Ruslan Leontjevas

A structural multidisciplinary approach to depression management in nursing-home residents: a multicentre, stepped-wedge cluster-randomised trial

BACKGROUND Depression in nursing-home residents is often under-recognised. We aimed to establish the effectiveness of a structural approach to its management. METHODS Between May 15, 2009, and April 30, 2011, we undertook a multicentre, stepped-wedge cluster-randomised trial in four provinces of the Netherlands. A network of nursing homes was invited to enrol one dementia and one somatic unit per nursing home. In enrolled units, nursing-home staff recruited residents, who were eligible as long as we had received written informed consent. Units were randomly allocated to one of five groups with computer-generated random numbers. A multidisciplinary care programme, Act in Case of Depression (AiD), was implemented at different timepoints in each group: at baseline, no groups were implenting the programme (usual care); the first group implemented it shortly after baseline; and other groups sequentially began implementation after assessments at intervals of roughly 4 months. Residents did not know when the intervention was being implemented or what the programme elements were; research staff were masked to intervention implementation, depression treatment, and results of previous assessments; and data analysts were masked to intervention implementation. The primary endpoint was depression prevalence in units, which was the proportion of residents per unit with a score of more than seven on the proxy-based Cornell scale for depression in dementia. Analyses were by intention to treat. This trial is registered with the Netherlands National Trial Register, number NTR1477. FINDINGS 16 dementia units (403 residents) and 17 somatic units (390 residents) were enrolled in the course of the study. In somatic units, AiD reduced prevalence of depression (adjusted effect size -7·3%, 95% CI -13·7 to -0·9). The effect was not significant in dementia units (0·6, -5·6 to 6·8) and differed significantly from that in somatic units (p=0·031). Adherence to depression assessment procedures was lower in dementia units (69% [SD 19%]) than in somatic units (82% [15%]; p=0·045). Adherence to treatment pathways did not differ between dementia units (43% [SD 33%]) and somatic units (38% [40%]; p=0·745). INTERPRETATION A structural approach to management of depression in nursing homes that includes assessment procedures can reduce depression prevalence in somatic units. Improvements are needed in depression screening in dementia units and in implementation of nursing-home treatment protocols generally. FUNDING The Netherlands Organization for Health Research and Development.

More insight into the concept of apathy: a multidisciplinary depression management program has different effects on depressive symptoms and apathy in nursing homes

BACKGROUND Apathy is common in nursing home (NH) residents and it overlaps with depression. This study examines the effects of a multidisciplinary depression program on apathy and depressive motivational and mood symptoms. METHODS Secondary analyses of a stepped-wedge cluster-randomized controlled trial were conducted with six measurements. Sixteen dementia NH units and 17 somatic units were enrolled. In the intervention condition, a program containing depression assessment procedures and multidisciplinary treatment (activating strategies, psychotherapy, and medication) was introduced. Usual care was provided in the control condition. Outcomes were assessed using the 10-item Apathy Evaluation Scale and the Cornell Scale for Depression in Dementia. RESULTS Intention-to-treat analyses showed that the whole depression management program reduced apathy in dementia units (p < 0.001; Cohens d, -0.35), and depressive motivational symptoms in somatic units (p = 0.008; Cohens d, -0.40). Depressive mood symptoms were not affected in both unit types. The effect on apathy in dementia units was mainly attributed to activating strategies (p < 0.001; Cohens d, -0.73). The effect on motivational symptoms in somatic units was mainly attributed to psychotherapy (p = 0.002; Cohens d, -0.80). Apathy worsening was associated with pharmacological depression treatment in both unit types (p = 0.009; Cohens d, 0.35). CONCLUSIONS Depression management may affect apathy and depressive symptoms differently, which underpins the position of apathy as a distinct syndrome. NH professionals can effectively use activating strategies in dementia units, and psychotherapy in somatic units. More research is needed on treating depressive mood symptoms, and on effects of antidepressants in NHs.

Nijmegen Observer-Rated Depression scale for detection of depression in nursing home residents

This study aims to test the accuracy of the Nijmegen Observer‐Rated Depression (NORD) scale, a new short scale for screening of depression in nursing home (NH) residents with and without dementia.

Resilience to affective disorders: A comparative validation of two resilience scales

BACKGROUND Resilience to affective disorders in rehabilitating patients or in individuals with a severe disability is of special research interest. However, there is no gold standard for measuring resilience. We aimed to test the accuracy of the Dutch translation of the Brief Resilience Scale (BRSnl) and of the Resilience Scale (RSnl) in recognizing rehabilitating patients without anxiety and depression, and to determine the reliability and construct validity of both scales. METHODS A within-subjects longitudinal study with six assessments, each one week apart. Forty residents of a nursing home rehabilitating unit were interviewed to assess resilience (BRSnl and RSnl), optimism and pessimism (LOT-R), depression and anxiety (HADS), positive and negative affect (PANAS), and pain (VAS). RESULTS Receiver operating characteristic analyses for recognizing the absence of depression and anxiety (HADS-score≤7) revealed better accuracy (P=0.038) for the BRSnl (AUC=0.84; p<0.0001) than for the RSnl (AUC=0.68; P=0.017). The scales correlated moderately at baseline (rs=0.35; p=0.026), and at four-week follow-up (rs=0.50; p=0.004). The RSnl was positively associated with positive outcomes (optimism and positive affect), and the BRSnl positively with positive outcomes, and negatively with negative outcomes (pessimism, anxiety and negative affect). The RSnl showed a better four-week test-retest reliability (ICC, 0.94; 95% CI, 0.87 to 0.97) than the BRSnl (0.66; 95% CI, 0.29 to.83). LIMITATIONS Short study duration, a relatively small sample. CONCLUSION The BRSnl showed better performance in detecting people without depression and anxiety than the RSnl, and performed better on construct validity.

Apathy: Risk Factor for Mortality in Nursing Home Patients

To determine the prognostic value of apathy for mortality in patients of somatic (SC) and dementia special care (DSC) nursing home (NH) units.

Exploring the association between whole blood Omega-3 Index, DHA, EPA, DHA, AA and n-6 DPA, and depression and self-esteem in adolescents of lower general secondary education

PurposeDepression is common in adolescents and long-chain polyunsaturated fatty acids (LCPUFA) are suggested to be associated with depression. However, research in adolescents is limited. Furthermore, self-esteem has never been studied in relation to LCPUFA. The objective here was to determine associations of depression and self-esteem with eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), Omega-3 Index (O3I), n-6 docosapentaenoic acid (n-6 DPA, also called Osbond acid, ObA), n-3 docosapentaenoic acid (DPA), and arachidonic acid (AA) concentrations in blood of adolescents attending lower general secondary education (LGSE).MethodsBaseline cross-sectional data from a krill oil supplementation trial in adolescents attending LGSE with an O3I ≤ 5% were analysed using regression models built with the BayesFactor package in R. Fatty acids and O3I were determined in blood. Participants filled out the Centre for Epidemiologic Studies Depression (CES-D) scale and the Rosenberg Self-Esteem scale (RSE).ResultsScores indicative of depression (CES-D ≥ 16) were found in 29.4% of the respondents. Of all fatty acids, we found extreme evidence [Bayes factor (BF) > 100] for a weak negative association between ObA and depression score [− 0.16; 95% credible interval (CI) − 0.28 to − 0.04; BF10 = 245], and substantial evidence for a weak positive association between ObA and self-esteem score (0.09; 95% CI, − 0.03 to 0.20; BF10 = 4). When all fatty acids were put in one model as predictors of CES-D or RSE, all of the 95% CI contained 0, i.e., no significant association.ConclusionNo evidence was found for associations of DHA, EPA and O3I with depression or self-esteem scores in LGSE adolescents with O3I ≤ 5%. The associations of higher ObA status with lower depression and higher self-esteem scores warrant more research.