American Journal of Geriatric Psychiatry最新文献

{"title":"Loneliness, Self-Efficacy and Adaptive Coping: Mixed Methods Analysis of Mediation in a Peer Support Intervention for Depression.","authors":"Jin Hui Joo, Alice Xie, Namkee Choi, Joseph J Gallo, Joseph Locascio, Mingyue Ma, Ryan A Mace, Phyllis Solomon, Uma Khemraj","doi":"10.1016/j.jagp.2025.02.013","DOIUrl":"https://doi.org/10.1016/j.jagp.2025.02.013","url":null,"abstract":"<p><strong>Objective: </strong>We assessed social connection, self-efficacy, and coping as mediators in a peer support intervention for depressed low-income and minoritized older adults.</p><p><strong>Methods: </strong>Convergent mixed methods analysis of data collected in an RCT with at-risk older adults (N = 149) comparing the effectiveness of PEERS, an 8-week peer support, self-care intervention on depression to telephone calls providing social interaction for the control group. Assessments occurred at baseline, postintervention, and every 3 months up to 12 months. Mediation effects of loneliness, self-efficacy, and coping were analyzed using longitudinal mixed effects modeling after z-score standardization, complemented by semi-structured interviews. We report results in regression coefficients, i.e. in standard deviation units.</p><p><strong>Results: </strong>Loneliness had an indirect effect on depression in both intervention (-0.32 [95% CI: -0.48, -0.19]) and control groups (-0.16 [95% CI: -0.27, -0.04]). Self-efficacy had an indirect effect of -0.17 (95% CI: [-0.24, -0.05]) at postintervention and -0.20 (95% CI: [-0.30, -0.08]) at 12 months for the PEERS group. Adaptive coping had an indirect effect with -0.15 (95% CI: [-0.26, -0.06]) at postintervention and -0.15 (95% CI: [-0.32, -0.04]) at 12 months for the PEERS group, No evidence of mediation for self efficacy nor coping was found for the control group. Qualitative results indicated reduced loneliness, improved coping and behavior change among intervention participants. Control group participants reported social support from telephone calls but did not mention improved self-efficacy and coping skills.</p><p><strong>Conclusions: </strong>Social engagement and peer support intervention have a common pathway, e.g. alleviation of loneliness in reducing depression, but the PEERS intervention can also decrease depression by improving self-efficacy and adaptive coping.</p>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Social Relationships and Genetic Risk With Frailty.","authors":"Wei-Qi Song, Wen-Fang Zhong, Hao-Yu Yan, Zhi-Hao Li, Jian Gao, Xiao-Meng Wang, Pei-Liang Chen, Fang-Fei You, Chuan Li, Huan Chen, Jia-Hao Xie, Yue-Bin Lv, Xiao-Ming Shi, Chen Mao","doi":"10.1016/j.jagp.2025.02.015","DOIUrl":"https://doi.org/10.1016/j.jagp.2025.02.015","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the association between social relationships and their changes with frailty among older adults, and whether genetic risk modifies these associations.</p><p><strong>Methods: </strong>This study included 11,559 older adults (mean age 80.1 years) from the Chinese Longitudinal Healthy Longevity Survey. Social relationships were categorized into three dimensions: social activities, social networks, and social support, each classified as favorable or unfavorable groups. Changes in social relationships were assessed at two time points. The polygenic risk score (PRS) was constructed using 59 single-nucleotide polymorphisms associated with frailty. Cox proportional hazards models were used to assess the effects of social relationships and their changes, and PRS on frailty. Two-sample Mendelian randomization identified causal associations.</p><p><strong>Results: </strong>During a median follow-up of 5.4 years, 4773 participants developed frailty. Unfavorable social relationships, particularly in social activities and social networks, were associated with increased frailty risk, with stronger effects in those with high genetic risk. Mendelian randomization revealed their harmful effects on frailty. An additive interaction between social relationships and genetic risk on frailty was observed. Combined unfavorable social relationships and high genetic risk increased frailty risk by 39% (HR: 1.39, 95% CI: 1.23-1.57). Persistent unfavorable relationships further increased frailty risk by 58% in those with high genetic risk (HR: 1.58, 95% CI: 1.27-1.97).</p><p><strong>Conclusion: </strong>Unfavorable social relationships increase frailty risk, particularly for individuals with high genetic susceptibility. Persistent unfavorable relationships further increase this risk over time, with the highest frailty risk observed in those with both persistent unfavorable social relationships and high genetic risk.</p>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improvements in Depressive Symptoms, Perceived Social Support, and Quality of Life Through an Educational Program in Community-Dwelling Older Adults With Frailty Phenotype: A Randomized Controlled Trial of the FRAGSALUD Project.","authors":"Manuel Costilla, Juan Corral-Pérez, María Ángeles Vázquez-Sánchez, Laura Ávila-Cabeza-de-Vaca, Andrea González-Mariscal, Cristina Casals","doi":"10.1016/j.jagp.2025.02.014","DOIUrl":"https://doi.org/10.1016/j.jagp.2025.02.014","url":null,"abstract":"<p><strong>Background: </strong>This study examined the impact of an educational program on depressive symptoms, cognitive function, social support, quality of life, and physical frailty among community-dwelling older adults with frailty or prefrailty.</p><p><strong>Methods: </strong>In this 12-month multicenter randomized controlled trial, 199 frail/prefrail community-dwelling older adults were allocated into the intervention (n = 109) or the control (n = 90) group. The 6-month educational intervention focused on guidelines for physical activity, nutrition, cognition, and psychosocial well-being, while participants in the control group maintained their usual healthcare attendance. Changes in depressive symptoms (15-item Geriatric-Depressive-Scale, GDS-15), cognitive function (Short Portable Mental Status Questionnaire, SPMSQ), social support (Duke-University of North Carolina Functional Social Support Questionnaire, Duke-UNC-11), quality of life (3-level EuroQoL five-dimensional questionnaire visual analog scale, EQ-VAS, and index, EQ-Index), physical frailty (Short Physical Performance Battery, SPPB, and Fried's criteria) were evaluated after six months of intervention and six months of follow-up.</p><p><strong>Results: </strong>After the follow-up, the intervention group improved the GDS-15 score (p <0.001), Duke-UNC-11 score (p <0.001), quality of life (EQ-VAS: p = 0.001, EQ-Index: p = 0.010), SPPB score (p <0.001), and reduced Fried's criteria (p <0.001) compared to the control group, which worsened Duke-UNC-11 score (p = 0.012) and EQ-Index (p <0.001). No significant changes in cognitive function were observed. Lastly, all significant changes in study variables after follow-up were significantly correlated with each other (p <0.05), indicating an interrelated evolution.</p><p><strong>Conclusions: </strong>This 6-month educational program improved depressive symptoms, social support, quality of life, and physical frailty in community-dwelling frail and prefrail older adults, as observed after a 6-month follow-up.</p>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thyroid-Stimulating Hormone Levels and Depression in Older Adults: Cross-Sectional and Longitudinal Analyses in a Community-Dwelling Population.","authors":"Malcolm Forbes, Tayler Watson, Duncan J Topliss, Mojtaba Lotfaliany, Mohammadreza Mohebbi, Robyn L Woods, John J McNeil, Michael Berk","doi":"10.1016/j.jagp.2025.02.012","DOIUrl":"https://doi.org/10.1016/j.jagp.2025.02.012","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the association between thyroid-stimulating hormone (TSH) levels and depression in older adults.</p><p><strong>Design: </strong>Prospective cohort study with an 11-year follow-up period.</p><p><strong>Setting: </strong>Community-dwelling participants from the ASPirin in Reducing Events in the Elderly (ASPREE) randomized controlled trial and its follow-up observational study in Australia.</p><p><strong>Participants: </strong>About 9,050 adults aged ≥70 years with baseline TSH measurements and depression assessments. Participants with thyroid cancer, baseline depression, or thyroid-altering medications were excluded.</p><p><strong>Measurements: </strong>Depression was assessed annually using the Center for Epidemiological Studies Depression Scale (CES-D-10) using a cut score of 12, and hospital admission records. TSH was measured at baseline and year 3, categorized as low (<0.34 mU/L), normal (0.34-3.75 mU/L), or high (>3.75 mU/L).</p><p><strong>Results: </strong>Cross-sectional analyses found no significant association between TSH levels and depression at baseline (p = 0.79) or year 3 (p = 0.054). Longitudinal analyses revealed no relationship between baseline or time-varying TSH levels and incident depression over the follow-up period (HR = 1.0, 95% CI: 0.96-1.05).</p><p><strong>Conclusions: </strong>TSH levels are not associated with prevalent or incident depression in older community-dwelling adults. These findings should guide screening approaches for depression in older adults.</p>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Information for Subscribers","authors":"","doi":"10.1016/S1064-7481(25)00021-1","DOIUrl":"10.1016/S1064-7481(25)00021-1","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 4","pages":"Page A1"},"PeriodicalIF":4.4,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143512064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Needs of Older Adults With Personality Disorders: Insights From State-Funded Mental Health Care Systems","authors":"Emily R. Edwards Ph.D. ,&nbsp;Ashley L. Greene Ph.D. ,&nbsp;Lillian A. Steedman M.A.","doi":"10.1016/j.jagp.2025.02.010","DOIUrl":"10.1016/j.jagp.2025.02.010","url":null,"abstract":"<div><h3>Objectives</h3><div>Due to a longstanding focus on early to middle adulthood, research into the clinical needs of older adults with personality disorders remains limited. This study sought to further understandings into the potentially unique needs of this population.</div></div><div><h3>Methods</h3><div>Analyses compared comorbid psychiatric diagnoses, settings of utilized mental health treatment, and sociodemographic variables among older (aged 65+, <em>n</em> = 11,426) and younger (aged 18–35, <em>n</em> = 57,847) adults diagnosed with a personality disorder who received state-funded mental health care in the United States in 2022.</div></div><div><h3>Results</h3><div>Older adults with personality disorder diagnoses were more likely to have comorbid psychotic and delirium/dementia disorder diagnoses, less likely to have comorbid trauma and stressor, anxiety, and attention-deficit/hyperactivity disorder diagnoses, and less likely to experience homelessness than younger adults with personality disorder diagnoses.</div></div><div><h3>Conclusions</h3><div>Findings highlight the importance of interventions to address co-occurring cognitive disorganization among older adults experiencing personality disorder pathology.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 6","pages":"Pages 628-634"},"PeriodicalIF":4.4,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing Treatment Models for the Delivery of the Antiamyloid Therapy, Lecanemab: Considerations for Implementation of Lecanemab in Healthcare Systems","authors":"Michael Weber M.D. ,&nbsp;Heidi L. Roth M.D. ,&nbsp;Amy Abramowitz M.D. ,&nbsp;Kim G. Johnson M.D.","doi":"10.1016/j.jagp.2025.02.007","DOIUrl":"10.1016/j.jagp.2025.02.007","url":null,"abstract":"<div><div>We describe the model developed by two separate healthcare systems to deliver the antiamyloid therapy, lecanemab, to patients with mild cognitive impairment and mild dementia. Based on current guidelines, the experience of two separate healthcare systems that developed lecanemab clinical care delivery programs is described in detail including the development of patient eligibility criteria, cooperation with specialty services, patient monitoring, and practical steps required to safely implement lecanemab programs at a systems level. Geriatric psychiatrists have a prominent role in prescribing and monitoring antiamyloid therapy in both systems and we highlight the unique role of the geriatric psychiatrist in the future delivery of antiamyloid therapies as memory care specialists.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 6","pages":"Pages 601-610"},"PeriodicalIF":4.4,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal Dynamics of Depressive Symptoms, Apathy, Daily Activities, and Cognitive Decline in Older People From the General Population: A Network Analysis.","authors":"Abe J C van der Slot, Simon P Mooijaart, Jan-Willem van Dalen, Marieke Hoevenaar, Edo Richard, Erik J Giltay","doi":"10.1016/j.jagp.2025.02.011","DOIUrl":"https://doi.org/10.1016/j.jagp.2025.02.011","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of depressive symptoms, apathy, and cognitive decline increases with age. Understanding the temporal dynamics of these symptoms could provide valuable insights into the early stages of cognitive decline, allowing for more timely and effective treatment and management.</p><p><strong>Methods: </strong>Participants from the Prevention of Dementia by Intensive Vascular Care (preDIVA) trial cohort with baseline and ≥3 follow-up measurements were included, with a median of 7.8 (0.68) years of follow-up. Dynamic Time Warping (DTW) analysis was used to model temporal dynamics of cognition using the Mini Mental State Exam (MMSE), activities of daily living (ADL) using the Amsterdam Linear Disability Scale (ALDS), and apathy and depressive symptoms using the 15-item Geriatric Depression Scale (GDS-15) at the individual and group level.</p><p><strong>Results: </strong>The 1,537 participants were aged 74 (2.0) years at baseline, 56.5% were female, and 19.9% had finished higher education. A decline in ADL and increase in apathy tended to precede most indicators of cognitive decline, with all apathy items (i.e. being 'dropped activities/interests', 'not feeling energetic' and 'not doing new things') and ADL showing significant outstrength (all p's < 0.001). Many mood-related symptoms other than apathy, and the MMSE items 'immediate memory', 'verbal comprehension' and 'naming objects' tended to be the last to deteriorate, showing significant instrength (all p's < 0.001).</p><p><strong>Conclusion: </strong>An increase apathy and a decline in ADL tended to precede mood-related symptoms and cognitive impairment in older adults from the general population. These changes may thus serve as potential early warning signs of both depression and dementia, and may allow for timely intervention.</p>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of Self-Reported Deterrents to Suicide Attempts in Depressed Older Adults.","authors":"Emma J O'Brien, Sarah T Stahl, Meghan T Wong, Michelle Perry-Falconi, Hanga Galfalvy, Katalin Szanto","doi":"10.1016/j.jagp.2025.02.009","DOIUrl":"https://doi.org/10.1016/j.jagp.2025.02.009","url":null,"abstract":"<p><strong>Background: </strong>This study examined deterrents to suicide in depressed older adults with and without a lifetime suicide attempt.</p><p><strong>Methods: </strong>Older adults (N=264, M±SD age = 62.5±7.9 years) participating in a study on late-life suicide risk provided deterrents to suicide via free-response item. Two independent raters categorized participant responses based on Linehan's Reasons for Living scale. Logistic regression compared deterrent categories between attempters and nonattempters.</p><p><strong>Results: </strong>Survival/coping beliefs (54%) and relationships (52%) were the most cited deterrents. Neither the number of categories endorsed, nor the type of deterrent categories were differentially associated with lifetime suicide attempt. Among attempters (n=106) individuals who attempted suicide more recently were less likely to endorse relationship deterrents compared to individuals who attempted suicide in the distal past.</p><p><strong>Conclusions: </strong>Beliefs in one's ability to deal with stressful situations may have long-standing positive effect on suicidal behavior, while social disconnectedness is associated with recent suicide attempts.</p>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Towards Mechanism-Informed Psychotherapies for Reducing Clinical Severity in Late-Life Depression: Promise and Challenges","authors":"Joseph S. Goveas M.D.","doi":"10.1016/j.jagp.2025.02.006","DOIUrl":"10.1016/j.jagp.2025.02.006","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 6","pages":"Pages 624-627"},"PeriodicalIF":4.4,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}