subjects also received psychiatric treatment., Results: Vascular nutritional factors differed between depression and comparison subjects. The depression group had higher intake of saturated fat and cholesterol, higher body mass indices, lower alcohol intake, and higher Keys score than the comparison group. After controlling for age, sex, education, race, and medical comorbidity, associations remained for cholesterol, alcohol, and Keys score. Depression was found to be associated with overall dietary pattern as defined by total kilocalories, saturated fat, cholesterol, body mass index, polyunsaturated fat, sodium, and alcohol., Conclusions: This study provides evidence that dietary vascular risk factors differ in individuals with current or prior depression when compared with individuals with no history of depression.

Objectives: To determine whether the characteristics of the usual medical care providers of older antidepressant users changed between 1986 and 1997 with the introduction of selective serotonin reuptake inhibitors., Design: Longitudinal study., Setting: Five-county Piedmont area of North Carolina., Participants: Stratified random sample of African-American (n=2,261) and white (n=1,875) community residents aged 65 to 105., Measurements: Sample members provided information on prescription medications, demographic and health status, and usual medical care provider (matched to North Carolina Health Professions Data Systems files to ascertain provider characteristics) in 1986/87, 1989/90, 1992/93, and 1996/97. Most (77.5%) named a provider (name unmatchable for 4.1%). Sample member characteristics were aggregated into probability (propensity) scores summarizing predisposing (demographic), enabling (medical care access), and need (health status) categories. Along with wave of study and whether a provider was named, these were entered as control variables in generalized estimating equation models that examined the association between provider race (white vs nonwhite), sex, age, location of practice, and primary versus specialist care and antidepressant use., Results: The characteristics of the usual medical care providers remained stable over the decade, although prevalence of antidepressant use increased. Two provider characteristics--race and area of practice (but not the interaction between them)--were significantly associated with patients' use of antidepressants. Patients of white physicians and of physicians with urban practices were more likely to use antidepressants., Conclusion: Although use of antidepressants has increased over time, there has been little change in the characteristics of users' usual medical care providers.

Objective: Neighborhood sociodemographic characteristics may be important to the mental health of older adults who have decreased mobility and fewer resources. Our objective was to examine the association between neighborhood context and level of depressive symptomatology in older adults in a diverse geographic region of central North Carolina., Methods: The sample included 2,998 adults 65 or older residing in 91 census tracts. Depressive symptoms were measured using the Center for Epidemiologic Studies-Depression scale (CES-D). Neighborhoods were characterized by five census-based characteristics: socioeconomic disadvantage, socioeconomic advantage, racial/ethnic heterogeneity, residential stability, and age structure., Results: In ecologic level analyses, level of census tract socioeconomic disadvantage was associated with increased depressive symptoms. To determine whether neighborhood context was associated with depressive symptoms independently of individual characteristics, the authors used multilevel modeling. The authors examined the ability of each of five neighborhood (level 2) characteristics to predict a level 1 outcome (CES-D symptoms) controlling for the effects of individual (level 1) characteristics. Younger age, being widowed, lower income, and having some functional limitations were associated with increased depression symptoms conditional on census tract random effects. However, none of the neighborhood characteristics was significantly associated with depression symptoms, conditional on census tract random effects, either unadjusted or adjusted for individual characteristics., Conclusion: Any observed association between neighborhood sociodemographic characteristics and individual depressive symptoms in our sample may reflect the characteristics of the individuals who reside in the neighborhood rather than the neighborhood characteristics themselves. The use of multilevel modeling is important to separate these effects.

Major depression can affect up to 10% of older adults in clinical samples. Longitudinal studies of older adults with major depression report that a significant proportion of patients do not fully recover. Partial remission or symptoms of major depression that do not meet criteria for major depression, is predicted by 1) clinical factors, such higher number of symptoms at diagnosis, presence of comorbid dysthymia, and health problems; 2) social variables, such as high levels of perceived stress and low levels of perceived social support; and 3) perceived health/well-being variables, such as limitations in mobility or instrumental activities of daily living, poorer self-perceived health, finding life not satisfying, and looking back over life and finding it unhappy. Treatment options include antidepressants (alone or in combination) and psychotherapy.

Objectives: To determine whether metabolic syndrome is an independent predictor of decline in mobility in an elderly community sample., Design: Biracial community-based prospective cohort study., Setting: Urban and rural areas of central North Carolina., Participants: One thousand two hundred twenty-nine older African Americans and whites, mean age 77.0, who were participants in the Duke Established Populations for Epidemiologic Studies of the Elderly., Measurements: Sociodemographic data and data on mobility (a subset of items from the Rosow-Breslau scale), depression (Center for Epidemiological Studies Depression Scale), self-report of medical conditions, body mass index, cognitive function (Short Portable Mental Status Questionnaire), blood pressure, height, and waist circumference. High-density lipoprotein cholesterol, triglycerides, and blood glucose were available from blood samples. Metabolic syndrome was calculated for subjects with complete data., Results: Twenty-nine percent of the sample met criteria for metabolic syndrome. In bivariate analyses, age, sex, race, education, cognitive impairment, depression, impairment in mobility, history of stroke and heart disease, and metabolic syndrome at baseline were associated with a decline in mobility 4 years later. Regression analysis controlling for the above variables demonstrated that metabolic syndrome persisted as an independent and highly significant predictor of decline in mobility., Conclusion: These findings suggest that metabolic syndrome may be a distinct risk factor for mobility decline in community-dwelling older people.

Objective: The purpose of this study was to identify residual symptoms in a sample of older adults treated for major depression and compare individual symptoms present at baseline with those at three months by remission status., Methods: The sample was comprised of 229 patients with DSM-IV major depression who were participants in the NIMH Mental Health Clinical Research Center at Duke University. Symptoms were measured using the Montgomery-Asberg Depression Rating Scale (MADRS)., Results: At three months, 86 patients (37.6%) had remitted, or had a MADRS score less than or equal to 9. In the remitted group, the most frequently reported symptoms at three months were inner tension and lassitude. Among nonremitters, the most frequently reported symptoms were reported and apparent sadness, as well as lassitude and inner tension. In the sample as a whole, the symptoms most likely to be present at baseline but not three months were pessimistic and suicidal thoughts, while the most frequently reported emergent symptoms were reduced appetite and inner tension. Patients were much more likely to no longer have a particular symptom than to acquire a new symptom. Overall, the symptoms present at three months were not severe in either group., Conclusions: In older adults treated for major depression, residual symptoms at three months may include emergent symptoms as well as persistent symptoms, and are likely to include symptoms of anxiety as well as sadness. These findings have clinical implications for the treatment of late-life depression., (Copyright (c) 2005 John Wiley & Sons, Ltd.)

Objective: The authors studied demographic, clinical, social, and perceived health and well-being factors as predictors of partial remission in older patients treated for major depressive disorder (MDD)., Methods: The sample included 186 patients who met DSM-IV criteria for MDD and underwent naturalistic treatment. Remission status was determined by Montgomery-Asberg Depression Rating Scale score. Ordinal logistic-regression was used to model the relationship between predictors and remission on an ordinal scale., Results: A total of 26.9% patients were in partial remission (score: 7-15), and 25.8% were not in remission (score: 16-60) 1 year after the index evaluation. In bivariate analyses, the odds of partial/no remission were significantly increased for those with comorbid MDD and dysthymia and for those with higher baseline depression scores, and decreased for those with higher perceived social support. Other factors potentially associated with outcome included number of mobility/IADL limitations, perceived stress, self-perceived health, life dissatisfaction, and heart trouble. Controlling for these potential confounders, comorbid MDD and dysthymia significantly predicted outcome. The effect of mobility/IADL limitations differed for those with comorbid dysthymia., Conclusions: Among older adults treated for MDD, factors predicting partial remission appear to be similar to those predicting no remission. Patients with comorbid MDD and dysthymia are at increased risk for poor outcome, and predictors may vary by dysthymia status.

Objective: Antidepressant use increased substantially among older adults with the introduction of the new-generation medications such as the selective serotonin reuptake inhibitors. The authors analyzed data from two follow-up intervals-1986-1987 to 1989-1990 (interval 1) and 1992-1993 to 1996-1997 (interval 2)-from a community-based cohort of 4,162 older adults to determine predictors of future antidepressant use., Method: Information on antidepressant use, demographic and health characteristics, and categories of depressive symptoms-positive affect, negative affect, somatic complaints, and interpersonal problems-were obtained. Logistic regression was used to control simultaneously for multiple variables predicting antidepressant use during the two intervals. Repeated-measures logistic regression (with generalized estimating equations) was employed to model the probability of antidepressant use, with adjustment for the effect of time., Results: Prior antidepressant use and white race were strong predictors of future use during both intervals. Negative affect was the only additional significant predictor of use during interval 1. In contrast, low positive affect scores, cognitive impairment, and poorer health were additional significant predictors during interval 2. In a repeated-measures model, race, prior antidepressant use, poor health, low positive affect scores, and somatic complaints varied as predictors over time. Negative affect and cognitive impairment were consistent predictors over time., Conclusions: The predictors of antidepressant use by older adults changed over time, with health-related measures of quality of life, such as positive affect, health status, and somatic complaints, becoming more prominent as predictors of use.

Objectives: We sought to determine whether, among older adults (>65 years), a perception that their basic needs are not being met increased mortality risk and whether this risk varied by race/ethnicity., Methods: We used Cox proportional hazards modeling to estimate the effect of perceived inadequacy in having one's basic needs (adequacy of income, quality of housing, and neighborhood safety) met on 10-year mortality rates., Results: After control for age, gender, race/ethnicity, marital status, education, income, and cognitive and functional status at baseline, perceived inadequacy in having one's basic needs met was shown to be a significant predictor of mortality (P<.0001), but no significant differences by race/ethnicity were observed., Conclusions: Perceived inadequacy in having one's basic needs met predicted mortality during a 10-year follow-up among community-dwelling elderly persons.

Objectives: To determine which symptoms of depression are most likely to increase the risk of mortality in a biracial sample of older adults., Design: Cross-sectional and longitudinal study., Setting: Baseline and mortality follow-up in urban and rural North Carolina., Participants: Four thousand one hundred sixty-two African-American and white elders aged 65 to 105 at baseline (mean age 73)., Measurements: Sociodemographic and health factors and four subscales of the Center for Epidemiologic Studies Depression Scale (negative affect, positive affect, somatic symptoms, and interpersonal function) were determined at baseline (1986-87). Mortality was assessed over 10 years of follow-up (through 1996)., Results: Fifty-one percent of the sample died over the 10-year follow-up. In controlled Cox proportional hazards modeling, those who scored lower on the positive affect scale were significantly more likely to die over the 10-year follow-up (hazard ratio=1.12, 95% confidence interval=1.05-1.18). For those who scored higher on the negative affect scale, the somatic scale, and the interpersonal scale, there was no increased risk for mortality in controlled analyses., Conclusion: These findings suggest that subjective views of well-being may be more important predictors of mortality in older adults than the classic symptoms of depression, such as negative affect and somatic symptoms.

This article reviews the prevalence and incidence of mental disorders in older adults. The authors outline the epidemiologic challenges in determining the frequency of mental disorders in late-life and discuss issues that are critical for understanding the prevalence of the disorders and for reviewing the evidence from epidemiologic studies of mental disorders in this population. The authors summarize the epidemiologic data for depression, anxiety, dementia, schizophrenia, and alcoholism. Also included is a discussion of risk factors and outcomes of these disorders and a discussion of the implications of these epidemiologic findings for geriatric medicine.

Background: Several studies have linked geriatric depression with cerebrovascular disease. The apolipoprotein E gene (APOE) epsilon 4 allele has been associated with a variety of late-life neuropsychiatric disorders, including Alzheimer's disease, vascular dementia, and depression., Methods: The sample consisted of 145 elderly depressive individuals and 100 nondepressed elderly control subjects. After a standardized clinical assessment, all subjects underwent a magnetic resonance imaging brain scan. Volumes of subcortical white and gray matter lesions were determined using a semi-automated method. Apolipoprotein E genotype was determined on blood sample using a standard protocol. A series of linear regression models were developed to assess the relationships between APOE genotype and white and gray matter lesion volumes., Results: Older age, lower Mini-Mental State Examination score, and having any APOE epsilon 4 allele were each correlated with gray-matter lesion volume in depressed patients. Apolipoprotein E genotype was not associated with any lesion volume among control subjects. In a subsequent linear regression model, gray matter lesion volume was associated with older age, having at least one APOE epsilon 4 allele, and white matter lesion volume among depressed patients., Conclusions: These results are consistent with previous reports linking cerebrovascular disease and APOE genotype. Further studies are needed to replicate this finding in elderly depressive individuals and to explain the relationship between the APOE locus and development of central nervous system vascular pathology.

The authors investigated the increased risk of mortality from subthreshold depression and examined differences in risk by gender. Data from the Duke University Established Populations for Epidemiologic Studies of the Elderly (EPESE) longitudinal study of 4,162 community-dwelling adults age 65 or older were used for these analyses. Depression was measured with a modified version of the Center for Epidemiologic Studies Depression Scale (CES-D). Three follow-up periods were assessed, 1986-1989, 1989-1992, and 1992-1996. Using logistic regression, they determined the odds of mortality from both CES-D depression (> or =9 symptoms) and subthreshold depression (6-8 symptoms) by sex for each follow-up period, controlling for sociodemographic factors, physical and cognitive health and functioning, and health behaviors. CES-D depression was not associated with mortality in either men or women. Subthreshold depression was also not associated with mortality in men; in women, however, subthreshold depression was negatively related to mortality (OR=0.60; p=0.002) across the three periods. Subthreshold depression may result in different outcomes in women, possibly mediating against mortality.

Purpose: The prevalence of depressive symptoms in elderly adults is high, yet the criteria to identify clinically significant depression may leave many elders undiagnosed and untreated. We explored the demographic and risk factor profiles of two groups, one with more severe depression and one with less severe depression., Design and Methods: The data come from the Duke University Established Populations for Epidemiologic Studies of the Elderly (EPESE) baseline survey of 4,162 community-dwelling adults aged 65 or older., Results: The prevalence of depression meeting criteria of the Center for Epidemiologic Studies-Depression scale (CES-D) and sub-threshold depression was 9.1% and 9.9%, respectively. In ordinal logistic regression, both CES-D and subthreshold depression were associated with impairment in physical functioning, disability days, poorer self-rated health, use of psychotropic medications, perceived low social support, female gender, and being unmarried., Implications: Depression appears to exist along a continuum, with demographic and social and physical health predictors of subthreshold depression similar to predictors of depression as defined by the CES-D scale.

Objective: Prescriptions of antidepressant medications have increased significantly over the past 15 years across the life cycle. One overall correlate of medication use in older adults is race, with African Americans using fewer medications than whites. Given the frequency of depressive symptoms among elderly populations, as well as the increased potential for adverse side effects from antidepressants, the relative contribution of race in the use of antidepressants is critical for determining well-designed studies. The authors analyzed data from a community-based cohort of elders followed for 10 years to determine the association of race to the use of antidepressants between 1986 and 1996, with control for known correlates of depression in late life., Method: Information on antidepressant use and demographic and health characteristics were obtained from a stratified, probability-based sample of 4,162 elders (equally distributed between African American and white community-dwelling subjects) in the Piedmont region of North Carolina during four in-person interviews spanning 10 years. Descriptive statistics were calculated. Logistic regression was used for the final models., Results: A total of 4.6% of whites and 2.3% of African Americans used antidepressants in 1986. Approximately 14.3% of whites and 5.0% of African Americans used antidepressants in 1996. In controlled analyses, the prevalence odds ratio for antidepressant use in whites, compared to African Americans, was 1. 76 in 1986 and 3.77 in 1996., Conclusions: African American elders are much less likely to take antidepressants, and the difference in use increased over the 10 years of the survey.

Background: Phobic disorder is one of the most prevalent psychiatric disorders in community populations and much attention has focused on the association of sociodemographic factors and social resources with the disorder. There has been little investigation of the more personal resources such as self-confidence, religiosity, social support and self-perceived health that may increase vulnerability., Methods: We used a sample of 2914 community residents aged 18 or older who participated in the Duke University Epidemiologic Catchment Area Study to explore the relationship between both social and personal resources and the prevalence of DIS/DSM-III phobic disorder., Results: The 1-month prevalence of any phobic disorder was 7.6%. In bivariate analyses, we found both race/ethnicity and gender differences in prevalence, with a higher prevalence of phobic disorder in African-Americans and females. Lower socio-economic status, rural residence and unmarried status were also associated with current prevalence. No association was found for social network and social interaction. Impaired subjective social support, low self-confidence, perceived poorer physical health and co-morbid psychiatric disorder were significantly associated with current prevalence in uncontrolled analyses, while associations between lack of a confidant as well as religiosity and phobic disorder were not. Female gender (OR = 1.7), perceived low self-confidence (OR = 2.0), and two interaction terms, age x co-morbid psychiatric disorder and race/ethnicity x perceived physical health were associated with phobic disorder in controlled analyses using logistic regression., Conclusions: We conclude that both social and personal resources, particularly self-confidence, co-morbidity and perceived physical health are important correlates of phobic disorder.