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David C Steffens

Publications and source records attributed to David C Steffens.

At least 37 records · Page 2Linked to original sources
PubMed2006

Vascular nutritional correlates of late-life depression.

OBJECTIVE: The authors sought to examine the association of vascular nutritional factors and depression in an elderly cohort of depression (currently and recently depressed) and comparison (never depressed) subjects. METHOD: Nutrient intake over the past year was assessed in 196 elderly depression and comparison individuals with a Block 1998 food-frequency questionnaire. Nutrient intake, body mass index, and Keys score (a measure of the serum cholesterol-raising capacity of the diet) were determined. Subjects were age 60 and over and were participants in a longitudinal study of major depression. All subjects received psychiatric and medical comorbidity assessments; depression subjects also received psychiatric treatment. RESULTS: Vascular nutritional factors differed between depression and comparison subjects. The depression group had higher intake of saturated fat and cholesterol, higher body mass indices, lower alcohol intake, and higher Keys score than the comparison group. After controlling for age, sex, education, race, and medical comorbidity, associations remained for cholesterol, alcohol, and Keys score. Depression was found to be associated with overall dietary pattern as defined by total kilocalories, saturated fat, cholesterol, body mass index, polyunsaturated fat, sodium, and alcohol. CONCLUSIONS: This study provides evidence that dietary vascular risk factors differ in individuals with current or prior depression when compared with individuals with no history of depression.

Age of Onset↗
PubMed2006

Reducing suicidal ideation in depressed older primary care patients.

OBJECTIVES: To determine the effect of a primary care-based collaborative care program for depression on suicidal ideation in older adults. DESIGN: Randomized, controlled trial. SETTING: Eighteen diverse primary care clinics. PARTICIPANTS: One thousand eight hundred one adults aged 60 and older with major depression or dysthymia. INTERVENTION: Participants randomized to collaborative care had access to a depression care manager who supported antidepressant medication management prescribed by their primary care physician and offered a course of Problem Solving Treatment in Primary Care for 12 months. Participants in the control arm received care as usual. MEASUREMENTS: Participants had independent assessments of depression and suicidal ideation at baseline and 3, 6, 12, 18, and 24 months. Depression was assessed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (SCID). Suicidal ideation was determined using the SCID and the Hopkins Symptoms Checklist. RESULTS: At baseline, 139 (15.3%) intervention subjects and 119 (13.3%) controls reported thoughts of suicide. Intervention subjects had significantly lower rates of suicidal ideation than controls at 6 months (7.5% vs 12.1%) and 12 months (9.8% vs 15.5%) and even after intervention resources were no longer available at 18 months (8.0% vs 13.3%) and 24 months (10.1% vs 13.9%). There were no completed suicides in either group. Information on suicide attempts or hospitalization for suicidal ideation was not available. CONCLUSION: Primary care-based collaborative care programs for depression represent one strategy to reduce suicidal ideation and potentially the risk of suicide in older primary care patients.

Aged↗
PubMed2006

Ascending digits task as a measure of executive function in geriatric depression.

The authors hypothesized that older depressed patients would perform more poorly on the Ascending Digits Task (ADT) when matched against a nondepressed elderly comparison group. In a novel measure, the ADT, 129 older depressives scored more poorly than 129 comparison subjects in bivariate analyses and models controlling for demographic variables. The ADT may be a good measure of executive function in older adults.

Activities of Daily Living↗
PubMed2006

Hippocampal volume is associated with physician-reported acute cognitive deficits after electroconvulsive therapy.

Predicting memory problems in older depressed patients receiving electroconvulsive therapy (ECT) is difficult. In this study, hippocampal volume and acute memory outcomes were examined in 15 patients following an index course of ECT. Smaller hippocampal volume was associated with poorer ECT-related memory outcomes. These results add to a growing literature on memory, ECT, and the hippocampus. Although the findings are significant, the sample size in the study is small, so future studies with more complex modeling of key variables that may influence memory are warranted.

Acute Disease↗
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

Lobar distribution of lesion volumes in late-life depression: the Biomedical Informatics Research Network (BIRN).

White matter hyperintense lesions on T2-weighted images are associated with late-life depression. Little work has been carried out examining differences in lesion location between elderly individuals with and without depression. In contrast to previous studies examining total brain white matter lesion volume, this study examined lobar differences in white matter lesion volumes derived from brain magnetic resonance imaging. This study examined 49 subjects with a DSM-IV diagnosis of major depression and 50 comparison subjects without depression. All participants were age 60 years or older. White matter lesion volumes were measured in each hemisphere using a semiautomated segmentation process and localized to lobar regions using a lobar atlas created for this sample using the imaging tools provided by the Biomedical Informatics Research Network (BIRN). The lobar lesion volumes were compared against depression status. After controlling for age and hypertension, subjects with depression exhibited significantly greater total white matter lesion volume in both hemispheres and in both frontal lobes than did control subjects. Although a similar trend was observed in the parietal lobes, the difference did not reach a level of statistical significance. Models of the temporal and occipital lobes were not statistically significant. Older individuals with depression have greater white matter disease than healthy controls, predominantly in the frontal lobes. These changes are thought to disrupt neural circuits involved in mood regulation, thus increasing the risk of developing depression.

Aged↗
PubMed2005

Clinical correlates of anxious depression among elderly patients with depression.

OBJECTIVE: The purpose of this study was to determine the clinical correlates of comorbid anxiety and depression in a sample of older patients with major depression. METHODS: 352 patients aged 59 and older with major depression were enrolled in the Study of Depression in Later Life at Duke University, of whom 148 met criteria for lifetime generalized anxiety disorder. Participants completed self-report assessments of performance in basic and instrumental activities of daily living, social support, suicidal ideation, life satisfaction, and stressful life events. Cognitive assessment was done with the Mini-Mental State Examination. RESULTS: The prevalence of lifetime anxiety in our depressed sample was 42%. Patients with anxious depression were significantly younger, and had greater suicidal ideation, more impairment of subjective social support, and more severe depressive symptoms. CONCLUSION: In elderly patients with anxious depression, psychosocial support and suicidal ideation should be assessed. Whether improvement of subjective social support leads to reduction in anxious depression should be investigated.

Aged↗
PubMed2005

The Aging, Demographics, and Memory Study: study design and methods.

OBJECTIVE: We describe the design and methods of the Aging, Demographics, and Memory Study (ADAMS), a new national study that will provide data on the antecedents, prevalence, outcomes, and costs of dementia and "cognitive impairment, not demented" (CIND) using a unique study design based on the nationally representative Health and Retirement Study (HRS). We also illustrate potential uses of the ADAMS data and provide information to interested researchers on obtaining ADAMS and HRS data. METHODS: The ADAMS is the first population-based study of dementia in the United States to include subjects from all regions of the country, while at the same time using a single standardized diagnostic protocol in a community-based sample. A sample of 856 individuals age 70 or older who were participants in the ongoing HRS received an extensive in-home clinical and neuropsychological assessment to determine a diagnosis of normal, CIND, or dementia. Within the CIND and dementia categories, subcategories (e.g. Alzheimer's disease, vascular dementia) were assigned to denote the etiology of cognitive impairment. CONCLUSION: Linking the ADAMS dementia clinical assessment data to the wealth of available longitudinal HRS data on health, health care utilization, informal care, and economic resources and behavior, will provide a unique opportunity to study the onset of CIND and dementia in a nationally representative population-based sample, as well as the risk factors, prevalence, outcomes, and costs of CIND and dementia.

Aging↗
PubMed2005

Greater MRI lesion volumes in elderly depressed subjects than in control subjects.

Hyperintense lesions in both white matter and gray matter on T2-weighted magnetic resonance imaging (MRI) are associated with late-life depression. This large study examined differences in gray and white matter lesion volumes on brain MRI between 253 elderly depressed and 146 control subjects. White matter and gray matter lesion volumes were measured in each hemisphere using a semi-automated segmentation process and compared against depression status. Depressed subjects exhibited significantly greater total white matter (mean 7.22 ml) and gray matter (mean 0.30 ml) lesion volumes in both hemispheres than did control subjects (mean 4.87 ml in white matter and 0.18 ml in gray matter). This difference remained statistically significant even after controlling for confounders such as age, sex, race and reports of hypertension, diabetes and heart disease. Patients with late-life depression have larger white matter lesion and gray matter lesion volumes than do control subjects. Future research should combine similar volumetric techniques with methods of identifying the location of lesions specific to late-life depression.

Aged↗
PubMed2005

Influence of serotonin transporter promoter region polymorphisms on hippocampal volumes in late-life depression.

CONTEXT: Polymorphisms in the promoter region of the serotonin transporter gene (5-HTTLPR) influence transcription and may play a role in the pathogenesis and course of depression. Recent research demonstrates that specific polymorphisms may be associated with differences in hippocampal volumes in subjects with depression. OBJECTIVE: To examine associations between 5-HTTLPR genotype and hippocampal volumes in elderly control subjects and elderly subjects classified as having early or late onset of depression. DESIGN: Cohort study examining baseline characteristics. PARTICIPANTS: Subjects were community dwelling and 60 years or older. Using a definition of early-onset depression as depression first occurring at 50 years or younger, we examined 72 subjects with early-onset depression, 63 subjects with late-onset depression, and 83 healthy control subjects. MAIN OUTCOME MEASURES: All subjects underwent genotyping for the 5-HTTLPR and underwent brain magnetic resonance imaging. Analyses of hippocampal volumes were controlled for total cerebral volume, age, and sex. RESULTS: The interaction between diagnosis and 5-HTTLPR genotype was statistically significant for the right hippocampus (P = .04). Subjects with late-onset depression who were homozygous for the long (L) allele (L /L genotype) had significantly smaller right hippocampal volumes than did L /L subjects with early-onset depression (P = .046) or L /L control subjects (P = .01). Post hoc analyses showed that later age of depression onset was associated with smaller hippocampal volumes in subjects with the L /L genotype, but earlier age of onset was associated with smaller hippocampal volumes in subjects who were homozygous for the short (S) allele (S/S genotype). CONCLUSIONS: Subjects with late-onset depression who were homozygous for the L allele exhibited smaller hippocampal volumes than other groups. Genotype also mediated the effect of age of onset on hippocampal volumes. Our findings differ from previous work; however, we examined an older and larger cohort of subjects than previous studies. Possible explanations for these findings include interactions between the serotonergic system and neurotrophic factors or cortisol response to stresses, each of which may affect hippocampal volumes.

Age Factors↗
PubMed2005

Residual symptoms in older patients treated for major depression.

OBJECTIVE: The purpose of this study was to identify residual symptoms in a sample of older adults treated for major depression and compare individual symptoms present at baseline with those at three months by remission status. METHODS: The sample was comprised of 229 patients with DSM-IV major depression who were participants in the NIMH Mental Health Clinical Research Center at Duke University. Symptoms were measured using the Montgomery-Asberg Depression Rating Scale (MADRS). RESULTS: At three months, 86 patients (37.6%) had remitted, or had a MADRS score less than or equal to 9. In the remitted group, the most frequently reported symptoms at three months were inner tension and lassitude. Among nonremitters, the most frequently reported symptoms were reported and apparent sadness, as well as lassitude and inner tension. In the sample as a whole, the symptoms most likely to be present at baseline but not three months were pessimistic and suicidal thoughts, while the most frequently reported emergent symptoms were reduced appetite and inner tension. Patients were much more likely to no longer have a particular symptom than to acquire a new symptom. Overall, the symptoms present at three months were not severe in either group. CONCLUSIONS: In older adults treated for major depression, residual symptoms at three months may include emergent symptoms as well as persistent symptoms, and are likely to include symptoms of anxiety as well as sadness. These findings have clinical implications for the treatment of late-life depression.

Affect↗
PubMed2005

Biological and social predictors of long-term geriatric depression outcome.

OBJECTIVE: In this study, we examined 204 older depressed individuals for up to 64 months to determine factors related to depression outcome. We hypothesized that both presence of vascular brain lesions seen on baseline magnetic resonance imaging (MRI) scans and lower baseline social support measures would be related to worse depression outcome. METHOD: At study entry, all subjects were at least 59 years old, had a diagnosis of major depression, and were free of other major psychiatric illness and primary neurological illness, including dementia and stroke. Depression was diagnosed via structured interview and clinical assessment by a geriatric psychiatrist who completed a Montgomery Asberg Depression Rating Scale (MADRS) to determine severity of depression. Subjects provided self-report data on social support variables and ability to perform basic and instrumental activities of daily living (ADL, IADL). All subjects agreed to have a baseline standardized MRI brain scan. Ratings of severity of hyperintensities were determined for the periventricular white matter, deep white matter, and subcortical gray matter by two readers who decided by consensus. Treatment was provided by geropsychiatrists following clinical guidelines. Using mixed models to analyze the data, we determined the effect of a variety of demographic, social and imaging variables on the trajectory of MADRS score, the outcome variable of interest. RESULTS: MADRS scores decreased steadily over time. In a final HLM model, in which time since entry, a baseline time indicator, age, gender, education and Mini-mental State Examination score were controlled, subjective social support, instrumental ADL impairment, subcortical gray matter severity, and the interactions of time with social network and with subcortical gray matter lesions remained significantly associated with MADRS score. CONCLUSIONS: Both social and biological factors at baseline are associated with longitudinal depression severity in geriatric depression.

Aged↗
PubMed2005

Impact of symptoms of generalized anxiety disorder on the course of late-life depression.

OBJECTIVE: The authors sought to examine the effect of symptoms of generalized anxiety disorder (GAD) on acute course of depression in a group of older depressed patients. METHODS: Authors assessed GAD symptoms in a sample of 204 patients age 60 and older with unipolar major depression. Patients were treated naturalistically by study geriatric psychiatrists using a treatment guideline for geriatric depression and assessed with the Montgomery-Asberg Depression Rating Scale. They were dichotomized as meeting or not meeting GAD symptom criteria. The groups were analyzed by Cox proportional-hazards models. RESULTS: There were 138 remitters and 66 non-remitters. After analysis controlled for benzodiazepine use, stressful life events, social support, and functional status, having GAD symptoms was associated with longer time-to-remission. CONCLUSIONS: Older depressed patients with GAD have a worse outcome than those without anxiety. Future studies will need to determine the appropriate role of benzodiazepines and other anxiolytics in the treatment of older depressed patients with symptoms of GAD.

Acute Disease↗
PubMed2005

Hippocampal volume as a predictor of short-term ECT outcomes in older patients with depression.

OBJECTIVE: The authors examined the relationship between hippocampal volume and acute electroconvulsive therapy (ECT) outcomes. METHODS: Depression was measured by Montgomery-Asberg Depression Rating Scale (MADRS) scores, and hippocampal volume was assessed by magnetic resonance imaging. RESULTS: After controlling for baseline MADRS score, larger right-hippocampal volume was associated with higher MADRS scores after an index course of ECT. CONCLUSION: These results are the converse of those obtained in a study assessing the relationship between hippocampal volume and pharmacotherapy. The findings suggest a need for further study in this area.

Aged↗
PubMed2005

Social support and locus of control as predictors of adherence to antidepressant medication in an elderly population.

OBJECTIVE: The authors examined whether social support and locus of control (LOC), either individually or jointly, would be associated with subsequent self-reported medication adherence and treatment barriers in a sample of depressed elderly patients. METHODS: A group of 85 elderly patients with major depression was enrolled in the Mental Health Clinical Research Center for the Study of Depression in Later Life at Duke University and treated with a standardized algorithm. During the course of the study, participants completed measures of social support and internal locus of control (LOC). A little more than 1 year later, they completed general measures of medication adherence and treatment barriers. RESULTS: Increasing subjective and instrumental social support and non-family interaction were associated with greater adherence among patients high in internal LOC but not among patients low in internal LOC. Less instrumental social support was associated with more treatment barriers among patients low in internal LOC but not among patients high in internal LOC. CONCLUSION: The relationship between social support and antidepressant medication adherence is moderated by beliefs about control over one's illness.

Aged↗
PubMed2005

Hormone therapy does not affect depression severity in older women.

OBJECTIVE: Although estrogens are thought to have a beneficial effect on menopausal symptoms, the role of estrogen in the etiology and treatment of depression in older women remains unclear. The authors examined the relationship between hormone therapy (HT) use and depressive symptom severity. METHODS: Authors report the findings from a cross-sectional analysis of baseline data from the Improving Mood: Promoting Access to Collaborative Treatment (IMPACT) Study, using data from 1,160 women age 60 years and older. RESULTS: Women who were taking HT were likely to be younger, White, married, and to have had at least some college education. They were also more likely to report good or better health and to have taken antidepressant medications in the past 3 months. Although HT use was associated with more severe depressive symptoms in the unadjusted analysis, it was not associated with depression severity in adjusted analyses. Although there was a trend for a differential effect of college education with HT use on depression scores, no significant interaction was found between HT and race. CONCLUSION: There was no evidence to suggest that women HT users differ from non-HT users in depressive symptom severity.

Aged↗
PubMed2005

Population-based study of medical comorbidity in early dementia and "cognitive impairment, no dementia (CIND)": association with functional and cognitive impairment: The Cache County Study.

OBJECTIVE: Authors investigated medical comorbidity in persons with dementia and "Cognitive Impairment, No Dementia" (CIND). METHODS: The Cache County Study is an ongoing population-based study of the epidemiology of dementia, the risk factors for conversion from CIND to dementia, and the progression of dementia. As part of the study's first incidence wave, persons with dementia (N=149), CIND (N=225), or without cognitive impairment (N=321) were identified and studied. Participants received comprehensive clinical evaluations and were rated on the General Medical Health Rating (GMHR), a global measure of seriousness of medical comorbidity. Participants and informants also completed the Mini-Mental State Exam and provided self-report information about comorbid medical conditions and functioning in activities of daily living. RESULTS: There were few differences in number or type of comorbid medical conditions between persons with CIND and dementia, but persons with dementia were prescribed more medications. Stroke was more common in dementia participants, but other illnesses common in old age were not significantly different across cognitive groups. Medical comorbidity was more serious in both dementia and CIND, such that both groups were less likely to have "little to no" comorbidity. Seriousness of medical comorbidity was significantly associated with worse day-to-day functioning and cognition. CONCLUSIONS: Persons with CIND and dementia have more serious medical comorbidity than comparable persons without cognitive impairment. This comorbidity may play a role in the progression of CIND and dementia. Future studies should investigate the role of medical comorbidity and its treatment on dementia onset or progression, as well as the mechanisms mediating its neuropathologic effects.

Activities of Daily Living↗