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Stressful Life Events and Depressive Symptoms among the Elderly
Abstract
We examined the effect of a series of common stressful life events on change in depressive symptoms among the elderly. The subjects were 1,962 noninstitutionalized people 65 years of age or older from the New Haven EPESE project. Multivariate regression models revealed that 8 of 11 stressful life events examined predicted change in depressive symptoms at follow-up (1985) after controlling for baseline depressive symptoms age, socioeconomic factors, functional status, and chronic conditions. In addition, the total number of stressful life events was significantly associated with higher CES-D depression scores. A dose-response relationship between cumulative life event stress and change in depressive symptoms was also shown. These results suggest that certain common life event stressors may have an impact on mental health, both singly and in combination.
... Andere Studien zeigten hingegen, dass ältere Menschen häufiger von Verlusten anderer Angehöriger als von Verwitwung betroffen waren [8,17], wobei sich ebenfalls negative gesundheitliche Auswirkungen in Form von teilweise sogar verstärkt erhöhter Depressivität zeigten [17,20]. Neben dem Tod nahestehender Personen wurden zudem für weitere Verlustarten wie schwere Erkrankung [15] und Umzug [21] nahestehender Personen Assoziationen mit erhöhter Depressivität festgestellt. Verwitwung stellt also nur einen Ausschnitt der Vielzahl möglicher gesundheitsrelevanter Verlusterlebnisse im Alter dar und eine breitere Konzeption von Verlusterlebnissen, die verschiedene Kategorien verlorener nahestehender Personen und Verlustarten einschließt, steht noch aus. ...
... In Übereinstimmung mit früheren Studien, in denen Zusammenhänge zwischen verschiedenen sozialen Verlusterlebnissen und einer erhöhten Depressivität gefunden wurden [15 -17, 19 -21], liefern die vorgelegten Ergebnisse weitere Hinweise darauf, dass verschiedene Arten sozialer Verlusterlebnisse wie auch Verluste verschiedener nahestehender Personen mit einer erhöhten Depressivität einhergehen können. Dabei zeigte sich in mehreren Forschungsarbeiten, dass insbesondere eine Kumulation belastender Lebensereignisse mit einer erhöhten Depressivität im Alter assoziiert war [15,21]. Allerdings fanden sich in anderen Studien auch häufiger keine oder inkonsistente Zusammenhänge für verschiedene Arten sozialer Verlusterlebnisse wie auch verlorene nahestehende Personen, welche von verschiedenen Faktoren beeinflusst worden sein könnten wie z. ...
... Da Selbstberichtsmaße zur Erfassung von depressiver Symptomatik und sozialen Verlusterlebnissen eingesetzt wurden, können Einflüsse von beispielsweise sozialer Erwünschtheit [40] nicht ausgeschlossen werden. Eine selbstberichtete depressive Symptomatik ist dabei nicht gleichzusetzen mit einer klinischen Depressionsdiagnose. Das Untersuchungsdesign erlaubte zudem keine Erfassung der depressiven Symptomatik vor dem Einsetzen von sozialen Verlusterlebnissen, welche ein starker Prädiktor für die spätere depressive Symptomatik sein könnte [21]. Weiterhin basiert die vorliegende Untersuchung auf querschnittlichen Daten, welche keine kausalen Aussagen erlauben. ...
Zusammenfassung
Ziel der Studie Verlusterlebnisse im Alter können mit einer Vielzahl negativer gesundheitlicher Folgen für Betroffene wie Depressionen einhergehen.
Methodik 706 Personen (75+ Jahre) wurden mit einem strukturierten klinischen Interview befragt.
Ergebnisse Es zeigte sich, dass soziale Verlusterlebnisse signifikant mit Depressionen assoziiert waren.
Schlussfolgerung Die vorliegende Arbeit legt erstmalig für Deutschland umfängliche Ergebnisse zu sozialen Verlusterlebnissen im hohen Alter vor und stellt einen wertvollen Ausgangspunkt für zukünftige Forschungsarbeiten dar.
... Older adults living in congregate housing are more likely to have a smaller social network, be older, female, live alone, be unmarried, and display higher rates of depressive symptoms compared to community-dwelling older adults (Adams and Roberts, 2010). The prevalence of depressive symptoms increases throughout late adulthood and becomes the highest in the oldestold group (aged > 80) (Glass et al., 1997). Moreover, in old age, people may experience grief more often compared to other groups in response to negative life events common in old age, such as bereavement, declining health, and relocation. ...
... Depressive symptoms include poor appetite, insomnia or hypersomnia, loss of energy, fatigue or tiredness, feelings of excessive guilt, inability to concentrate or think, and suicidal thoughts (Bulut, 2009;Ryan and Shea, 1996). Depression is not only a risk factor for mortality (Glass et al., 1997;Kaplan and Reynolds, 1988) but also for functional impairment (Hybels et al., 2001), decreased quality of life, and subjective distress among older adults (Lavretsky and Kumar, 2002). Between 11 percent and 40 percent of community-dwelling older adults report depressive symptoms, with an average of around 20 percent (Bulut, 2009). ...
... Negative stressful life events including bereavement, onset of significant health problem, and relocation are significant risk factors of depressive symptoms among older adults (De Beurs et al., 2001;Glass et al., 1997). However, the specific effects of negative life events on depression are inconsistent among the oldest-old group. ...
The objective of this study was to research grief and depression in oldest-old people living in urban congregate housing by examining the various types of grief that they experience by using a stress process model for depression among the oldest old. This study used a convenience sample of the 128 participants aged 80 and older living in congregate housing. We found that the two types of grief most significantly associated with depressive symptoms were grieving about relocating, and loss of health. Our findings demonstrate the need to explore a variety of grief which influences mental health among oldest-old.
... In contrast to the methodology used in daily hassles studies, research on life events in community-dwelling older adults (age 50+) and the oldest old (age 85+) has typically employed one or two times of measurement, [16][17][18][19][20][21][22][23] assessed variables over a longer time period (e.g., past 12 months except for two studies [past 3 and 6 months]), [16][17][18][19][20][21][22][23][24][25][26] and examined stress in relation to more severe outcomes (i.e., depressive symptoms or diagnoses) [16][17][18][19][20][21][22][23][24][25][26][27] . Importantly, the lack of repeated measure designs and the use of lengthy time frames precludes the study of the 'durability' of life events stressors. ...
... In contrast to the methodology used in daily hassles studies, research on life events in community-dwelling older adults (age 50+) and the oldest old (age 85+) has typically employed one or two times of measurement, [16][17][18][19][20][21][22][23] assessed variables over a longer time period (e.g., past 12 months except for two studies [past 3 and 6 months]), [16][17][18][19][20][21][22][23][24][25][26] and examined stress in relation to more severe outcomes (i.e., depressive symptoms or diagnoses) [16][17][18][19][20][21][22][23][24][25][26][27] . Importantly, the lack of repeated measure designs and the use of lengthy time frames precludes the study of the 'durability' of life events stressors. ...
... In contrast to the methodology used in daily hassles studies, research on life events in community-dwelling older adults (age 50+) and the oldest old (age 85+) has typically employed one or two times of measurement, [16][17][18][19][20][21][22][23] assessed variables over a longer time period (e.g., past 12 months except for two studies [past 3 and 6 months]), [16][17][18][19][20][21][22][23][24][25][26] and examined stress in relation to more severe outcomes (i.e., depressive symptoms or diagnoses) [16][17][18][19][20][21][22][23][24][25][26][27] . Importantly, the lack of repeated measure designs and the use of lengthy time frames precludes the study of the 'durability' of life events stressors. ...
The present study investigated the temporal association between life event stressors relevant to older adults and depressive symptoms using a micro-longitudinal design (i.e., monthly increments over a six-month period). Existing research on stress and depressive symptoms has not examined this association over shorter time periods (e.g., monthly), over multiple time increments, or within-persons.
An in-person initial interview was followed by six monthly interviews conducted by telephone.
Community.
Data were drawn from a study of 144 community-dwelling older adults with depressive symptoms.
Stressful life events were measured using the Geriatric Life Events Scale (GALES), and depressive symptoms were assessed with the Short - Geriatric Depression Scale (S-GDS).
Using multilevel modeling, 31% of the S-GDS' and 39% of the GALES' overall variance was due to within-person variability. Females and persons with worse health reported more depressive symptoms. Stressful life events predicted concurrent depressive symptoms, but not depressive symptoms one month later.
The lack of a time-lagged relationship suggests that older adults with depressive symptoms may recover more quickly from life stressors than previously thought, although additional research using varying time frames is needed to pinpoint the timing of this recovery as well as to identify older adults at risk of long-term effects of life stressors.
... Rather than specifying how each variable contributes to regulation of sadness, we explicitly take a holistic view and use the temporal relations among all these variables to derive how an individual's regulation of sadness is related to the experience of depressive symptoms. Given that change in depressive symptoms may also be related to individuals' immediate life context [46][47][48], we control for differences in stressful life events. ...
... Given that burst-to-burst changes in depressive symptoms may be related to individuals' immediate life context [46][47][48], we controlled for differences in recent life events. Individuals' recent life experiences were probed using 12 items adapted from life events scales [59,60]. ...
Socioemotional processes engaged in daily life may afford and/or constrain individuals’ emotion regulation in ways that affect psychological health. Recent findings from experience sampling studies suggest that persistence of negative emotions (emotion inertia), the strength of relations among an individual’s negative emotions (density of the emotion network), and cycles of negative/aggressive interpersonal transactions are related to psychological health. Using multiple bursts of intensive experience sampling data obtained from 150 persons over one year, person-specific analysis, and impulse response analysis, this study quantifies the complex and interconnected socioemotional processes that surround individuals’ daily social interactions and on-going regulation of negative emotion in terms of recovery time. We also examine how this measure of regulatory inefficiency is related to interindividual differences and intraindividual change in level of depressive symptoms. Individuals with longer recovery times had higher overall level of depressive symptoms. Also, during periods where recovery time of sadness was longer than usual, individuals’ depressive symptoms were also higher than usual, particularly among individuals who experienced higher overall level of stressful life events. The findings and analysis highlight the utility of a person-specific network approach to study emotion regulation, how regulatory processes change over time, and potentially how planned changes in the configuration of individuals’ systems may contribute to psychological health.
... Rather than specifying how each variable contributes to regulation of sadness, we explicitly take a holistic view and use the temporal relations among all these variables to derive how an individual's regulation of sadness is related to the experience of depressive symptoms. Given that change in depressive symptoms may also be related to individuals' immediate life context [46][47][48], we control for differences in stressful life events. ...
... Given that burst-to-burst changes in depressive symptoms may be related to individuals' immediate life context [46][47][48], we controlled for differences in recent life events. Individuals' recent life experiences were probed using 12 items adapted from life events scales [59,60]. ...
Socioemotional processes engaged in daily life may afford or constrain individuals’ emotion regulation in ways that affect psychological health and the aging process. In particular, multiple theories of aging suggest that the dynamic interplay between social contact and emotional experience contributes to healthy aging. Using multiple bursts of intensive experience sampling data obtained over one year from 150 persons age 18 to 89 years, this study examines the temporal dynamics of individuals’ daily socioemotional lives, and quantifies those dynamics in terms of regulation inefficiency. In line with expectations, regulation inefficiency was associated with experience of depressive symptoms, both between-persons and within-persons, and particularly so among individuals who experienced more life events. The findings highlight the utility of a person-specific network approach in study of emotion regulation, and the opportunity life events provide for “testing the limits” of systemic function.
... The findings by Moon and colleagues (2012) support previous studies demonstrating that older adults grieving a loss reported more depressive symptoms Glass et al., 1997), including the oldest-old group (Meller et al., 1997). Understanding the distinctions between depression and grief following bereavement has important implications for the mental and physical health of the bereaved individuals, in addition to providing important points of intervention for health professionals. ...
Grief is a major physical and psychological health concern for adults, as well as a key risk factor for depression. The direct and indirect costs of depression in adults place heavy burdens on societal resources. Indeed, bereavement is a stressful and profound life experience, with the grieving process combining reactions to a loss that may originate in complications for bereaved individuals. The goal of this systematic review is to synthesize the findings regarding depression and grief. Studies related to the topic were obtained from multiple databases through rigorous exclusion and inclusion criteria. Only empirical studies with quantitative methodologies were included. Objectives, sample (type of sample, % male, and age), instruments, and main conclusions were extracted from each study. Overall, there are personality and contextual factors that, in addition to affecting depressive reactions following a loss, may also interface with one’s ability to grieve. Furthermore, after the patient’s death, there was a decrease in depressive symptoms over time, indicating that these symptoms are dynamic. Individuals who experience prolonged grief exhibit depressive symptoms, and those who suffer a loss may have depressive symptoms, but in a natural and non-pathological way, that is, sadness and not depression. Depression tends to decrease over time, with the existence of more children and a focus on occupation.
... In addition, perceived stress has been shown to influence depression [13]. In the case of the elderly, it has been reported that the stress of negative life events such as a spouse's disease affects depression [14] and that this is due to a decline in health and a decrease in psychosocial resources due to aging [15]. In contrast, Valimaki et al. [16] found that depression was higher when the spouse was a caregiver and depression negatively affected HRQoL. ...
Recently, there has been a rise in the number of spouses becoming primary caregivers to patients with dementia. This study identifies the mediating effects of depression and sleep quality on the relationship between perceived stress and health-related quality of life (HRQoL) among primary caregiving spouses of patients with severe dementia through a secondary data analysis of the 2018 Korea Community Health Survey by the Korea Disease Control and Prevention Agency. Data from 229 primary caregiving spouses of patients with severe dementia were analyzed using descriptive statistics, Spearman's rank correlation or Pearson's correlation analysis, and the lavaan R package, version 0.6-9. The association between perceived stress status (PSS) and the European Quality of Life Five Dimension (EQ-5D) index was highly significant. The direct effect of PSS observed in the model was nullified with both the Patient Health Questionnaire-9 and the Pittsburgh Sleep Quality Index as mediators, which implies that they mediate the effect of PSS on caregivers' EQ-5D indexes. The mediation model accounted for 33.2% of the variance in the EQ-5D index of caregivers. The results suggest the need to develop an intervention to improve sleep quality and manage depression to mitigate a decline in HRQoL for these caregivers.
... Response options were yes (=1) or no (=0), and affirmative answers were used to construct a count of stressful life events. Higher values reflected a greater number of stressful life events (Assari & Lankarani, 2015;Glass et al., 1997;Lincoln, 2019). ...
Objectives: This study assessed whether multiple stress exposures and stress accumulation explained differences in physical health among Afro-Caribbean and African American women in older adulthood. Whether specific stressors uniquely influenced the health of African American and Afro-Caribbean women was also examined. Methods: Data were drawn from the National Survey of American Life (NSAL) ( N=867; 50 years and older). Physical health was assessed by multiple chronic conditions, functional limitations, and self-rated health. Weighted binary logistic regression and ordered logistic regression analyses were conducted. Results: Compared to Afro-Caribbean women, African American women had worse physical health and greater stress exposure. Nonetheless, stress exposure did not explain ethnic differences in physical health. The association between specific measures of stress and physical health was dependent on the stressor and physical health measure. Discussion: Findings emphasize the importance of ethnic variation in health and stress exposure among older US Black women. Study implications are discussed.
... Indeed, negative life events, such as family upheavals, illness, and injury, have been the focus of aging studies in the past decades because older adults often experience them at an elevated level and face heightened risk of stress proliferation. As such, negative life events has been considered as one of the most important stressors of depression for older adults (12,28). ...
Although it is widely acknowledged that older adults who have gone through negative life events are more likely to develop depression, there is limited evidence on whether and which type of social ties moderate this perceived relationship. Based on 2016 and 2018 waves of Chinese Longitudinal Aging Social Survey (4,466 individuals, 8,932 observations), we apply linear fixed effects models and confirm that negative life events are associated with depressive symptoms for older adults (Coef. = 0.35; 95% CIs 0.11–0.61), and social ties are negatively associated with depression (Coef. = −0.08; 95% CIs −0.10 to −0.07). Our study further suggests that the association between negative life events and depressive symptoms is significantly moderated by friendship ties (Coef. = −0.18, 95% CIs −0.30 to −0.07), rather than family ties (Coef. = −0.03, 95% CIs −0.09 to 0.15). Moreover, the buffering effects of friendship ties are more prominent for the less resilient and less privileged groups, namely male, rural, and less educated older adults. Our findings point to the importance of expanding and strengthening social networks for Chinese older adults in promoting their psychological health.
... Both general stress (e.g. Lin & Ensel, 1989, Thoits, 1995 and stressful life events (Estrada-Martínez, Caldwell, Bauermeister, & Zimmerman, 2012;Glass, Kasl, & Berkman, 1997;Hammen, 2005;Mazure, 1998;Paykel, 2003;Tennant, 2002) are associated with internalizing disorders like depressive symptoms. The association between stress (Conger, 1956;Cooper, Russell, Skinner, Frone, & Mudar, 1992), stressful life events (Fife et al., 2013;Shrout & Weigel, 2018), and externalizing behaviors such as heavy alcohol use is also well established. ...
Extradyadic sex (EDS) is a major relationship violation, yet it occurs in nearly a quarter of United States cohabiting and marital unions. While many relationships dissolve in the wake of EDS, a majority remain intact. Theories of social stress suggest that substantial psychological distress should result unless EDS is a symptom of stress caused by involvement in a relationship marked by other negative characteristics. This study investigates how one’s own EDS, a partner’s EDS, and mutual EDS are related to internalizing and externalizing behaviors: depressive symptoms and heavy alcohol use, respectively. Analyses of data from the National Longitudinal Study of Adolescent to Adult Health suggest that one’s own EDS is associated with heavy alcohol use among cohabiters and spouses and with depressive symptoms among spouses, while partner EDS has no association with either outcome, net of confounders. We discuss the implications of these findings in the study’s conclusions.
... A complex interaction of psychological, social, or biological factors contributes to depression [4]. Various previous studies showed that the number of chronic health conditions [5,6], cognitive impairment [7,8], low exercise level [1,9,10], functional limitations [6,9,11], lack of social support [12], negative life events [13,14], and other stressful events can affect depressive symptoms either directly or indirectly. ...
Background:
The number of patients with depressive symptoms worldwide is increasing steadily, and the prevalence of depression among caregivers is high. Therefore, the present study aimed to identify the effects of individuals' caregiving status with respect to their family members requiring activities of daily living (ADLs) assistance on depressive symptoms among those aged 45 or over.
Methods:
Data were collected from the 2006-2016 using the Korean Longitudinal Study of Aging surveys. Participants were categorized into three groups based on their caregiving status with respect to family members requiring ADL assistance: whether they provided the assistance themselves, whether the assistance was provided by other caregivers, or whether no assistance was required. We analyzed the generalized estimating equation model and subgroups.
Results:
A total of 3744 men and 4386 women were included for the analysis. Men who cared for family members requiring ADL assistance had higher depressive symptoms than those with family members who did not require ADL assistance. Among women, participants who had family members requiring ADL assistance that they themselves or others were providing had higher depressive symptoms than those without family members requiring ADL assistance. Subgroup analysis was conducted based on age, job status, regular physical activities, participation status in social activities, and the number of cohabiting generations.
Conclusions:
The study results indicated higher depressive symptoms among those with family members requiring ADL assistance and those who care for such family members themselves. This suggests that an alternative to family caregiving is necessary, especially for the elderly, regardless of caregiver sex.
... ;Fink, Kuskowski, and Marshall (2014);Gerritsen and colleagues (2010);Glass, Kasl, and Berkman (1997);Hardy, Concato, and Gill (2002);Hays, Pieper, and Purser (2003); Holt and colleagues (2012); Hsu (2011); Katsumata and colleagues (2012); Lim and colleagues (2015); Morikawa and colleagues (2013); Osmanovic-Thunström, Mossello, Åkerstedt, Fratiglioni, and Wang (2015); Seematter-Bagnoud, Karmaniola, and Santos-Eggimann (2010); Tschanz and colleagues ...
Purpose of the Study
(1a) We use the Cardiovascular Health Study (CHS), a multi-site heterogeneous sample of Medicare enrollees (N = 5,849) to provide rates for specific life events experienced within 6 months; (1b) We present rates for 29 other studies of community-residing older adults (N = 41,308); (2) For the CHS, we provide demographic-specific rates and predicted probabilities for age [young-old (65–75) vs old-old (≥75)], gender, race, marital status, and education.
Design/Methods
The CHS sample is 57.6% women, 84.2% white (15.8% black), and 66.3% married. Mean age is 72.8 years (standard deviation [SD] = 5.6, range = 65–100) and education is 13.7 years (SD = 4.8). Life events were interviewer-assessed. Regressions estimated associations of life event rates with demographic groups (e.g., age), controlling for other demographic variables (e.g., gender, etc.).
Results
(1a) CHS rates ranged from 44.7% (death of someone close) to 1.1% (retirement/work changes). (1b) Most life event studies used total scores and only 5 that met our inclusion criteria used time intervals <1 year; longer intervals were associated with higher rates. (2) In the CHS, the life event for illnesses was related to 5 demographic variables (net the other 4 demographic variables), difficulties caregiving to 4, and worse relationships to 3 demographic variables. Race was related to 8 life events, marital status to 7, education to 6, and age to 4 events.
Implications
By identifying demographic groups at highest risk for life events, this research focuses on older adults at greatest risk for health problems. These data are necessary for translating research into interventions, practice, and policy.
... In addition, living in a nursing home will aggravate depressive symptoms further as shown in our results and those of Ahmed et al. [36]. A dose-response relationship between cumulative life event stress and change in depressive symptoms was also shown [37]; the more the total number of stressful life events, the higher the depression score. ...
Abstract
Background/Aim: Although the rates of depression and anxiety disorders have been shown to be higher in older people, especially those living in institutional settings, most of this population remains undiagnosed and untreated. The objective is to translate the full-scale Geriatric Depression Scale (30 items, GDS) into Arabic for use in elderly patients in Lebanon, to check its validity and reproducibility in comparison to the original version of the questionnaire, and assess the risk factors associated with depression in the Lebanese geriatric population. Methods: This case-control study was conducted between June and August 2016 and included
500 patients aged more than 60 years (250 living inside and 250 outside a nursing home). Results: Strongly positive correlations (p < 0.001 for all items of the scale) were found between each item of the scale and the total scale. The mean inter-item correlation for our scale was 0.51, higher than that of the original scale (0.36), with an excellent internal consistency (Cronbach α = 0.901). Living in a nursing home, stress, anxiety, being married, age, and the primary level of education would significantly increase depression (β = 2.211, β = 0.223, β = 0.041, β = 0.902, β = 0.118, and β = 3.533, respectively). A normal nutritional status and a university
level of education would significantly decrease depression (β = –0.732; β = –1.961). Conclusion: The Arabic
version of the GDS can be used to estimate the severity of depression in the Lebanese elderly population. Periodic screening for anxiety, nutritional status, and stress is also recommended among geriatric people living in Lebanon.
... The 3 most commonly reported stressful life events by our study participants were "death of relatives/important persons" (31%), "patient's own disease" (21%), and "disease of relatives/important persons" (19%), accounting for more than 70% of all events. The frequency of diseaserelated events agrees with previous studies on stressful life events done in elderly populations, where health-related events were found to be the most frequent type of stress in older adults [21,22]. Different events were perceived differently by our study participants. ...
Background:
There is a general notion that stressful life events may cause mental and physical health problems.
Objectives:
We aimed to describe stressful life events reported by patients with chronic obstructive pulmonary disease (COPD) and to assess their impact on health outcomes and behaviors.
Methods:
Two hundred and sixty-six primary care patients who participated in the ICE COLD ERIC cohort study were asked to document any stressful life events in the past 3 years. We assessed the before-after (the event) changes for symptoms of depression and anxiety, health status, dyspnea-related quality of life, exacerbations, cigarette use, and physical activity. We used linear regression analysis to estimate the crude and adjusted magnitude of the before-after changes.
Results:
About 41% (110/266) of patients reported the experience of any stressful life events and "death of relatives/important persons" was most common (31%). After accounting for age, sex, living status, lung function, and anxiety/depression status at baseline, experiencing any stressful life events was associated with a 0.9-point increase on the depression scale (95% CI 0.3 to 1.4), a 0.8-point increase on the anxiety scale (95% CI 0.3 to 1.3), and a 0.8-point decrease in the physical activity score (95% CI -1.6 to 0).
Conclusions:
Experiencing stressful life events was associated with a small to moderate increase in symptoms of depression and anxiety in COPD, but no discernable effect was found for other physical outcomes. However, confirmation of these results in other COPD cohorts and identification of patients particularly vulnerable to stressful life events are needed.
... In addition, living in a nursing home will aggravate depression further as shown in our results and those of Ahmed et al. [27]. A doseresponse relationship between cumulative life event stress and change in depressive symptoms was also shown [28]; the more the total number of stressful life events, the higher the depression score. ...
... Depression is a significant contributor to the global burden of disease, and the world mental health survey conducted in 17 countries found that, on average, about 1 in 20 people reported having an episode of depression in the previous year [1]. Several risk factors have been indicated, including socio-economic factors (e.g., educational attainment), physical activity, and other health-related factors (e.g., activities of daily living, and current history of the disease) [2][3][4]. It is also important to note that car driving could be considered a potential risk factor for depression in rural areas [5]. ...
Given that public transportation networks are often worse in rural areas than in urban areas, it is difficult for elderly non-drivers to access health-promoting goods, services, and resources related to mental health. Moreover, geographical location, assessed by elevation, could modify this association in a rural area. The aim of this study was to test whether the association between car driving (being a driver or not) and depression, as measured by the Zung Self-Rating Depression Scale (SDS), varied by elevation. Data were collected from a cross-sectional study conducted in the town of Ohnan located in a rural area of Japan. After excluding participants with missing data (n = 26), 876 participants were analysed in this study. After adjustment for potential confounders, being a non-driver had a significantly higher odds ratio of SDS (40+) among elderly people living at a low elevation (odds ratio = 2.17, 95% confidence interval = 1.28-3.71). However, similar findings were not observed among elderly people living at a high elevation. These results suggest that car driving importantly predicts depression in elderly people living at relatively low elevations in rural areas.
... There is a debate regarding whether or not stress response is independent of setting and context (5,15,16), or is context dependent (17)(18)(19)(20)(21). Despite decades of research to understand characteristics that alter the effect of stress on depression (22,23), our information is still limited on factors that mitigate the SLE-depression association (24)(25)(26)(27). ...
Background
Although stressful life events (SLEs) predict subsequent risk of developing a major depressive episode (MDE), limited information exists on whether or not race and gender alters the predictive role of SLE on risk of MDE over a long-term period. The current study explored race and gender differences in the long-term predictive role of SLE at baseline (1986) on subsequent risk of MDE 25 years later (2011) in a nationally representative cohort in the United States.
Methods
Using a life course epidemiological approach, this longitudinal study borrowed data from the Americans’ Changing Lives (ACL) Study 1986–2011. Main predictor of interest was baseline SLE over the last 3 years measured at 1986. Main outcome was risk of MDE [Composite International Diagnostic Interview (CIDI)] 25 years later (2011). Covariates included demographics, socioeconomics, depressive symptoms [Center for Epidemiological Studies-Depression Scale (CES-D)], chronic medical conditions, and health behaviors measured at baseline (1986). Gender and race were the focal moderators. We employed logistic regressions in the pooled sample, and specific to race and gender, to test whether or not SLE × race and SLE × gender interactions are significant.
Results
In the pooled sample, baseline SLE (1986) predicted risk of MDE 25 years later (2011). We also found a gender by SLE interaction, suggesting a stronger predictive role of SLE for subsequent clinical depression for men compared to women. Race did not modify the predictive role of SLE on subsequent risk of MDE 25 years later.
Conclusion
How SLE predicts MDE 25 years later differs for men and women, with a stronger predictive role for men compared to women. More research is needed to better understand the complex links between gender, sex, stress, and depression.
... While in the clinical sample, SLE is 2.5 times higher in patients with depression compared to controls, community-based studies have found major SLEs preceding depression in 80 % of patients with depression [6]. The SLE depression link seems to be independent of stressor [2,3], developmental stage of the individual [4,7], and setting [8]. ...
Background
Although stressful life events (SLEs) and depression are associated, we do not know if the intersection of race and gender modifies the magnitude of this link. Using a nationally representative sample of adults in the USA, we tested if the association between SLE and major depressive episode (MDE) depends on the intersection of race and gender.
Methods
Data came from the National Survey of American Life (NSAL), 2003, a cross-sectional survey that enrolled 5899 adults including 5008 Blacks (African-Americans or Caribbean Blacks), and 891 Non-Hispanic Whites. Logistic regression was used for data analysis. Stressful life events (past 30 days) was the independent variable, 12-month MDE was the dependent variable, and age, educational level, marital status, employment, and region of country were controls.
Results
In the pooled sample, SLE was associated with MDE above and beyond all covariates, without the SLE × race interaction term being significant. Among men, the SLE × race interaction was significant, suggesting a stronger association between SLE and MDE among White men compared to Black men. Such interaction between SLE × race could not be found among women.
Conclusions
The association between SLE and depression may be stronger for White men than Black men; however, this link does not differ between White and Black women. More research is needed to better understand the mechanism behind race by gender variation in the stress–depression link.
... Another longitudinal study (n=1962) analyzed perceived stressful life events and depressive symptoms measured with the Center for Epidemiological Studies Depression scale (CESD). A study using a regression analysis model showed predictive change for driving cessation on depressive symptoms among older adults (Glass, Kasl, & Berkman, 1997). A longitudinal study of an elderly cohort monitored depressive symptoms over three to five years post-driving cessation and showed a greater risk for worsening depressive symptoms over this extended timeframe (Fonda, Wallace, & Herzog, 2001). ...
Many driving rehabilitation specialists and researchers have emphasized the “on-road” driving assessment as the most appropriate method to determine driving performance. Difficulty arises with consensus surrounding the standardization of the clinical assessment and on-road assessment protocols. This research was designed to evaluate the psychometric properties and clinical utility of a standardized method for behind-the-wheel (BTW) driving assessment for older adults. Ninety-five older adults from the Gainesville, Fla, area were assessed for BTW performance by driving rehabilitation specialists. A global rating (criterion) of overall driving competence was correlated with an objective performance score. The global rating was found to be significantly correlated with the driving performance score (r = 0.84, P < .001). Intraclass correlation coefficients (ICC) were calculated for interrater (0.94) and test-retest (0.95) reliability for the performance score. Internal consistency for the BTW assessment was 0.94. These assessment methods and the course design provide a valid and reliable outcome measure of driving performance for older adults.
... Gerontological studies suggest that stress in daily life may be related to depression in late life, and that exposure to stressful life events may increase depressive symptoms in older age groups (Colenda & Smith, 1993;Krause, 1986;Norris & Murrell, 1987). Life events that may adversely affect the elderly include the illness or death of a loved one, illness or death of a close friend or relative, being robbed or burgled, legal and financial problems, admission to nursing home, and hospitalization (Brown & Harris, 1978;Glass, Kasl, & Berkman, 1997). ...
... Finally, our finding of a strong positive relation between the number of incident traumatic events during a 1-year follow-up period and change in depression severity corroborates prior evidence of dose-response relations between the number of lifetime traumatic events and depression [23,[46][47][48][49][50][51] as well as between more general measures of stressful life events and increased depression [114]. These results highlight the central importance of cumulative trauma as a risk factor for increased mental health problems, suggesting that traumatic events should not be considered in isolation. ...
A substantial proportion of adults experience traumatic events each year, yet little is known about the effects of different types of traumatic events on depression severity over time. We prospectively assessed the effects of traumatic event exposure during a 1-year period on changes in depression severity during that period among a representative sample of adults living in Detroit, Michigan in the United States.
We used data from 1,054 participants in the first two waves of the Detroit Neighborhood Health Study (2008-2010). Depression severity was measured with the Patient Health Questionnaire-9 (PHQ-9). Negative binomial regression was used to estimate the effect of traumatic event exposure on depression severity at Wave 2, adjusting for Wave 1 PHQ-9 score and potential confounders.
The mean depression severity score at Wave 2 among those exposed to at least one traumatic event during follow-up was 1.71 times higher than among those with no traumatic event exposure [95 % confidence interval (CI) 1.27-2.29]. Also positively associated with depression severity at Wave 2 (vs. no traumatic events) were assaultive violence (mean ratio 2.49, 95 % CI 1.41-4.38), injuries and other directly experienced shocking events (mean ratio 2.59, 95 % CI 1.62-3.82), and three or more traumatic events (mean ratio 2.58, 95 % CI 1.62-4.09).
Violence, injuries, and other directly experienced traumatic events increase depression severity and may be useful targets for interventions to alleviate the burden of depression in urban areas.
... Gerontological studies suggest that stress in daily life may be related to depression in late life, and that exposure to stressful life events may increase depressive symptoms in older age groups (Colenda & Smith, 1993;Krause, 1986;Norris & Murrell, 1987). Life events that may adversely affect the elderly include the illness or death of a loved one, illness or death of a close friend or relative, being robbed or burgled, legal and financial problems, admission to nursing home, and hospitalization (Brown & Harris, 1978;Glass, Kasl, & Berkman, 1997). ...
... depression (Fonda, Wallace, & Herzog, 2001; T. A. Glass, Kasl, & Berkman, 1997;Marottoli, et al., 1997), finding an ecologically valid means of measuring change and improvement is necessary. ...
Older individuals represent the fastest growing portion of the population in the United States, and are threatened by the loss of mobility and independence. The present study examined the relationship of a computer-based training program, specifically Posit Science CortexTM with InSight DriveSharpTM, and performance on neuropsychological measures and an on-road driving paradigm in a normal aging sample. Participants, ranging in ages 60-75 and randomly assigned to the treatment group, completed the DriveSharpTM as did, subsequently, a wait-list control group. Identical neuropsychological and on-road assessments were conducted at each visit. Neuropsychological assessment of visual attention included the Useful Field of View test (UFOV; Edwards, Vance, et al., 2005), Attention Network Test (ANT; Fan, McCandliss, Sommer, Raz, & Posner, 2002), and the Trailmaking test (Franzen, Paul, & Iverson, 1996; Reitan, 1986). Results indicated improved performance on neuropsychological measures of attention after intervention. Analysis of the waitlist control groups across three visits, revealed possible practice effects for the ANT. However, this was not true for the UFOV test, which, revealed significant improvements between visits 1 and 3, suggesting that practice effects may not be a factor. During the on-road driving tasks, standard deviations of horizontal and vertical eye gaze were measured while participants completed auditory and visual working memory tasks. Given the improvements within the waitlist control group across three visits, it is unclear whether the improvements are resulting from the training or rather comfort in the vehicle. Overall results indicated there were trends in increased standard deviation of both horizontal and vertical eye gaze during the auditory working memory task. More robust improvements were seen during the visual working memory exercise, with significant improvements in horizontal gaze. These findings suggest more horizontal scanning behavior and possibly an increased field of view while driving. These results provided evidence that cognitive training may improve not only performance on neuropsychological tests but also on more ecologically valid outcome measures of driving. However, limitations of the current study may be addressed in future research by using a larger sample size, providing better control of practice effects on neuropsychological testing, and incorporating more direct measures of driving.
... Although there are some concerns about bias in responses related to physical health problems (Grayson, Mackinnon, Jorm, Creasey, & Broe, 2000), it has been widely used and is correlated with other depression scales (Bowling, 1995). It has been used extensively in research with older people (Glass, Kasl, & Berkman, 1997;Haynie, Berg, Johansson, Gatz, & Zarit, 2001) and particularly in studies relating to driving cessation (Fonda, Wallace, & Herzog, 2001;Marottoli et al., 1997). The questionnaire has a list of depressive symptoms and participants are required to indicate how often these have occurred in the past week. ...
Abstract Background: Driving is a valued life role. Because of age-related changes, older people
... Negative health changes have also been found in older adults after natural disasters (Phifer, 1990). Other research not specific to natural disasters has cautioned that any stressful life event may lead to increased depressive symptomatology in older adults (Glass & Kasl, 1997). ...
This article is an exploratory-descriptive study of older adult public housing residents who were forcibly relocated from their homes when Hurricane Andrew struck Miami-Dade County in 1992. The subjects were all African Americans (N = 58) with a mean age of 67 years (S.D. = 9.8) who lived in economically depressed, low-income communities. Almost 70% were females. The subjects suffered from an array of physical and mental health maladies that were exacerbated when they were uprooted from key support systems, including families, social services, and health care facilities they depended on. A variety of com- plaints surfaced about their new living arrangements and almost 70% ex- pressed a desire to return to their previous homes after long-term structural repairs were complete. Implications are discussed regarding the need for pre-emptive "elder-sensitive" strategic planning, the role of
... This is echoed in the additive burden hypothesis, which suggests that elderly people are at greater risk of experiencing negative outcomes, because they have accumulated many more stressful life experiences or negative life events than younger people (Dohrenwend and Dohrenwend, 1981). Indeed, research has shown a dose-response relationship between cumulative life event stress and change in depressive symptoms among the elderly ( Glass et al., 1997). ...
Debate persists about whether people of different ages react similarly to traumatic events, and whether elderly people are more vulnerable to such events, or better able to cope with them. The first aim of this paper was to shed light on this debate by comparing the post-traumatic responses of young, middle-aged and elderly community residents who had been exposed to technological disasters. The second aim was to differentiate between these three age groups in terms of coping strategies.
One hundred and forty-eight community residents, who were exposed to two technological disasters, participated in the study. They were assessed using the Impact of Event Scale (IES), the General Health Questionnaire (GHQ-28) and the Ways of Coping Checklists (WOC).
The results showed that in terms of IES, GHQ and WOC scores, no significant differences were found across the three age groups. However, main effects were found according to type of disaster and intensity of exposure to disaster. One significant interaction effect was that residents exposed to the aircraft crash used significantly more confrontive coping than those exposed to the train collision, in all three age groups. Correlation coefficients results showed that for all three age groups, on the whole, the more they experienced intrusive thoughts and avoidance behaviour, the more they experienced general health problems.
Following exposure to technological disasters, young, middle-aged and elderly community residents could display similar post-traumatic responses and employ similar coping strategies, which contradicts the vulnerability hypothesis and the inoculation hypothesis.
... For some potential risk factors, especially in older adults who are struggling to maintain homeostastis in many spheres of their lives, establishing the temporal sequence is less obvious. Indeed, for many older adults there is a cumulative effect of life event stress that increases their risk of developing depression (Glass et al. 1997). For example, an older adult who experienced a myocardial infarction, the death of their spouse, and retirement from their lifes work all within the past two years may be at high risk of developing an affective illness. ...
Late-life depression (LLD) is a devastating disease, complicating medical illnesses and their management. In addition to treating LLD, prevention of the disorder should be a priority, as identifying and modifying risk factors can pave the way for more effective intervention efforts. This article contrasts the Institute of Medicines classification of prevention (universal, selective, indicated) with classic public health definitions (primary, secondary, tertiary) and describes how these terms are applied to LLD. The authors focus on three areas for prevention of LLD: 1) enabling access to effective treatment; 2) preventing the development of depression in high-risk individuals; and 3) treating mood disorders to complete remission to prevent recurrence. Medical, psychosocial, and genetic risk factors are described, as is work from the authors own laboratory in the area of LLD prevention. Declaration of interest: Dr. Karp is on the speakers bureau of Pfizer and Eisai. Dr. Reynolds has received investigator initiated research support from GlaxoSmithKline, Eli Lilly, and Forest Laboratories, and Pfizer. Dr. Lenze has received investigator initiated research support from OrthoMcNeill Neurologics, Pfizer, Forest Laboratories. Dr. Solai has nothing to declare. Dr. Rosen has nothing to declare.
Population aging is sweeping the globe. In the foreseeable future, though being replaced soon by India as the most populous nation, China is and will be holding the largest older population in the world. According to the most recent census of China in 2020, the proportion of Chinese older individuals aged 65 years old and above has approached nearly 14 percent, suggesting China is becoming an aged society. This is a huge challenge for China nowadays, especially regarding how to meet the health needs of the large size of older Chinese. Research is thus called for, including but not limited to investigations on the prevalence and trend of chronic diseases and their related risk factors, the transformation of eldercare and healthcare, and evaluations of the policies and interventions of population aging. This Research Topic on Aging and health in China has collected cutting-edge studies on these critical topics from an interdisciplinary perspective, representing the current research progress in this vital field.
Social engagement is associated with healthy aging and preserved cognition. Two dimensions of engagement, verbal interactions and perceived support, likely impact cognition via distinct mechanistic pathways. We explored the cognitive benefit of each construct among enrollees (N = 1,052, mean age = 60.2 years) in the Wisconsin Registry for Alzheimer's Prevention study, who provide neuropsychological and sociobehavioral data at two-year intervals. Outcomes included six cognitive factor scores representing key domains of executive function and memory. Key predictors included self-reported perceived social support and weekly verbal interaction. Results indicated that after adjusting for lifestyle covariates, social support was positively associated with Speed and Flexibility and that verbal interactions were associated with Verbal Learning and Memory. These findings suggest that support, which may buffer stress, and verbal interaction, an accessible, aging-friendly form of environmental enrichment, are uniquely beneficial. Both are integral in the design of clinical and community interventions and programs that promote successful aging.
Objectives: The objectives were to study changes in morale in individuals 85 years and older, and to assess the effect of negative life events on morale over a five-year follow-up period.
Method: The present study is based on longitudinal data from the Umeå85+/GERDA-study, including individuals 85 years and older at baseline (n = 204). Morale was measured with the Philadelphia Geriatric Center Morale Scale (PGCMS). Negative life events were assessed using an index including 13 negative life events occurring during the follow-up period. Linear regression was used for the multivariate analyses.
Results: The majority of the sample (69.1%) had no significant changes in morale during the five-year follow-up. However, the accumulation of negative life events was significantly associated with a greater decrease in PGCMS. A higher baseline PGCMS score did not attenuate the adverse effect negative life events had on morale.
Conclusion: Morale seemed to be mainly stable in a five-year follow-up of very old people. It seems, nonetheless, that individuals are affected by negative life events, regardless of level of morale. Preventing negative life events and supporting individuals who experience multiple negative life events could have important implications for the care of very old people.
This study was aimed to evaluate the cross-sectional and longitudinal associations between various perceived-stress and depressive symptoms in old Taiwanese men and women aged 50 years and over. Data were derived from the Taiwan Longitudinal Study on Aging. Stress for health, finance, and family members’ related issues were all cross-sectionally associated with concurrent depressive symptoms for men and women (all P < 0.05). Increased/constant-high health stress was positively associated with subsequent depressive symptoms in both genders (all P < 0.05). Constantly high job stress and increased stress over family members’ problems were associated with higher likelihood of subsequent depressive symptoms in men (P < 0.05). Constantly high/increased financial stress and relationship strain with family members were positively associated with subsequent depressive symptoms in women (all P < 0.05). The results suggest that stress for health, job, finance, and family members-related issues are unequally associated with depressive symptoms among Taiwanese men and women aged 50 years and over. Changes of health stress even reduced are significantly associated with subsequent depressive symptoms. Long-term job stress and increased stress over family members’ problems increase occurrences of men’s depressive symptoms, while increased/long-term financial stress and relationship-strain with family members increase occurrences of women’s depressive symptoms. Long-term high health stress has more impacts on men’s depressive symptoms than women’s, while long-term high relationship strain with family members has more impacts on women’s depressive symptoms than men’s.
Depression is a leading cause of disability in the U.S., affecting 2-9% of the adult population each year. Although numerous studies have examined the social origins of depression, questions remain about the influence of traumatic events and neighborhood conditions on depressive symptoms. This dissertation uses data from the Detroit Neighborhood Health Study (DNHS) to examine (1) the effects of different types of recent traumatic events on changes in depression severity over a one-year period and whether individual characteristics like initial depression severity influence these relations; (2) the effects of prior traumatic events including childhood abuse on changes in current depression severity and responses to subsequent traumatic events; and (3) the effects of neighborhood disadvantage, crime, physical disorder, and social cohesion on exposure to traumatic events and changes in depression severity.
The first analysis found higher increases in depression severity among those exposed to assaultive violence and other injuries and shocking experiences during follow-up, as well as those experiencing multiple traumatic events; associations were stronger among individuals with lower depression severity at baseline. The second analysis found positive associations between the number of lifetime traumatic events prior to baseline (especially childhood abuse events) and depression severity at follow-up, adjusting for baseline depression severity, traumatic event exposure during follow-up, and other potential confounders including prior psychopathology. Evidence for a stress sensitization effect was also found, such that individuals with a history of childhood abuse, prior assaultive violence, and greater total number of prior traumatic events exhibited greater depression severity than participants without such adverse histories when exposed to low numbers of recent traumatic events. The third analysis found only minimal associations between neighborhood conditions and traumatic event exposure. However, living in socioeconomically disadvantaged and less cohesive neighborhoods was positively associated with depression severity at follow-up, and modified relations between trauma exposure and depression severity. These findings confirm the influence of traumatic events and neighborhood conditions on depression severity and highlight the importance of considering the context in which traumatic events occur (including the individual???s prior history of depression, traumatic event exposure, and neighborhood environment) when assessing need for intervention after trauma exposure.
Very old adults have experienced many events in their lives, some many years ago, some more recently. This chapter highlights events perceived as the most important ones in the lives of centenarians. Domain-specific events are also considered in this chapter, including health events, family events, and work events. Finally, the impact of life events on the overall well-being of the oldest-old adults is considered. The evidence suggests that positive cumulative (“lifetime”) events reduce levels of negative affect, whereas cumulative (“lifetime”) negative events promote negative affect. When proximal events (i.e., those experienced in the past 20 years) and distal events (i.e., those experienced more than 20 years ago) are considered, proximal events are more likely to reduce levels of positive affect and enhance levels of negative affect. Distal events, on the other hand, are more likely to enhance overall feelings of positive affect. INTRODUCTION Individuals who have lived for a long time can look back on a life filled with many experiences. Formative life events can go back as far as early childhood, spread over the adolescent and adult years, and continue to occur very late in life. The effect of these events on physical and mental health, as well as on ways of coping and adaptation has been demonstrated in many studies. For example, a meta-analysis of 25 studies (Kraaij, Arensman, & Spinhoven, 2002) suggested that older adults in general may be at greater risk of depression because they have experienced an accumulation of many stressful events and daily hassles.
Depression is quite common among the elderly members of the Hong Kong Chinese society. This study examined the impact of a series of common stressful life events (SLEs) on change in depressive symptoms among the older people. The respondents were 411 people aged sixty years or older from a survey of a representative community sample of the elderly population in Hong Kong. Using multiple regression models, the authors found that sense of control acted as a mediator in the linkage between the number of SLEs and depressive symptoms, even after controlling sociodemographic, and physical health status were applied. In addition, the social support measured by Lubben Social Network Scale moderated the influence of the exposure to SLEs on depression. Findings suggest that sense of control and social support play distinguished and important roles in the stress-outcome relationship. Service implications were discussed based on these findings.
Depression is quite common among the elderly members of Hong Kong Chinese society. This study examined the impact of a series of common stressful life events (SLEs) on changes in depressive symptoms among the older people. The respondents were 260 people aged seventy years or older from a longitudinal study of a representative community sample of the elderly population in Hong Kong. Using multiple regression models, the authors found that, of eight SLEs examined, only widowhood was associated with depressive symptoms three years later, even after controlling sociodemographic, physical health status, and social support variables were applied. In addition, the SLE influenced the depression differently for men and women, as we found that the death of a spouse was associated with increased in depressive symptoms among elder women, and the moving out of children was associated with a decrease in depressive symptoms among old men. Finally, we also found a close relationship between number of SLEs and depression.
BACKGROUND: Depression is common among older patients yet is often inadequately treated. Patient beliefs about antidepressants are known to affect treatment initiation and adherence, but are often not expressed in clinical settings.
OBJECTIVE: To explore attitudes toward antidepressants in a sample of depressed, community-dwelling elders who were offered treatment.
DESIGN. Cross-sectional, qualitative study utilizing semi-structured interviews.
PARTICIPANTS: Primary care patients age 60 years and over with depression, from academic and community primary care practices of the University of Pennsylvania Health System and the Philadelphia Department of Veterans Affairs. Patients participated in either the Prevention of Suicide in Primary Care Elderly: Collaborative Trial or the Primary Care Research in Substance Abuse and Mental Health for the Elderly Trial. Sixty-eight patients were interviewed and responses from 42 participants with negative attitudes toward medication for depression were analyzed.
MEASUREMENTS: Interviews were audiotaped, transcribed, and entered into a qualitative software program for coding and analysis. A multidisciplinary team of investigators coded the transcripts and identified key features of narratives expressing aversion to antidepressants.
RESULTS: Four themes characterized resistance to antidepressants: (1) fear of dependence; (2) resistance to viewing depressive symptoms as a medical illness; (3) concern that antidepressants will prevent natural sadness; (4) prior negative experiences with medications for depression.
CONCLUSIONS: Many elders resisted the use of antidepressants. Patients expressed concerns that seems to reflect their concept of depression as well as their specific concerns regarding antidepressants. These findings may enhance patient-provider communication about depression treatment in elders.
Objective:
The association between exposure to stressful life events (SLEs) and late-life depression is well-documented. However, the role of resilience as a buffer against the adverse mental health effects of SLEs in late life has not been convincingly demonstrated. In this paper, the moderating effect of resilience in the relationship between SLEs and depressive symptomatology in older Chinese adults is investigated.
Method:
A population sample of 385 community-dwelling older Chinese adults aged ≥60 years responded to questionnaires on resilience (Connor-Davidson resilience scale), depressive symptomatology (Geriatric Depression Scale, GDS-15) and SLEs.
Results:
Increased numbers of SLEs (β = 0.343, p < .001) and lower levels of resilience (β = -0.137, p < 0.001) were significantly associated with higher levels of depressive symptomatology. There was a significant interaction of resilience and number of SLEs on depressive symptomatology (p = 0.003). The sense of personal competence and optimism was the principal underlying resilience dimension moderating the relationship for both the young-old (aged 60-69) and the old-old (aged 70 and above).
Conclusion:
The finding of significant interaction supported the role of resilience in moderating the adverse effect of SLEs in terms of depressive symptoms among older Chinese adults.
This study examined the relationships between older veterans' psychosocial status, their perceived general self-efficacy and their use of health care services. This study will assist Department of Veterans Affairs (VA) social workers in assessing and helping veterans with significant psychosocial needs. It examined veterans' self-reported physical, mental and social health. It also explored how they subjectively perceived their general self-efficacy in coping with challenges in different life domains. The sample consisted of 122 veterans age 60 and older. The study revealed significant relationships between these older veterans' general self-efficacy and their physical, mental and social health. The study concludes by suggesting gerontological social work practice and research implications.
Traditional models of depression in later life describe the illness in terms of intra-physiologic and intra-psychic processes. In an effort to investigate and describe the interpersonal nature of depression, data on levels of depression, stress, health, and marital distress in 535 married couples was analyzed. Specifically, the results showed that marital distress was significantly associated with levels of depression for both partners and that wives' distress was also significantly related to husbands' depression. Results also showed, with a few exceptions, that levels of stress and/or health in either partner were directly and indirectly associated with depression for husbands and wives. Implications for clinical practice with and future research on later life couples experiencing depression are discussed.
The use of zinc injection in boiling water reactors to limit the buildup of the activated corrosion product Co-60 has resulted in the presence of Zn-65 in plant contamination. The detection of Zn-65 is difficult using standard monitoring methods for personnel and equipment. An analysis of the 1 cm whole body depth dose, skin dose, and ingestion dose from plant contamination in zinc injection boiling water reactors is used to illustrate the relative health hazards from Zn-65 and other radionuclides at levels which may cause them to go undetected. The 1 cm depth for the whole body depth dose is chosen as an industry standard because incident photons of energies between 0.05 and 3 MeV yield the maximum dose equivalent at a depth less than or in the vicinity of 1.0 cm in the body. In this paper, adjustment factors are presented which may be applied to radiological work in zinc injection plants to help in the selection of protective clothing and respiratory protection equipment.
This article is an exploratory-descriptive study of older adult public housing residents who were forcibly relocated from their homes when Hurricane Andrew struck Miami-Dade County in 1992. The subjects were all African Americans (N = 58) with a mean age of 67 years (S.D. = 9.8) who lived in economically depressed, low-income communities. Almost 70% were females. The subjects suffered from an array of physical and mental health maladies that were exacerbated when they were uprooted from key support systems, including families, social services, and health care facilities they depended on. A variety of complaints surfaced about their new living arrangements and almost 70% expressed a desire to return to their previous homes after long-term structural repairs were complete. Implications are discussed regarding the need for pre-emptive “elder-sensitive” strategic planning, the role of Public Housing Authorities in properly caring for older adults before and after a hurricane or other natural disaster, the need for appropriate training of public housing property managers, and the key role of social workers during post-disaster interventions with older adults and their families.
Chronic stress may take its toll on the body at any period in the life course, but age may be linked to characteristics of stressor exposure and response, as well as underlying biological vulnerabilities, which modulate the effects of stressor experience on biological well-being. In this review, we first address age-related patterns of stressor exposure and response, highlighting commonly experienced stressors in older adults and characteristics of stressor appraisal and coping in later life. We then review patterns of biological functioning associated with chronic stress experience and aging in an effort to highlight the biological commonalities associated with both conditions. We conclude with an examination of the idea that the biological changes typically observed with advancing age may render older adults more susceptible to negative biological and health consequences of chronic stress experience.
This paper relates a common problem in community practice. A client chose to share information with a support worker who was unsure of her competence to deal with the disclosure. An innovative and reflective approach to finding evidence for potential benefit or harm is described, together with an interpretation of this evidence, and finally recommendations for clinical practice based on ‘best available evidence’.
This paper assesses the impact of disturbing life events over five years on the wellbeing of 340 people aged 80–84 years at baseline, by analysing data from a longitudinal survey in Switzerland. The guiding proposition was that the negative effect of life events is moderated by the event domain, i.e. health, deaths and changes in family setting and relationships, and by cognitive adaptation to one's own health state (adopting a more or less optimistic view). Multi-level regression that controlled for the effect of socio-demographic and health factors was used. Corroborating the first hypothesis, a model that differentiated the event categories, instead of their additive inclusion, gave the best fit. In support of the second hypothesis, it was shown that the positive impact of self-rated health reduced the negative effect of life events on wellbeing for survivors, but not for those who died within five years. This suggests that the former made more optimistic appraisals of their mental and physical health, while the latter adjusted their subjective health rating to their functional abilities. Survivors had better psychological resources for coping with disturbing life events, while the deceased lacked these resources, which buffered the impact of negative events. The psychological meaning of stressful events at the end of life is discussed. By encouraging optimistic self-evaluations of health, and raising awareness of the range of normal functioning of older people, health- and social-care practitioners can promote the maintenance of meaningful lives in old age.
A randomly selected sample of 549 women age 55 years and older and 2,669 women age 18–34 years was interviewed via telephone to determine prevalences of physical and sexual assault, posttraumatic stress disorder (PTSD) symptomatology, and depression. Prevalences of sexual and physical assaults were lower in older compared to younger women. In addition, given a trauma, prevalences and proportionate risk of posttraumatic psychopathology and depression were also lower for older, relative to younger women. Specifically, multivariate analyses revealed that sexual assault predicted only PTSD avoidance in older adults, but all forms of PTSD symptomatology and depression in younger adult women. Similarly, physical assault predicted only PTSD re-experiencing symptoms in older women, but all forms of PTSD symptoms and depression in younger women. Self-reported health status was not associated with any increased risk of psychopathology, and low income predicted increased avoidance and depression only in younger women.
Über die Lebensspanne wirken sich unterschiedliche Umweltkontexte mittel- und langfristig auf Gesundheit und Wohlbefinden
aus. Welche Alltagskontexte sich auf verschiedene Aspekte von Alltagsanforderungen auswirken ist jedoch bisher kaum untersucht.
In der vorliegenden Untersuchung wurden daher mit Hilfe einer telefonischen Erhebung an einer Stichprobe von 365 Personen
zwischen 51 und 80 Jahren (a) Altersunterschiede in den bestehenden Alltagsanforderungen, (b) die Zusammenhänge zwischen verschiedenen
Aspekten selbstberichteter Anforderungen und (c) die Zusammenhangsmuster zwischen alltäglichen Anforderungen einerseits und
bedeutsamen Alltagskontexten andererseits verglichen. Die Ergebnisse belegen eine alterskorrelierte Verringerung von Alltagsanforderungen,
Unterschiede zwischen verschiedenen Aspekten von Alltagsanforderungen und Hinweise auf eine sich alterskorreliert verändernde
Zusammenhangsstruktur mit den bestehenden Anforderungen in wichtigen Alltagskontexten.
Across the lifespan, different environmental contexts may, in the long term, affect health and well-being. Exactly which
contextual demands translate into different aspects of self-reported everyday demands has hardly been examined. In this telephone-based
study with 365 adults between 51 and 80 years, we assessed (a) age differences in the existing everyday demands, (b) relations
between different measures of everyday demands, and (c) the correlational patterns between measures of everyday contexts and
everyday demands. Results demonstrate age effects in all measures of everyday demands, and differences between measures. The
findings suggest age-related differences in the correlational patterns between specific everyday contexts and the levels of
everyday demands.
Four hypotheses previously put forth to explain the strong association between social class and mental health in the general population were examined in 1,326 older adults (aged 55 yrs and older). Respondents were interviewed 3 times at 6-mo intervals. Lower class was associated with more past life changes (occurring before Wave 1) and more subsequent life events (occurring between Waves 1 and 3); these changes were predictive of distress, supporting the differential exposure hypothesis. Lower class was associated with weaker social support (embeddedness), which was related to distress, supporting the resource deterrent hypothesis. There was little evidence that people of the lower classes were more vulnerable to stress or that their status was due to their weaker social support; thus, the differential vulnerability and applied buffering hypotheses were not consistently supported. Social support does appear to be a versatile resource for older adults. A significant portion of the class–distress relationship was not accounted for by life change, social support, or the interaction between these factors. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Effects of social support, negative life events, and daily hassles on depressive symptoms were assessed in 301 adults aged 65 or older, in person 3 times at 6-month intervals and by mail questionnaires every month over a 12-month period. Initial social support predicted severity of depressive symptoms 12 months later. Social support and initial levels of depressive symptomatology predicted number of daily hassles but not number of major life events. Effects of social support, depression, and major life events on the incidence of daily hassles remained significant without the inclusion of hassles reflecting depressive symptomatology or problems in relationships or whose content overlapped with major life events. Daily hassles mediated the effects of major life events on subsequent depression. Results did not differ for men and women. Implications for models of the relations among social support, stress, and depression are discussed.
Although life events continue to be the major focus of stress research, recent studies suggest that chronic stress should be a more central focus. An evaluation of this issue is presented using data from a large community survey of married men (n = 819) and women (n = 936). Results show that chronic stresses are more strongly related to depressive symptoms than acute stresses in all but one life domain. The interaction patterns exhibited by chronic and acute stresses are predominantly associated with lower levels of depression than those predicted by a main effects model. This pattern suggests that chronic stresses may reduce the emotional effects of acute stresses. Although the processes through which this effect occurs are not clear, it is suggested that anticipation and reappraisal reduce the stressfulness of an event by making its meaning more benign. Implications for future research on chronic and acute stress effects are discussed.
A survey of 821 same-sex female twin pairs from a population-based registry assessed 8 dimensions of social support and social integration. Twin analyses documented significant common environmental influences on 5 of these 8 measures and significant genetic influences on 5 of the 8. A decomposition of the multiplicative association between support and a measure of stressful life experiences in predicting depressed mood--an association typically interpreted as providing evidence for a stress-buffering effect of social support--shows clearly that it is the environmental and genetic factors that cause support, rather than support itself, that buffer the effects of stress on mood in most cases. We discuss the implications of this result for future research on the relationship between social support and psychopathology.
Research in the United States indicates that stressful life events may create psychological distress among older adults by eroding their sense of personal control and by diminishing their feelings of self-worth. The purpose of this study was twofold: (a) to replicate these findings with data provided by a recent nationwide survey of elderly people in the United States (N = 1,523) and (b) to compare these findings with results obtained from a nationwide survey of older adults in Japan (N = 1,517). The findings from both surveys are quite similar. The data indicate that financial strain tends to erode feelings of control and self-worth in both cultures, and the weakening of these personal resources in turn tends to increase depressive symptoms.
Four functions were examined by which health and self-esteem could ward off depression over time in older adults. Adults (N = 1,074)--55 years and older--were interviewed 5 times at 6-month intervals. Demographic and prevent depression controls were included. Neither health nor self-esteem served as an interactive buffer. Both had direct negative effects on depression, independent of events, over 2 years. Neither illnesses nor bereavements had direct effects on depression; both had indirect effects through other events; illness also had indirect effects by weakening health. Health had stronger preventive effect on illnesses but was more vulnerable to undesirable events than was self-esteem. There was little support for the specificity hypothesis that a close match between event and resource would increase resource effects.
The presence of depression and cognitive impairments was examined in seventy patients with Parkinson's disease (PD). Forty nine patients of this original cohort were re-examined between three and four years after the first evaluation. While both depressed and non-depressed patients showed a significant decline in cognitive function during the follow up period, intellectual decline was significantly more severe for the depressed group. Depressed patients also showed a faster rate of progression of motor signs (mainly tremor) than the non-depressed group. Patients that died during the follow up period showed significantly more cognitive impairments than patients who were alive at follow up. These findings suggest that either there may be two forms of PD: one with depression and rapid cognitive decline and one without depression and a gradual cognitive decline; or that the mechanisms of cognitive impairment in PD and depression may interact to produce a more rapid evolution in cognitive impairment among PD patients with a previous depression than among patients without a previous depression.
We investigated the role of two major stressors, recent disability and conjugal bereavement, in older adults' self-reports of mental health and recovery from stress. A sample of 246 older adults between the ages of 60-80 was interviewed monthly for 3 months by trained elderly interviewers; Month-10 interview data were also analyzed. Control subjects, who were not experiencing the stressors, were carefully selected from a sample of adults matched on age, sex, and socioeconomic status. Dependent variables were psychological distress and psychological well-being, each with component subscales. The disabled group evidenced significantly lower positive well-being and significantly greater distress than did the other groups. Bereaved subjects demonstrated high levels of depression compared with the disabled subjects, but showed less anxiety. Bereaved subjects showed recovery on several indicators of mental health, but disabled subjects continued to show considerable psychological upset in comparison with the other groups.
The association between the presence of depressive symptoms and cancer incidence and mortality and mortality from noncancer causes was studied in a population-based cohort of 6848 persons free of cancer who were followed from 1965 to 1982 as part of the Alameda County study. Age-adjusted and multivariate analyses involving over 111,000 person-years of follow-up demonstrated an association between high levels of depressive symptoms at baseline and deaths from noncancer causes but no association with either cancer incidence or cancer mortality. Our analyses suggest the possibility that the presence of previously diagnosed cases of cancer and the inclusion of items which tap somatic problems in depression scales may contribute to differences between these results and others in which depression has been linked to cancer mortality.
This study examined the phenomenon of post-stroke depression and evaluated its impact on rehabilitation outcome. Sixty-four patients presenting to a rehabilitation program within weeks of first stroke were evaluated for depression through self-report measures and staff ratings. Patients also rated the particular coping strategies which they used in dealing with their illness and hospital stay. Physical and occupational therapists provided measures of functional impairment at admission and discharge. A high (47%) prevalence of depression was found in this population, with no overall differences observed between patients with right or left hemisphere lesions. Depressed patients, in comparison to non-depressed, evidenced greater functional impairment at both admission and discharge. However, both groups showed similar gains over the course of rehabilitation. Coping strategies employed by depressed patients appeared to reflect a lower level of participation in the rehabilitation process. A subgroup of patients evaluated 6 weeks after discharge revealed that depression was associated with a worsening on one measure of functional status. These findings indicate that depression is a frequent companion of stroke, that it is associated with degree of functional impairment, and that it may exert a negative impact on the rehabilitation process and outcome.
The association between status attributes, personal resources, life stress, physical health, and occurrence of depressive symptoms nine years later was assessed by the 1965 Human Population Laboratory survey of a random sample of 6,928 adults in Alameda County, California, and by a subsequent follow-up survey in 1974. In multiple logistic analyses, depressive symptoms at baseline, low education, physical disability or presence of chronic conditions, poor perceived health, personal uncertainty, residential move, job loss, money problems, anomy, and social isolation were independently associated with increased risk of depressive symptoms at the nine-year follow-up. Age, low income, ethnicity, marital status, separation or divorce, and health practices at baseline were unrelated to depressive symptoms. These results underscore both the multifactorial nature of depression and the importance of prospective analyses of depressive phenomena.
This study uses longitudinal data to observe how life events, chronic life strains, self concepts, coping, and social supports come together to form a process of stress. It takes involuntary job disruptions as illustrating life events and shows how they adversely affect enduring role strains, economic strains in particular. These exacerbated strains, in turn, erode positive concepts of self, such as self-esteem and mastery. The diminished self-concepts then leave one especially vulnerable to experiencing symptoms of stress, of which depression is of special interest to this analysis. The interventions of coping and social supports are mainly indirect; that is, they do not act directly to buffer depression. Instead, they minimize the elevation of depression by dampening the antecedent process.
• Mitogen-induced lymphocyte stimulation responses in ambulatory patients with major depressive disorder did not differ from those of matched controls. Lymphocyte responses in hospitalized schizophrenic patients and in patients hospitalized for elective herniorrhaphy similarly did not differ from responses of controls. The number of peripheral-blood T cells was decreased among the ambulatory depressed patients but not in the schizophrenic patients. These findings, together with previously reported decreased lymphocyte function in hospitalized depressed patients, suggest that decreased lymphocyte function is associated specifically with depression and not related to hospital effects or nonspecifically to other psychiatric disorders. The results also suggest that altered immunity in depression may be related to severity of depressive symptoms.
The CES-D scale is a short self-report scale designed to measure depressive symptomatology in the general population. The items of the scale are symptoms associated with depression which have been used in previously validated longer scales. The new scale was tested in household interview surveys and in psychiatric settings. It was found to have very high internal consistency and adequate test- retest repeatability. Validity was established by pat terns of correlations with other self-report measures, by correlations with clinical ratings of depression, and by relationships with other variables which support its construct validity. Reliability, validity, and factor structure were similar across a wide variety of demographic characteristics in the general population samples tested. The scale should be a useful tool for epidemiologic studies of de pression.
Past research has shown that the emotional impact of undesirable life events is significantly greater among women than men. This finding has led to speculation that women possess a deficit in coping capacity or in access to social support that renders them pervasively disadvantaged in responding emotionally to problematic situations. We present a different argument in this paper. We hypothesize and then document that women are not pervasively more vulnerable to the effects of undesirable events. A disaggregated analysis of life-event effects shows, further, that female vulnerability is largely confined to "network" events: life events that do not occur to the focal respondent but to someone in his or her social network who is considered important. Further results are presented to argue that this greater vulnerability is due to the greater emotional involvement of women in the lives of those around them. It is demonstrated that this emotional cost of caring is responsible for a substantial part of the overall relationship between sex and distress.
review aspects of the complex interactions among the central nervous system (CNS), the endocrine system, and the immune system from the perspective of behavioral immunology, exploring the hypothesis that various psychological stressors impact on the CNS, with a resulting CNS modulation of the immune response
two central questions to be explored involve the mechanisms of the interactions of the CNS-endocrine-immune axis and the implications for health (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A sample of community-dwelling geriatric primary care patients were given survey measuring which demographic, medical, and environmental factors predict higher levels of state anxiety, trait anxiety, depression, and comorbid anxiety-depression. The authors used multivariate linear regression methods to predict scores for the outcome measures. Younger age, more stressful life events, increasing medical comorbidity, and fewer years of formal education predicted higher levels of state anxiety. Lower perceived health status, and comparative health status, and benzodiazepine use predicted higher trait anxiety scores. Older age, male gender, benzodiazepine use, more stressful life events, worse comparative health status, and less social support predicted higher depression scores. More stressful life events, less social support, poorer perceived general health status, and benzodiazepine use predicted higher comorbid anxiety-depression scores. The authors discuss the utility of developing clinical models to predict anxiety and depression in geriatric patients. Anxiety and depressive symptoms are distinguished by different psychosocial, clinical, and environmental factors, even in a sample of older subjects, who, by all measures, have good physical and psychological health.
Copyright (C) 1993 American Association for Geriatric Psychiatry
This paper presents the findings of an epidemiological analysis of disability among adults in the noninstitutionalized continental United States population. Data were collected through interviews with a probability sample of persons 18 and over, yielding 6,493 completed schedules comprising 80.3 percent of the sample. Distinctions were made among concepts and indicators of pathology, impairment, individual performance, and social performance. Central to the analysis were two dimensions of individual performance (physical and emotional) and two dimensions of disability in social performance (work and independent living). A number of socio-demographic characteristics were included in the analysis. The results show the relative contributions of pathology and impairment to performance on the individual level, and the relative contributions of all of these factors on social performance, that is, the two dimensions of disability. Through pathology, impairment, performance at the individual level, and the socio-demographic characteristics, it was possible to account for 38 percent of the variance in work disability and 74 percent of dependence-independence in community living. Further explanations are given for variance in work disability. Estimates of the size of populations reporting varying types and severities of disability are also presented.
In this study, the relationship between age and depression is analyzed, looking for effects of maturity, decline, life-cycle stage, survival, and historical trend. The data are from a 1990 sample of 2,031 U.S. adults and a 1985 sample of 809 Illinois adults. The results show that depression reaches its lowest level in the middle aged, at about age 45. The fall of depression in early adulthood and rise in late life mostly reflects life-cycle gains and losses in marriage, employment, and economic well-being. Depression reaches its highest level in adults 80 years old or older, because physical dysfunction and low personal control add to personal and status losses. Malaise from poor health does not create a spurious rise of measured depression in late adulthood. However, some of the differences among age groups in depression reflect higher education in younger generations, and some reflect different rates of survival across demographic groups that also vary in their levels of depression.
Symptoms of depression in the majority of patients immediately following acute myocardial infarctions (AMI) resolve rapidly; they are an adjustment reaction. However, in a group of 552 male patients there were 80 (14.5%) patients with persistent major depressive symptoms during a finite period after AMI. Infarction size was assessed by maximum creatine kinase levels, the QRS-complex and the occurrence of late potentials. These measures did not correlate with the degree of depressed moods in these groups. An arrhythmic event in the early hospitalization phase, a recurrent infarction, dyspnoea, and persistent angina pectoris before the AMI were significantly related to more profound degrees of depression. Patients who reported serious life-events in the last 2 yr before AMI, or who suffered from exhaustion and fatigue in the prehospital phase were subject to significantly higher levels of depression. A prodromal phase prior to hospitalization free of bodily symptoms and the use of denial were related to low levels of depression. The logistic regression model incorporating all univariate significant variables revealed that symptoms of exhaustion and fatigue prior to AMI had the strongest independent correlation with post AMI depression.
A total of 251 elderly residents of 2 boroughs of greater Athens were examined by a psychiatrist. For the assessment of depressive symptoms, the Center for Epidemiological Studies Depression (CES-D) Scale was used. Cognitive functioning was also evaluated. The prevalence of affective disorders of any type was estimated by a clinical examination with a semistructured psychiatric interview (PEF) supplemented by DSM-III criteria. A total of 27.1% of the elderly respondents reported a significant number of dysphoric or depressive symptoms and were identified as depressed cases. Respondents who had lower socioeconomic status, were widowed, were experiencing stressful life events or were living alone exhibited a significant degree of depressive psychopathology. An association between depressed mood and cognitive impairment was also found. A total of 9.5% of the sample was diagnosed as suffering from any type of affective disorder (1.6% major depression, 0.6% bipolar, 5.5% dysthymic disorder and 2.0% adjustment disorder with depressed mood). Affective disorders constitute nearly half of the total number of psychiatric diagnoses (20.3% at the sample). It is interesting that, of the 27.1% of the sample with depressed mood (> or = 16 score on CES-D Scale), only 9.5% of the sample were diagnosed as suffering from clinical types of depression.
The purpose of this study was to examine the effect of characteristics of social networks and support on depressive symptoms in the elderly. The subjects were 1,962 noninstitutionalized persons 65 years and older from the New Haven Establishment of Populations for Epidemiologic Study of the Elderly in 1982, who were available to give a complete follow-up interview in 1985. Baseline depression, functional disability in 1982, and any change in disability by 1985 were considered as additional influences on 1985 depression, requiring adjustment along with sociodemographic variables. Multiple regression procedures were used to simultaneously examine the variables. Baseline depression, functional disability, and change in functional disability made the largest contribution to explaining the variance in depression. Among the social support and network characteristics, loss of a spouse, adequacy of emotional support, and its change during 1982-1985 made the largest contributions. Other significant characteristics in relative order of magnitude of effect, based on contrast tests, included tangible support adequacy and its change, loss of a confidant between 1982 and 1985, number of children making weekly visits and change in this number by 1985, and the absence of a confidant in both 1982 and 1985. For mental health outcomes, these findings emphasize the need to consider specific dimensions of social support and networks rather than global measures.
Limited information is available regarding the relationship between elderly individuals and depression; but the clinician can anticipate problems in those who have had depression in the past, in those who are bereaved, in caretakers, and in patients with a number of other illnesses, including Alzheimer's disease, Parkinson's disease, Huntington's disease, stroke, alcoholism, and severe medical illness. Treatment may shorten the duration of the depression, limit long-term sequelae, and reduce the likelihood of suicide. More research with careful methodology would be helpful in clarifying directions for primary, secondary, and tertiary prevention.
The substantial placebo response in depression confounds treatment decisions and the assessment of new therapies. Improvement with placebo occurs infrequently in patients with chronic depression and in those with pituitary-adrenocortical hyperfunction, but other consistent predictors of placebo response have not been detected. We divided 241 moderately to severely depressed patients who had received placebo on a double-blind basis for 3 to 6 weeks into responders (greater than or equal to 50% improvement in Hamilton depression score, final Hamilton depression score less than or equal to 10), extreme nonresponders (less than 25% improvement), and partial responders (all others). Improvement with placebo was associated with a relatively short illness, a precipitating event, depression of only moderate global severity, and a good response to previous antidepressant treatment. These observations suggest that depressed patients who do and do not recover with placebo have different conditions that have not yet been fully characterized.
Investigated the buffering properties of six types of social support (three perceived, three received) with regard to four psychological consequences (depression, anxiety, fear of crime, hostility) of criminal victimization (violent crime, property crime). These relationships were examined using longitudinal data collected from a sample composed of representative subsamples of victims and nonvictims. Effects of the perceived support measures (perceived appraisal support, perceived tangible support, self-esteem) were more pervasive than those of the received support measures (received informational support, received tangible support, received emotional support). Perceived support consistently exhibited buffering effects, protecting both violent and property crime victims against various symptoms they would have otherwise experienced. The stress-buffering capabilities of received support were limited to informational and tangible help protecting victims of violence from experiencing excessive fear. These findings are discussed in the context of recent theoretical developments concerning the stress-support matching hypothesis.
Gender differences in the experience of life events surrounding the retirement transition and the effects of such life event
experiences on men's and women's adaptation to retirement were investigated. Data based on a stratified random sample of retirees
covered by Florida's State Retirement System (n = 452 women and 378 men) indicate that women report more life events than
men, particularly during the period preceding retirement. Furthermore, women's retirement adaptation seems more affected than
men's by the experience of life events. The major conclusion to be drawn from these results is that better understanding of
gender differences in the retirement experience can be achieved only if gender variations in the circumstances of the retirement
transition are acknowledged and further explored
This study investigates the extent to which cognitions mediate the relationship between negative life events and depression. College students and their same-sex parents and grandparents (N = 171) completed measures of stressful life events, automatic thoughts, dysfunctional attitudes, and depression. There was an interaction between negative life events and cognition for the young adults but not for either of the older groups.
This research examined gender differences with regard to the effects of social density and stressors upon depressive symptomatology
among 600 Black elderly community residents (aged 55–85 years) of Nashville, Tennessee. The sample had more females than males
and fewer married individuals. Approximately half of the males and females lived alone. Regression analyses show that poor
ego and chronic medical problems were the common predictors of depression among both the males and females. Gender differences
were found with regard to life events in that females tended to become more depressed as the number of events increased and
as level of contact with relatives and friends decreased. Further, females with lower levels of social attachment, guidance,
and reliability were more depressed. None of these social support dimensions related to depression among the males. These
relationships tended to be stronger for those living alone than for those living with others
Few studies have examined whether risk factors for depressive symptomatology differ in bereaved and nonbereaved individuals or whether risk factors differ in bereaved individuals over time. Between 1979 and 1983 in Washington County, Maryland, the associations between various health and social network variables and depressive symptomatology were evaluated prior to bereavement and at 1 and 12 months after bereavement in 136 widows and 409 married controls. Prior Center for Epidemiologic Studies Depression Scale scores were generally a good predictor of subsequent scores; however, shortly after bereavement prior scores proved relatively uninformative as most widows experienced a marked increase in depressive symptomatology. Poor health and limitations in physical activity at baseline were consistently associated with higher levels of symptomatology. Although having more friends was also consistently associated with lower levels of symptomatology, the effect of family size appeared to be time and circumstance specific. These results suggest that women at risk of prolonged depression after the death of their husbands can be identified prior to or at the time of bereavement and that widows have risk factors similar to those of women at risk of depression in the general community.
The impact of clinically diagnosed depression on recovery in activities of daily living over a 2-year follow-up was examined in a prospective study of 63 stroke patients. Although impairment in activities of daily living, neurologic diagnoses and findings, lesion location and volume as measured on computed tomographic scan, demographic variables, cognitive impairment, and social functioning were comparable between depressed (n = 25) and nondepressed (n = 38) patients during their acute hospitalization, the two groups had different patterns of recovery in activities of daily living. At 2 years after suffering a stroke, patients with an in-hospital diagnosis of depression (either major or minor depression) were significantly more impaired in both physical activities and language functioning than were non-depressed patients. Among patients with major depression, this disparity in the recovery profile was present even after the depression had remitted. This study emphasizes the need for early recognition and treatment of poststroke depression.
It has been suggested that higher levels of distress among women may be partially a function of their nurturant roles. Role-related differences in exposure and/or responsiveness to events occurring to network members are hypothesized to represent a "cost of caring" for women that translates into elevated levels of depressive symptoms. This paper examines the significance for depressive symptoms of gender differences in exposure and vulnerability to eventful stress among a sample of physically disabled subjects. This sample provides an opportunity to more fully assess the relevance of employment for understanding gender differences in depression. Our results indicate that men and women are equally exposed and equally vulnerable to life events occurring to themselves. However, we found women to be both more exposed and more vulnerable to events occurring to others. When labor force participation is taken into account, dramatic gender differences are revealed in the apparent significance of employment for exposure and vulnerability to various kinds of stressful events. The implications of these findings for public health interventions are discussed.
Interviews were conducted with 181 people 65 years of age or older to study depressive symptoms and life stresses. The sample was approximately equally divided between men and women, blacks and whites, and higher and lower socioeconomic classes. Few life events were significantly related to level of depression either before or after controlling for physical disability and living with a spouse. Findings of Linn et al. (1980) were therefore generally confirmed with a broader sample.
Six-month and lifetime rates of DSM-III major depressive disorder (MDD) and characteristics of the disorder were compared in mothers of children with disabilities (chronic stress sample, n = 310) and in a geographically based probability sample (controls, n = 357). The presence of DSM-III MDD was ascertained by the National Institute of Mental Health Diagnostic Interview Schedule. Although mothers in the chronic stress sample had significantly more depressive symptoms, rates of MDD were not significantly different in the two samples. The women with MDD in the chronic stress sample reported a lower age of onset and more episodes in lifetime than diagnostically comparable controls, but the two samples did not differ in symptomatology of worst episode. The data do not support an etiologic role for chronic stress in MDD, nor do they support the hypothesis that chronic stress is associated with a unique symptom profile or more severe episodes. They suggest a role for chronic stress in precipitating episodes, although the evidence on this point must be interpreted with caution.
Because both bereavement and depression have been associated with impaired immune responses, the authors studied two indicators of immune function, natural killer (NK) cell activity and measures of T cell subpopulations, in 37 women who differed in the magnitude of recent life events. Women who had experienced major life changes had lower NK cell activity than women who had few changes. Severity of depressive symptoms in these women was associated with an impairment of NK cell activity, an absolute loss of suppressor/cytotoxic cells, and an increase in the ratio of T helper to T suppressor/cytotoxic cells.
As a crisis event and major life transition, bereavement is believed to precipitate or exacerbate physical and psychologic dysfunction. Yet, despite an ever-growing body of research, the causal relationship between bereavement and subsequent morbidity remains unsettled. Using a large sample, prospective measurements, and multivariate analyses, a literature-based model of the determinants of clinical depression after bereavement was tested. Results show that consanguinity, patient age, poor prior physical and mental health, family tension, and survivor dissatisfaction with their caretaking abilities during the terminal phase were the most important determinants of risk of depression after bereavement. Among spouses, bereavement depression was significantly associated with poor prior physical and mental health and dissatisfaction with caretaking abilities. Analyses of the consequences of bereavement in terms of health-care utilization found strong effects of depression on physician utilization. In light of the aging of the United States population, and thus the growth of the bereaved population, the results suggest the importance of preventive medicine to avert the costs to the health-care system of depression-related somatization following bereavement.
A probability sample of 1,429 adults aged 55 and older was interviewed in their homes three times at six-monthh intervals. Measures of symptoms, social support, and education were obtained before measures of life-event stress. A LISREL analysis of three waves and two intervals of data yielded a goodness of fit of .989 between the data and the model. For both intervals, increases in stress led to increases in symptoms, which supported the Dohrenwend hypothesis of a normative stress reaction. This reaction typically did not persist beyond six months unless there was high stress over both intervals. Contrary to Dohrenwend's resource mediation hypothesis, social support and education did not influence either the reaction to or the recovery from stress. Symptoms were very stable over the one-year period. Overall, the results depict older adults as quite consistent and resilient. Because life events were correlated over time and were predicted by person characteristics, they should not be considered as independent of person factors.
Depression has been reported to be common in patients with coronary artery disease (CAD), using a variety of criteria for the diagnosis of depression. However, many studies have relied solely on the presence of symptoms such as a dysphoric mood and fatigue in making a diagnosis of depression. Both fatigue and dysphoric mood are also associated with medical illnesses, and psychiatric diagnoses based on such nonspecific symptoms may lack the specificity necessary to predict the need for psychiatric treatment. To assess the incidence of depression likely to require and respond to psychiatric treatment, 50 patients documented to have CAD by coronary angiography underwent psychiatric diagnostic interviews. Current research-based criteria (DSM-III) were used to make diagnoses of major depressive disorder. In addition, the applicability of a brief screening inventory the (Beck depression inventory) for detecting the presence of depression in these patients was tested. Nine patients (18%) met criteria (DSM-III) for major depressive episode. Depression was not related to the extent of CAD, age or use of beta blockers. There was a relation between depression and smoking. Only 2 of the 9 depressed patients had been diagnosed previously and were being treated for depression. When a score of greater than or equal to 10 on the Beck depression inventory was used to distinguish patients with depression, it had moderate sensitivity (78%) and specificity (90%) for the identification of depression.
The purpose of this study was to examine whether social support buffers the deleterious effects of stressful life events on
depressive symptoms among a random community sample of older adults. Previous research has provided contradictory conclusions
regarding the stress buffering capacity of supportive social relations. The reason for these inconclusive findings may be
traced in part to the failure of researchers to disaggregate their social support and stressful life event inventories. The
findings from the present study reveal that, although social support fails to modify the effects of a global stressful life
events indicator, specific types of social support buffer the impact of specific types of stressors (bereavement, crime, and
social network crises).
The purpose of this study was to present a re-conceptualization of the role played by locus of control beliefs in mediating the effects of stressful life events on the psychological well-being of older adults. We hypothesized that elderly persons with extreme internal and extreme external locus of control beliefs are especially vulnerable to the deleterious effects of life stress. Findings from a random community survey of 351 older adults confirmed this hypothesis. We further proposed that extreme internal control beliefs are not entirely detrimental and that these beliefs could lead to the avoidance of certain stressors. This hypothesis also was supported by the data. Based on these findings, researchers are urged to consider more complex models of the coping process.
Although there is some evidence that stressful life events are related to depression in the general population, there has been less research on this relationship with random community samples of older adults. The purpose of this study was to examine whether life stress (both stressful life events and chronic life strains) is correlated with depressive symptoms among a representative sample of noninstitutionalized elderly people. The findings indicate that chronic life strains (strains associated with financial and physical health problems) as well as bereavement are highly significant correlates of depression. Issues in the statistical estimation of these effects are also addressed.
This study was undertaken to provide information on the impact of demographic factors, stressful life events, and sociocultural patterns on depressive symptomatology among 142 noninstitutionalized Black men. The findings indicate that age, family income, household size, employment status, and conflict between the sexes were related to the presence of depressive symptoms. When controls were introduced, only family income and conflict between the sexes were correlates of depressive symptoms among Black men in this study.
The Index of Independence in Activities of Daily Living (ADL), now in frequent use in rehabilitation settings, has application for prevention of disability and maintenance of rehabilitation gains in the aging person in all settings. Since the Index is sensitive to changes in meaningful self-care functions, uses well-defined criteria, and can be broadly taught to non-professionals, it has considerable practical value as a longitudinal measure of change and predictor of adaptive capacity in terms of community residences and congregate living facilities.
IN PREVIOUS studies [l] it has been established that a cluster of social events requiring change in ongoing life adjustment is significantly associated with the time of illness onset. Similarly, the relationship of what has been called ‘life stress,’ ‘emotional stress,’ ‘object loss,’ etc. and illness onset has been demonstrated by other investigations [2-131. It has been adduced from these studies that this clustering of social or life events achieves etiologic significance as a necessary but not sufficient cause of illness and accounts in part for the time of onset of disease. Methodologically, the interview or questionnaire technique used in these studies has yielded only the number and types of events making up the cluster. Some estimate of the magnitude of these events is now required to bring greater precision to this area of research and to provide a quantitative basis for new epidemiological studies of diseases. This report defines a method which achieves this requisite. METHOD
Examined the role of stress and coping factors in depression by comparing a group of 409 Ss (over age 18) entering psychiatric treatment for unipolar depression with a sociodemographically matched group of 409 nondepressed Ss. In addition to reporting significantly more stressful events than controls, depressed Ss also experienced more severe life strains associated with their own and their family members' physical illness, their family relationships, and their home and work situations. Depressed Ss were less likely to use problem-solving and more likely to use emotion-focused coping responses and had fewer and less supportive relationships with friends, family members, and co-workers. These group differences were consistent for both depressed women and men. Findings indicate the value of expanding the consideration of psychosocial factors in depression to include individuals' chronic strains and acute stressors as well as their coping responses and social resources. (53 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
There is a general agreement that the elderly experience a higher proportion of significant life event changes than the younger adult population, and research suggests that life event changes often precede episodes of psychiatric illness. It is also evident, however, that most people over 60 successfully adapt to their changing circumstances without psychiatric disorders. Clearly, the presence of certain physical, psychological, and social mediators may modify the stress response in a predictable fashion. Off-time life events, absence of a confidante, and intrapunitive personality, and a dependence on alcohol, psychotropic, and sedative/hypnotic medications are all examples of mediators that indicate an individual who may be at risk. It is our hope that researchers will continue to identify specific risk factors associated with psychiatric illness in the elderly for use in designing specific prevention and intervention programs for those at risk.
In a comparison between elderly depressed subjects and normal elderly people in the general population, an association was found between severe life events, major social difficulties, poor physical health and the onset of depression. Working class subjects within the general population had a higher incidence of depression and this appeared to be explained by their poorer health and greater social difficulties. Those elderly people who lacked a confiding relationship were more vulnerable to depression. Evidence is presented that the lack of a confidant was a reflection of life-long personality traits.
Studied 188 elderly living in the community in terms of the relationship of recent life events to symptoms of depression. Three discriminators of depression were found among 12 events that occurred in the past year. Ss with greater depressive symptomatology had been involved in more arguments, experienced more deaths of relatives and friends, and among the white elderly, reported more accidents among relatives and friends. This group also reported experiencing a higher magnitude of stress. The relevance of these findings for clinical diagnosis and treatment planning is explored.