The level of physical activity (PA) and the prevalence of depression both change across the lifespan. We examined whether the association between PA and depression is moderated by age. As sense of ...mastery and functional limitations have been previously associated with low PA and depression in older adults, we also examined whether these are determinants of the differential effect of age on PA and depression.
1079 patients with major depressive disorder (aged 18-88 years) were followed-up after two-years; depression diagnosis and severity as well as PA were re-assessed. Linear and logistic regression analyses were used to test reciprocal prospective associations between PA and depression outcomes. In all models the interaction with age was tested.
PA at baseline predicted remission of depressive disorder at follow-up (OR = 1.43 95% CI: 1.07-1.93, p = .018). This effect was not moderated by age. PA predicted improvement of depression symptom severity in younger (B = -2.03; SE = .88; p = .022), but not in older adults (B = 2.24; SE = 1.48; p = .128) (p = .015 for the interaction PA by age in the whole sample). The level of PA was relatively stable over time. Depression, sense of mastery and functional limitation were for all ages not associated with PA at follow-up.
Age did not moderate the impact of PA on depressive disorder remission. Only in younger adults, sufficient PA independently predicts improvement of depressive symptom severity after two-year follow-up. Level of PA rarely changed over time, and none of the determinants tested predicted change in PA, independent of age.
Abstract
Background
Recovery in mental health care comprises more than symptomatic improvement, but preliminary evidence suggests that only collaborative care may improve functioning of depressed ...older adults. This study therefore evaluates the effectiveness of behavioural activation (BA) on functional limitations in depressed older adults in primary care.
Methods
This study uses data from a multicentre cluster randomised controlled trial in which 59 primary care centres (PCCs) were randomised to BA and treatment as usual (TAU), and 161 consenting older (≥65 years) adults with clinically relevant symptoms of depression participated. Interventions were an eight-week individual BA programme by a mental health nurse (MHN) and unrestricted TAU. The outcome was self-reported functional limitations (WHODAS 2.0) at post-treatment (9 weeks) and at 12-month follow-up.
Results
At the end of treatment, the BA participants reported significantly fewer functional limitations than TAU participants (WHODAS 2.0 difference −3.62,
p
= 0.01, between-group effect size = 0.39; 95% CI = 0.09–0.69). This medium effect size decreases during follow-up resulting in a small and non-significant effect at the 12-month follow-up (WHODAS 2.0 difference = −2.22,
p
= 0.14, between-group effect size = 0.24; 95% CI = -0.08–0.56). MoCA score moderated these results, indicating that the between-group differences were merely driven by those with no cognitive impairment.
Conclusions
Compared to TAU, BA leads to a faster improvement of functional limitations in depressed older adults with no signs of cognitive decline. Replication of these findings in confirmatory research is needed.
ABSTRACT
Depression is one of the most prevalent mental disorders in older adults and leads to considerable decreases in health, well‐being, and impaired functioning. Intervention studies have ...focused on the effects on symptomatic recovery, and most do not include functional recovery as an outcome. Reduction of functional limitations as a treatment goal in old‐age psychiatry aligns with the values of older persons. The objective of this review was therefore to evaluate the effectiveness of late‐life depression interventions on functional limitations. This systematic review identified 15 randomized controlled trials in which the effectiveness of different interventions on functional limitations was evaluated in patients with late‐life depression. The interventions were categorized into four categories: psychological interventions, drug treatment, physical exercise, and collaborative care. Multicomponent and collaborative‐care interventions appear to be the most promising for improvement of functional limitations, particularly in primary care and community‐dwelling populations of older persons with symptoms of depression. There is, however, a lack of evidence regarding studies in specialized mental health care.
Abstract Background Knowledge about characteristics explaining low level of physical activity in late-life depression is needed to develop specific interventions aimed at improving physical health in ...depressed people above the age of 60. Methods This cross-sectional study used data from the Netherlands Study of Depression in Older Persons (NESDO), a longitudinal multi-site naturalistic cohort study. People aged 60 and over with current depression and a non-depressed comparison group were included, and total amount of PA per week was assessed with the short version of the International Physical Activity Questionnaire (IPAQ). Depression characteristics, socio-demographics, cognitive function, somatic condition, psycho-social, environment and other lifestyle factors were added in a multiple regression analysis. Results Depressed persons >60 y were less physically active in comparison with non-depressed subjects. The difference was determined by somatic condition (especially, functional limitations) and by psychosocial characteristics (especially sense of mastery). Within the depressed subgroup only, a lower degree of physical activity was associated with more functional limitations, being an inpatient, and the use of more medication, but not with the severity of the depression. Limitation This study is based on cross-sectional data, so no conclusions can be drawn regarding causality. Conclusions This study confirms that depression in people over 60 is associated with lower physical activity. Patient characteristics seem more important than the depression diagnosis itself or the severity of depression. Interventions aimed at improving physical activity in depressed persons aged 60 and over should take these characteristics into account.
Objectives
Functional limitations give an indication of the total impact of diseases, such as depression, on individuals health and recovery. This study examines the change in several domains of ...functioning over 2 years in older persons depressed at baseline (non-remitted group and remitted group after 2 years) and in a non-depressed comparison group.
Methods
Data were used from a cohort study (Netherlands Study of Depression in Older persons NESDO) consisting of depressed older persons ≥ 60 years (
N
= 378) and a non-depressed comparison group (
N
= 132) with 2 years of follow-up (attrition rate 24%). Functional limitations (outcome) were assessed with the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) questionnaire every 6 months. Total scores and domain scores were used. Depression was classified according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria at baseline and at 2-year follow-up. Severity of depression (predictor) was assessed with the Inventory of Depressive Symptomatology (IDS) at 6-month intervals.
Results
Linear mixed models showed that the level of functional limitations differed between the three groups during 2 years of follow-up. The non-remitted group had the highest level of functional limitations during 2 years, followed by the remitted group. Stable low levels of functional limitations were found for the non-depressed group. Remission from depression was accompanied by improvements in functioning, however, compared to the non-depressed comparison group significant functional limitations remained. Higher severity of depression appeared as risk factor for a declining course of functioning, especially the social aspects of functioning.
Methodological considerations
Participants that were more severely depressed and more functionally impaired at baseline had higher attrition rates than the participants that were included in the analytical sample.
Conclusion
This study showed that depression in later life has long-term debilitating effects on functioning, enduring even after remission from depression. This implies that depression treatment in later life should aim broader than just symptomatic recovery, but also include functional recovery.
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