Erico Castro-Costa

Measuring disability across cultures - the psychometric properties of the WHODAS II in older people from seven low- and middle-income countries. The 10/66 Dementia Research Group population-based survey

We evaluated the psychometric properties of the 12‐item interviewer‐administered screener version of the World Health Organization Disability Assessment Schedule – version II (WHODAS II) among older people living in seven low‐ and middle‐income countries. Principal component analysis (PCA), confirmatory factor analysis (CFA) and Mokken analyses were carried out to test for unidimensionality, hierarchical structure, and measurement invariance across 10/66 Dementia Research Group sites.

Ascertaining late-life depressive symptoms in Europe: An evaluation of the survey version of the EURO-D scale in 10 nations. The SHARE project

The reported prevalence of late‐life depressive symptoms varies widely between studies, a finding that might be attributed to cultural as well as methodological factors. The EURO‐D scale was developed to allow valid comparison of prevalence and risk associations between European countries. This study used Confirmatory Factor Analysis (CFA) and Rasch models to assess whether the goal of measurement invariance had been achieved; using EURO‐D scale data collected in 10 European countries as part of the Survey of Health, Ageing and Retirement in Europe (SHARE) (n = 22,777). The results suggested a two‐factor solution (Affective Suffering and Motivation) after Principal Component Analysis (PCA) in 9 of the 10 countries. With CFA, in all countries, the two‐factor solution had better overall goodness‐of‐fit than the one‐factor solution. However, only the Affective Suffering subscale was equivalent across countries, while the Motivation subscale was not. The Rasch model indicated that the EURO‐D was a hierarchical scale. While the calibration pattern was similar across countries, between countries agreement in item calibrations was stronger for the items loading on the affective suffering than the motivation factor. In conclusion, there is evidence to support the EURO‐D as either a uni‐dimensional or bi‐dimensional scale measure of depressive symptoms in late‐life across European countries. The Affective Suffering sub‐component had more robust cross‐cultural validity than the Motivation sub‐component. Copyright

Norms for the mini-mental state examination: adjustment of the cut-off point in population-based studies (evidences from the Bambuí health aging study)

OBJECTIVE To estimate the prevalence of cognitive impairment in an elderly population-based cohort, using several Mini-Mental State Examination (MMSE) cut-off points recommended by Brazilian authors and to examine the percentile distribution of MMSE scores in the study population. METHOD A total of 1558 subjects aged>60 years (89.4% of the total), living in the city of Bambuí, MG, completed the MMSE and were included in the present study. RESULTS The estimated prevalences of cognitive impairment varied from 13.2% to 27.0% depending on the cut-off point and agreement varied widely between them (kappa range: 0.38 to 0.88). Cut-off point 13/14 corresponded to the 5th percentile and 21/22 corresponded to the lower quartile of the MMSE score distribution. CONCLUSION In the absence of comparable cut-off points, percentile distributions are more adequate for population-based studies of elderly with low schooling level.

Packages of Care for Dementia in Low- and Middle-Income Countries

In the fifth in a series of six articles on packages of care for mental disorders in low- and middle-income countries, Martin Prince and colleagues discuss the treatment of dementia.

Factors associated with depressive symptoms measured by the 12-item General Health Questionnaire in Community-Dwelling Older Adults (The Bambuí Health Aging Study)

OBJECTIVE To investigate factors associated with depressive symptoms in community-dwelling older adults. METHOD This study evaluated 1,510 participants of the Bambuí Health Aging Study baseline. The dependent variable was the presence of depressive symptoms assessed by the 12-item General Health Questionnaire and predictive variables were sociodemographic characteristics, social support network, lifestyle and health conditions. RESULTS The prevalence of depressive symptoms was 38.5% (12-item General Health Questionnaire > or = 5). Depressive symptoms were positively and independently associated with female gender (PR = 1.15; 95%CI 1.01-1.33), aged 80 years or over (PR = 1.22; 95%CI: 1.02-1.54) compared with 60-69 years, single (PR = 1.25; 95%CI: 1.02-1.46) or separated (PR = 1.30; 95%CI: 1.03-1.65) marital status, less than 4 years of schooling (PR = 1.42; 95%CI: 1.04-2.00), self-reported global health (reasonable: PR = 1.84; 95%CI 1.45-2.34; bad or very bad: PR = 2.44; 95%CI 1.91-3.12), incapacity or great difficulty in performing daily activities (PR = 1.39; 95%CI: 1.22-1.57) and complaint of insomnia in the last month (PR = 1.77; 95%CI: 1.22-1.99). CONCLUSION The similarities between factors associated with depressive symptoms in this population and in others do not explain the high prevalence rates previously reported in Bambuí. These findings may guide efforts to investigate others factors to elucidate the etiopathogenesis of depression in this population.

Association between sleep duration and all-cause mortality in old age: 9-year follow-up of the Bambui Cohort Study, Brazil

This study investigates the association of sleep duration with risk of all‐cause mortality among elderly Brazilians using data from a 9‐year population‐based cohort study and applying a multivariable longitudinal categorical and continuous analysis using Cox’s proportional hazards models. This analysis used data from the Bambui Health and Ageing Study (BHAS), conducted in Bambuí city (approximately 15 000 inhabitants) in southeastern Brazil. The study population comprised 1512 (86.8%) of all eligible 1742 elderly residents. In multivariable analysis, using sleep duration as categorical variable and controlling for multiple measures of sociodemographic and health status, those who slept 9 h or more per night were found to be at higher risk of mortality than those who slept 7 h [hazard ratio (HR): 1.53; 95% confidence interval (CI): 1.12–2.09]. Excluding those whose deaths occurred within 2 years after entry, this association remained significant (HR: 1.56; 95% CI: 1.12–2.18). In analyses using sleep duration as a continuous variable, a linear correlation was found between sleep duration and mortality in all adjusted models in the whole sample (HR: 1.08; 95% CI: 1.02–1.15) and following exclusion of those whose deaths occurred within 2 years after entry (HR: 1.13; 95% CI: 1.06–1.21). Both linear and quadratic terms were significant, reflecting a predicted relationship, with mortality predominantly increasing in association with long sleep duration but with the addition of a slight decrease in association with shorter sleep duration. In conclusion, long rather than short sleep duration was associated principally with all‐cause mortality in this sample. It is therefore reasonable to suggest that clinicians should be aware of the potential adverse prognosis associated with prolonged sleep.

Alcohol consumption in late-life — The first Brazilian National Alcohol Survey (BNAS)

To investigate the alcohol consumption in later life in Brazil and its association with socio-demographic characteristics. This study was a cross-sectional analysis of nationally representative survey data. A multistage cluster sampling procedure was used to select 3007 individuals of 14 years of age and older from the Brazilian household population. In this study we analyzed data from all 400 participants who were over 60 years old. Alcohol Abuse and Dependence Syndrome was established according to DSM-IV and Risky Drinking was defined in two ways: heavy drinkers (>7 drinks/week) and as binge drinkers (>3 drinks/one occasion). Twelve percent of participants reported heavy drinking behavior while 10.4% and 2.9% were binge drinkers and alcohol dependent respectively. In the adjusted logistic regression only gender was associated with heavy drinking behavior. Males, the youngest and the wealthiest were more likely to report binge drinking behaviors. In conclusion, alcohol related-problems are common but under recognized among older adults. Health professionals should be aware that common definitions of alcohol abuse and dependence may not apply as readily to older people, who have had biological changes for alcohol tolerance and its effects on the Central Nervous System.

Bipolar disorder prevalence: a systematic review and meta-analysis of the literature

OBJECTIVE Bipolar disorder (BD) is common in clinical psychiatric practice, and several studies have estimated its prevalence to range from 0.5 to 5% in community-based samples. However, no systematic review and meta-analysis of the prevalence of BD type 1 and type 2 has been published in the literature. We carried out a systematic review and meta-analysis of the lifetime and 1-year prevalence of BD type 1 and type 2 and assessed whether the prevalence of BD changed according to the diagnostic criteria adopted (DSM-III, DSM-III-R vs. DSM-IV). METHODS We searched MEDLINE, Scopus, Web of Science, PsycINFO, and the reference lists of identified studies. The analyses included 25 population- or community-based studies and 276,221 participants. RESULTS The pooled lifetime prevalence of BD type 1 was 1.06% (95% confidence interval [95%CI] 0.81-1.31) and that of BD type 2 was 1.57% (95%CI 1.15-1.99). The pooled 1-year prevalence was 0.71% (95%CI 0.56-0.86) for BD type 1 and 0.50% (95%CI 0.35-0.64) for BD type 2. Subgroup analysis showed a significantly higher lifetime prevalence of BD type 1 according to the DSM-IV criteria compared to the DSM-III and DSM-IIIR criteria (p < 0.001). CONCLUSION This meta-analysis confirms that estimates of BD type 1 and type 2 prevalence are low in the general population. The increase in prevalence from DSM-III and DSM-III-R to DSM-IV may reflect different factors, such as minor changes in diagnostic operationalization, use of different assessment instruments, or even a genuine increase in the prevalence of BD.

The Influence of Socio-Economic Conditions On the Prevalence of Depressive Symptoms and Its Covariates in an Elderly Population With Slight Income Differences: the Bambuí Health and Aging Study (Bhas)

Background: The influence of socio-economic conditions on covariates of depression has received little attention. Aims: Examine whether prevalence and covariates of depressive symptoms are affected by socio-economic circumstances. Methods: Participants were 1,499 (86%) residents in Bambuí city, Brazil, aged ->- 60 years. Depressive symptoms were assessed by the GHQ-12 questionnaire and exploratory variables included demographic characteristics, life events, social support, health conditions and health service use. The analysis was stratified by family income (< US

Dimensions Underlying the Mini-Mental State Examination in a Sample With Low-Education Levels: The Bambuí Health and Aging Study

240.00 [lowest tertile] vs. ->- US