Michel Préville

Reliability, Validity and Reference Values of the Zarit Burden Interview for Assessing Informal Caregivers of Community-Dwelling Older Persons with Dementia

Zarit Burden Interview (ZBI) is the most widely used instrument for assessing the burden experienced by the caregivers of persons with dementia. As part of the Canadian Study of Health and Aging, the 22-item ZBI was administered to a representative sample of 312 informal caregivers of community-dwelling subjects with dementia. The mean score was 22.4 out of 88 (sd: 16.2) and the median score was 18.5, which is far lower than those reported in previous studies using this instrument with convenience samples. There was no significant difference in the burden score according to the age, gender, living arrangement, marital status or employment status of the caregiver. The ZBI score was more strongly correlated to the depressive mood of the caregivers (r = 0.59) and the behaviour problems of the care recipients (r = 0.64) than their cognitive (r = 0.32) and functional (r = 0.31) status. Following a factor analysis, a 12-item short version of the instrument is proposed with two factors: personal strain (3 items) and role strain (9 items).

Sleep quality and 1-year incident cognitive impairment in community-dwelling older adults.

STUDY OBJECTIVES To examine in cognitively intact older men and women the associations between subjective sleep quality and 1-yr incident cognitive impairment. DESIGN Prospective cohort study. SETTING General community. PARTICIPANTS 1,664 cognitively intact individuals age 65 to 96 years. MEASUREMENTS AND RESULTS Sleep quality at baseline was measured using the Pittsburgh Sleep Quality Index (PSQI). Cognitive functioning was assessed at baseline and 12 months later using the Mini-Mental State Examination (MMSE). Incident general cognitive impairment was defined according to a follow-up MMSE score below the 15(th) percentile according to normative data and of at least 2 points below baseline. General cognitive impairments were also separated into amnestic and nonamnestic subtypes according to MMSE delayed recall performance. Associations between sleep quality indicators at baseline and incident cognitive impairment were assessed by odds ratio (OR) adjusted for age, education, baseline MMSE score, psychotropic drug use, anxiety, depressive episodes, cardiovascular conditions, and chronic diseases. Results revealed that global PSQI score was significantly linked with incident cognitive impairment (OR 1.17, 95% confidence interval (CI) 1.05-1.30) in men, but not in women. In women, sleep disturbance score (OR 2.62, 95% CI 1.41-4.86) and long sleep duration (≥ 9 hr; OR 3.70, 95% CI 1.49-9.17) were associated with nonamnestic and amnestic incident cognitive impairment, respectively. In men, short sleep duration (≤ 5 hr; OR 4.95, 95% CI 1.72-14.27) and habitual sleep efficiency score (OR 1.94, 95% CI 1.42-2.66) were associated with amnestic and general incident cognitive impairment, respectively. CONCLUSIONS Sleep quality in older adults should receive particular attention by clinicians because poor sleep quality can be an early sign of cognitive decline.

The Epidemiology of Psychiatric Disorders in Quebec's Older Adult Population

Objective: To document the prevalence of psychiatric disorders in Quebecs older adult population. Method: Data came from the Enquête sur la santé des aînés study conducted in 2005–2006 using a representative sample (n = 2798) of community-dwelling older adults. Results: Our results indicate that 12.7% of the respondents met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for depression, mania, anxiety disorders, or benzodiazepine dependency. The 12-month prevalence rate of major depression was 1.1% and the prevalence of minor depression 5.7%. A total of 5.6% of the respondents reported an anxiety disorder. The most prevalent anxiety disorders were specific phobia (2.0%), obsessive–compulsive disorder (OCD) (1.5%), and generalized anxiety disorder (GAD) (1.2%). Agoraphobia without panic disorder and panic disorder were reported by 0.3% and 0.6% of the respondents, respectively. The prevalence rate of benzodiazepine dependency was 2.3%. The 12-month comorbidity prevalence rate between any psychiatric disorders was 2.2%. Among those with depressive disorder, the most frequent comorbidity was observed between minor depression and specific phobia (4.3%), GAD (4.3%), OCD (3.7%), and mania (1.3%). Further, only 39% of those having at least one active DSM-IV diagnosis reported having used health services for their psychological distress symptoms during the previous 12 months. Among those who consulted health services, 85% visited a general practitioner. Conclusions: Our results indicate that a large proportion of the elderly population in Quebec presents mental health needs. Longitudinal research focusing on the individual and social consequences of mental health problems reported by older adults is needed to avoid misinterpretation of this finding.

La détresse psychologique dans la population du Québec non institutionnalisée résultats normatifs de l'enquête Santé Québec

Based on the results of the Santé Québec survey, this article describes the normative values of the psychological distress indices developed as part of the Santé Québec survey (IDPESQ-29 and IDPESQ-14) for the reference population as a whole, women and men separately, and for certain age groups.

Physical health and mental disorder in elderly suicide: A case-control study

The psychological autopsy method was used to study 95 cases of suicide. Ninety-five comparison subjects matched for gender, age, region, and date of death were selected from the death register. This study showed that suicide cases did not differ from controls with regard to the number of chronic health problems and, compared to the suicide cases, the controls had less functional autonomy six months prior to death. If minor and sub-threshold depression cases were included, 74.7% of the suicide cases would have been considered as having a mental health disorder compared to 12.6% in the control group. When the effect of other co-variables were controlled for, multivariate analysis showed that suicide cases and controls did not differ according to marital status, education, income, and living arrangement. Furthermore, suicide cases were no more likely than controls to seldom meet with family members or friends or to have been isolated during the six-month period preceding their death. Our findings suggest that detection of psychiatric disorders, mainly depression, must be included in late life suicide prevention strategies.

The Impact of DSM-IV Symptom and Clinical Significance Criteria on the Prevalence Estimates of Subthreshold and Threshold Anxiety in the Older Adult Population

OBJECTIVES Subthreshold anxiety refers to a condition where individuals do not meet the full symptom criteria (i.e., the number of symptoms required for a formal diagnosis is not reached) and/or do not report significant impairment or distress in functioning (i.e., the clinical significance criterion is not met). The purpose of this study was to examine how the symptom and the clinical significance criteria may affect the prevalence estimates of anxiety problems in the older adult population and whether applying these criteria results in an identifiable older group showing more severe anxiety. SETTING AND PARTICIPANTS Data came from a large representative sample of community-dwelling older adults age 65 years and older (N = 2,784). RESULTS Results showed that the 12-month prevalence rate of any anxiety problem varied from 5.6% when DSM-IV criteria for anxiety disorders were used to 26.2% when all subthreshold manifestations of anxiety were considered. Findings also indicated that when compared with respondents without anxiety, older adults presenting different manifestations of subthreshold or threshold anxiety appear to be more similar than different in their health and health behavior characteristics. CONCLUSIONS Subthreshold anxiety has a high prevalence and may cause significant impairment. Both symptom and clinical significance criteria do not perfectly discriminate between older adults with or without a severe anxiety problem presenting comorbid disorders and needing psychiatric help.

A life-course and time perspective on the construct validity of psychological distress in women and men. Measurement invariance of the K6 across gender

BackgroundPsychological distress is a widespread indicator of mental health and mental illness in research and clinical settings. A recurrent finding from epidemiological studies and population surveys is that women report a higher mean level and a higher prevalence of psychological distress than men. These differences may reflect, to some extent, cultural norms associated with the expression of distress in women and men. Assuming that these norms differ across age groups and that they evolve over time, one would expect gender differences in psychological distress to vary over the life-course and over time. The objective of this study was to investigate the construct validity of a psychological distress scale, the K6, across gender in different age groups and over a twelve-year period.MethodsThis study is based on data from the Canadian National Population Health Survey (C-NPHS). Psychological distress was assessed with the K6, a scale developed by Kessler and his colleagues. Data were examined through multi-group confirmatory factor analyses. Increasing levels of measurement and structural invariance across gender were assessed cross-sectionally with data from cycle 1 (n = 13019) of the C-NPHS and longitudinally with cycles 1 (1994-1995), 4 (2000-2001) and 7 (2006-2007).ResultsHigher levels of measurement and structural invariance across gender were reached only after the constraint of equivalence was relaxed for various parameters of a few items of the K6. Some items had a different pattern of gender non invariance across age groups and over the course of the study. Gender differences in the expression of psychological distress may vary over the lifespan and over a 12-year period without markedly affecting the construct validity of the K6.ConclusionsThis study confirms the cross-gender construct validity of psychological distress as assessed with the K6 despite differences in the expression of some symptoms in women and in men over the life-course and over time. Findings suggest that the higher mean level of psychological distress observed in women reflects a true difference in distress and is unlikely to be gender-biased. Gender differences in psychological distress are an important public health and clinical issue and further researches are needed to decipher the factors underlying these differences.

Social relationships and depression among people 65 years and over living in rural and urban areas of Quebec

To compare the prevalence of depression within the elderly Quebec population residing in rural areas, urban areas and metropolitan Montreal, and to assess differences in the associations between social relationships and depression across these urban and rural settings.

Anxiety, Depression, and 1-Year Incident Cognitive Impairment in Community-Dwelling Older Adults

OBJECTIVES: To examine in men and women the independent associations between anxiety and depression and 1‐year incident cognitive impairment and to examine the association of cognitive impairment, no dementia (CIND) and incident cognitive impairment with 1‐year incident anxiety or depression.

Daily hassles, physical illness, and sleep problems in older adults with wishes to die.

BACKGROUND Factors associated with the wish to die should be investigated in order to gain more opportunities for preventive interventions targeting older adults at risk for suicide. The goal of the research was to study the prevalence and associated factors of wishes to die in older adults living in the community using the data from a survey on the prevalence of mental disorders in this population. METHODS With a representative sample of community living older adults aged 65 years and over (N = 2777), we compared individuals with the wish to die (n = 163) to those without the wish to die on the basis of the presence and severity of daily hassles, physical illness, and sleep quality. RESULTS Logistic regression revealed that when depression and sociodemographic variables were held constant, self-rated physical health, number of chronic illnesses, number and intensity of daily hassles, as well as sleep problems were significantly associated with the wish to die in older adults. Painful illnesses and daytime dysfunction due to sleep problems were also associated factors with the wish to die. CONCLUSION Since desire for death is the first step into the suicidal process, health professionals should seriously consider the important and unique contribution of these variables in order to have more opportunities for detection and intervention.