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Prevalence and correlates of depressive symptoms in older adults across the glycaemic spectrum: the Atherosclerosis Risk in Communities (ARIC) study.

ABSTRACT: AIMS:To document the prevalence of current depressive symptoms and history of depression across the glycaemic spectrum in older adults, and examine if measures of health status and healthcare satisfaction, access and utilization explain differences in the prevalence of current depressive symptoms by diabetes status. METHODS:We conducted a cross-sectional study of 6226 participants aged 67-90 years who attended the 2011-2013 visit of the Atherosclerosis Risk in Communities (ARIC) study. Diabetes was based on self-report, medication use and HbA1c . Current depressive symptoms were defined using the Center for Epidemiologic Studies Depression 11-item questionnaire, and history of depression was assessed via self-report. We examined obesity, history of cardiovascular disease, hypertension, kidney disease, cognitive function, and self-reported health compared with others. Prevalence and prevalence ratios were estimated using age-, race-, and sex-adjusted Poisson regression. RESULTS:The prevalence of current depressive symptoms was 5.4% in people without diabetes and 11.0% in people with diabetes (prevalence ratio 2.04, 95% CI 1.60, 2.48); the prevalence of history of depression was 11% in people without diabetes and 17.7% in people with diabetes (prevalence ratio 1.61, 95% CI 1.28,1.95). Strong correlates of current depressive symptoms were history of depression (prevalence ratio 3.86, 95% CI 3.05, 4.90) and reporting poor health compared with others (prevalence ratio 3.88, 95% CI 2.93, 5.15). No variables had significantly different associations with depressive symptoms across glycaemic categories (P for interaction >0.10). CONCLUSIONS:In older adults, current depressive symptoms were twice as prevalent in people with diabetes compared with those without. Measures of health status and healthcare did not explain differences in depressive symptoms between people with and without diabetes.

SUBMITTER: Rawlings AM

PROVIDER: S-EPMC5902432 | biostudies-literature | 2018 May

REPOSITORIES: biostudies-literature

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Prevalence and correlates of depressive symptoms in older adults across the glycaemic spectrum: the Atherosclerosis Risk in Communities (ARIC) study.

Rawlings A M AM Sharrett A R AR Golden S H SH Windham B G BG Selvin E E

Diabetic medicine : a journal of the British Diabetic Association 20180218 5

<h4>Aims</h4>To document the prevalence of current depressive symptoms and history of depression across the glycaemic spectrum in older adults, and examine if measures of health status and healthcare satisfaction, access and utilization explain differences in the prevalence of current depressive symptoms by diabetes status.<h4>Methods</h4>We conducted a cross-sectional study of 6226 participants aged 67-90 years who attended the 2011-2013 visit of the Atherosclerosis Risk in Communities (ARIC) s ...[more]

PMID: 29384594

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Project description:Aims/hypothesisThere is controversy regarding the performance of HbA1c in old age. We evaluated the prognostic value of HbA1c and other glycaemic markers (fructosamine, glycated albumin, fasting glucose) with mortality risk in older adults (66-90 years).MethodsThis was a prospective analysis of 5636 participants (31% with diagnosed diabetes, mean age 76, 58% female, 21% black) in the Atherosclerosis Risk in Communities (ARIC) study, baseline 2011-2013. We used Cox regression to examine associations of glycaemic markers (modelled in categories) with mortality risk, stratified by diagnosed diabetes status.ResultsDuring a median of 6 years of follow-up, 983 deaths occurred. Among older adults with diabetes, 30% had low HbA1c (<42 mmol/mol [<6.0%]) and 10% had high HbA1c (≥64 mmol/mol [≥8.0%]); low (HR 1.32 [95% CI 1.04, 1.68]) and high (HR 1.86 [95% CI 1.32, 2.62]) HbA1c were associated with mortality risk vs HbA1c 42-52 mmol/mol (6.0-6.9%) after demographic adjustment. Low fructosamine and glycated albumin were not associated with mortality risk. Both low and high fasting glucose were associated with mortality risk. After further adjustment for lifestyle and clinical risk factors, high HbA1c (HR 1.81 [95% CI 1.28, 2.56]), fructosamine (HR 1.96 [95% CI 1.43-2.69]), glycated albumin (HR 1.81 [95% CI 1.33-2.47]) and fasting glucose (HR 1.81 [95% CI 1.24, 2.66]) were associated with mortality risk. Low HbA1c and fasting glucose were no longer significantly associated with mortality risk. Among participants without diabetes, associations of glycaemic markers with mortality risk were less robust.Conclusions/interpretationElevated HbA1c, fructosamine, glycated albumin and fasting glucose were associated with risk of mortality in older adults with diabetes. Low HbA1c and fasting glucose may be markers of poor prognosis but are possibly confounded by health status. Our findings support the clinical use of HbA1c in older adults with diabetes. Graphical abstract.

Project description:BACKGROUND AND PURPOSE:Cerebral microbleed (CMB) location (deep versus strictly lobar) may elucidate underlying pathology with deep CMBs being more associated with hypertensive vascular disease and lobar CMBs being more associated with cerebral amyloid angiopathy. The objective of this study was to determine whether neuroimaging signs of vascular disease and Alzheimer pathology are associated with different types of CMBs. METHODS:Among 1677 nondemented ARIC (Atherosclerosis Risk in Communities) participants (mean age=76±5 years; 40% men; 26% black) with 3-Tesla MRI scans at the fifth examination (2011-2013), we fit multinomial logistic regression models to quantify relationships of brain volumes (Alzheimer disease signature regions, total gray matter, frontal gray matter, and white matter hyperintensity volumes), infarct frequencies (lacunar, nonlacunar, and total), and apolipoprotein E (number of ?4 alleles) with CMB location (none, deep/mixed, or strictly lobar CMBs). Models were weighted for the sample selection scheme and adjusted for age, sex, education, hypertension, ever smoking status, diabetes mellitus, race site membership, and estimated intracranial volume (brain volume models only). RESULTS:Deep/mixed and strictly lobar CMBs had prevalences of 8% and 16%, respectively. Larger white matter hyperintensity burden, greater total infarct frequency, smaller frontal volumes (in women only), and smaller total gray matter volume were associated with greater risk of both deep and lobar CMBs relative to no CMBs. Greater white matter hyperintensity volume was also associated with greater risk of deep relative to lobar CMBs. Higher lacunar and nonlacunar infarct frequencies were associated with higher risk of deep CMBs, whereas smaller Alzheimer disease signature region volume and apolipoprotein E ?4 homozygosity were associated with greater risk of lobar CMBs. CONCLUSIONS:CMBs are a common vascular pathology in the elderly. Markers of hypertensive small-vessel disease may contribute to deep CMBs while cerebral amyloid angiopathy may drive development of lobar CMBs.

Project description:BackgroundGlobally, an estimated five percent of adults have major depressive disorder. However, little is known about the relationship between these individuals' depressive symptoms and their household members' mental health and well-being.ObjectivesWe aimed to investigate the prevalence and predictors of depressive symptoms among adult household members of patients living with major depressive disorder in Neno District, Malawi.MethodsAs part of a cluster randomized controlled trial providing depression care to adults with major depressive disorder, we conducted surveys with patients' household members (n = 236) and inquired about their overall health, depressive symptoms, disability, and social support. We calculated prevalence rates of depressive disorder and conducted multivariable linear regression and multivariable logistic regression analyses to assess correlates of depressive symptom severity and predictors of having depressive disorder (PHQ-9), respectively, among household members.ResultsWe observed that roughly one in five household members (19%) screened positive for a depressive disorder (PHQ-9 > 9). More than half of household members endorsed six or more of the nine symptoms, with 68% reporting feeling 'down, depressed, or hopeless' in the prior two weeks. Elevated depression symptom severity was associated with greater disability (β = 0.17, p < 0.001), less social support (β = -0.04, p = 0.016), and lower self-reported overall health (β = 0.54, p = 0.001). Having depressive disorder was also associated with greater disability (adjusted Odds Ratio [aOR] = 1.12, p = 0.001) and less social support (aOR = 0.97, p = 0.024).ConclusionsIn the Malawian context, we find that depressive disorder and depression symptoms are shared attributes among household members. This has implications for both screening and treatment, and it suggests that mental health should be approached from the vantage point of the broader social ecology of the household and family unit.Trial registrationClinicalTrials.gov (NCT04777006) - March 2, 2021.

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Prevalence and correlates of depressive symptoms in older adults across the glycaemic spectrum: the Atherosclerosis Risk in Communities (ARIC) study.

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Prevalence and correlates of depressive symptoms in older adults across the glycaemic spectrum: the Atherosclerosis Risk in Communities (ARIC) study.

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