Kaarin J. Anstey

Recall of depressive episode 25 years previously

BACKGROUNDnLifetime rates of depression reported in epidemiological surveys are generally only twice the 12 month rates. Either people forget the symptoms of depression or many people who have a depressive episode remain depressed for many years. Both may be true. There is a need to examine the long-term clinical validity of interviews that are used to make lifetime diagnoses.nnnMETHODSnForty-five patients who were part of a long-term follow-up study of depression were interviewed 25 years after the index episode. The diagnoses from the original, fully structured interviews were compared with the responses people made for that period when interviewed using the CIDI 25 years later.nnnRESULTSnTwenty-seven patients met CIDI DSM-III-R criteria for depression at index episode. At the 25 year follow-up, 19 of the 27 reported the essential symptoms of depression or loss of interest being present at the index time, and in 14 of the 27 the depressive symptoms recalled met criteria for DSM-III-R major depressive episode at that time.nnnCONCLUSIONSnSeventy per cent of people who were hospitalized for a major depressive episode can recall being depressed but only half can recall sufficient detail to satisfy the diagnostic criteria when interviewed 25 years later. As depressive episodes, especially those severe enough to warrant admission, are recalled better than many other diagnoses, one must be cautious about the lifetime rates for mental disorders reported in retrospective epidemiological surveys.

Cognitive therapy for depression in the elderly

The applicability for older patients of cognitive (CT) and cognitive‐behavioural (CBT) therapies for depression, now well established for clinical populations aged less than 65 years, was reviewed. Eighteen English language articles published to the end of 1994 were located using Medline, Psychlit and key reference searches. Outcome data from seven studies indicate that CT is clearly more effective than no therapy or placebo, through prediction of success remains uncertain. Several variables may influence outcome. Outcome in younger and older depressives with CT was comparable. Adaptation of cognitive‐behavioural techniques for older depressives is described. While these may enhance CT’s efficacy with older people, they as yet lack empirical evidence. The review, though limited, concludes that CT is an effective intervention for depression in older people and recommends strategies for further research to enable more accurate targeting of therapy.

Measuring human functional age : A review of empirical findings

A review of empirical functional age studies published in English was conducted. Types of biomarkers used in functional age studies included sensorimotor, cognitive, psychosocial, behavioral, anthropometric, biomedical, physiological, and dental variables. Previous criticisms of the validity and utility of functional age research were evaluated with reference to empirical studies. While some of these criticisms remain valid, areas of research currently using established biomarkers to predict functional outcomes were identified, including driving, falls, and cognitive functioning. It was concluded that the success of functional age research is dependent on the relevance of biomarkers to specific functional outcomes.

Physiologic, health and lifestyle factors associated with femoral neck bone density in older women

Three hundred eleven women aged between 60 and 91 years (mean age 72.2) who were randomly recruited from the community underwent bone density assessments of the femoral neck. Two complementary multivariate techniques were used to assess the relationships between femoral neck bone density and a range of anthropometric, health, and lifestyle measures. Stepwise multiple linear regression analysis revealed age, weight, height, quadriceps strength, and lifelong smoking to be variables that independently and significantly explained part of the variance in femoral neck bone density within the group. Multiple logistic regression revealed that after adjusting for established predictors of bone mineral density, age, height, and weight, reduced quadriceps strength, lifelong smoking, and little childhood activity were significantly associated with low bone density (< 0.70 g/cm2), whereas superior quadriceps strength, nonsmoking, and high levels of current physical activity were significantly associated with high bone density (> 0.84 g/cm2). In contrast, current calcium intake was not significantly associated with bone density. The study findings highlight possible public health initiatives for minimizing age-related femoral neck bone loss in older women.

Psychosocial Stressors, Physical Illness and the Spectrum of Depression in Elderly Inpatients

Objectives: To describe all elderly patients hospitalised with principal and secondary diagnoses of depression, and to determine whether a relationship can be demonstrated between psychosocial stressors, physical illness and type of depression. Method: A retrospective chart review of elderly patients admitted to a general hospital psychiatry ward over a 7-year period with principal or secondary diagnoses of depression was undertaken. Four broad diagnostic categories of depression were used: major depression, psychotic depression, minor depression, and organic depression. Chief outcome measures were: number of medical diagnostic categories, presence of psychosocial stressors, global clinical improvement, and length of stay. Results: Of 228 patients admitted with depression (194 principal diagnoses and 34 secondary diagnoses), 100 had major depression, 47 psychotic depression, 48 minor depression and 33 organic depression. Psychiatric comorbidi-ty occurred in 70%, about half of which was due to organic brain syndrome. Patients with psychotic depression had the fewest medical problems and those with organic depression the most, while patients with minor depression had the highest rate of family and marital problems, comorbid personality dysfunction and suicide attempts. Patients with psychotic depression had the longest admissions, while those with minor depression had the shortest. Overall, 89% showed significant clinical improvement. Conclusions: Elderly inpatients have a wide spectrum of depressive disorders with different psychosocial, medical and treatment profiles. Future studies of depression in old age should include all patients with clinical depression.

The Parent Adult-Child Relationship Questionnaire (PACQ): The assessment of the relationship of adult children to their parents

We review current understanding of the parent adult-child relationship, describe the development of an instrument to measure this relationship and propose key themes which define the relationship. A 97-item self-report questionnaire was administered to two convenience samples (N = 302, N = 100) comprising primary care patients and community residents. The most interpretable solutions to Principal Components Analyses of a reduced pool of items were, for the mother, an orthogonal two-factor solution (regard and responsibility , comprising 13 items) and, for the father, a three-factor solution (regard, responsibility and control, comprising 13 items).The Parent Adult-Child Questionnaire (PACQ) was found to be valid and reliable as a self-report measure of the filial relationship.We suggest that PACQ has both clinical and research utility.