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ObjectiveTo evaluate the association between changes in functional disability and suicide ideation among older adults following psychotherapy for depression.MethodsSixty-five participants (65-91 years old, 72% White, and 66% female) with depression completed 12 sessions of problem solving therapy (PST) and completed measures of disability (WHO Disability Assessment Schedule 2.0) and suicide ideation (Geriatric Suicide Ideation Scale [GSIS]) at baseline and post-treatment.ResultsHierarchical linear regressions found that reductions in functional disability were associated with overall reductions in suicide ideation on the GSIS (F[4,60] = 4.06, p < 0.01), particularly with the Loss of Worth GSIS subscale (F[4,60] = 7.86, p < 0.001, ΔR2 = 0.140).ConclusionsResults suggest decreased functional disability following depression treatment is associated with decreased suicide ideation, especially thoughts regarding loss of worth. These results highlight the potential for treatments that reduce functional disability (e.g., PST) to reduce risk of suicide among older adults.

ObjectiveTo compare patterns of cognitive performance in older adults with late-onset depression (LOD; ≥65 years of age) with that of older adults with early-onset depression (EOD;

ObjectiveCortical atrophy has been associated with late-life depression (LLD) and recent findings suggest that reduced right hemisphere cortical thickness is associated with familial risk for major depressive disorder, but cortical thickness abnormalities in LLD have not been explored. Furthermore, cortical atrophy has been posited as a contributor to poor antidepressant treatment response in LLD, but the impact of cortical thickness on psychotherapy response is unknown. This study was conducted to evaluate patterns of cortical thickness in LLD and in relation to psychotherapy treatment outcomes.MethodsParticipants included 22 individuals with LLD and 12 age-matched comparison subjects. LLD participants completed 12 weeks of psychotherapy and treatment response was defined as a 50% reduction in depressive symptoms. All participants underwent magnetic resonance imaging of the brain, and cortical mapping of gray matter tissue thickness was calculated.ResultsLLD individuals demonstrated thinner cortex than controls prominently in the right frontal, parietal, and temporal brain regions. Eleven participants (50%) exhibited positive psychotherapy response after 12 weeks of treatment. Psychotherapy nonresponders demonstrated thinner cortex in bilateral posterior cingulate and parahippocampal cortices, left paracentral, precuneus, cuneus, and insular cortices, and the right medial orbitofrontal and lateral occipital cortices relative to treatment responders.ConclusionsOur findings suggest more distributed right hemisphere cortical abnormalities in LLD than have been previously reported. In addition, our findings suggest that reduced bilateral cortical thickness may be an important phenotypic marker of individuals at higher risk for poor response to psychotherapy.

• What is the primary question addressed by this study? What is the prevalence of Hoarding Disorder (HD) in Late Life Depression (LLD) and do hoarding symptoms in LLD contribute to greater executive dysfunction, disability, and poorer depression treatment response? • What is the main finding of this study? HD concurrence with LLD is common at 30.1%, which is higher than HD comorbidity with obsessive-compulsive disorder (≤18%) or HD prevalence in the general population of older adults (6%). Hoarding symptoms concurrent with LLD were associated with greater executive dysfunction, disability, and poorer response to depression treatment. • What is the meaning of the findings? Individuals with HD and LLD may be at greater risk for cognitive and functional decline, thus underscoring the need for increased screening of hoarding symptoms in LLD and tailored interventions for individuals with both conditions. Late life depression (LLD) and hoarding disorder (HD) are common in older adults and characterized by executive dysfunction and disability. We aimed to determine the frequency of co-occurring HD in LLD and examine hoarding severity as an additional contributor to executive dysfunction, disability, and response to psychotherapy for LLD. Cross-sectional. Outpatient psychiatry program. Eighty-three community-dwelling adults ages 65–90 with LLD. Problem-solving therapy. Measures of executive function, disability, depression, and hoarding severity were completed at post-treatment. Pearson's chi-squared tests evaluated group differences in rates of cognitive impairment, disability, and depression treatment response between participants with HD (LLD+HD) and LLD only. Separate linear regressions assessed associations between hoarding severity and executive function, disability, and psychotherapy response. Covariates included age, education, gender, and depression severity. 30.1% (25/83) of LLD participants met HD criteria. Relative to LLD, LLD+HD participants demonstrated greater impairment rates on measures of executive function (Letter-Number-Sequencing, X2 (1)=4.0, p = 0.045; Stroop-Interference, X2 (1) = 4.8, p = 0.028). Greater hoarding severity was associated with poorer executive functioning performance (Letter-Number-Sequencing (t [70] = −2.1, β = −0.05, p = 0.044), Digit-Span (t [71] = −2.4, β = −0.07, p = 0.019), Letter-Fluency (t [ 71] = −2.8, β = −0.24, p = 0.006)). Rates of disability were significantly higher for LLD+HD (88.0%) than LLD (62.3%), (X2 [1] = 5.41, p = 0.020) and higher hoarding severity was related to greater disability (t [72] = 2.97, β = 0.13, p = 0.004). Depression treatment response rates were significantly lower for LLD+HD (24.0%) compared to LLD (48.3%), X2 (1) = 4.26, p = 0.039, and HD status predicted psychotherapy response, t (67) = −2.15, β = −15.6, p = 0.035. We found 30.1% co-occurrence of HD in LLD, which was accompanied by greater executive dysfunction, disability, and poorer response to depression treatment. Results underscore the need for increased screening of hoarding behaviors in LLD and tailored interventions for this LLD+HD group. [ABSTRACT FROM AUTHOR]

The author comments on a study which examined the effects of cognitive impairment on expectancy on late life depression.

The author comments on a study published within the issue which examined the effects to depressed older adults of adherence and dosing on response during antidepressant treatment in primary care.

Objective: Prior work suggests executive dysfunction (ED) on the Stroop Color and Word Test (SCWT) and the Mattis Dementia Rating Scale-2 Initiation/Perseveration subscale (DRS IP) predicts poor antidepressant response in late-life depression. This study examined if either patient perception of ED or the Trail Making Test Part B (TMT-B) could identify patients with impairment on the SCWT or DRS IP.Methods: Patients were 65 or older and had a diagnosis of major depression without dementia. Cognition was assessed with the TMT-B, the SCWT, and the DRS IP. A self-reported Perceived Deficits Questionnaire (PDQ) subscale assessed patients' perceptions of ED.Results: In 247 participants (mean age 71.3 years), the PDQ subscale was not associated with test performance. The sensitivity of the TMT-B in identifying impairment on the SCWT or DRS IP was low (35% and 23%, respectively).Conclusion: Neither the TMT-B nor self-reports are useful screening tools for ED on the SCWT or DRS IP. [ABSTRACT FROM AUTHOR]

The article discusses the study "Extent and Predictors of Potentially Inappropriate Antidepressant Use Among Older Adults With Dementia and Major Depressive Disorder," by S. Bhattacharjee, J. K. Lee and A. E. Patanwala, that was published within the issue.

The article discusses research which was conducted to investigate the effectiveness of psychotherapy in treating late life depression. Researchers performed a literature review which included a systematic review and meta analysis of articles which discussed depression in subjects aged 55 and older. They found that while psychotherapy was effective in treating depression in older patients the magnitude of the effectiveness varied with the type of control group used in research.

The article focuses on a study examining the impact of psychotherapy on cognitive functioning in older people suffering from executive dysfunction and mental depression. It talks about a randomized clinical trial of 221 adults ages 60 and older comparing the efficacy of supportive therapy and problem solving therapy for late-life depression. It comments that information processing speed performance for the Stroop Color and Word Test improved after treatment.

The article focuses on a study on the prevalence of major and minor depression in older adults in Stockholm, Sweden and assesses whether or not minor depression should be treated. Topics covered include the risks associated with minor depression, the criteria for minor depression, and the effectiveness of psychotherapy in the treatment of depression.

Introduction Depression has been strongly linked to suicide ideation in older adults. However, the role of other factors is less clear. Perceived stress is a factor that is emerging as a potential contributing factor in suicide ideation in older adults. We hypothesized higher levels of perceived stress would be associated with increased self-reported suicidal ideation independent of depressive symptom severity in older adults with LLD. Methods This study used data from community-dwelling older adults aged 65 with current diagnosis of major depression. Eligible participants completed measures of depression symptom severity (Hamilton Depression Rating Scale-17 item), current suicidal ideation (Geriatric Suicide Ideation Scale; GSIS), and perceived stress (Perceived Stress Scale; PSS). Statistical analyses were conducted using SPSS version 20. Descriptive statistics, including demographic and clinical characteristics of the participants were obtained. A linear regression analysis was then conducted, assessing the relationship of perceived stress to suicidal ideation, controlling for the effects of age, education, gender, and depression symptom severity. R2 were then calculated based on standardized beta values in the final model. Results Participants were 225 older adults with a mean age of 71.4 (SD = 5.6), who were 64.9% female. Sixteen percent of the variance in suicidality (GSIS total score) was accounted for by the variables assessed. In particular, lower education (B = −.13, p =.04), male gender (B = −.13, p =.04), greater depression severity (B =.15, p =.02) and higher current perceived stress (B =.32, p <.001) were all significantly associated with higher suicidality ratings. In this model; perceived stress accounted for 10.1% of the variance in suicide ideation ratings, over half of the variance explained by the total model. Conclusions Our findings suggest that increased perceived stress might be a particularly important factor of those more likely to think about suicide. Perceive stress may thus be a useful factor that could improve early identification and intervention of suicide ideation among late life depression patients at a high risk for suicidal behaviors. Mechanisms and coping strategies to reduce perceived stress could be directly implemented in depressed patients with suicidal ideation. Further research is warranted on perceived stress in relation to suicidal ideation. This research was funded by This work was supported by R01 MH0977669: (PI:Mackin), R01 MH101472 (PI:Mackin); UCSF Epstein Endowment Fund [ABSTRACT FROM AUTHOR]