Medication Adherence in Renal Transplant Recipients: A Latent Variable Model of Psychosocial and Neurocognitive Predictors

Objective Estimates indicate that 20–70% of renal transplant recipients are medication non-adherent, significantly increasing the risk of organ rejection. Medication adherence is negatively impacted by lower everyday problem solving ability, and associations between depressive symptoms, self-efficacy, and adherence are reported in renal transplant recipients. Nonetheless, to date, these associations have not been examined concurrently. Given the relationship between non-adherence and organ rejection, it is critical to gain a better understanding of the predictors of adherence in renal transplant recipients. To this end, we modeled relationships among cognitive abilities, depressive symptoms, self-efficacy, and adherence in this group. Methods Participants (N = 211) underwent renal transplant at least one year prior to participation. Adherence was measured via self-report, medication possession ratio, and immunosuppressant blood-level. Traditionally-measured neurocognitive and everyday problem-solving abilities were assessed. Depressive symptoms were measured via self-report, as were general and medication adherence related self-efficacy. Structural equation modeling was used to assess the fit of the model to available data. ResultsEveryday problem solving and self-efficacy had direct positive associations with adherence. Depressive symptoms were negatively associated with self-efficacy, but not adherence. Traditionally-measured neurocognitive abilities were positively associated with self-efficacy, and negatively associated with depressive symptoms. Conclusions We present a comprehensive investigation of relationships between cognitive and psychosocial factors and adherence in medically stable renal transplant recipients. Findings confirm the importance of everyday problem solving and self-efficacy in predicting adherence and suggest that influences of depressive symptoms and neurocognitive abilities are indirect. Findings have important implications for future development of interventions to improve medication adherence in renal transplant recipients

Depressive cognitive functioning among spousal caregivers of suspected dementia patients: application of the hopelessness theory of depression

This study provides the first examination of the hopelessness theory of depression among an older adult population. Adapted from the theory of learned helplessness, hopelessness depression is hypothesized to exist as a specific depressive subtype within a heterogeneous grouping of affective disorders. Salient negative life events are hypothesized to trigger depressive attributional processes among predisposed persons. This entails the propensity to attribute responsibility for negative events to stable and global causes, leading to the generalized perception of hopelessness. Seventy spousal caregivers of suspected dementia patients were recruited within an outpatient geriatric assessment clinic. One-time interviews were conducted with caregivers at the time of their relative's assessment. Caregivers were grouped within a predetermined matrix on the basis of responses to two depression screening measures. Analyses were subsequently conducted to assess the degree of association between the construct of hopelessness and depressive attributional style. A second focus of this study was an examination of the relationship between hopelessness and caregiver burden. This analysis suggests the constrained cognitive processes associated with the construct of hopelessness are significantly related to burden among caregivers. It is hypothesized that caregiver burden may be a specific type of hopelessness depression within this population. The results of univariate and multivariate analyses indicated a strong and significant association between hopelessness and depressive attributional processes. In contrast, depressed persons who do not present as hopeless do not appear to attribute negative events to stable and global causes. These findings provide the first indication that hopelessness effectively differentiates cognitive functioning within this population of older adults. The construct of hopelessness also appears significantly related to expressed burden among spousal caregivers. The constrained cognitive set epitomized by hopeless ideation may reflect the despair perceived by those caregivers who are overwhelmed by this role. This association appears over and above objective variables related to patient impairment and duration of caregiving. The sample recruited for the current study was compared against a randomly derived grouping of spousal caregivers from the Canadian Study of Health and Aging (CSHA). Demographic similarity between samples would suggest that caregivers recruited for the current study are representative of Canadian caregivers. Based on this finding, results from the current study can be generalized with greater confidence.Education, Faculty ofEducational and Counselling Psychology, and Special Education (ECPS), Department ofGraduat

Older Adults with Alzheimer’s Disease, Comorbid Arthritis and Prescription of Psychotropic Medications

OBJECTIVES: It is assumed that analgesia is underutilized among those with Alzheimer disease and that these patients may be inappropriately prescribed neuroleptics and benzodiazepines. The current study examines this assertion.DESIGN: For this study, prescription levels of analgesics and psychotropic medications for Alzheimer disease patients with (n=245) and without (n=215) musculoskeletal conditions (ie, arthritis or rheumatism) are compared.SETTING: A national sample of community dwelling and institutionalized older adults was identified from the Canadian Study of Health and Aging* (CSHA).PARTICIPANTS: Persons from 36 cities and surrounding rural areas over 64 years of age were randomly identified for the CSHA from government health records in all but one province.MEASUREMENTS: Prescribed analgesic and psychotropic medications were examined, as well as dementia severity and dementia related behavioural disturbance.RESULTS: Less than half of Alzheimer patients with arthritis or rheumatism were treated for pain (ie, 109 of 245 patients); they were also more likely to be prescribed benzodiazepines compared with Alzheimer patients without musculoskeletal conditions (subsequent to initial consideration for analgesia, dementia severity and dementia-related behaviours; äX2[ädf =1] =3.97, P=0.046).CONCLUSIONS: These findings are in accord with prior research attesting to the undertreatment of pain among older adults. These results can be generalized with greater confidence, given the random composition of the patient sample.Peer Reviewe

Ecological Momentary Assessment of Mood and Movement With Bipolar Disorder Over Time: Participant Recruitment and Efficacy of Study Methods

Objectives Mobile technology and ambulatory research tools enable the study of human experience in vivo, when and where it occurs. This includes cognitive processes that cannot be directly measured or observed (e.g., emotion) but can be reported in the moment when prompted. Methods For the Bipolar Affective Disorder and older Adults (BADAS) Study, 50 participants were randomly prompted twice daily to complete brief smartphone questionnaires. This included the Bipolar Disorder Symptom Scale which was developed to briefly measure symptoms of both depression (cognitive and somatic) and hypo/mania (affrontive symptoms and elation/loss of insight). Participants could also submit voluntary or unsolicited app responses anytime; all were time- and GPS-stamped. Herein, we describe BADAS study methods that enabled effective recruitment, adherence and retention. Results We collected 9600 app responses over 2 year, for an average response rate of 1.4×/day. Over an average of 145 consecutive days (range 2–435 days), BADAS participants reported depression and hypo/mania symptom levels (a.m. and p.m.), sleep quality (a.m.), medication adherence (a.m.) and any significant events of the day (p.m.). They received id="mce_marker"/day for the first 90 days after submitting both a.m. and p.m. questionnaires. Conclusion BADAS study methods demonstrates the utility of ecological momentary assessment in longitudinal psychiatric research

COVID-19 and Mental Health of Minority Arab Higher-Education Students in Israel: Social, Economic, and Academic Factors

The mental health and well-being of higher-education students is a topic of growing interest. COVID-19 impacted higher education in many ways and the challenges were especially pronounced for minority students. This study examines the impact of COVID-19 on the mental health of Arab minority students in Israel in relation to social, academic, and financial factors. We recruited 420 Arab higher-education students enrolled in academic colleges or universities in Israel who completed a battery of online questionnaires. Mental health status was measured by the Depression, Anxiety, and Stress Scale 21 (DASS-21). Moderate to severe symptoms of depression, anxiety, and stress were reported by 49.3%, 45.2%, and 54% of Arab students, respectively. Analyses indicate that low quality of online learning, academic difficulties, and negative economic effects of COVID-19 predicted stress, anxiety, and depression. Women reported higher levels of depression and stress; job loss predicted depression and anxiety; low income predicted depression; and COVID-19-related health concerns predicted anxiety. This study highlights the unique and multiple challenges faced by minority students from disadvantaged backgrounds. Campus programs are needed to address the emotional needs of students. Longitudinal research is needed to more fully understand the impact of COVID-19 on higher-education students

Psychometric properties of responses by clinicians and older adults to a 6-item Hebrew version of the Hamilton Depression Rating Scale (HAM-D₆)

Abstract Background The Hamilton Depression Rating Scale (HAM-D) is commonly used as a screening instrument, as a continuous measure of change in depressive symptoms over time, and as a means to compare the relative efficacy of treatments. Among several abridged versions, the 6-item HAM-D6 is used most widely in large degree because of its good psychometric properties. The current study compares both self-report and clinician-rated versions of the Hebrew version of this scale. Methods A total of 153 Israelis 75 years of age on average participated in this study. The HAM-D6 was examined using confirmatory factor analytic (CFA) models separately for both patient and clinician responses. Results Reponses to the HAM-D6 suggest that this instrument measures a unidimensional construct with each of the scales’ six items contributing significantly to the measurement. Comparisons between self-report and clinician versions indicate that responses do not significantly differ for 4 of the 6 items. Moreover, 100% sensitivity (and 91% specificity) was found between patient HAM-D6 responses and clinician diagnoses of depression. Conclusion These results indicate that the Hebrew HAM-D6 can be used to measure and screen for depressive symptoms among elderly patients.</p

Social Support and Symptoms of Depression in Late Life: Bidirectional Associations over Time

Social support functions as an effective buffer against depression, especially among older adults with limited social networks. For the current study, we examined longitudinal bidirectional associations between social support and depression among those 75+ years of age. We recruited and followed a sample of Israeli adults 75+ years of age (N = 824; M = 80.84; range 75&ndash;96 years). Structured interviews were conducted in the homes of participants at three annual points of measurement. Participants reported depressive symptoms and emotional and instrumental support received from friends and family. We examined a cross-lagged, longitudinal structural equation model (SEM) in which social support and depressive symptoms predict each other over time, covarying for previously reported social support and depressive symptoms. We found that both depressive symptoms and social support are largely consistent in late life. Depressive symptoms and social support reported at baseline predict levels reported 1 and 2 years thereafter. Cross-over effects emerged over time. Depressive symptoms predicted lower social support in future, and social support at baseline predicted depressive symptoms 2 years later. These findings suggest that associations between depressive symptoms and social support are bidirectional in late life. Further research is needed to replicate findings in other cultures and over longer periods, ideally until end of life