Antonette M. Zeiss

Clinical implications of subthreshold depressive symptoms

There is active debate regarding whether diagnosable depression exists on a continuum with subthreshold depressive symptoms or represents a categorically distinct phenomenon. To address this question, multiple indexes of dysfunction (psychosocial difficulties, mental health treatment history, and future incidence of major depression and substance abuse/dependence) were examined as a function of the extent of depressive symptoms in 3 large community samples (adolescent, adult, and older adult; N = 3,003). Increasing levels of depressive symptoms were associated with increasing levels of psychosocial dysfunction and incidence of major depression and substance use disorders. These findings suggest that (a) the clinical significance of depressive symptoms does not depend on crossing the major depressive diagnostic threshold and (b) depression may best be conceptualized as a continuum. Limitations of the present study are discussed.

Relationship of physical disease and functional impairment to depression in older people.

Physical disease is commonly considered a risk factor for depression among older adults. However, this pattern is not consistently supported, and a theoretical framework for understanding such a relationship has not been articulated. P.M. Lewinsohn, H. Hoberman, L. Teri, and M. Hautzingers (1985) integrative model of depression predicts that disease will be a risk factor for depression only when disease results in functional impairment, and that impairment in the absence of disease is also a risk factor for depression. The authors tested these predictions in a community-based sample of older adults followed longitudinally and found that functional impairment was a significant risk factor for depression, regardless of disease status. Disease was not a significant predictor of major depression, nor did it interact with impairment to predict depression.

Integrating Mental Health and Primary Care Services in the Department of Veterans Affairs Health Care System

Integrating mental health care in the primary care setting has been identified in the literature as a model for increasing access to mental health services and has been associated with enhanced clinical and functional patient outcomes and higher patient satisfaction. The Department of Veterans Affairs (VA), which operates the nation’s largest integrated health care system, has taken a leadership role in creating a health care system in which mental health care is provided in the primary care setting. This article examines VA’s efforts and progress to date in implementing evidence-based models of integrated mental health services nationally in community based outpatient clinics, home based primary care, and outpatient primary clinics at medical facilities. Psychology plays an important role in this progress, as part of an overall interdisciplinary effort, in which all professions are crucially important and work together to promote the overall well-being of patients.

Personal models of osteoarthritis and their relation to self-management activities and quality of life.

We examined the personal models of osteoarthritis (OA) of 61 patients over 60 years of age. Models were elicited using a structured interview. Shared beliefs included perceiving OA as a serious, painful, chronic, and incurable condition that can be managed by recommended medical treatment. Considerable individual differences were found on six personal-model constructs: Symptoms, Seriousness, Cause, Control, Helpfulness of Treatment, and Negative Feelings about Treatment. The constructs of Symptoms and Seriousness were consistently related to a variety of important outcomes. For example, participants with higher scores on Symptoms and Seriousness reported higher levels of self-management (both concurrently and prospectively), reported more utilization of medical services, and experienced a poorer quality of life. The implications for the design of health-education materials and for patient-provider interactions are discussed.

Enduring deficits after remissions of depression: A test of the scar hypothesis

Abstract People who have recovered from an episode of clinical depression have an elevated risk for developing a new episode of depression compared with those not previously depressed. One possible explanation for this finding is that depression may leave ‘scars’—enduring psychological changes resulting from depression. This hypothesis was examined for a set of interpersonal variables which measured self-perceptions, behavior observed in dyadic and group interactions, and ratings by peers and coders based on those interactions. The ‘scar’ pattern was defined as a deficit observed during depression which remained after the depressive episode ended. Data for 21 patients who improved during psychotherapy, 20 patients who did not improve, and 80 nondepressed participants were examined. No variables fit the ‘scar’ pattern. Seven variables were identified as concomitants of depression. Nine variables provided predictive information, in that patients who subsequently improved in treatment significantly differed at pre-test from patients who subsequently failed to improve. The failure to support the scar hypothesis is discussed, along with alternative explanation for the higher risk for a new depressive episode seen in the previously depressed. The importance of the finding that some measures of interpersonal behavior predict response to treatment is also discussed.

Self-Efficacy as a Mediator of Caregiver Coping: Development and Testing of an Assessment Model

Development and utilization of two self-efficacy measures thought to be relevant to stressed family caregivers, Caregiver Self-Care Self-Efficacy and Caregiver Problem-Solving Self-Efficacy, are described. Data obtained in the context of a psychoeducational intervention program are available for 217 caregivers of frail and/or cognitively impaired elders. Analyses of psychometric properties of the efficacy measures demonstrate good internal consistency and test-retest reliability for both measures. In addition, both measures of self-efficacy are related to depression as measured by the Beck Depression Inventory and caregiver distress as measured by the Zarit Burden Scale. Problem-Solving Self-efficacy also is related to subjective caregiver burden as measured by Zarits Memory and Behavior Problem Checklist. Results are promising in terms of the utility of the measure and the application of self-efficacy theory to the caregiving situation. Limitations of these measures are discussed and suggestions made for improved second-generation self-efficacy scales.

The impact of dementia and mild memory impairment (MMI) on intimacy and sexuality in spousal relationships

BACKGROUND Sexuality and intimacy in couples in which one partner is affected by dementia has been widely researched. Few studies have explored these issues in couples where one partner is affected by mild memory impairment (MMI) or mild cognitive impairment (MCI). The objectives of this study were to (1) identify and contrast issues of intimacy and sexuality that spousal caregivers of persons with MMI and dementia may experience, and (2) identify future lines of research in this population. METHODS Fourteen dementia and nine MMI spousal caregivers participated in focus groups conducted between 2008 and 2009 at the Stanford/VA Alzheimers Research Center. Content analyses were conducted to identify themes. RESULTS Five themes emerged: communication, marital cohesion, affectional expression, caregiver burden, and ambiguity concerning the future of the relationship. Dementia caregivers reported more difficulties with communication, cohesion, and perceptions of increased burden than their MMI counterparts. Both groups indicated reduced sexual expression due to physical limitations; substitute activities including hand-holding, massaging, and hugging were noted. Both groups reported difficulty anticipating the future of the relationship due to present stressors. While dementia caregivers could consider future romantic relationships with others, MMI caregivers were primarily able to consider future relationships only for companionship and emotional intimacy. CONCLUSION Early therapeutic interventions may assist couples in modifying activities, behaviors, and expectations about the future of the relationship. Such modifications may help maintain relationship satisfaction, decrease burden, preserve quality of life, and delay time-to-placement. Extending time-to-placement could have cost savings implications for families and the healthcare system.

Sexuality and Intimacy in Alzheimer's Patients and Their Partners

Geriatric Sexuality remains one of the more sensitive and controversial issues to be confronted in todays clinical setting. Research indicates that older adults continue to be sexually active well into later life. Older adults with dementing illnesses experience deleterious changes in sexual functioning that can affect their quality of life. However, few health care professionals ask older adults about their sexual functioning. This paper addresses means of fostering acceptance by professionals and families and creating an environment that nurtures sexuality in couples coping with dementia.

The incidence and correlates of erectile problems in patients with Alzheimer's disease.

Loss of erection was reported in 53% of 55 male Alzheimers disease patients with a mean age of 70.25. Loss of erection is not related to degree of cognitive impairment, age, or depression. Modal time of onset of erectile problems is concurrent with onset of Alzheimers symptoms. Patients with erectile problems were not taking more medications overall than those without problems and had no greater overall incidence of concurrent physical problems. Thus, the evidence suggests that there may be an elevated incidence of erectile failure in patients with Alzheimers disease as a primary problem not attributable to other age-related factors.

Role perceptions, self-role congruence and marital satisfaction in dual-worker couples with preschool children

The current study investigated role perceptions, self-role congruence and marital satisfaction among dual-worker couples with preschool children. Evidence was foundfor two types of role conflict-conflict between mens and womens expectations of the spousal and parental roles (intra-role conflict) and conflict among the demands of multiple roles (inter-role conflict). Moreover, congruence between self-characteristics and role demands were related to marital satisfaction and to the stability of the dual-worker structure at a one year follow-up.