To summarize and update the current knowledge regarding the effectiveness of videoconference-based interventions in alleviating loneliness and social isolation among older adults.

A systematic search of the PubMed, Cochrane CENTRAL, EMBASE, CINAHL, and PsycINFO databases was performed in February 2024. Two researchers independently conducted literature screening, risk-of-bias assessment, and data extraction.

Ten studies with 1034 participants were included. The meta-analysis indicated that interventions had a significantly small-to-medium effect on enhancing social support (SMD=0.40, CI=0.13 to 0.66) and small effect on reducing loneliness (SMD=-0.30, CI=-0.50 to -0.10) and depressive symptoms (SMD=-0.34, CI=-0.57 to -0.11). The subgroup analysis showed that familial interaction was identified as a significant intervention component for loneliness, whereas intervention by trained experts was pivotal for depressive symptoms.

This review provides robust evidence from a comprehensive perspective that videoconference-based interventions can be effectively applied as a strategic approach to manage mental health in older adults.

To assess the comparative efficacy of interventions on depressive symptoms and disorders in older adults living in long-term care (LTC).

Systematic review and network meta-analysis.

Older adults living in LTC or equivalent settings.

We searched 6 electronic databases and gray literature sources to identify randomized controlled trials describing pharmacologic or nonpharmacologic interventions. Studies had to measure depression as an outcome in persons living in LTC. Study inclusion and study quality were assessed in duplicate. Population characteristics, descriptions of intervention and control treatments, and end-point depression outcomes for each treatment were extracted from included studies. A network meta-analysis using the standardized mean difference (SMD) of depression scores was completed using a random effects model.

A total of 182 studies were included in the review. The network meta-analysis was completed with 147 studies and included 31 treatment conditions. Compared with usual care, horticulture therapy (SMD, -6.85; 95% Credibility Interval, -8.49 to -5.22) and cognitive behavioral therapy (SMD, -1.98; 95% Credibility Interval, -2.91 to -1.05) were the most efficacious treatments. Animal therapy, group reminiscence therapy, multicomponent nonpharmacologic treatments, exercise, and socialization interventions also significantly improved depressive symptoms compared with usual care.

Many nonpharmacologic treatments for depression in LTC have been studied and are found to be efficacious. The low-risk and cost-effective nature of many of the nonpharmacologic treatments makes them ideal for use in LTC. More studies of pharmacologic treatments are needed to inform prescribing for depression in the LTC population. The range of treatments available for depression may help clinicians select therapies individualized to resident needs.

Background and Objective: The association between depression severity and cardiovascular health (CVH) represented by Life's Essential 8 (LE8) was analyzed, with a novel focus on ranked levels and different ages. Machine learning (ML) algorithms were also selected aimed at providing predictions to suggest practical recommendations for public awareness and clinical treatment. Methods: We included 21,279 eligible participants from the National Health and Nutrition Examination Survey (NHANES) 2007-2018. Weighted ordinal logistic regression (LR) was utilized with further sensitivity and dose-response analysis, and ML algorithms were analyzed with SHapley Additive exPlanations (SHAP) applied to make interpretable results and visualization. Results: Our studies demonstrated an inverse relationship between LE8 and elevated depressive levels, with robustness confirmed through subgroup and interaction analysis. Age-specific findings revealed middle-aged and older adults (aged 40-60 and over 60) which showed higher depresion severity, highlighting the need for greater awareness and targeted interventions. Eight ML algorithms were selected to provide predictive results, and further SHAP would become ideal supplement to increase model interpretability. Conclusions: Our studies demonstrated a negative association between LE8 and elevated depressive levels and provided a suite of ML predictive models, which would generate recommendations toward clinical implications and subjective interventions.

Depression is an important public health issue. Over the years, the consumption of antidepressants has increased in the population, which on one hand may mean increased diagnostic accuracy, but on the other could mean a problem of inappropriate consumption and prescribing. The aim of the study is to analyze trends in antidepressant consumption and major drug classes in Italy in the last 15 years to provide useful public health insights for policymakers. Data were collected from Osservasalute and OsMed reports from 2008 to 2022. We included the overall consumption of antidepressants and the three subclasses of the most widely used antidepressant drugs: selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs). Data were expressed as the daily defined dose (DDD) per 1,000 inhabitants. A joinpoint analysis was conducted for each data point in order to describe the trend and identify the Annual Percentage Change (APC) and the Average Annual Percent Change (AAPC). In Italy, there was an increase in antidepressant consumption of 36.7% over the period. Overall, Joinpoint analysis shows a significant AAPC of + 2.31%. Analyzing the subclasses also showed a significant increase in the consumption of SSRIs (AAPC = 1.46%) and SNRIs (AAPC = + 2.14%). In contrast, there was a significant decrease in the consumption of TCAs (AAPC = - 1.46%). The trend of antidepressant use has been increasing steadily over the considered period. Public Health plays a key role in proposing solutions to improve the mental health of the population. Targeted interventions must be carried out to raise awareness among policy makers, clinicians and the population.

Later life depression is an important mental health concern requiring knowledge and skill competencies for behavioral health providers. This study developed and evaluated the initial validity of the Later Life Depression Knowledge Questionnaire (LLD-KQ) as a measure of clinical knowledge of later life depression.

Domain identification, item generation, and content validity were first explored with five geropsychologists. Initially drafted questions were pre-tested with 10 additional geropsychologists. A pool of prospective survey items was administered to licensed masters-level social workers (n = 300) for individual item examination, confirmatory factor analyses testing 1- and 3-factor models, and initial estimates of reliability and validity.

From the pool of items pertaining to three identified domains (i.e. psychopathology, assessment/diagnosis, and treatment), 25 items were retained for the final LLD-KQ. The three-factor CFA model did not demonstrate adequacy above that of the single factor CFA model. The results provide initial support for internal consistency and construct validity.

Initial psychometric support for the LLD-KQ was observed while further research on scale dimensionality is warranted.

The LLD-KQ may advance research on behavioral health providers' knowledge of later life depression to evaluate the current state of specialized knowledge in mental health and aging.

Late-life depression (LLD) stands as a prevalent mental health issue among older adults, frequently intertwined with cardiovascular and cerebrovascular diseases as well as cognitive decline. The occurrence of LLD in the older adults, who often present with multiple aging-related conditions, frequently results in this disorder being overlooked. However, the astronomical treatment costs and the considerable societal burden associated with LLD necessitate urgent and sustained attention.

Utilizing data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 (GBD 2021), we extracted incidence rates and disability-adjusted life years (DALYs) of LLD in individuals aged 60 and older. The extracted data underwent rigorous evaluation through the application of age-period-cohort models, the health inequality concentration index, and frontier analysis.

From 1990 to 2021, a global increase was observed in both the age-standardized incidence rate (ASIR) and DALY rate of LLD. Specifically, the ASIR ascended by 0.01 per 100,000 annually, while the DALY rate rose by 0.03 per 100,000 each year. Notably, a statistically significant inverse relationship was identified between ASIR and the Socio-demographic Index (SDI) (p < 0.001). Additionally, a notable linear correlation was discerned between age-standardized death rate (ASDR) and SDI, albeit without a discernible downward trend (p < 0.001). According to the SDI, the Estimated average percentage change (EAPC) of five SDI districts showed no increase or decrease. Globally, the incidence of LLD showed an upward trend in the high SDI, middle SDI, and low-middle SDI regions, a downward trend in the high-middle SDI region, and no significant increase or decrease in the low SDI region. In the age-period-cohort analysis, we found that the incidence of LLD increased with age in high and middle SDI regions compared with low SDI regions, and the results were the opposite in low SDI regions, with significant regional characteristics. The period effect analysis revealed that irrespective of gender, the trends in incidence and DALY rates remained relatively unchanged globally from 1992 to 2021. As SDI levels rose, the SDI-adjusted disparities in incidence and DALY rates tended to stabilize. A comparative analysis of data from 1990 to 2021 highlighted a relative decline in health inequalities.

This comprehensive assessment of the disease burden of LLD among the global population aged 60 and older underscores significant accomplishments while simultaneously emphasizing areas requiring ongoing vigilance. In the context of relentless population growth and aging, the favorable downturns in incidence and DALY rates reflect tangible advancements in managing LLD.

As a highly prevalent and disabling mental health condition among older adults, the epidemiology of depressive disorders could have evolved with global ageing. We aimed to assess the global, regional, and national burdens and trends of depressive disorders among older adults aged ≥ 55 years.

We retrieved data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 on the incidence, prevalence and disability-adjusted life-years (DALYs) of depressive disorders for older adults. Estimated annual percentage changes were calculated to quantify the temporal trends.

In 2021, there were an estimated 93.1 million (95 % UI 80.4-108.5) older adults with depressive disorders globally, representing a substantial increase of 136.1 % from the 1990 estimates. The number of DALYs globally in 2021 was 14.8 million (10.3-20.1) for depressive disorders. The largest increase in DALYs was observed in High-income Asia Pacific, while the largest reduction was in Eastern Europe. In terms of risk factors, the corresponding estimated annual percentage change for intimate partner violence was -0.02 % (-0.11 to 0.07), and for childhood sexual abuse and bullying was -0.22 % (-0.30 to -0.14), from 1990 to 2021.

For three decades, improved health conditions had not resulted in the expected decline in depressive disorders burdens among older adults, highlighting the need for health policy attention, especially in countries with low to medium Socio-demographic Index. It is important to align funding priorities with epidemiological shifts in low- and middle-income countries to mitigate depressive disorders burdens among this population.

Recent evidence from clinical and animal studies with anti-inflammatory agents in depression is conflicting. One possible reason is the heterogeneity of baseline inflammation levels. Since older adults are generally associated with chronic low-grade inflammation and depression is one of the most common mental disorders in this population, this meta-analysis aimed to evaluate the therapeutic and preventative effects of anti-inflammatory interventions for depression among older adults. PubMed, Cochrane Library, Embase, and PsycINFO were searched for randomized controlled trials (RCTs) up to November 18, 2024. The primary outcomes were mean change scores of depression scores and incidences of depression after treatment. Pooled standard mean differences (SMDs) and odds ratios (ORs) including 95% confidence intervals (95% CI) were calculated. Of 3116 screened articles, 31 RCTs met the inclusion criteria, with 25 studies investigating efficacy and 7 studies investigating the incidence following anti-inflammatory treatment. Anti-inflammatory interventions were statistically significantly more effective than placebo in reducing depressive scores for older adults with depression (SMD = -0.57, 95% CI = -0.98 to -0.15, p = 0.008). Sub-group analyses supported the use of omega-3 fatty acids (SMD = -0.14, 95% CI = -0.27 to -0.02, p = 0.03) and botanical drug or dietary intervention (SMD = -0.86, 95% CI = -1.58 to -0.13, p = 0.02) among older participants. While limited by substantial heterogeneity among included studies, these results reveal the moderate beneficial effects of anti-inflammatory interventions for the treatment and prevention of depression among older adults. Future high-quality RCTs are warranted to determine which anti-inflammatory interventions are most preferential for older patients with depression.

The risk factors for motoric cognitive risk syndrome (MCR) remains unclear, and a lack of predictive studies on the risk of developing MCR. This proof-of-concept study aims to investigate the risk factors of MCR, and develop and internally validate a prediction system to assess the risk of MCR in older Chinese adults.

Through performing a meta-analysis to obtain the risk factors and pooled risk ratio of MCR, the Rothman-Keller model which could be used to predict risk level of MCR was constructed. A total of 5020 participants from the CHARLS were used to validate discrimination and calibration of model. Predictive performance was assessed using AUC-ROC, accuracy, sensitivity, and specificity.

The pooled prevalence of MCR was 12.0 %. The results of the meta-analysis showed that there are eleven significant risk factors of MCR, including age, sex, marital status, diabetes, stroke, depression, falls, physical inactivity, social isolation, fear responses, and hospitalization, with RRi of 3.00, 1.29, 1.21, 1.53, 2.90, 2.13, 2.95, 1.46, 0.79, 1.55, and 1.31, respectively. Rothman-Keller model performed well to predict MCR risk with an AUC-ROC of 0.631 (95 %CI: 0.610-0.653), and the score was well calibrated (chi-square test for goodness-of-fit = 5.981, P = 0.649).

MCR is highly prevalent in China, caused by the complex interaction of genetics, comorbidities, and lifestyle factors. This study serves as proof-of-concept that Rothman-Keller model performs a good calibration and fair discrimination, which can be used as a simple, time-saving, and cost-effective mean to assess and monitor the risk level of MCR.

Environmental enrichment (EE) is a significant approach to influencing brain function by altering the environment and changing living conditions and has been shown to modulate mood-related diseases, including depression. Among the elderly, depression is particularly prevalent and is often linked to social isolation. However, the specific role of EE in social isolation-related geriatric depression remains imprecise. This study was intended to explore the status of EE exposure in geriatric depression and to uncover its underlying mechanisms. We utilized 19-month-old male C57BL/6J mice, which are equivalent to humans aged 50-60 years, and induced depression through social isolation. After 2 weeks of social isolation, mice were identified as depressive by using the sugar preference test and then classified into either standard or enrichment environment groups for 4 weeks. Subsequently, conventional indices associated with depression, including neurogenesis, neurotrophic factors, and neuroinflammation, were measured. Results display that EE alleviated the depressive-like symptoms in elderly mice and enriched their social activities. Concurrently, EE regulated levels of certain neurotransmitters in the hippocampus, including the systems of glutamate, tyrosine, and histamine. Moreover, the ability of neurogenesis also increased in the hippocampus of EE mice. At the neuroinflammation level, the activation of Natural Killer (NK) cells and ARG1+ microglia is considered a major contributor to mediating the effects of EE-regulated geriatric depression. Collectively, these results underline the importance of EE in the treatment of geriatric depression and partially elucidate its underlying mechanism, offering valuable suggestions for treating social isolation--related depression via environmental modulation.

Traditional Chinese medicine (TCM) body constitution is a key factor in determining and influencing the occurrence, development, and variation of diseases. As the mind interact with the body, TCM body constitution is useful in preventing and treating psychiatric disorders and insomnia.

To investigate the interrelationship between TCM body constitution, psychiatric disorders and sleep quality.

A total of 2441 participants were enrolled in our study. TCM body constitution was measured using the Constitution in Chinese Medicine Questionnaire, sleep quality was assessed using the Chinese version of the Pittsburgh Sleep Quality Index, and psychopathological symptoms were evaluated using Symptom Checklist-90. Logistic regression was used to estimate the interrelationship between TCM body constitution, psychiatric disorders and sleep quality.

The Pittsburgh Sleep Quality Index score and the proportions of participants with Qi-deficiency constitution, Qi-stagnation constitution, and blood-stasis constitution were significantly higher in the psychiatric symptoms group. Additionally, psychiatric symptoms were considerably associated with sleep quality, Qi-deficiency constitution, and Qi-stagnation constitution, but were inversely associated with male sex. Obsessive-compulsive symptoms were considerably associated with sleep quality, Qi-deficiency constitution and Qi-stagnation constitution. Depression was considerably associated with sleep quality, hyperuricemia, and Qi-stagnation constitution. Anxiety was considerably associated with sleep quality, diabetes, and Qi-stagnation constitution. Finally, poor sleep quality was considerably associated with Qi-deficiency constitution, Qi-stagnation constitution, dampness-heat constitution, phlegm-dampness constitution, and blood-stasis constitution but was inversely associated with male sex and body mass index > 23.9.

TCM body constitutions are strongly associated with psychiatric symptoms and sleep quality. Further research is needed to verify whether TCM body constitution can be used to treat and prevent psychiatric conditions as well as enhance sleep quality.

Understanding the differences between various instruments for assessing depression will help researchers and health practitioners to choose a more appropriate tool and develop a framework to enhance resilience to mental health problems in the older population. The current study aimed to compare the 10-item Center for Epidemiological Studies-Depression (CES-D) scale with the Composite International Diagnostic Interview-Short Form (CIDI-SF) for measuring depressive symptoms in older Indians.

Data came from the first wave of the Longitudinal Aging Study in India (LASI) which was conducted during 2017-19. The final sample included 30,368 older individuals aged 60 years and above (15,824 women and 14,544 men). The level of agreement between the CES-D and CIIDI-SF instruments for depression classification was assessed using Kappa coefficients at various cut-off values. Multivariable logistic regression models were used to examine the associations between background characteristics and depressive symptoms assessed by both instruments.

The prevalence of depressive symptoms based on the CES-D instrument was higher than that of CIDI-SF (30.2% vs. 8.3%). The level of agreement between the CES-D and CIDI-SF for depression classification was 'none' to 'minimal' (κ = 0.04-0.24). Assuming the CIDI-SF scale as the "gold standard", with rising threshold values, sensitivity of the CES-D scale decreased while specificity increased. The CES-D scale yielded a sensitivity of 29-82% and specificity of 39-92% across cut-off values of 3 to 6. The Pearson correlation between the CIDI-SF and CES-D total scores was significant but weak (r =.20). Multivariable analysis showed that depressive symptoms were more prevalent among women, those with higher education, individuals living alone, those with diagnosed psychiatric disorders, and individuals with two or more chronic conditions, compared to men, those who were uneducated, those not living alone and healthier peers, when assessed using both CES-D and CIDI-SF scales. The associations of marital status, religion and wealth quintiles were significant only for depressive symptoms assessed using the CES-D scale.

Depression cases identified by the CES-D showed poor agreement with those identified by the CIDI-SF. Therefore, the prevalence of depressive symptoms measured by the CESD is not interchangeable with that measured by the CIDI-SF. These findings suggest the importance of using both the CES-D and CIDI-SF in large population-based cohorts and surveillance surveys to obtain more accurate and nuanced understanding of depressive disorders across various subgroups of the older population.

Depression is prevalent among older adults, particularly those with somatic comorbidities, and is linked to cognitive decline and reduced quality of life. Driving may act as a protective factor by enhancing cognitive function and social engagement. However, few prospective studies have investigated this association. This study aimed to assess whether driving was associated with a lower risk of new-onset depression and lower antidepressant medication.

This ancillary study of the prospective S.AGES cohort (Sujets AGÉS-Aged Subjects) which included 3,434 participants (mean age 77.6 ± 6.2 years) with somatic comorbidities (chronic pain, type 2 diabetes, or atrial fibrillation) enrolled between 2009 and 2014. Driving status was recorded at baseline, and participants were monitored for 36 months. Depression was measured by the Geriatric Depression Scale (GDS), and antidepressant prescription was recorded at follow-up. Time-to-event analyses were performed on propensity-matched cohorts comparing drivers and non-drivers for new-onset depression (GDS ≥ 5/15) and antidepressant use.

In the first cohort (126 drivers and 126 matched non-drivers), drivers had a significantly lower risk of new-onset depression (hazard ratio [HR] = 0.58 [0.40-0.86]). In the second cohort (368 drivers and 368 non-drivers), drivers had a lower risk of antidepressant use (HR = 0.49 [0.29-0.84]).

Driving at baseline was associated with a reduced risk of depression and antidepressant prescription in older adults with somatic comorbidities, highlighting the potential importance of maintaining mobility and driving to support mental health in this population.

The study was registered at ClinicalTrials.gov NCT01065909 with a first registration date of February 8, 2010.

To validate the Depression, Anxiety, and Apathy (DA3) scale for assessing symptoms of depression, anxiety, and apathy in community-dwelling mid- and late-life adults with and without cognitive impairment.

Cross-sectional psychometric validation study.

Community-based longitudinal study of brain health.

A total of 252 participants (mean age, 68.8 ± 9.4 years; 68.5% women; 71.3% non-Hispanic White; 66.8% cognitively normal) completed the study.

The DA3 scale was compared with established measures of mood including the Hospital Anxiety and Depression Scale (HADS), Apathy Scale (AS), Generalized Anxiety Disorder-7 (GAD7), Patient Health Questionnaire-8 (PHQ8), and Neuropsychiatric Inventory Questionnaire (NPI-Q). Psychometric properties were assessed using reliability and validity measures, confirmatory factor analysis (CFA), and Mokken scale analysis.

The DA3 demonstrated strong internal consistency (Cronbach's alpha, 0.670-0.781). CFA supported a three-factor model corresponding to distinct depression, anxiety, and apathy dimensions, with excellent goodness-of-fit. Mokken analysis confirmed acceptable-to-strong scalability (H coefficients, 0.36-0.54). The DA3 subscales demonstrated strong convergent validity with established measures (e.g., HADS, AS, GAD-7, and PHQ-8). Cut-off scores of five on each subscale achieved optimal agreement with gold standard measures. Performance of the DA3 was consistent across sociodemographic, neuropsychological, and cognitive subgroups.

The DA3 is a unitary, brief, valid, and reliable tool for assessing depression, anxiety, and apathy in community-dwelling older adults, including those with cognitive impairment. Its strong psychometric properties support its use in both clinical and research settings. Future studies should examine its longitudinal utility to better understand its role in tracking mood symptoms over time.

Participatory interventions, such as art therapy and group activities, have been shown to promote healthy aging. However, the effectiveness of shared reading among older adults requires further evidence. The aim of this systematic review was to explore the impact and effectiveness of shared reading groups in slowing cognitive impairment, improving social interaction, promoting psychosocial well-being, and enhancing functional aspects among older adults living in the community. The selection criteria included studies published in English after 2000 focusing on individuals aged 60 and above and examining the benefits of shared reading. The studies also included participants with cognitive or psychiatric conditions who were independent. Seven databases were queried for this research. A total of 11 articles met the inclusion criteria. A descriptive analysis of the included studies revealed the tools used to measure the impact of interventions on outcomes and the key results obtained. Despite variability in methodology and outcomes, the results showed that group activities can improve self-rated health and reduce depressive symptoms in older adults. Interventions that include reading as a form of cognitive stimulation enhance communication skills, contribute to well-being, improve quality of life, reduce loneliness, and increase social engagement. Shared reading has positive effects on satisfaction with social relationships and community support. The findings suggested that shared reading groups represent a promising, non-pharmacological intervention for promoting psychological health, well-being, and social interaction. This review gathers existing literature and highlights the need for further studies to explore the effectiveness of this approach and to improve its implementation.

It is known that the serotonin and norepinephrine systems change with age. Consequently, response to antidepressants having different effects on these two systems may vary between patients of different ages. We systematically searched Embase/Medline/PsychINFO until December 2024 for randomised controlled trials (RCT) in patients with unipolar major depressive disorder comparing response rates to serotonergic versus noradrenergic antidepressants (PROSPERO pre-registration #CRD42020145386). Our primary outcome was to assess the effect of age on response rates to serotonergic versus noradrenergic antidepressants in unipolar depression. We then performed a pooled analysis of individual participant data (IPD). Seventy-four RCTs with a total of 8981 participants (4488 with serotonergic and 4493 with noradrenergic antidepressants) were included in the meta-analysis. We found no differences in the response rates to the two antidepressants, although the improvement in depressive symptoms was greater in the noradrenergic arm (subset of n = 31 studies, z = -2.61; p = 0.009); younger age was associated with a greater response to serotonergic than noradrenergic agents both in terms of response rates (estimate = -0.011; p-value = 0.041) and symptom improvement (estimate = -0.016; p-value<0.0001), even after controlling for year of publication, study design, baseline severity, type of noradrenergic medication, inpatients, and dropout rates. The effect of age on antidepressant response was also confirmed in the IPD pooled analysis (n = 339), in which responders to serotonergic antidepressants were significantly younger than non-responders (p-value = 0.028) and than responders to noradrenergic antidepressants (p-value = 0.034). Our study highlights the importance of age when considering the efficacy of serotonergic versus noradrenergic antidepressants as part of a precision psychiatry-oriented approach.

As people age, the efficiency of various regulatory processes that ensure proper communication between cells and organs tends to decline. This deterioration can lead to difficulties in maintaining homeostasis during physiological stress. This includes but is not limited to cognitive impairments, functional difficulties, and issues related to caregivers which contribute significantly to medication errors and non-adherence. These factors can lead to higher morbidity, extended hospital stays, reduced quality of life, and even mortality. The decrease in homeostatic capacity varies among individuals, contributing to the greater variability observed in geriatric populations. Significant pharmacokinetic and pharmacodynamic alterations accompany ageing. Pharmacokinetic changes include decreased renal and hepatic clearance and an increased volume of distribution for lipid-soluble drugs, which prolong their elimination half-life. Pharmacodynamic changes typically involve increased sensitivity to various drug classes, such as anticoagulants, antidiabetic and psychotropic medications. This review examines the primary age-related physiological changes in geriatrics and their impact on the pharmacokinetics and pharmacodynamics of medications.

Escitalopram is commonly prescribed for depressive and anxiety disorders in elderly patients, who often show variable drug responses and face higher risks of side effects due to age-related changes in organ function. The CYP2C19 polymorphism may further affect escitalopram pharmacokinetics in elderly patients, complicating dose optimization for this group. Previous pharmacogenetic studies examining the impact of CYP2C19 phenotype on escitalopram treatment outcomes have primarily focused on younger adults, leaving a gap in understanding its effects on the elderly. The aim of this investigation is to determine the impact of CYP2C19 phenotypes on escitalopram exposure in geriatrics using a physiologically-based pharmacokinetic (PBPK) model with geriatric-specific parameters and our clinical sample of 88 elderly patients with major depressive disorder. Based on PBPK simulations, the exposure of escitalopram in CYP2C19 poor metabolizers (PMs) was 2.1-fold higher compared with CYP2C19 extensive metabolizers (EMs). In line with PBPK results, the dose-normalized trough concentration in our clinical sample varied according to CYP2C19 phenotype (P = 0.0132), with PMs having a 1.6-fold higher concentration than EMs. Based on simulated and observed results, it is suggested that an escitalopram dose of 10 mg/day maybe appropriate for PMs, while a maximum dose of 20 mg/day could be used for EMs and IMs who do not achieve therapeutic responses at 10 mg/day. These findings suggest that CYP2C19 genotyping in elderly patients could be beneficial for tailoring dosing regimens in clinical practice, potentially improving treatment outcomes and reducing the risk of adverse drug reactions associated with escitalopram in this vulnerable group.

Chronic stress constitutes a major precipitating factor for Major Depressive Disorder (MDD), and comprehending individual differences in stress responses is crucial for the development of effective intervention strategies for MDD. Recent studies indicate that an individual's vulnerability to chronic stress is closely associated with gut microbiota composition, but the underlying mechanisms remain unclear. This study aims to investigate whether the gut microbiota and its metabolites can serve as gut-brain signaling molecules and explores how the gut microbiota affects stress sensitivity. Here, we showed that gut microbiome-derived indole-3-carboxaldehyde (I3C) can act as a gut-brain signaling molecule that links tryptophan metabolism by gut microbes to stress vulnerability in the host. First, we identified a specific reduction in gut microbiome-derived I3C levels in the hippocampus and colon through untargeted and targeted metabolomic analyses. Then, the study of gut microbiota suggested that the relative abundance of lactobacillus was reduced significantly in stress-susceptible rats, whereas fecal microbiota transplantation regulates stress vulnerability. Furthermore, supplementation with I3C and the representative I3C-producing strain, Lactobacillus reuteri, was shown to alleviate depression-like behaviors induced by chronic stress. Further research confirms that I3C can inhibit neuroinflammation and promote hippocampal neurogenesis through the aryl hydrocarbon receptors (AhR) signal pathway, thereby mitigating the host's susceptibility to stress. In conclusion, our findings elucidate that the gut microbiome-derived-I3C can help buffer the host's stress through the AhR/SOCS2/NF-κB/NLRP3 pathway, providing a gut-brain signaling basis for emotional behavior.

Being physically inactive can worsen mental health. Physical inactivity and depression are associated, but the temporal precedence and underlying mechanism are unclear; symptoms affecting future physical activity may not be the same symptoms as those associated with and affected by it. We used large European cohort (Survey of Health, Ageing, and Retirement in Europe, SHARE, N = 124, 526) to study temporal associations between physical inactivity and individual depressive symptoms. Multivariate regression with robust standard errors were used to analyze how physical inactivity is associated with later depression and how depressive symptoms predict later physical inactivity. After adjusting the models for demographics, other health behaviors, BMI, and chronic diseases, physical inactivity was prospectively associated with 10 of the 12 depressive symptoms and 7 of the 12 baseline depressive symptoms were prospectively associated with physical inactivity. These findings were robust for adjusting for antidepressant medication. Age-stratified analyses suggested that the associations between physical inactivity and depressive symptoms were independent of age. Omitting the most influential symptom, lack of enjoyment, from the sum score attenuated the association by 13% in the longitudinal and by 26% in the cross-sectional analyses. These findings suggest that physical inactivity and depression are bidirectionally associated even at symptom-level.

Frailty and depression are highly prevalent in older adults. However, the complex association of their interlinked factors, including lifestyle behaviors, remains unexplored in population-based epidemiological studies.

This study aimed to evaluate the relationship between frailty and depression and to determine associated modifiable lifestyle risk factors for depression among older adults in the UK Biobank (UKB).

Data were obtained from 69,178 older adults (aged ≥ 65 yrs) in the baseline survey of the UKB. Frailty status was measured using the frailty phenotype criteria (range: 0-5). Participants were classified into frail (≥ 3), pre-frail (1-2), and non-frail (0) groups. The outcome of depression was defined by participants who had sought medical attention for nerves, anxiety, tension, or depression. Lifestyle behaviors included the self-reported time spent in moderate-to-vigorous physical activity (MVPA), screen-based sedentary behavior, and sleep. The association of interest is examined using multivariable logistic regression models.

29% of participants had depression, of which 7% and 45% were frail and pre-frail, respectively. Significant correlations are observed between frailty and lifestyle behaviors (p's < 0.05). Frailty is significantly associated with increased odds of having depression (Frail: aOR = 1.87, 95% CI = 1.72, 2.04); Pre-frail: aOR = 1.22, 95% CI = 1.18, 1.27), and sleep (7-8 h/d) is associated with lower odds of having depression (aOR = 0.81, 95% CI = 0.78, 0.84).

Frail and pre-frail older adults have a higher likelihood of experiencing depression than their non-frail counterparts. Meeting the recommended sleep duration (7-8 h/d) can be used as a modifiable behavioral strategy to manage or prevent depression. Further longitudinal studies are warranted to examine the time sequence in this relationship.

Dissemination and Implementation of Function Focused Care for Assisted Living (NCT03459118).

Emerging evidence has shown that mindfulness-based cognitive therapy (MBCT) is effective in improving depressive symptoms in the older population. However, the accessibility to MBCT is limited by the shortage of psychotherapists or mindfulness teachers. One potential solution is to involve social workers, who have the knowledge and skills to promote individual and community well-being in various settings, in delivering modified MBCT to enhance its accessibility and sustainability. This study examined the effectiveness of an eight-week age-modified MBCT led by different mental health professionals (mindfulness teacher only vs. mindfulness teacher and social worker) in improving mental health outcomes as compared with a control group.

Older adults (N = 112) were recruited through five community-based centres for older adults and mental wellness in Hong Kong. Participants were allocated to one of three groups: (1) mindfulness teacher-led modified MBCT, (2) social worker/teacher co-led modified MBCT (50% led by social workers and 50% led by mindfulness teacher), or (3) control (care as usual). The age-modified MBCT consisted of eight weekly sessions, with age-related modifications including more sitting meditation, shortened duration of each session, and the removal of the retreat. Outcome variables (i.e., depressive symptoms, anxiety symptoms, perceived stress, and mindfulness) were assessed at baseline (T0), after the intervention (T1), and four weeks after the intervention (T2), through self-reported questionnaires. Linear mixed models were performed while controlling for demographic variables to examine changes in outcome variables between the groups.

Participants from the age-modified MBCT intervention groups (teacher-led and social worker/teacher co-led) showed significantly greater reductions in depressive symptoms and stress, as well as greater increase in mindful non-reactivity, compared to the control group post-intervention. No significant interaction effect of time and group was found for anxiety and both overall mindfulness and its other facets. The improvements in mental health and mindfulness outcomes post-intervention were not significantly different between the teacher-led and social worker/teacher co-led MCBT groups.

Age-modified MBCT is beneficial in managing depressive and stress symptoms and in improving mindful non-reactivity among older adults at risk for depression. The findings support the feasibility and effectiveness of partial task-shifting in the delivery of MBCT to trained social workers. Future studies may explore the possibility for social workers in leading MBCTs independently to further improve its scalability and service accessibility for older adults in the community.

ClinicalTrials.gov NCT05995587. Retrospectively registered on 16 August 2023.

Middle-aged and older adult men are at a heightened risk of depression. Green tea, as a popular beverage, has drawn widespread attention for its health benefits. However, there remains controversy over the effects of green tea on combating depression and regulating hormones.

This study aimed to investigate the effects of long-term green tea consumption on depression levels, hormones, and brain structure in, middle-aged and older adult men.

A total of 280 volunteers participated in the study, divided into a tea-drinking group and a control group. Basic demographic information and biological marker data, as well as MRI data from some of the volunteers, were collected. A controlled study was conducted to explore the effects of long-term tea drinking on them.

BMI (p = 0.002), depression level (p = 0.003), insomnia severity (p = 0.008), and systemic inflammation index (p = 0.009) were significantly lower in the tea drinking group, and their testosterone levels were significantly higher than those in the control group (p = 0.001). Moreover, GM volume in the right precuneus in the control group was significantly reduced compared with that in the tea drinking group.

Long-term tea consumption helps reduce BMI and increase testosterone levels in middle-aged and older adult men, and it can also reduce their risk of depression by lowering inflammation and improving sleep quality. Additionally, long-term tea consumption may have the potential to delay brain aging in middle-aged and older adult men.

Background and Objectives: Subthreshold depression (StD) presents with depressive symptoms similar to major depressive disorder (MDD) but of lower intensity. Despite its milder form, StD is significantly prevalent in the older population, affecting up to 12.9%. StD is associated with adverse outcomes, such as an increased risk of MDD and mild cognitive impairment (MCI). Treating StD in older adults is challenging due to the limited efficacy and side effects of traditional antidepressants. As a result, clinicians often adopt a "watchful waiting" strategy, which increases the risk of StD progressing into MDD or MCI. Choline alphoscerate (α-GPC), a cholinergic drug, is indicated in the treatment of pseudodepression in the elderly, a condition that corresponds to the actual definition of StD. This review highlights the role of α-GPC in the treatment of StD in older subjects. Methods: A comprehensive review of preclinical and clinical studies was conducted, focusing on the efficacy of α-GPC in improving cognitive and behavioral functions in mental conditions and in modulating neurotransmitter systems involved in depression, such as dopamine and serotonin. Results: Evidence points to the therapeutic benefits of using α-GPC in StD as it acts on cholinergic dysfunction and cognitive impairment. Additionally, it may improve mood regulation and motivation, key factors in StD and in depressive disorders. These findings suggest that α-GPC may reduce the risk of progression from StD to MDD or MCI. Conclusions: α-GPC represents an effective and safe therapeutic option for the treatment of StD in the older population, improving clinical outcomes and enhancing the quality of life in this high-risk group.

The relationship between depression and cognition in middle-aged adults is a topic of interest. Whether poor cognitive function exacerbates depression remains controversial. We clarified the association between cognitive decline and depression based on six nationwide cohorts.

89,056 participants were retrieved from six cohorts in Europe, North America, Asia and Africa. Each two consecutive interviews were collected as a sample set with a total of twenty-eight sample sets to assess changes in depression and cognitive function. Multiple linear regression was conducted within each sample set to evaluate the association between cognitive decline and depression. A two-stage meta-analysis was performed to obtain the average effect within each cohort and the overall effect excluding population and regional heterogeneity. Meta-regression and subgroup analysis were used to explore heterogeneity and potential effect modifiers.

Almost all sample sets indicated negative association between changes in cognitive function and depression scores. The average effects varied across regions: Korea (-0.150 [-0.175, -0.126]), Europe (-0.130 [-0.149, -0.112]), South Africa (-0.090 [-0.129, -0.060]), China (-0.083 [-0.137, -0.030]), Mexico (-0.063 [-0.084, -0.042]), and North America (-0.048 [-0.056, -0.040]). The overall effect excluding population and regional heterogeneity was -0.094 [-0.129, -0.060], and was robust across populations of different age, sex, alcohol consumption, daily living activities and marital status.

The cross-sectional design limited our ability to determine causal relationships.

Cognitive decline was associated with the exacerbation of depression status in middle-aged and older adults worldwide. Country-level factors, rather than individual-level factors, are more likely to modify this effect.

Urban-rural differences in depression are evident among older adults in China but not in the United States. By comparing the two countries, this study aims to explore strategies for promoting regional equality in depression in China.

Data from the China Health and Retirement Longitudinal Study (CHARLS) and the Health and Retirement Study (HRS) were utilized. Longitudinal data were used to describe urban-rural differences in depression prevalence among older adults in China (2011-2020) and the United States (2010-2020). Cross-sectional data from 2018 (CHARLS: 9840 participants; HRS: 10,381 participants) were used to identify key modifiable factors. A random forest algorithm was employed to determine the most important factors influencing depression, and comparisons between the two countries were made to identify modifiable factors. Multivariate logistic regression was used to analyze the relationship between these key modifiable factors and depression. A mediation model was applied to assess the mediating role of key modifiable factors in the relationship between residence and depression.

1) From 2011 to 2020, Urban-rural differences in depression prevalence among older adults were observed in China, but not in the United States. 2) In both China and the U.S., the top five factors ranked by importance were activities of daily living disability (ADLs), instrumental activities of daily living disability (IADLs), pain levels, self-reported health (SRH), and age. However, Urban-Rural Differences in ADLs, IADLs, and SRH were present in China but not in the United States. 3) ADLs, IADLs, and SRH collectively mediated 31.6 % (95 % CI: 0.268 - 0.360) of the relationship between residence and depression scores among older adults in China.

Urban-rural differences in physical health status (ADLs, IADLs, and self-reported health) among older adults in China are associated with Urban-Rural Differences in depression. The absence of such inequalities in the U.S. may offer insights for developing policies to promote regional equality in depression among older adults in China.

Background and Objectives: Depression is a common mental problem in the older population and has a significant impact on recovery and general well-being. A comprehensive understanding of the prevalence of depressive symptoms and their effects on functional outcomes is essential for improving care strategies. The primary aim of this study was to determine the prevalence of depressive symptoms in older patients undergoing geriatric rehabilitation and to assess their specific impact on their functional abilities. Materials and Methods: A retrospective study was conducted at the Lucerne Cantonal Hospital in Wolhusen, Switzerland, spanning from 2015 to 2020 and including 1159 individuals aged 65 years and older. The presence of depressive symptoms was assessed using the Geriatric Depression Scale (GDS) Short Form, while functional abilities were evaluated using the Functional Independence Measure (FIM) and the Tinetti test. Data analysis was performed using TIBCO Statistica 13.3, with statistical significance set at p < 0.05. Results: Of the participants, 22.9% (N = 266) exhibited depressive symptoms, with no notable differences between genders. Although all patients showed functional improvements, the duration of rehabilitation was prolonged by two days (p = 0.012, d = 0.34) in those with depressive symptoms. Alarmingly, 76% of participants were classified as at risk of falling based on the Tinetti score. However, no significant correlation was found between the GDS and Tinetti scores at admission (p = 0.835, r = 0.211) or discharge (p = 0.336, r = 0.184). The results from the non-parametric Wilcoxon matched-pairs test provide compelling evidence of significant changes in FIM scores when comparing admission scores to those at discharge across all FIM categories. Conclusions: Depressive symptoms are particularly common in geriatric rehabilitation patients, leading to prolonged recovery time and increased healthcare costs. While depressive symptoms showed no correlation with mobility impairments, improvements in functional status were directly associated with reduced GDS scores. Considering mental health during admission and planning is critical in optimizing rehabilitation outcomes.

As primary care practices increase depression screening, it is unknown whether screening is associated with appropriate and equitable treatment.

To investigate factors associated with initial treatment among patients who screen positive for depression and/or suicidal ideation (SI).

Cohort study using electronic health record data from September 2017 to September 2021, from a large US academic health system. Participants were adult primary care patients with elevated depressive symptoms (Patient Health Questionnaire-9 score ≥10) and/or SI, excluding patients with baseline depression, bipolar disorder, schizophrenia, schizoaffective disorder, or dementia. Data were analyzed from December 30, 2022, to February 17, 2024.

Patient characteristics including gender, age, preferred language, and race and ethnicity.

Primary outcome was antidepressant or mental health referral ordered at screening. Secondary outcomes were antidepressant/referral and antidepressant/referral or follow-up visit within 8 weeks.

Of 60 062 patients screened, 3980 (7%) reported elevated depressive symptoms or SI. The cohort was 68.1% women (2711), and the mean (SD) age was 46.5 (17.6) years; 0.8% were 12.4% African American or Black (493), American Indian or Alaska Native (30), 24.8% Asian (988), 14.6% Latino/Latina/Latinx (582), 1.5% Pacific Islander (58), and 36.9% White (1470), and 9.0% other/unknown (359); 5.6% preferred a non-English language (223). Approximately 38% (1518) received antidepressants/referrals when screened (including 44% of 461 patients [203] with SI). By 8 weeks, 2785 patients (70%) received antidepressant/referral and/or follow-up (including 75% of 783 patients with SI). In multivariable logistic regression models adjusting for site and clustered on primary care physician, there were no statistically significant differences in the primary outcome by gender, preferred language, or health insurance. African American or Black and Asian patients had lower estimated probabilities of treatment ordered when screened (34.0% [95% CI, 28.4%-39.6%] for Black patients and 35.4% [95% CI, 31.5%-39.4%] for Asian patients) than White patients (40.5% [95% CI 37.4%-43.5%]). Estimated treatment decreased with increasing age (46.4% [95% CI, 41.2%-51.5%] for patients aged 18-30 years and 17.5% [95% CI, 12.1%-22.9%] for patients aged ≥75 years). Patients with SI had greater estimated treatment than those without SI (43.5% [95% CI, 39.9%-47.1%] vs 35.2% [95% CI, 33.0%-37.5%]), although treatment was overall low for this high-risk group. Secondary outcomes were consistent, although there were no statistically significant differences in follow-up visits for African American or Black and Asian patients compared with White patients.

In this cohort study, moderate rates of initial treatment among patients with elevated depressive symptoms and/or SI were found. Targeted interventions are needed for patients at risk of undertreatment, including patients with SI, African American or Black and Asian patients, and older adults.

Modern psychiatry aims to adopt precision models and promote personalized treatment within mental health care. However, the complexity of factors underpinning mental disorders and the variety of expressions of clinical conditions make this task arduous for clinicians. Globally, major depression is a common mental disorder and encompasses a constellation of clinical manifestations and a variety of etiological factors. In this context, the use of Artificial Intelligence might help clinicians in the screening and diagnosis of depression on a wider scale and could also facilitate their task in predicting disease outcomes by considering complex interactions between prodromal and clinical symptoms, neuroimaging data, genetics, or biomarkers. In this narrative review, we report on the most significant evidence from current international literature regarding the use of Artificial Intelligence in the diagnosis and treatment of major depression, specifically focusing on the use of Natural Language Processing, Chatbots, Machine Learning, and Deep Learning.

Late-life depression (LLD) is often accompanied by cognitive impairment, which may persist despite antidepressant treatment. Repetitive transcranial magnetic stimulation (rTMS) is an efficacious treatment for depression, with potential benefits on cognitive functioning. However, research on cognitive effects is inconclusive, relatively sparse in LLD, and predominantly focused on group-level cognitive changes. This study aimed to explore individual-level cognitive changes following rTMS treatment in patients with LLD.

Data were analyzed from 153 patients with LLD from the FOUR-D study (ClinicalTrials.gov identifier: NCT02998580) who received bilateral standard rTMS or theta burst stimulation (TBS) targeting the dorsolateral prefrontal cortex (DLPFC). Cognitive function was assessed pre- and post-treatment using measures of executive function, information processing speed, and learning and memory. Reliable change indices, adjusted for practice effects and test-retest reliability, were employed to evaluate individual-level cognitive changes. Chi-square tests examined if proportions of cognitive improvers differed from expected proportions.

Cognitive performance from baseline to end of treatment remained stable for most patients. Reliably improved performance was observed in 0.0% to 20.0% of participants across cognitive measures, while worsened performance was observed in 0.0% to 2.7%. A small but significant proportion (20.0%) of participants showed improvement in verbal learning.

Bilateral standard rTMS or TBS of the DLPFC in LLD yielded no substantial cognitive enhancing effects, although a small proportion showed improved verbal learning after treatment. Importantly, both interventions were cognitively safe with relatively stable performance across time. Future research is needed to explore approaches to enhance the cognitive benefits of standard rTMS and TBS in patients with LLD.

Depression long been a key concern for scholars worldwide; however, the field of depression has not received sufficient attention in traditional Chinese medicine. It was not until the 21st century that research into depression gradually entered a period of rapid development, with an increasing number of academic studies published in major journals. However, one limitation of this field is that no scholars have yet summarised the development process and key research issues. Therefore, the present study aimed to summarise the research trends and progress in this field, providing relevant information and presenting potential future research directions for subsequent researchers.

Literature in this field was searched from January 1, 2000 to April 20, 2024 in the Web of Science Core Collection database, to analyse the current status of the literature and publication trends. Bibliographic information, including study authors, organisations, keywords, countries, references, citations, and co-citations, was extracted using CiteSpace and VOSviewer software for quantitative analysis, visual mapping, and scientific evaluation.

A total of 921 papers were included, with a significant increase in the number of publications from 2017 to 2021, and a stable number of more than 140 publications between 2022 and 2023, with publications in these two years accounting for 31.38 % of the total. The Journal of Ethnopharmacology had the highest number of publications (97) and citations (2067), as well as the highest number of co-citations (1369). China (847 publications, 13256 citations), Beijing University of Chinese Medicine (90 publications, 1232 citations), and Qin Xuemei (30 publications, 759 citations) were the most prolific and influential countries, organisations, and authors in the field, respectively. Keyword clustering co-occurrence analysis revealed nine different clusters with good homogeneity. The top three clusters were randomised controlled trials, traditional Chinese medicine, and hippocampal neurogenesis. In the timeline analysis of keywords, from 2000 to 2010, keywords in this field were concentrated on hippocampal neurology and forced swimming test as clustering axes of Traditional Chinese Medicine. From 2010 to 2020, the research hotspots focused on randomised controlled trials and hippocampal neurogenesis. After 2020, keywords became more focused on network pharmacology. In addition, the occurrence time of explosive keywords were distributed before 2010 and after 2020. Before 2010, these keywords included the forced swimming test, Tail Suspension Test, Chronic Cold Stress, Neural Regeneration, and Banxia Houpu Decoction. Conversely, network Pparmacology and Molecular Docking arose as key buzzwords starting in 2020.

This study comprehensively analysed and summarised the research hotspots and trends in this field of research in the 21st century from a bibliometric perspective, further generating a series of visual graphs to help researchers understand the current research status, potential collaborators, collaborating institutions, and potential future research hotspots in this field.

The association between air pollution and depressive symptoms has not been thoroughly investigated, and the role of physical activity (PA) is particularly unclear. Although PA has been shown to alleviate depression, it may also increase exposure to air pollution, potentially exacerbating its adverse effects. A total of 17,332 participants aged 45 years and older from the 2018 wave of the China Health and Retirement Longitudinal Study (CHARLS) were included in this study to assess the causal effect of air pollution on depressive symptoms in China and to clarify the role of PA in this relationship. Depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale (CES-D). Data on particulate matter (PM1, PM2.5, and PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), and carbon monoxide (CO) were obtained from the ChinaHighAirPollutants (CHAP) dataset. PA levels were measured using a standardized questionnaire and categorized as low or high. An instrumental variable (IV) approach was used to estimate the causal effect of air pollution on depressive symptoms. Potential effect modification by PA was assessed. The IV estimates showed that all air pollutants were significantly and adversely associated with depressive symptoms, with a per interquartile range (IQR) increase in PM1, PM2.5, PM10, NO2, SO2, O3, and CO associated with 1.57 (95% confidence interval (CI): 1.15, 1.99), 1.49 (95% CI: 1.10, 1.89), 1.71 (95% CI: 1.26, 2.17), 2.22 (95% CI: 1.62, 2.81), 1.30 (95% CI: 0.96, 1.65), 4.67 (95% CI: 3.37, 5.98), and 0.97 (95% CI: 0.71, 1.22) units increase in CES-D scores, respectively. PA significantly modified this association, with higher PA levels mitigating the adverse effects of air pollution on depressive symptoms.

The 2-fold objective of this research is to investigate machine learning's (ML) predictive value for the incidence of depression among China's older adult population and to determine the noteworthy aspects resulting in depression.

This research selected 7,880 older adult people by utilizing data from the 2020 China Health and Retirement Longitudinal Study. Thereafter, the dataset was classified into training and testing sets at a 6:4 ratio. Six ML algorithms, namely, logistic regression, k-nearest neighbors, support vector machine, decision tree, LightGBM, and random forest, were used in constructing a predictive model for depression among the older adult. To compare the differences in the ROC curves of the different models, the Delong test was conducted. Meanwhile, to evaluate the models' performance, this research performed decision curve analysis (DCA). Thereafter, the Shapely Additive exPlanations values were utilized for model interpretation on the bases of the prediction results' substantial contributions.

The range of the area under the curve (AUC) of each model's ROC curves was 0.648-0.738, with significant differences (P < 0.01). The DCA results indicate that within various probability thresholds, LightGBM's net benefit was the highest. Self-rated health, nighttime sleep, gender, age, and cognitive function are the five most important characteristics of all models in terms of predicting the occurrence of depression.

The occurrence of depression among China's older adult population and the critical factors leading to depression can be predicted and identified, respectively, by ML algorithms.

As part of the opioid crisis, opioid overuse is increasing in U.S. older adults. However, research on granular measures of depressive symptoms and opioid use exclusively in this population are limited.

Using data from the 2020 National Health Interview Survey, we constructed multivariate logistic and multinomial logistic regression models to examine the association of frequency and intensity of depressive symptoms with frequency of prescribed opioid use.

The study population consisted of 8,637 participants with a mean age of 74.3 ( SD = 6.4) years. Sixteen percent of the participants used prescribed opioids. Compared with participants who never felt depressed, those who felt depressed daily ( OR = 1.796, 95% CI [1.371, 2.337]), weekly ( OR = 1.579, 95% CI [1.236, 2.003]), or a few times a year ( OR = 1.237, 95% CI [1.077, 1.418]) had increased odds of prescribed opioid use. Compared with participants who felt a little depressed, those who felt depressed somewhere in between a little and a lot ( OR = 1.538, 95% CI [1.283, 1.842]) and those who felt depressed a lot ( OR = 1.784, 95% CI [1.336, 2.274]) had increased odds of prescribed opioid use. Compared with participants who never felt depressed, those who felt depressed weekly ( OR = 2.295, 95% CI [1.012, 5.204]) and those who felt depressed monthly ( OR = 2.385, 95% CI [1.051, 5.409]) had increased OR of using prescribed opioid every day from using prescribed opioid some days.

Frequency and intensity of depressive symptoms were independently and positively associated with prescribed opioid use.

Recently, methods of quickly and accurately screening for geriatric depression have attracted substantial attention. Short forms of the 30-item Geriatric Depression Scale have been developed based on classical test theory, such as the GDS-4, GDS-5, and GDS-15, but they have shown low diagnostic accuracy. Therefore, in this study, we developed a new short form of the GDS-30 based on item response theory and the RiskSLIM, a machine learning method, and validated it based on gray matter volume. We found that the short form based on IRT (GDS-9) and the short form based on the RiskSLIM (GDS-14) had higher diagnostic accuracy than other short forms of the scale. In addition, in the Region of Interest based brain analysis, we found that the GDS-9 was significantly negatively correlated with the gray matter volumes of the right hippocampus, the right parahippocampal gyrus, and the right superior temporal gyrus, whereas the other short forms were not significantly associated with the gray matter volumes of any regions. This implies that the GDS-9 has higher empirical validity than other short forms and corresponds with brain structure. Therefore, the GDS-9 can be used to screen for geriatric depression and may improve the efficiency and accuracy of screening.

The purpose of this study was to investigate the mediating effect of social support on the relationship between social activity and depressive symptoms among older widows in Taiwan. A cross-sectional study was conducted that recruited 256 older widows in southern Taiwan. Data were collected on demographic characteristics, self-rated health, instrumental activities of daily living, social activity, social support, and depression. Multiple linear regressions performed examined whether social activities and social support were significantly associated with depressive symptoms and which types of social activity were significantly related to social support and depressive symptoms. Mediation analyses performed tested the mediation effect of social support between the number of different types of social activities performed (termed "number of activities" in this study) and depression. Overall, 17.2% of the participants reported having at least two depressive symptoms. The total effect of the number of activities on depressive symptoms was significant (p < .001). The direct pathway from the number of activities to depressive symptoms remained significant (p < .001), and the mediation pathway (from the number of activities to depressive symptoms through social support) was also significant (Bootstrap CI = -.072, -.003). These findings demonstrated that older widows had more social support when they participated in more social activities, which could then decrease depressive symptoms. In addition, informal community group activities and religious group activities were the most effective at increasing social support and reducing depressive symptoms among the older Taiwanese widows.

Growing evidence suggests that repeated-dose intravenous ketamine in patients with depression had rapid antianhedonic effects. However, a comparison of the antianhedonic effects of repeated-dose intravenous ketamine between younger adults and older depressed patients has not been examined.

To the best of my knowledge, this study with a total of 135 patients with major depressive episodes (MDE) is the first to compare the antianhedonic effects between younger adult (n = 116) and older (n = 19) depressed patients receiving six ketamine infusions (0.5 mg/kg over 40 min). Montgomery- Åsberg Depression Rating Scale (MADRS) was applied in this study to evaluate the clinical symptoms, and MADRS anhedonia item scoring was used to evaluate anhedonia symptoms.

Patients received six open-label intravenous infusions of ketamine for 12 days. MADRS anhedonia subscale scores decreased in both younger (3.3, 95% CI = 2.5-4.1, p < 0.05) and older (2.8, 95% CI = 1.1-4.6, p < 0.05) MDE patients at 4h after the first infusion compared to baseline scores and the reduction was maintained over the subsequent infusion period in both groups (all Ps < 0.05). Younger MDE patients had lower MADRS anhedonia subscale scores on day 26 compared with older patients (P = 0.02). Compared with younger adult MDE patients, older patients had a lower antianhedonic response (51.7% [95% CI = 42.5%-61.0%] versus 31.6% [95% CI = 8.6%-54.6%)] and remission (24.1% [95% CI = 16.2%-32.0%] versus 0%).

This study indicates that repeated-dose intravenous ketamine administration induces rapid and robust antianhedonic effects in older MDE patients. However, older MDE patients displayed less response to ketamine than younger adult MDE patients.

Depression, a prevalent mental disorder, significantly impairs the quality of life and social functioning. Targeting neuroinflammation is a promising therapeutic approach, highlighting the need for natural neuroprotective agents. Gypenosides (Gyp) from Gynostemma pentaphyllum exhibit anxiolytic and antidepressant effects, yet the underlying mechanisms remain unclear. We investigated whether Gyp, isolated and purified by our laboratory, can exert neuroprotective effects by modulating neuroinflammation in the hippocampus and prefrontal cortex (PFC) of mice with LPS-induced anxiety and depression, thereby ameliorating behavioral phenotypes.

LPS (1 mg/kg, i.p.) was used to induce anxiety and depression-like behaviors. Gyp was administered at 50, 100, or 200 mg/kg in pretreatment, with fluoxetine hydrochloride (Flu) as a positive control, for 10 consecutive days.

Gyp, especially at 100 mg/kg, significantly ameliorated LPS-induced anxiety and depression in mice, normalizing cytokine expression in the hippocampus and PFC, with IL-1β showing the most pronounced regulation (Hippocampus: RatioGyp-100/LPS = 30.73 %, PFC: RatioGyp-100/LPS = 55.89 %). Gyp also reversed LPS-induced neuronal loss and necrosis, reduced glial cell activation, and prevented the transition of microglia to the M1 phenotype. Mechanistically, Gyp suppressed the activation of the NLRP3 inflammasome in the PFC, and modulated hippocampal synaptic protein loss, thereby mediating neuroinflammation.

Gyp improved anxiety and depression in LPS-induced mice, which may be achieved by balancing systemic inflammatory levels, regulating glial cell activation and phenotypic polarization, regulating hippocampal synaptic plasticity, and suppressing the NLRP3/Caspase-1/ASC signaling pathway in the PFC.

Objectives: This study explores depression changes and influencing factors in middle-aged and older individuals, focusing on different cognitive function states. Methods: This cohort study uses panel data from seven waves of the nationally representative Taiwan Longitudinal Study on Aging (1996-2015) with 2344 participants aged 50 or above. Data analysis was conducted from 25 January 2023 to 4 May 2023. Results: Multivariate logistic regression analyzed three trajectories: maintained mood, progressive depression, and consistent depression. Protective factors for progressive depression included self-health perception, exercise, family satisfaction, and financial well being, while risk factors were chronic diseases, pain, substance use, and daily activity limitations. Cognitive function emerged as a significant protective factor, while pain exhibited the highest risk. In the cognitive dysfunction group, only social participation showed notable differences. Conclusion: Progressive and consistent depression in middle-aged and older people have aroused concern. In addition to necessary protection and risk factors, special attention should be paid to the risks posed by the level of pain. Addressing pain as a crucial risk factor is essential, particularly for middle-aged and older people with cognitive impairment and depression, necessitating targeted support.

The global ageing population faces rising depression rates due to social, economic, and health changes. Depression in older adults, often linked to isolation and health issues, requires comprehensive care. Psychotherapeutic interventions could be effective in reducing symptoms, offering personalized and holistic support. Particularly low-threshold interventions, such as those offered in community-dwelling older adults, which older adults can easily access and which may reduce stigma, promise to close the treatment gap. This review examines community-based psychotherapeutic interventions for older adults with depression.

This review investigates psychotherapeutic interventions for reducing depressive symptoms in older adults in a community setting. RCTs were assessed using Joanna Briggs Institute tools. The following databases were searched: CINAHL Plus with Full Text, MedicLatina, MEDLINE with Full Text, and the Psychology and Behavioral Sciences Collection.

A meta-analysis of 13 studies with 1528 participants showed a medium, significant pooled effect size at post-intervention (Hedges' g = -0.36, p < 0.001) and substantial heterogeneity. Follow-up analysis of studies indicated a small, non-significant effect (Hedges' g = -0.17, p = 0.27). Group interventions, particularly the "reminiscence protocol", had the largest significant effect.

This systematic review and meta-analysis found that in community-dwelling older adults' group psychotherapeutic interventions, particularly the "reminiscence protocol" and "modified behavioral activation treatment" are most effective for reducing depressive symptoms. Individual psychotherapeutic interventions like "prevention of suicide in primary care elderly" and "behavioral activation" also show effectiveness, with group psychotherapeutic interventions being generally more effective than when these treatments are offered in individual psychotherapeutic interventions.

Group and individual psychotherapeutic interventions reduce depressive symptoms in community-dwelling older adults, with group psychotherapeutic interventions being more effective.