Determinants of Depression in Older Adults in Europe: An Investigation into Demographic and Psychosocial Risk Factors

Summary Ageing is becoming a significant public health concern, particularly in Europe, where the undergoing a dramatic shift. It is estimated that by 2050, 25% of the European population will be 65 years of age and older (WHO, 2012). This unprecedented fluctuation in the population will create a significant imbalance in the population structure, which is predicted to have a substantial impact on the existing social setting by putting additional strains on future health care systems, social security and pension systems, international economies, and on the overall health and wellbeing of society. This calls for action from international governments to create policies that will support this unprecedented population growth; therefore provisions need to be put in place in order to cater for these contingencies. Coupled with this is the inevitable increase in mental disorders which will develop in parallel with an ageing population and will add layers of complexity to the public health issue of ageing. Depressive and anxiety disorders are prolific in older adults, and constitute the majority of late-life mental disorders (Byers et al., 2010). The impact of these disorders on older adults is significant and debilitating, where depressive disorders has been invariably associated with negative health outcomes, such as cognitive decline, increased disability, self-neglect, heart disease, diabetes, morbidity and mortality (suicide). Moreover, depression produces the greatest decrement in health compared with other chronic diseases, such as angina, arthritis, asthma and diabetes (Moussavi et al., 2007). Simultaneously, anxiety disorders, which are even more prolific in older adults, have been associated with comorbidity,reduced cognitive ability, disability, increased healthcare utilization and poor quality of life. For the purpose of this dissertation, depression will be the main focus of the papers, however, anxiety is also addressed in one of the papers with a view to provide a broader context and to provide a more comprehensive assessment of mental disorders in the elderly, since both disorders often occur co-morbidly. Depression transcends culture, country and boarders, and its prevalence has caused a significant public health concern across Europe. Although the prevalence of depression varies considerably across countries, it is important to understand the various contextual factors that contribute to depression within and between countries. Additionally, there are many important determinants associated with depression in older adults, (which differ to those determinants in younger cohorts) and comprise of physical disability, bereavement, cognitive decline, and other psychosocial factors such as loneliness and isolation. Considering that depressive disorders consist of distinct differences in the aetiology of depression in older adults, it is important to give late-life depression the same attention that the disorder receives in younger populations, and since the population of older adults in Europe is growing at a staggering rate, understanding the aetiology of depression in this cohort is of clinical, public and economic significance. Therefore, the main aim of the current research was to epidemiologically investigate the role of demographic and psychological variables on mental disorders, specifically depression, in the older European population, and to contribute to findings that can inform public policy measures.:1. Introduction 1.1 No Health without Mental Health 1.2 Ageing as a Public Health Concern 1.3 Mental Disorders in the Older European Population 1.3.1 Prevalence 1.3.2 Depression in the Elderly 1.4 Socioeconomic Status and Depression 1.4.1 Education 1.4.2 Income and Wealth 1.5 The Role of Ageing Perceptions on Depression 1.6 Impact of Depression on Health Status 1.7 Rationale of Research and Introduction to Articles 2. Publications 2.1 Paper 1: Negative perceptions of ageing predict the onset and persistence of depression and anxiety: Findings from a prospective analysis of the Irish Longitudinal Study on Ageing (TILDA) 2.2 Paper 2: The Role of Socio-Economic Status in Depression: Results from the COURAGE (Aging survey in Europe) 3. Dissertation Summary (Zusammenfassung der Arbeit) 3.1 Thematic Context 3.2 Rationale for Research 3.3 Publications 3.4 Research Findings and Implications 4. Bibliography 5. Appendices 5.1 Declaration of Independent work for Dissertation (Erklärung über die eigenständige Abfassung der Arbeit) 5.2 Statement of own Contribution (Darstellung des eigenen Beitrags) 5.2.1 Paper 1: Negative perceptions of ageing predict the onset and persistence of depression and anxiety: Findings from a prospective analysis of the Irish Longitudinal Study on Ageing (TILDA) 5.2.2 Paper 1: The Role of Socio-Economic Status in Depression: Results from the COURAGE (Aging Survey in Europe) 5.3 Curriculum Vitae (Lebenlauf) 5.4 Publications and Presentations 5.4.1 Publications. 5.4.2 Presentations 5.5 Acknowledgement

A systematic review of brief mental health and well-being interventions in organizational settings

Objectives The aim of the systematic review was to provide an overview of the evidence on the effectiveness of brief interventions targeting mental health and well-being in organizational settings and compare their effects with corresponding interventions of common (ie, longer) duration. Methods An extensive systematic search was conducted using the Medline and PsycINFO databases for the period of 2000-2016. Randomized-controlled trials (RCT) and quasi-experimental studies evaluating primary or secondary brief interventions carried out in the workplace settings were included. Subsequently, common interventions matching brief interventions by type and assessed outcomes were included. The methodological quality of included studies was appraised using NICE guidelines and the best evidence synthesis approach was applied. Results The review identified 11 brief interventions and 9 corresponding common interventions. Included studies varied substantially in sample size and characteristics, methodological quality, duration of follow-up, types of intervention, and assessed outcomes. All but one study evaluating brief interventions had high risk of bias. No evidence was found on the effectiveness of brief stress management, relaxation, massage, mindfulness meditation, or multimodal interventions. We found limited evidence on the effectiveness of brief positive psychology interventions. Conclusions Our review highlights the need for high-quality studies evaluating brief mental health and well-being interventions in organizational settings. Future studies should use methodologically rigorous designs and improved reporting of methods and results to provide conclusive evidence on the effectiveness and sustainability of the intervention effects

The role of socio-economic status in depression: results from the COURAGE (aging survey in Europe)

BACKGROUND: Low socio-economic status (SES) has been found to be associated with a higher prevalence of depression. However, studies that have investigated this association have been limited in their national scope, have analyzed different components of SES separately, and have not used standardized definitions or measurements across populations. The aim of the current study was to evaluate the association between SES and depression across three European countries that represent different regions across Europe, using standardized procedures and measurements and a composite score for SES. METHOD: Nationally-representative data on 10,800 individuals aged ≥18 from the Collaborative Research on Ageing in Europe (COURAGE) survey conducted in Finland, Poland and Spain were analyzed in this cross-sectional study. An adapted version of the Composite International Diagnostic Interview was used to identify the presence of depression, and SES was computed by using the combined scores of the total number of years educated (0-22) and the quintiles of the country-specific income level of the household (1-5). Multivariable logistic regression was used to assess the association between SES and depression. RESULTS: Findings reveal a significant association between depression and SES across all countries (p ≤ 0.001). After adjusting for confounders, the odds of depression were significantly decreased for every unit increase in the SES index for Finland, Poland and Spain. Additionally, higher education significantly decreased the odds for depression in each country, but income did not. CONCLUSION: The SES index seems to predict depression symptomatology across European countries. Taking SES into account may be an important factor in the development of depression prevention strategies across Europe

The role of socio-economic status in depression : results from the COURAGE (aging survey in Europe)

Abstract Background Low socio-economic status (SES) has been found to be associated with a higher prevalence of depression. However, studies that have investigated this association have been limited in their national scope, have analyzed different components of SES separately, and have not used standardized definitions or measurements across populations. The aim of the current study was to evaluate the association between SES and depression across three European countries that represent different regions across Europe, using standardized procedures and measurements and a composite score for SES. Method Nationally-representative data on 10,800 individuals aged ≥18 from the Collaborative Research on Ageing in Europe (COURAGE) survey conducted in Finland, Poland and Spain were analyzed in this cross-sectional study. An adapted version of the Composite International Diagnostic Interview was used to identify the presence of depression, and SES was computed by using the combined scores of the total number of years educated (0–22) and the quintiles of the country-specific income level of the household (1–5). Multivariable logistic regression was used to assess the association between SES and depression. Results Findings reveal a significant association between depression and SES across all countries (p ≤ 0.001). After adjusting for confounders, the odds of depression were significantly decreased for every unit increase in the SES index for Finland, Poland and Spain. Additionally, higher education significantly decreased the odds for depression in each country, but income did not. Conclusion The SES index seems to predict depression symptomatology across European countries. Taking SES into account may be an important factor in the development of depression prevention strategies across Europe

Determinants of Depression in Older Adults in Europe: An Investigation into Demographic and Psychosocial Risk Factors

Summary Ageing is becoming a significant public health concern, particularly in Europe, where the undergoing a dramatic shift. It is estimated that by 2050, 25% of the European population will be 65 years of age and older (WHO, 2012). This unprecedented fluctuation in the population will create a significant imbalance in the population structure, which is predicted to have a substantial impact on the existing social setting by putting additional strains on future health care systems, social security and pension systems, international economies, and on the overall health and wellbeing of society. This calls for action from international governments to create policies that will support this unprecedented population growth; therefore provisions need to be put in place in order to cater for these contingencies. Coupled with this is the inevitable increase in mental disorders which will develop in parallel with an ageing population and will add layers of complexity to the public health issue of ageing. Depressive and anxiety disorders are prolific in older adults, and constitute the majority of late-life mental disorders (Byers et al., 2010). The impact of these disorders on older adults is significant and debilitating, where depressive disorders has been invariably associated with negative health outcomes, such as cognitive decline, increased disability, self-neglect, heart disease, diabetes, morbidity and mortality (suicide). Moreover, depression produces the greatest decrement in health compared with other chronic diseases, such as angina, arthritis, asthma and diabetes (Moussavi et al., 2007). Simultaneously, anxiety disorders, which are even more prolific in older adults, have been associated with comorbidity,reduced cognitive ability, disability, increased healthcare utilization and poor quality of life. For the purpose of this dissertation, depression will be the main focus of the papers, however, anxiety is also addressed in one of the papers with a view to provide a broader context and to provide a more comprehensive assessment of mental disorders in the elderly, since both disorders often occur co-morbidly. Depression transcends culture, country and boarders, and its prevalence has caused a significant public health concern across Europe. Although the prevalence of depression varies considerably across countries, it is important to understand the various contextual factors that contribute to depression within and between countries. Additionally, there are many important determinants associated with depression in older adults, (which differ to those determinants in younger cohorts) and comprise of physical disability, bereavement, cognitive decline, and other psychosocial factors such as loneliness and isolation. Considering that depressive disorders consist of distinct differences in the aetiology of depression in older adults, it is important to give late-life depression the same attention that the disorder receives in younger populations, and since the population of older adults in Europe is growing at a staggering rate, understanding the aetiology of depression in this cohort is of clinical, public and economic significance. Therefore, the main aim of the current research was to epidemiologically investigate the role of demographic and psychological variables on mental disorders, specifically depression, in the older European population, and to contribute to findings that can inform public policy measures.:1. Introduction 1.1 No Health without Mental Health 1.2 Ageing as a Public Health Concern 1.3 Mental Disorders in the Older European Population 1.3.1 Prevalence 1.3.2 Depression in the Elderly 1.4 Socioeconomic Status and Depression 1.4.1 Education 1.4.2 Income and Wealth 1.5 The Role of Ageing Perceptions on Depression 1.6 Impact of Depression on Health Status 1.7 Rationale of Research and Introduction to Articles 2. Publications 2.1 Paper 1: Negative perceptions of ageing predict the onset and persistence of depression and anxiety: Findings from a prospective analysis of the Irish Longitudinal Study on Ageing (TILDA) 2.2 Paper 2: The Role of Socio-Economic Status in Depression: Results from the COURAGE (Aging survey in Europe) 3. Dissertation Summary (Zusammenfassung der Arbeit) 3.1 Thematic Context 3.2 Rationale for Research 3.3 Publications 3.4 Research Findings and Implications 4. Bibliography 5. Appendices 5.1 Declaration of Independent work for Dissertation (Erklärung über die eigenständige Abfassung der Arbeit) 5.2 Statement of own Contribution (Darstellung des eigenen Beitrags) 5.2.1 Paper 1: Negative perceptions of ageing predict the onset and persistence of depression and anxiety: Findings from a prospective analysis of the Irish Longitudinal Study on Ageing (TILDA) 5.2.2 Paper 1: The Role of Socio-Economic Status in Depression: Results from the COURAGE (Aging Survey in Europe) 5.3 Curriculum Vitae (Lebenlauf) 5.4 Publications and Presentations 5.4.1 Publications. 5.4.2 Presentations 5.5 Acknowledgement

Determinants of Depression in Older Adults in Europe: An Investigation into Demographic and Psychosocial Risk Factors

Summary Ageing is becoming a significant public health concern, particularly in Europe, where the undergoing a dramatic shift. It is estimated that by 2050, 25% of the European population will be 65 years of age and older (WHO, 2012). This unprecedented fluctuation in the population will create a significant imbalance in the population structure, which is predicted to have a substantial impact on the existing social setting by putting additional strains on future health care systems, social security and pension systems, international economies, and on the overall health and wellbeing of society. This calls for action from international governments to create policies that will support this unprecedented population growth; therefore provisions need to be put in place in order to cater for these contingencies. Coupled with this is the inevitable increase in mental disorders which will develop in parallel with an ageing population and will add layers of complexity to the public health issue of ageing. Depressive and anxiety disorders are prolific in older adults, and constitute the majority of late-life mental disorders (Byers et al., 2010). The impact of these disorders on older adults is significant and debilitating, where depressive disorders has been invariably associated with negative health outcomes, such as cognitive decline, increased disability, self-neglect, heart disease, diabetes, morbidity and mortality (suicide). Moreover, depression produces the greatest decrement in health compared with other chronic diseases, such as angina, arthritis, asthma and diabetes (Moussavi et al., 2007). Simultaneously, anxiety disorders, which are even more prolific in older adults, have been associated with comorbidity,reduced cognitive ability, disability, increased healthcare utilization and poor quality of life. For the purpose of this dissertation, depression will be the main focus of the papers, however, anxiety is also addressed in one of the papers with a view to provide a broader context and to provide a more comprehensive assessment of mental disorders in the elderly, since both disorders often occur co-morbidly. Depression transcends culture, country and boarders, and its prevalence has caused a significant public health concern across Europe. Although the prevalence of depression varies considerably across countries, it is important to understand the various contextual factors that contribute to depression within and between countries. Additionally, there are many important determinants associated with depression in older adults, (which differ to those determinants in younger cohorts) and comprise of physical disability, bereavement, cognitive decline, and other psychosocial factors such as loneliness and isolation. Considering that depressive disorders consist of distinct differences in the aetiology of depression in older adults, it is important to give late-life depression the same attention that the disorder receives in younger populations, and since the population of older adults in Europe is growing at a staggering rate, understanding the aetiology of depression in this cohort is of clinical, public and economic significance. Therefore, the main aim of the current research was to epidemiologically investigate the role of demographic and psychological variables on mental disorders, specifically depression, in the older European population, and to contribute to findings that can inform public policy measures.:1. Introduction 1.1 No Health without Mental Health 1.2 Ageing as a Public Health Concern 1.3 Mental Disorders in the Older European Population 1.3.1 Prevalence 1.3.2 Depression in the Elderly 1.4 Socioeconomic Status and Depression 1.4.1 Education 1.4.2 Income and Wealth 1.5 The Role of Ageing Perceptions on Depression 1.6 Impact of Depression on Health Status 1.7 Rationale of Research and Introduction to Articles 2. Publications 2.1 Paper 1: Negative perceptions of ageing predict the onset and persistence of depression and anxiety: Findings from a prospective analysis of the Irish Longitudinal Study on Ageing (TILDA) 2.2 Paper 2: The Role of Socio-Economic Status in Depression: Results from the COURAGE (Aging survey in Europe) 3. Dissertation Summary (Zusammenfassung der Arbeit) 3.1 Thematic Context 3.2 Rationale for Research 3.3 Publications 3.4 Research Findings and Implications 4. Bibliography 5. Appendices 5.1 Declaration of Independent work for Dissertation (Erklärung über die eigenständige Abfassung der Arbeit) 5.2 Statement of own Contribution (Darstellung des eigenen Beitrags) 5.2.1 Paper 1: Negative perceptions of ageing predict the onset and persistence of depression and anxiety: Findings from a prospective analysis of the Irish Longitudinal Study on Ageing (TILDA) 5.2.2 Paper 1: The Role of Socio-Economic Status in Depression: Results from the COURAGE (Aging Survey in Europe) 5.3 Curriculum Vitae (Lebenlauf) 5.4 Publications and Presentations 5.4.1 Publications. 5.4.2 Presentations 5.5 Acknowledgement

The role of socio-economic status in depression: results from the COURAGE (aging survey in Europe)

BACKGROUND: Low socio-economic status (SES) has been found to be associated with a higher prevalence of depression. However, studies that have investigated this association have been limited in their national scope, have analyzed different components of SES separately, and have not used standardized definitions or measurements across populations. The aim of the current study was to evaluate the association between SES and depression across three European countries that represent different regions across Europe, using standardized procedures and measurements and a composite score for SES. METHOD: Nationally-representative data on 10,800 individuals aged ≥18 from the Collaborative Research on Ageing in Europe (COURAGE) survey conducted in Finland, Poland and Spain were analyzed in this cross-sectional study. An adapted version of the Composite International Diagnostic Interview was used to identify the presence of depression, and SES was computed by using the combined scores of the total number of years educated (0-22) and the quintiles of the country-specific income level of the household (1-5). Multivariable logistic regression was used to assess the association between SES and depression. RESULTS: Findings reveal a significant association between depression and SES across all countries (p ≤ 0.001). After adjusting for confounders, the odds of depression were significantly decreased for every unit increase in the SES index for Finland, Poland and Spain. Additionally, higher education significantly decreased the odds for depression in each country, but income did not. CONCLUSION: The SES index seems to predict depression symptomatology across European countries. Taking SES into account may be an important factor in the development of depression prevention strategies across Europe