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Biomedical subjects

Dan G Blazer

Publications and source records attributed to Dan G Blazer.

At least 19 recordsLinked to original sources
PubMed2006

Sociodemographic characteristics of the neighborhood and depressive symptoms in older adults: using multilevel modeling in geriatric psychiatry.

OBJECTIVE: Neighborhood sociodemographic characteristics may be important to the mental health of older adults who have decreased mobility and fewer resources. Our objective was to examine the association between neighborhood context and level of depressive symptomatology in older adults in a diverse geographic region of central North Carolina. METHODS: The sample included 2,998 adults 65 or older residing in 91 census tracts. Depressive symptoms were measured using the Center for Epidemiologic Studies-Depression scale (CES-D). Neighborhoods were characterized by five census-based characteristics: socioeconomic disadvantage, socioeconomic advantage, racial/ethnic heterogeneity, residential stability, and age structure. RESULTS: In ecologic level analyses, level of census tract socioeconomic disadvantage was associated with increased depressive symptoms. To determine whether neighborhood context was associated with depressive symptoms independently of individual characteristics, the authors used multilevel modeling. The authors examined the ability of each of five neighborhood (level 2) characteristics to predict a level 1 outcome (CES-D symptoms) controlling for the effects of individual (level 1) characteristics. Younger age, being widowed, lower income, and having some functional limitations were associated with increased depression symptoms conditional on census tract random effects. However, none of the neighborhood characteristics was significantly associated with depression symptoms, conditional on census tract random effects, either unadjusted or adjusted for individual characteristics. CONCLUSION: Any observed association between neighborhood sociodemographic characteristics and individual depressive symptoms in our sample may reflect the characteristics of the individuals who reside in the neighborhood rather than the neighborhood characteristics themselves. The use of multilevel modeling is important to separate these effects.

Aged↗
PubMed2006

Successful aging.

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Activities of Daily Living↗
PubMed2006

Spirituality and depressive symptoms in a racially diverse US sample of community-dwelling adults.

The role of spirituality in depression is understudied. We examined the relationship between one dimension of spirituality, spiritual experiences, and depressive symptoms, and evaluated whether differences in gender, race, age, and stress moderated the relationship. The study was conducted with a community-based sample of 630 racially diverse middle-aged and older adults. Structural equation modeling was used to estimate a model linking spiritual experiences to depressive symptoms while controlling for demographic and health variables. Spiritual experiences were operationalized using six items of the Daily Spiritual Experiences Scale. Sample items included, "I feel God's presence," and, "I feel comfort in my religion or spirituality." The model achieved satisfactory goodness of fit. Spiritual experiences were significantly associated with fewer depressive symptoms, and age as well as stress moderated the association, but not gender and race. Spirituality appears to be a psychosocial resource against depressive symptoms, although the results must be confirmed in longitudinal investigations.

Adult↗
PubMed2006

Metabolic syndrome predicts mobility decline in a community-based sample of older adults.

OBJECTIVES: To determine whether metabolic syndrome is an independent predictor of decline in mobility in an elderly community sample. DESIGN: Biracial community-based prospective cohort study. SETTING: Urban and rural areas of central North Carolina. PARTICIPANTS: One thousand two hundred twenty-nine older African Americans and whites, mean age 77.0, who were participants in the Duke Established Populations for Epidemiologic Studies of the Elderly. MEASUREMENTS: Sociodemographic data and data on mobility (a subset of items from the Rosow-Breslau scale), depression (Center for Epidemiological Studies Depression Scale), self-report of medical conditions, body mass index, cognitive function (Short Portable Mental Status Questionnaire), blood pressure, height, and waist circumference. High-density lipoprotein cholesterol, triglycerides, and blood glucose were available from blood samples. Metabolic syndrome was calculated for subjects with complete data. RESULTS: Twenty-nine percent of the sample met criteria for metabolic syndrome. In bivariate analyses, age, sex, race, education, cognitive impairment, depression, impairment in mobility, history of stroke and heart disease, and metabolic syndrome at baseline were associated with a decline in mobility 4 years later. Regression analysis controlling for the above variables demonstrated that metabolic syndrome persisted as an independent and highly significant predictor of decline in mobility. CONCLUSION: These findings suggest that metabolic syndrome may be a distinct risk factor for mobility decline in community-dwelling older people.

Activities of Daily Living↗
PubMed2006

Provider characteristics related to antidepressant use in older people.

OBJECTIVES: To determine whether the characteristics of the usual medical care providers of older antidepressant users changed between 1986 and 1997 with the introduction of selective serotonin reuptake inhibitors. DESIGN: Longitudinal study. SETTING: Five-county Piedmont area of North Carolina. PARTICIPANTS: Stratified random sample of African-American (n=2,261) and white (n=1,875) community residents aged 65 to 105. MEASUREMENTS: Sample members provided information on prescription medications, demographic and health status, and usual medical care provider (matched to North Carolina Health Professions Data Systems files to ascertain provider characteristics) in 1986/87, 1989/90, 1992/93, and 1996/97. Most (77.5%) named a provider (name unmatchable for 4.1%). Sample member characteristics were aggregated into probability (propensity) scores summarizing predisposing (demographic), enabling (medical care access), and need (health status) categories. Along with wave of study and whether a provider was named, these were entered as control variables in generalized estimating equation models that examined the association between provider race (white vs nonwhite), sex, age, location of practice, and primary versus specialist care and antidepressant use. RESULTS: The characteristics of the usual medical care providers remained stable over the decade, although prevalence of antidepressant use increased. Two provider characteristics--race and area of practice (but not the interaction between them)--were significantly associated with patients' use of antidepressants. Patients of white physicians and of physicians with urban practices were more likely to use antidepressants. CONCLUSION: Although use of antidepressants has increased over time, there has been little change in the characteristics of users' usual medical care providers.

Aged↗
PubMed2006

Perception of unmet basic needs as a predictor of physical functioning among community-dwelling older adults.

OBJECTIVES: The present study examined the influence of participant's perception that their basic needs were not being met on their physical functioning problems. The association between lower social economic status (SES), typically indexed by income and education, and physical disability has been clearly established. Although income and education are not easily modifiable among older adults, perceptions of resource deficits may be more easily influenced through interventions. METHOD: Among community-dwelling older adults (N = 4,162), the authors examined the influence of participants' perception that their basic needs were not being met on physical functioning problems during a 10-year period using growth curve analyses. RESULTS: Baseline problems meeting basic needs influenced the growth in physical functioning problems, even after controlling for more objective indices of SES and for health problems and behaviors. DISCUSSION: Interventions focused on providing older adults with resources for meeting basic needs may substantially reduce the subsequent level of disability.

Activities of Daily Living↗
PubMed2006

Leighton's theory of sentiments: explorations and speculations on barriers to interpersonal forgiveness.

In My Name Is Legion (Leighton, 1959), the basic assumption of Alexander H. Leighton's theory of sentiment is as follows: 'A given personality exists more or less continuously throughout life in the act of striving, and interference with that striving has consequences which in turn often lead to psychiatric disorder' (p. 136). This commentary focuses first on selected sources of interference to interpersonal forgiveness and then elaborates a research agenda that aims to expand our knowledge of barriers to interpersonal forgiveness.

Anger↗
PubMed2006

Partial remission. A common outcome in older adults treated for major depression.

Major depression can affect up to 10% of older adults in clinical samples. Longitudinal studies of older adults with major depression report that a significant proportion of patients do not fully recover. Partial remission or symptoms of major depression that do not meet criteria for major depression, is predicted by 1) clinical factors, such higher number of symptoms at diagnosis, presence of comorbid dysthymia, and health problems; 2) social variables, such as high levels of perceived stress and low levels of perceived social support; and 3) perceived health/well-being variables, such as limitations in mobility or instrumental activities of daily living, poorer self-perceived health, finding life not satisfying, and looking back over life and finding it unhappy. Treatment options include antidepressants (alone or in combination) and psychotherapy.

Aged↗
PubMed2005

Racial disparities in elevated prenatal depressive symptoms among black and white women in eastern north Carolina.

PURPOSE: Black women have an increased risk for preterm birth compared with white women, and prior research indicated that maternal prenatal depressive symptoms are associated with increased risk for preterm outcomes among black women. Race-related differences in prenatal depression could be of etiologic significance in understanding racial disparities in preterm birth. Our study focused on Center for Epidemiologic Studies' Depression Scale (CES-D) scores of pregnant black and white women. METHODS: Women were administered the CES-D at the time of their first visit to hospital-based prenatal clinics. Two cutoff scores for the CES-D were used: 16 or higher, which indicates "significant" depressive symptoms, and 23 or higher, which indicates major depressive disorder. RESULTS: For the sample of 1163 women, mean CES-D scores were significantly higher among black (17.4) than white (13.7) women. Of black women, 49% had CES-D scores higher than 15 compared with 33.5% of white women. Also, 27.5% of black women had scores higher than 22 compared with 16% of white women. After adjustment for maternal age, marital status, and education, odds ratios for race for both CES-D cutoff scores were approximately 1.5. CONCLUSIONS: Results of this study indicate that black women have greater rates of prenatal depression than white women.

Adolescent↗
PubMed2005

Aging-related diagnostic variations: need for diagnostic criteria appropriate for elderly psychiatric patients.

It is commonly thought and taught that most psychiatric disorders other than dementia are much less prevalent among the elderly than among younger adults. This perception is based on a relatively small number of published epidemiologic investigations of the incidence and prevalence of mental illnesses in elderly populations. Most of these studies have had a number of methodologic problems, including improper definitions and diagnostic criteria for older persons. A likely consequence of these misconceptions is that clinically significant and potentially treatable mental illnesses might be overlooked, misdiagnosed, and mistreated in elderly patients. Studies in community samples suggest that many older adults who experience clinically significant psychopathology do not fit easily into our existing nomenclature, and yet are disabled. There is a need to develop aging-appropriate diagnostic criteria for major psychiatric disorders. In this article, we discuss the potential causes of this diagnostic confusion. Four specific classes of disorders-mood (specifically depressive) disorders, schizophrenia (and related psychotic disorders), anxiety disorders, and substance use disorders-are discussed as examples. Finally, we suggest some future steps for clarifying this diagnostic confusion.

Age of Onset↗
PubMed2005

Origins of depression in later life.

BACKGROUND: Despite the burden of depression in late life, its origins present a paradox to investigators and clinicians alike. METHOD: We review biological (genetics and heredity factors, neurotransmitter dysfunction, endocrine changes, vascular disorders, and medical co-morbidities), psychological (personality attributes, neuroticism, cognitive distortions, and the lack of emotional control and self-efficacy) and social (stressful life events, bereavement, chronic stress or strain, socio-economic disadvantage and impaired social support) origins of late-life depression based upon an extensive though not exhaustive review of the extant literature. In addition, modifying psychological and social factors are discussed. RESULTS: Older adults appear to be at greater risk for major depression biologically, such as depression resulting from vascular changes, yet the frequency of depression is lower compared to younger adults. Older adults may be protected psychologically due to factors such as socio-emotional selectivity and wisdom, compared to younger adults, and perhaps relatively protected from social risks. CONCLUSIONS: A biopsychosocial approach to evaluating the origins of late-life depression is heuristically valuable, a continual reminder of the many factors that contribute to the onset and persistence of clinically significant symptoms in late life.

Age of Onset↗
PubMed2005

Racial differences in cognitive decline in a sample of community-dwelling older adults: the mediating role of education and literacy.

OBJECTIVE: The authors examined racial differences in cognitive decline (CD) and the role of education and literacy in mediating this relationship. METHODS: The relationship between race and CD was examined over a 3-year period in a biracial community sample of older adults (N = 3,097) living in North Carolina. RESULTS: African Americans, as compared with White participants, had fewer years of education and were more likely to be assessed by the interviewer as not literate. Race predicted CD such that African Americans had higher rates than Whites. When education and literacy were entered into the analysis, the association between race and CD, although remaining statistically significant, was reduced and was of relatively weak magnitude. Also, physical functioning problems also predicted CD and were found to be greater in African Americans than in Whites. CONCLUSIONS: Education and literacy may be protective factors against CD. Socioeconomic disadvantages experienced by older African Americans in the South early in life, leading to poorer educational opportunities, may explain, in part, the increased rates of CD in older African Americans versus Whites.

Aged↗
PubMed2005

The influence of depression on cognitive decline in community-dwelling elderly persons.

OBJECTIVE: An association between depression and cognitive decline (CD) has been observed in cross-sectional and case/control studies of elderly populations. Whereas a handful of longitudinal community studies have found depressive symptoms to predate the onset of CD, others have found no association between depression and subsequent cognitive dysfunction. The authors examined the association between depressive symptoms and cognitive errors measured 3 years apart in a longitudinal sample of community-dwelling elderly persons. METHODS: Data were obtained from 4,162 subjects assessed as part of the Established Populations for Epidemiologic Studies of the Elderly, a population survey assessing physical, psychological, and social functioning of persons 65 years and older. RESULTS: Depressive symptoms were associated with subsequent CD even after controlling for baseline cognitive status, as well as demographic (e.g., race, gender, age, and socioeconomic status) and physical functioning variables. This was true for the sample as a whole, as well as for a subsample of participants who evidenced no baseline cognitive difficulties. CONCLUSION: Study results are consistent with others finding an association between depressive symptoms and subsequent CD. Theories regarding the causal mechanisms underlying the association between depression and cognitive decline are discussed.

Activities of Daily Living↗
PubMed2005

Predictors of partial remission in older patients treated for major depression: the role of comorbid dysthymia.

OBJECTIVE: The authors studied demographic, clinical, social, and perceived health and well-being factors as predictors of partial remission in older patients treated for major depressive disorder (MDD). METHODS: The sample included 186 patients who met DSM-IV criteria for MDD and underwent naturalistic treatment. Remission status was determined by Montgomery-Asberg Depression Rating Scale score. Ordinal logistic-regression was used to model the relationship between predictors and remission on an ordinal scale. RESULTS: A total of 26.9% patients were in partial remission (score: 7-15), and 25.8% were not in remission (score: 16-60) 1 year after the index evaluation. In bivariate analyses, the odds of partial/no remission were significantly increased for those with comorbid MDD and dysthymia and for those with higher baseline depression scores, and decreased for those with higher perceived social support. Other factors potentially associated with outcome included number of mobility/IADL limitations, perceived stress, self-perceived health, life dissatisfaction, and heart trouble. Controlling for these potential confounders, comorbid MDD and dysthymia significantly predicted outcome. The effect of mobility/IADL limitations differed for those with comorbid dysthymia. CONCLUSIONS: Among older adults treated for MDD, factors predicting partial remission appear to be similar to those predicting no remission. Patients with comorbid MDD and dysthymia are at increased risk for poor outcome, and predictors may vary by dysthymia status.

Activities of Daily Living↗
PubMed2005

Predictors of antidepressant use among older adults: have they changed over time?

OBJECTIVE: Antidepressant use increased substantially among older adults with the introduction of the new-generation medications such as the selective serotonin reuptake inhibitors. The authors analyzed data from two follow-up intervals-1986-1987 to 1989-1990 (interval 1) and 1992-1993 to 1996-1997 (interval 2)-from a community-based cohort of 4,162 older adults to determine predictors of future antidepressant use. METHOD: Information on antidepressant use, demographic and health characteristics, and categories of depressive symptoms-positive affect, negative affect, somatic complaints, and interpersonal problems-were obtained. Logistic regression was used to control simultaneously for multiple variables predicting antidepressant use during the two intervals. Repeated-measures logistic regression (with generalized estimating equations) was employed to model the probability of antidepressant use, with adjustment for the effect of time. RESULTS: Prior antidepressant use and white race were strong predictors of future use during both intervals. Negative affect was the only additional significant predictor of use during interval 1. In contrast, low positive affect scores, cognitive impairment, and poorer health were additional significant predictors during interval 2. In a repeated-measures model, race, prior antidepressant use, poor health, low positive affect scores, and somatic complaints varied as predictors over time. Negative affect and cognitive impairment were consistent predictors over time. CONCLUSIONS: The predictors of antidepressant use by older adults changed over time, with health-related measures of quality of life, such as positive affect, health status, and somatic complaints, becoming more prominent as predictors of use.

Affect↗
PubMed2005

Perception of unmet basic needs as a predictor of mortality among community-dwelling older adults.

OBJECTIVES: We sought to determine whether, among older adults (>65 years), a perception that their basic needs are not being met increased mortality risk and whether this risk varied by race/ethnicity. METHODS: We used Cox proportional hazards modeling to estimate the effect of perceived inadequacy in having one's basic needs (adequacy of income, quality of housing, and neighborhood safety) met on 10-year mortality rates. RESULTS: After control for age, gender, race/ethnicity, marital status, education, income, and cognitive and functional status at baseline, perceived inadequacy in having one's basic needs met was shown to be a significant predictor of mortality (P<.0001), but no significant differences by race/ethnicity were observed. CONCLUSIONS: Perceived inadequacy in having one's basic needs met predicted mortality during a 10-year follow-up among community-dwelling elderly persons.

Activities of Daily Living↗