Salene M. W. Jones

The Feasibility of Reducing Sitting Time in Overweight and Obese Older Adults

Background. Overweight and obese older adults have high sedentary time. We tested the feasibility and preliminary effects of a sedentary time reduction intervention among adults over age 60 with a body mass index over 27 kg/m2 using a nonrandomized one-arm design. Methods. Participants (N = 25, mean age = 71.4, mean body mass index = 34) completed an 8-week theory-based intervention targeting reduced total sitting time and increased sit-to-stand transitions. An inclinometer (activPAL™) measured the primary outcomes, change in total sitting time and sit-to-stand transitions. Secondary outcomes included physical activity (ActiGraph GT3X+ accelerometer), self-reported sedentary behaviors, physical function (Short Physical Performance Battery), depressive symptoms (8-item Patient Health Questionnaire), quality of life (PROMIS), and study satisfaction. Paired t tests examined pre–post test changes in sitting time, sit-to-stand transitions, and secondary outcomes. Results. Inclinometer measured sitting time decreased by 27 min/day (p < .05) and sit-to-stand transitions increased by 2 per day (p > .05), while standing time increased by 25 min/day (p < .05). Accelerometer measured sedentary time, light-intensity, and moderate-to-vigorous physical activity improved (all p values ≤ .05). Self-reported sitting time, gait speed, and depressive symptoms also improved (all p values < .05). Effect sizes were small. Study satisfaction was high. Conclusions. Reducing sitting time is feasible, and the intervention shows preliminary evidence of effectiveness among older adults with overweight and obesity. Randomized trials of sedentary behavior reduction in overweight and obese older adults, most of whom have multiple chronic conditions, may be promising.

Translating CESD-20 and PHQ-9 Scores to PROMIS Depression.

This study examined the accuracy of depression cross-walk tables in a sample of people with multiple sclerosis (MS). The tables link scores of two commonly used depression measures to the Patient Reported Outcome Measurement Information System Depression (PROMIS-D) scale metric. We administered the 8-item PROMIS-D (Short-Form 8b; PROMIS-D-8), the 20-item Center for Epidemiologic Studies Depression Scale (CESD-20), and the 9-item Patient Health Questionnaire (PHQ-9) to 459 survey participants with MS. We examined correlations between actual PROMIS-D-8 scores and the scores predicted by cross-walks based on PHQ-9 and CESD-20 scores. Intraclass correlation coefficients were used to assess correspondence. Consistency in severity classification was also calculated. Finally, we used Bland–Altman plots to graphically examine the levels of agreement. The correlations between actual and cross-walked PROMIS-D-8 scores were strong (CESD-20 = .82; PHQ-9 = .74). The intraclass correlation was moderate (.77). Participants were consistently classified as having or not having at least moderate depressive symptoms by both actual and cross-walked scores derived from the CESD-20 (90%) and PHQ-9 (85%). Bland–Altman plots suggested the smaller differences between actual and cross-walked scores with greater-than-average depression severity. PROMIS cross-walk tables can be used to translate depression scores of people with MS to the PROMIS-D metric, promoting continuity with previous research.

Assessing measurement invariance of three depression scales between neurologic samples and community samples

AbstractPurpose Measurement invariance is necessary for meaningful group comparisons. The purpose of this study was to test measurement invariance of three patient-reported measures of depressive symptoms between neurologic and community samples.MethodsThe instruments tested included the center for epidemiologic studies depression scale (CESD-20), the patient health questionnaire-9 (PHQ-9), and the patient-reported outcome measurement information system depression short form (PROMIS-D-8). Responses from a community sample were compared to responses from samples with two neurologic conditions: multiple sclerosis and spinal cord injury. Multi-group confirmatory factor analysis was used to evaluate successive levels of measurement invariance: (a) configural invariance, i.e., equivalent item factor structure between groups; (b) metric invariance, i.e., equivalent unstandardized factor loadings between groups; and (c) scalar invariance, i.e., equivalent item intercepts between groups.ResultsResults of this study supported metric invariance for the CESD-20, PHQ-9, and PROMIS-D-8 scores between the community sample and the samples with neurologic conditions. The most rigorous form of invariance (i.e., scalar) also holds for the CESD-20 and the PROMIS-D-8.ConclusionsThe current study suggests that depressive symptoms as measured by three different outcome measures have the same meaning across clinical and community samples. Thus, the use of these measures for group comparisons is supported.

Health care worry is associated with worse outcomes in multiple sclerosis.

PURPOSE/OBJECTIVE People with multiple sclerosis (MS) experience higher levels of depression and anxiety than the general population. This is the first study to examine the relationship of worry about affording health care and symptoms in MS. RESEARCH METHOD/DESIGN People with MS (n = 405) were recruited for a needs assessment study. Participants completed a structured telephone interview measuring depression, anxiety, fatigue, sleep disturbance, pain interference, social function, and perceived cognitive functioning, and rated their worry about the following: premiums increasing, income decreasing, affording health care services, insurance dropping coverage, and affording prescriptions. Multiple regression analyses controlled for age, gender, disability status, education, income, and health insurance coverage. RESULTS The highest rated worry was inability to afford health care services. Higher health care worry was reported by women, younger participants, participants with lower incomes, and those with only private (vs. public) insurance. Total level of health care worry was significantly related to depression, anxiety, fatigue, sleep disturbance, pain interference, social function, and perceived cognitive functioning. CONCLUSIONS/IMPLICATIONS Health care worry was significantly related to psychological, physical, and cognitive symptoms. Future research should compare health care worry in MS with other populations (i.e., healthy adults) and should examine changes in health care worry over time.

A psychometric examination of multimorbidity and mental health in older adults

Objectives: Multimorbidity, the presence of multiple chronic medical conditions, is particularly prevalent in older adults. We examined the relationship of multimorbidity with mental health, social network and activity limitations in the National Health and Aging Trends Study, a nationally representative, age-stratified sample of older adults. Method: After excluding participants who used a proxy to complete the survey and those who did not answer any of the depressive symptoms, anxiety symptoms and positive and negative affect items, the final sample was 7026. A disease count of 10 conditions (heart disease, hypertension, arthritis, osteoporosis, diabetes, lung disease, stroke, dementia, cancer, fracture) was used. Results: Factor analysis indicated a one factor structure for disease count was tenable, although cancer did not appear to fit the model. Therefore, a count of the nine other diseases was used. Disease count was related to increased depressive symptoms, anxiety symptoms and negative affect and less positive affect. All individual diseases including cancer were related to worse mental health as was having two or more conditions. Disease count, having two or more conditions and several individual diseases (heart disease, hypertension, arthritis, cancer and fracture) were also related to increases in social network size while other individual diseases (osteoporosis, diabetes, lung disease, stroke and dementia) were related to decreases in social network size. All the measures of multimorbidity and individual diseases were associated with the increased odds of activity limitations. Conclusions: Results support a broader focus for older adults with multimorbidity that includes mental health needs.

The relationship of age, function, and psychological distress in multiple sclerosis

Age is related to less distress in several populations including people with multiple sclerosis (MS). One theory posits this is due to decreased emotional reactivity and better coping as people age and we attempted to test this theory in MS. We used a cross-sectional survey of 429 people with MS. Participants completed measures of physical and cognitive function, depressive symptoms and anxiety. Age moderated the relationship of physical function to distress, such that decreased physical function was related to more distress in younger participants. Age moderated the relationship of cognitive function to depression, such that decreased cognitive function was related to more depressive symptoms in younger participants. Age did not moderate the relationship of cognitive function and anxiety. The effect was only seen in women with MS; however, there were fewer men in the sample. The results are consistent with the theory of decreased emotional reactivity and better coping with age. However, we were unable to test this in much older adults (75+ years of age).

A differential item function analysis of somatic symptoms of depression in people with cancer.

BACKGROUND The overlap of somatic symptoms of depression with symptoms of cancer treatment is widely acknowledged and studied. However, this literature provides little guidance for clinicians as to whether these items should be used in assessing depression. The current study examined the appropriateness of using somatic items for assessment of depression in people with cancer. METHODS People with newly diagnosed breast, lung or colorectal cancer (n=251) completed the Patient Health Questionnaire-9 (PHQ9) shortly after cancer diagnosis but before cancer treatment (baseline), 4 months later, typically during or shortly after treatment, and 12 months later. Pharmacy data was used to classify participants as having low somatic symptoms or high somatic symptoms. Differential item function (DIF) compared the functioning of the somatic items of the PHQ9 in the low vs. high symptom groups and the chemotherapy vs. no chemotherapy groups at the 4-month assessment. RESULTS Significant DIF was not found on any of the four somatic items of the PHQ9 and differences in the item parameters of the somatic items were not consistent across the groups. However, fatigue and sleep indicated only mild depression. Only removing the fatigue item greatly affected the number screening positive for depression at 4 months (8.3%) but removing the other somatic items did not have as large an effect. Only one participant at baseline screened positive for depression by somatic symptoms alone (no psychological symptoms) and no participants screened positive by somatic symptoms alone at 4 months and 12 months. LIMITATIONS The sample size was small for DIF and consisted of mostly women with breast cancer. CONCLUSIONS Somatic symptoms of depression can continue to be administered to people with cancer, however the fatigue and sleep items should be used with caution.

A yoga & exercise randomized controlled trial for vasomotor symptoms: Effects on heart rate variability

OBJECTIVES Heart rate variability (HRV) reflects the integration of the parasympathetic nervous system with the rest of the body. Studies on the effects of yoga and exercise on HRV have been mixed but suggest that exercise increases HRV. We conducted a secondary analysis of the effect of yoga and exercise on HRV based on a randomized clinical trial of treatments for vasomotor symptoms in peri/post-menopausal women. DESIGN Randomized clinical trial of behavioral interventions in women with vasomotor symptoms (n=335), 40-62 years old from three clinical study sites. INTERVENTIONS 12-weeks of a yoga program, designed specifically for mid-life women, or a supervised aerobic exercise-training program with specific intensity and energy expenditure goals, compared to a usual activity group. MAIN OUTCOME MEASURES Time and frequency domain HRV measured at baseline and at 12 weeks for 15min using Holter monitors. RESULTS Women had a median of 7.6 vasomotor symptoms per 24h. Time and frequency domain HRV measures did not change significantly in either of the intervention groups compared to the change in the usual activity group. HRV results did not differ when the analyses were restricted to post-menopausal women. CONCLUSIONS Although yoga and exercise have been shown to increase parasympathetic-mediated HRV in other populations, neither intervention increased HRV in middle-aged women with vasomotor symptoms. Mixed results in previous research may be due to sample differences. Yoga and exercise likely improve short-term health in middle-aged women through mechanisms other than HRV.

Do depressed newly diagnosed cancer patients differentially benefit from nurse navigation

OBJECTIVE To examine whether the effects of a nurse navigator intervention for cancer vary with baseline depressive symptoms. METHOD Participants were enrolled in a randomized controlled trial of a nurse navigation intervention for patients newly diagnosed with lung, breast or colorectal cancer (N=251). This exploratory analysis used linear regression models to estimate the effect of a nurse navigator intervention on patient experience of care. Models estimated differential effects by including interactions between randomization group and baseline depressive symptoms. Baseline scores on the 9-item Patient Health Questionnaire (PHQ) were categorized into 3 groups: no depression (PHQ=0-4, N=138), mild symptoms of depression (PHQ=5-9, N=76) and moderate to severe symptoms (PHQ=10 or greater, N=34). Patient experience outcomes were measured by subscales of the Patient Assessment of Chronic Illness Care (PACIC) and subscales from an adaptation of the Picker Institutes patient experience survey at 4-month follow-up. RESULTS With the exception of the PACIC subscale of delivery system/practice design, interaction terms between randomization group and PHQ-9 scores were not statistically significant. CONCLUSIONS The intervention was broadly useful; we found that it was equally beneficial for both depressed patients and patients who were not significantly depressed in the first 4 months postdiagnosis. However, because of the small sample size, we cannot conclude with certainty that patients with depressive symptoms did not differentially benefit from the intervention.

Financial difficulty, worry about affording care, and benefit finding in long-term survivors of cancer

To examine the associations of worry about affording care and reporting financial difficulties with benefit finding in long‐term cancer survivors.