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Objective: Studies on the course of depression often ignore comorbid anxiety disorders or anxiety symptoms. We explored predictors of complete remission (no depression nor anxiety diagnoses at follow-up) and of the course of comorbid anxiety symptoms. We additionally tested the hypothesis that the course of anxiety disorders and symptoms in depressed patients is explained by negative life-events in the presence of high neuroticism or a low sense of mastery.Methods: An observational study of 270 patients (≥60 years) diagnosed with major depressive disorder and 2-year follow-up data, who participated in the Netherlands Study of Depression in Older persons (NESDO). Sociodemographic, somatic, psychiatric, and treatment variables were first explored as possible predictors. A multiple logistic regression analysis was used to examine their predictive value concerning complete remission. Subsequently, negative life-events, personality and their interaction were tested as potential predictors. Linear Mixed Models were used to assess whether the personality traits modified the effect of early and recent life-events, and time and their interactions on the course of the anxiety symptoms.Results: A total of 135 of 270 patients achieved complete remission. Depressed patients with a comorbid anxiety disorder at baseline less often achieved complete remission: 38 of 103 (37.0%) versus 97 of 167 (58.1%). The severity of depressive and anxiety symptomatology, the presence of a comorbid anxiety disorder, and a poorer physical health at baseline predicted nonremission. In line with our hypothesis, a less favorable course of self-reported anxiety symptoms was associated with more recent negative life-events, but only among patients with a high level of neuroticism or a low level of mastery.Conclusion: Comorbid anxiety in depression as a negative impact on complete remission at 2-year follow-up. The course of anxiety severity seems dependent on the interaction of personality traits and life-events. [ABSTRACT FROM AUTHOR]

Objectives: Depressive symptoms and low vitamin D status are common in older persons and may be associated, but findings are inconsistent. This study investigated whether 25-hydroxyvitamin D (25(OH)D) concentrations are associated with depressive symptoms in older adults, both cross-sectionally and longitudinally. We also examined whether physical functioning could explain this relationship, to gain a better understanding of the underlying mechanisms.Methods: Data from two independent prospective cohorts of the Longitudinal Aging Study Amsterdam were used: an older cohort (≥65 years, n = 1282, assessed from 1995-2002) and a younger-old cohort (55-65 years, n = 737, assessed from 2002-2009).Measurements: Depressive symptoms were measured at baseline and after 3 and 6 years with the Center of Epidemiological Studies Depression Scale. Cross-sectional and longitudinal linear regression techniques were used to examine the relationship between 25(OH)D and depressive symptoms. The mediating role of physical functioning was examined in the longitudinal models.Results: Cross-sectionally, associations were not significant after adjustment for confounders. Longitudinally, women in the older cohort with baseline 25(OH)D concentrations up to 75 nmol/L experienced 175 to 24% more depressive symptoms in the following 6 years, compared with women with 25(OH)D concentrations >75 nmol/L. Reduced physical performance partially mediated this relationship. In men and in the younger-old cohort, no significant associations were observed.Conclusions: Older women showed an inverse relationship between 25(OH)D and depressive symptoms over time, which may partially be explained by declining physical functioning. Replication of these findings by future studies is needed. [ABSTRACT FROM AUTHOR]

Objectives: To examine the six-year prognosis of patients with late-life depression and to identify prognostic factors of an unfavorable course.Design and Setting: The Netherlands Study of Depression in Older Persons (NESDO) is a multisite naturalistic prospective cohort study with six-year follow-up.Participants: Three hundred seventy-eight clinically depressed patients (according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision criteria) and 132 nondepressed comparisons were included at baseline between 2007 and 2010.Measurements: Depression was measured by the Inventory of Depressive Symptomatology at 6-month intervals and a diagnostic interview at 2- and 6-year follow-up. Multinomial regression and mixed model analyses were both used to identify depression-related clinical, health, and psychosocial prognostic factors of an unfavorable course.Results: Among depressed patients at baseline, 46.8% were lost to follow-up; 15.9% had an unfavorable course, i.e., chronic or recurrent; 24.6% had partial remission; and 12.7% had full remission at six-year follow-up. The relative risk of mortality in depressed patients was 2.5 (95% confidence interval 1.26-4.81) versus nondepressed comparisons. An unfavorable course of depression was associated with a younger age at depression onset; higher symptom severity of depression, pain, and neuroticism; and loneliness at baseline. Additionally, partial remission was associated with chronic diseases and loneliness at baseline when compared with full remission.Conclusions: The long-term prognosis of late-life depression is poor with regard to mortality and course of depression. Chronic diseases, loneliness, and pain may be used as putative targets for optimizing prevention and treatment strategies for relapse and chronicity. [ABSTRACT FROM AUTHOR]

Introduction: The occurrence of well-established risk factors for depression differs across the lifespan. Risk factors may be more strongly associated with depression at ages when occurrence, and therefore expectance, is relatively low ("on-time off-time" hypothesis). This large-scale study examined absolute and relative risks of established risk factors for depression across the lifespan.Methods: Participants were 2,215 currently or never depressed adults aged 18 to 93 years from two cohort studies: NESDA and NESDO. The occurrence of 19 established risk factors (absolute risk) was examined in different age groups. In addition, the relative risk of these risk factors for depression was compared across age groups by examining risk factor × age interaction.Results: The occurrence of all risk factors differed significantly across age groups. Although most risk factors had significant associations with depression across the lifespan, for five risk factors the strength of the association was age-dependent. Stronger associations with depression in younger age were found for childhood abuse, pain, higher body mass index (BMI) and number of chronic diseases, whereas low income imposed a stronger risk in older age. Associations with depression were strongest in age groups where occurrence was lowest.Conclusions: Although the exposure to risk factors changes across the lifespan, the relative risk associating them to depression remains similar for most risk factors. Some specific risk factors (low income, and health factors pain, BMI, and number of chronic diseases), however, seem more strongly associated with depression in ages in which occurrence is lowest and least expected. [ABSTRACT FROM AUTHOR]

Objectives: Late-life depression often has a chronic course, with debilitating effects on functioning and quality of life; there is still no consensus on important risk factors explaining this chronicity. Cross-sectional studies have shown that childhood abuse is associated with late-life depression, and in longitudinal studies with chronicity of depression in younger adults. We aim to investigate the impact of childhood abuse on the course of late-life depression.Design: Two-year longitudinal cohort study.Setting: Data were derived from the Netherlands Study of Depression in Older Persons (NESDO).Participants: 282 participants with a depression diagnosis in the previous 6 months (mean age: 70.6 years), of whom 152 (53.9%) experienced childhood abuse.Measurements: Presence of childhood abuse (yes/no) and a frequency-based childhood abuse index (CAI) were calculated. Dependent variable was depression diagnosis after 2 years.Results: Multivariable mediation analysis showed an association between childhood abuse and depression diagnosis at follow-up. Depression severity, age at onset, neuroticism, and number of chronic diseases were important mediating variables of this association, which then lost statistical significance. For childhood abuse (yes/no), loneliness was an additional, significant mediator. Depression severity was the main mediating variable, reducing the direct effect by 26.5% to 33.3% depending on the definition of abuse (respectively, 'yes/no" abuse and CAI).Conclusions: More depressive symptoms at baseline, lower age at depression onset, higher levels of neuroticism and loneliness, and more chronic diseases explain a poor course of depression in older adults who reported childhood abuse. When treating late-life depression it is important to detect childhood abuse and consider these mediating variables. [ABSTRACT FROM AUTHOR]

Objective: To investigate associations between testosterone levels and major depressive disorder (MDD) in older men and women.Methods: In a cross-sectional, 2-year prospective analyses within the Netherlands Study on Depression in Older persons cohort study, 469 participants comprised 350 patients with MDD and 119 nondepressed participants in the comparison group (mean age 70.5 ± 7.3 years; 166 [35.4%] men). MDD was assessed by the Composite International Diagnostic Interview. Baseline plasma total testosterone and sex hormone binding globulin (SHBG) were assessed to calculate free testosterone. The Inventory of Depressive Symptomatology was assessed every 6 months.Results: Whereas SHBG levels did not differ between the depressed/nondepressed groups (F(1,149) = 0.075, p = 0.78), men with MDD had lower mean total and free testosterone levels than the comparison group in the multivariate adjusted analyses (F(1,150) = 7.249, p = 0.008, Cohen's d = 0.51; and F(1,149) = 8.548, p = 0.004 Cohen's d = 0.55, respectively). This could be ascribed to lower testosterone in men with "pure" MDD and not in men with MDD and comorbid anxiety. Nine men (5.4%) had a total testosterone level < 8 nmol/L, of whom 8 suffered from MDD. In women, hormone levels showed no significant difference between the groups. In men (using all five measurement points during follow-up) baseline free testosterone was inversely associated with depression severity in the adjusted analyses (β = -0.15, t(151) = -2.15, p = 0.03).Conclusion: Testosterone levels were lower in men with MDD compared with healthy men after adjustment for confounders, such as body mass index. No significant associations were found in women. [ABSTRACT FROM AUTHOR]

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

Objective: The clinical profile of late-life depression (LLD) is frequently associated with cognitive impairment, aging-related brain changes, and somatic comorbidity. This two-site naturalistic longitudinal study aimed to explore differences in clinical and brain characteristics and response to electroconvulsive therapy (ECT) in early- (EOD) versus late-onset (LOD) late-life depression (respectively onset <55 and ≥55 years).Methods: Between January 2011 and December 2013, 110 patients aged 55 years and older with ECT-treated unipolar depression were included in The Mood Disorders in Elderly treated with ECT study. Clinical profile and somatic health were assessed. Magnetic resonance imaging (MRI) scans were performed before the first ECT and visually rated.Results: Response rate was 78.2% and similar between the two sites but significantly higher in LOD compared with EOD (86.9 versus 67.3%). Clinical, somatic, and brain characteristics were not different between EOD and LOD. Response to ECT was associated with late age at onset and presence of psychotic symptoms and not with structural MRI characteristics. In EOD only, the odds for a higher response were associated with a shorter index episode.Conclusion: The clinical profile, somatic comorbidities, and brain characteristics in LLD were similar in EOD and LOD. Nevertheless, patients with LOD showed a superior response to ECT compared with patients with EOD. Our results indicate that ECT is very effective in LLD, even in vascular burdened patients. [ABSTRACT FROM AUTHOR]

Objective: It is uncertain if the raised mortality in schizophrenia persists in later life. Register-based studies suggest that excess mortality continues, although at a lower level than in younger age groups. However, prospective follow-up studies of older schizophrenia samples are lacking.Methods: A cohort of 157 older patients (mean age at study entry: 68 years) diagnosed with schizophrenia or schizoaffective disorder in a psychiatric catchment area in Amsterdam, the Netherlands was studied. Standardized mortality rate (SMR) was estimated at a 5-year follow-up, in referral to the same age group in the general catchment area population. The impact on survival time of a range of independent demographic and clinical predictors was evaluated.Results: The cohort had an all-cause SMR of 1.89 (95% CI: 1.28-2.70). SMR was higher in men (2.60; 95% CI: 1.42-4.37) than in women (1.78; 95% CI: 1.02-2.90). All deaths were from natural causes. Reduced survival was associated with higher age (HR: 1.10; 95% CI: 1.05-1.16), male gender (HR: 3.94; 95% CI: 1.87-8.31), and having had one or more compulsory admissions in the past (HR: 2.61; 95% CI: 1.46-4.68). In contrast, no mortality associations were found with diagnosis (schizophrenia versus schizoaffective disorder), age at onset of the disorder, or current prescription of antipsychotics.Conclusion: The excess mortality in schizophrenia continues into late life, affecting men more often than women. Given the poor insight into the underlying mechanisms of this disquieting finding, there is a need to identify modifiable clinical and social risk factors. [ABSTRACT FROM AUTHOR]

Objective: To study the prevalence of autism spectrum disorder (ASD) characteristics in older adults with and without depressive disorders and the social network and past negative life events in those with a high number of ASD characteristics and those without a large number of these characteristics.Methods: This large, multisite, naturalistic, prospective cohort study used data from the Netherlands Study of Depression in Older persons (aged 60-90 years) with (N = 259) and without (N = 114) a depressive disorder according to DSM-IV criteria. ASD characteristics were measured with the abbreviated Autism Spectrum Quotient with a cutoff score of 70. Additional measures were the Composite International Diagnostic Interview, the Inventory of Depressive Symptomatology, the Becks Anxiety Inventory, the Close Person Inventory, and the life events questionnaire.Results: Of the older adults with a depressive disorder, 31% showed elevated ASD characteristics, which is much higher than the observed 6% in the comparison group. High ASD characteristics were associated with elevated depression and anxiety symptoms and more comorbid anxiety disorders. Those with a high number of ASD characteristics did not differ in the size of their social network or the number of negative life events as compared with those with less ASD characteristics.Conclusion: ASD might be overlooked in older adults, especially within geriatric psychiatry. When diagnosing and treating depression and anxiety in older patients, one should be attentive to ASD. [ABSTRACT FROM AUTHOR]

The article discusses research investigating the relationship between vascular burden and cognitive functioning in clinically depressed older persons. Research methodology, including the use of Framingham Risk Score (FRS) to measure vascular risk profile, the effect of vascular burden on information processing speed, and poor interference control in relation to vascular risk factors, which was absent in subclinical or manifest vascular disease, are discussed.

The article discusses a cross-sectional study using the Netherlands Study of Depression in Older Persons (NESDO) to assess the differences in leukocyte telomere length (TL) between persons with and without late-life depression and to examine the association between late-life depression characteristics and TL within the depressed group. The research methodology and the non-association of late-life depression and increased cellular aging, or telomere shortening, are discussed.

The article discusses research which was conducted to investigate whether cognitive functioning was associated with the perception of sexuality in old age. Researchers performed a cross-sectional analysis which focused on 1,908 older adults with a mean age of 71. They found that higher cognitive functioning was associated with the way in which older people perceive their sexuality.

The article discusses an examination of the association between attention deficit hyperactivity disorder (ADHD) and personality characteristics and the potential mediating role of these characteristics in the relationship between ADHD and depression in older adults in the general Dutch population. Data from the Longitudinal Aging Study Amsterdam in 2008/2009 is mentioned, along with questionnaires assessing issues such as self-esteem, self-efficacy, and neuroticism.

The article presents a study comparing the level of agreement between major depressive disorder (MDD) with high levels of anxiety symptoms according to the dimensional approach and MDD with comorbid anxiety disorders according to the syndromal approach. Topics discussed include an overview of anxiety in depression, the DSM-IV-R criteria, and the importance of employing same anxious distress specifier across studies.

The article presents a study aimed at analyzing the extra value of preventive metabolic screening in elderly outpatients with severe mental illness (SMI). Findings discussed include the baseline characteristics and screening measures of patients and the comparison group, the lower frequency of metabolic syndrome in patients with SMI compared with the healthy elderly, and the possible discovery of undetected metabolic abnormalities that routine screening for metabolic syndrome may show.

The article discusses research which was conducted to compare alcohol use between depressed and non-depressed older adults and to investigate alcohol abstinence and at risk alcohol consumption in depressed older adults. Researchers evaluated 373 adults who had been diagnosed with depression and 128 non-depressed adults. They found that alcohol abstinence was more common in depressed adults and that 19% of depressed adults were at risk drinkers.

The article reports on research which was conducted to investigate white matter hyperintensities (WMH) and cognitive impairment during electroconvulsive therapy (ECT) in severely depressed elderly patients. Researchers evaluated 81 patients before and after ECT. They found that depressed elderly patients with WMH who receive bilateral ECT are at increased risk of transient cognitive impairment and that the cognitive impairment improves when ECT is continued.

The article discusses research in geriatric psychiatry, with a focus on the validity of a cognitive screening examination investigating the occurrence of Attention Deficit Hyperactivity Disorder (ADHD) in older people. Topics include data from a longitudinal study, statistical reliability of the test, and semi-structured diagnostic interviews.

The article discusses research into the connection between feelings of depression in old age and cognitive functioning, particularly attempting the determine of the two factors are interrelated. It addresses depressive symptoms as a predictor of late-life cognitive ability, the relationship between cognitive and depressive symptom development and severity, and an evaluation of the degree to which the relationship demonstrates a causative effect.

Objective: Elderly patients constitute the fastest growing segment of the schizophrenia population. Still, their needs for care are poorly understood. This study aimed to gain insight into the care needs of older patients with schizophrenia spectrum disorders. Setting and Participants: Patients, aged 60 years and older, in contact with mental health services within a Dutch psychiatric catchment area, diagnosed with schizophrenia spectrum disorders. Measurements: Needs and the extent to which these were met were assessed from the perspective of both patients and staff members. Agreement between patients and staff on the presence of needs was evaluated. In addition, the association between patient characteristics and the number of unmet needs was examined. Results: On average, patients (N = 114, mean age: 69 years) reported 7.6 needs, of which 6.1 were met and 1.5 were unmet. Staff members reported slightly more needs, both met and unmet. Patients and staff showed consensus on the presence of most needs, but discrepancies existed in individual need areas. Psychological and social needs were unmet more often than environmental and physical needs. The number of unmet needs correlated with several patient variables, with the strongest association found for self-reported quality of life. Conclusion: In elderly schizophrenia patients, similar to what has been reported in younger patients, psychological and social needs appear to be underserviced. Having more unmet needs was associated with a lower perceived quality of life. [ABSTRACT FROM AUTHOR]

The article discusses the association between recent life-events and level of anxiety in depressed older patients.

The article examines personality characteristics as well as early and recent life-events as possible determinants of comorbid anxiety disorders in late-life depression, taking previously examined determinants into account.