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OBJECTIVES: Caring for a person with dementia can be challenging over the years. To support family carers throughout their entire caregiving career, interventions with a sustained effectivity are needed. A novel 6-week mobile health (mHealth) intervention using the experience sampling method (ESM) showed positive effects on carers' well-being over a period of 2 months after the intervention. In this study, the effects after 6 months of the selfsame intervention were examined to evaluate the sustainability of positive intervention effects. METHOD: The 6-week mHealth intervention consisted of an experimental group (ESM self-monitoring and personalized feedback), a pseudo-experimental group (ESM self-monitoring without feedback), and a control group (providing regular care without ESM self-monitoring or feedback). Carers' sense of competence, mastery, and psychological complaints (depression, anxiety and perceived stress) were evaluated pre- and post-intervention as well as at two follow-up time points. The present study focuses on the 6-month follow-up data (n = 50). RESULTS: Positive intervention effects on sense of competence, perceived stress, and depressive symptoms were not sustained over 6-month follow-up. CONCLUSION: The benefits of this mHealth intervention for carers of people living with dementia were not sustained over a long time. Similarly, other psychosocial interventions for carers of people with dementia rarely reported long-lasting effects. In order to sustainably contribute to carers' well-being, researchers and clinicians should continuously ensure flexible adjustment of the intervention and consider additional features such as ad-hoc counseling options and booster sessions. In this regard, mHealth interventions can offer ideally suited and unique opportunities. ispartof: AGING & MENTAL HEALTH vol:24 issue:12 pages:2082-2093 ispartof: location:England status: published

BACKGROUND: The associations of different patterns of alcohol consumption and the incidence and persistence of depressive and anxiety symptoms in older age remain unclear. METHODS: Data on 6095 adults aged ≥ 50 years old from the Irish Longitudinal Study on Aging (TILDA) was analyzed. Participants completed the CAGE instrument to screen for problematic alcohol use at baseline between October 2009 and February 2011. Outcomes were incident (assessed by the CES-D scale) and anxiety (assessed by the Hospital Anxiety and Depressive scale) symptoms after a two-year follow-up as well as persistence of probable depression and anxiety among those with a positive screen for those disorders at baseline. Associations were adjusted for potential confounders through multivariable models. RESULTS: In the overall sample, problem drinking did not predict incident and persistent depression and anxiety in this sample. Among females, problem drinking increased the risk for incident depression (OR = 2.11; 95%CI = 1.12-4.00) and anxiety (OR = 2.22; 95%CI = 1.01-4.86). In addition, problem drinking increased the risk of persistent depressive symptoms (OR = 2.43; 95%CI = 1.05-5.06) among females. CONCLUSION: Problem drinking may increase the risk of incident probable depression and anxiety among older females. Furthermore, problem drinking led to a higher likelihood of persistent depressive symptoms in older female participants. Interventions targeting problem drinking among older females may prevent the onset and persistence of depression in this population, while also decreasing the incidence of anxiety symptoms. ispartof: JOURNAL OF AFFECTIVE DISORDERS vol:238 pages:651-658 ispartof: location:Netherlands status: published

The first generation of genome-wide association studies (GWA studies) for psychiatric disorders has led to new insights regarding the genetic architecture of these disorders. We now start to realize that a larger number of genes, each with a small contribution, are likely to explain the heritability of psychiatric diseases. The contribution of a large number of genes to complex traits can be analyzed with genome-wide profiling. In a discovery sample, a genetic risk profile for depression was defined based on a GWA study of 1738 adult cases and 1802 controls. The genetic risk scores were tested in two population-based samples of elderly participants. The genetic risk profiles were evaluated for depression and anxiety in the Rotterdam Study cohort and the Erasmus Rucphen Family (ERF) study. The genetic risk scores were significantly associated with different measures of depression and explained up to similar to 0.7% of the variance in depression in Rotterdam Study and up to similar to 1% in ERF study. The genetic score for depression was also significantly associated with anxiety explaining up to 2.1% in Rotterdam study. These findings suggest the presence of many genetic loci of small effect that influence both depression and anxiety. Remarkably, the predictive value of these profiles was as large in the sample of elderly participants as in the middle-aged samples. Molecular Psychiatry (2011) 16, 773-783; doi:10.1038/mp.2010.65; published online 22 June 2010

Background and Objective: We examined the reliability and validity of self-reported limitations encountered in the activities of daily living (ADL) as measure of functional performance, for Turkish, Moroccan, and indigenous Dutch elderly in the Netherlands.Methods: We obtained data on self-reported ADL measured by Katz' ADL index and on five related health outcomes among a general population sample of 304 Dutch, 330 Turkish, and 299 Moroccan respondents aged 55-74 years, in Amsterdam, the Netherlands (response: 60%).Results: Katz' ADL index demonstrated good internal consistencies for each ethnic group (Cronbach's alphas: 0.84-0.94). Regarding validity, the ADL index showed relatively strong associations with related outcomes, that is, long-term limitations in mobility and SF-36 physical functioning (rank correlations: 0.64 and -0.60, respectively). Associations with more general health outcomes, number of chronic disorders, Center for Epidemiologic Studies-Depression scale symptoms, and SF-36 role performance were weaker, as expected. Associations were stronger for Moroccans than for indigenous Dutch elderly regarding both SF-36 outcomes and depressive symptoms.Conclusion: Katz' ADL index is valid to assess functional performance of Turkish, Moroccan, and Dutch elderly, but comparisons with Moroccan elderly should be handled with caution. The explanation of these findings and their generalizability to other ethnic groups deserve further study. (C) 2007 Elsevier Inc. All rights reserved.

Background: Valuations of depression are useful to evaluate depression interventions offered to patients with chronic somatic conditions. The only classification system to describe depression developed specifically for valuation purposes is the McSad, but it has not been used among somatic patients. The aim of this study was to test the construct validity of the McSad among diabetes and cancer patients and then to compare the McSad to the commonly used EuroQol - 5 Dimensions (EQ-5D (TM)) classification system. The comparison was expected to shed light on their capacity to reflect the range of depression states experienced by somatic patients.Methods: Cross-sectional data were collected online from 114 diabetes and 195 cancer patients; additionally, 241 cancer patients completed part of the survey on paper. Correlational analyses were performed to test the construct validity. Specifically, we hypothesized high correlations of the McSad domains with depression (Center for Epidemiological Studies Depression Scale (CES-D) and the Patient Health Questionnaire (PHQ-9)). We also expected low/moderate correlations with self-esteem (Rosenberg Self-Esteem scale - RSE) and extraversion (Eysenck Personality Questionnaire Extraversion scale - EPQ-e). Multiple linear regression analyses were run so that the proportion of variance in depression scores (CES-D, PHQ-9) explained by the McSad could be compared to the proportion explained by the EQ-5D classification system.Results: As expected, among all patients groups, we found moderate to high correlations for the McSad domains with the CES-D (.41 to .70) and the PHQ-9 (.52 to .76); we also found low to moderate correlations with the RSE (-.21 to .-48) and the EPQ-e (.18 to .31). Linear regression analyses showed that the McSad explained a greater proportion of variance in depression (CES-D, PHQ-9) (Diabetes: 73%, 82%; Cancer: 72%, 72%) than the EQ-5D classification system (Diabetes: 47%, 59%; Cancer: 51%, 47%).Conclusions: Findings support the construct validity of the McSad among patients with somatic conditions and demonstrate that it performs better than the EQ-5D classification system to reflect the range of depression states. For future valuation purposes, the McSad classification system could therefore be recommended to describe depression as experienced by patients with a chronic medical condition.

European studies about ethnic inequalities in depressive symptoms are scarce, show inconclusive results and are complicated by the discussion of what constitute (im)migrant and ethnic minority groups. Moreover, comparisons across countries are hampered by a lack of comparable measures of depressive symptoms. This study aims to assess the prevalence and determinants of depressive symptoms among immigrants, ethnic minorities and natives in 23 European countries. Multilevel analyses are performed using data from the third wave of the European Social Survey (ESS-3). This dataset comprises information about 36,970 respondents, aged 21 years or older, of whom 13.3% immigrants and 6.2% ethnic minorities. Depressive symptoms were assessed with an 8-item version of the Center for Epidemiologic Studies-Depression scale. Main determinants are immigrant status, socio-economic conditions and the experience of ethnic discrimination in the host country. The results show that immigrants and ethnic minorities do experience more depressive symptoms than natives in an essential part of the countries. Moreover, socio-economic conditions and the experience of ethnic discrimination are important risk factors. Immigrant status seems irrelevant, once the other risk factors are accounted for. Finally, immigrant and ethnic minority groups do not consist of the same individuals and therefore have different prevalence rates of depressive symptoms. The prevalence rates of depressive symptoms are higher for immigrant and ethnic minority groups in a substantial part of the European countries. A clear definition is indispensable for developing policies that address the right-targeted population.

Background: The Zarit Burden Interview ( ZBI) was originally developed to assess the level of subjective burden in caregivers of people with dementia. The Involvement Evaluation Questionnaire ( IEQ) is amongst the leading scales to assess caregiving consequences in severe mental illness. We aimed to compare the psychometric properties of the ZBI, a generic tool, and of the IEQ, a more specific tool to assess the consequences of caregiving in schizophrenia and related disorders. Methods: Secondary analyses of a 16- week, randomized controlled trial of a psychoeducational intervention in 223 primary caregivers of patients with schizophrenia or schizoaffective disorder. Psychometric properties ( internal consistency, convergent and discriminative validity, and sensitivity to change) were evaluated for both ZBI and IEQ. Results: Internal consistency was good and similar for both scales ( ZBI: 0.91, 95% CI: 0.89, 0.94; IEQ: 0.86, 95% CI: 0. 83, 0.89). Convergent validity was relevant for similar domains ( e. g. ZBI total score vs IEQ- tension r = 0.69, 95% CI: 0. 61, 0.75) and at least moderate for the rest of domains ( ZBI total score, personal strain and role strain vs IEQ- urging and supervision). Discriminative validity against psychological distress and depressive symptoms was good ( Area Under the Curve [ AUC]: 0.77, 95% CI: 0.71, 0.83; and 0.69, 95% CI: 0.63, 0.78 - for ZBI against GHQ- 28 and CES- D respectively; and AUC: 0.72, 95% CI: 0.65, 0.78; and 0.69, 95% CI: 0.62, 0.77 - for IEQ against GHQ- 28 and CES- D respectively). AUCs against the reference criteria did not differ significantly between the two scales. After the intervention, both scales showed a significant decrease at endpoint ( p- values < 0.001) with similar standardised effect sizes for change (- 0.36, 95% CI: - 0.58, - 0.15 - for ZBI; - 0.39, 95% CI: - 0.60, - 0.18 - for IEQ). Conclusions: Both ZBI and IEQ have shown satisfactory psychometric properties to assess caregiver burden in this sample. We provided further evidence on the performance of the ZBI as a general measure of subjective burden. The study was entirely funded by a public research grant (FIS PI10/01049, Spain).