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Biomedical subjects

H G Koenig

Publications and source records attributed to H G Koenig.

At least 55 records · Page 3Linked to original sources
PubMed1998

Religious activity and depression among community-dwelling elderly persons with cancer: the moderating effect of race.

OBJECTIVES: Research has been oriented toward elucidating the links between religion and mental health. The purpose of this article is to further our knowledge in this area by examining the effect of religious activity on depressive symptomatology among community-dwelling elderly persons with cancer. We also test whether these effects differ between Blacks and Whites. METHODS: We use two waves of data collected from a community-dwelling sample of elderly persons living in North Carolina. Depressive symptomatology is measured using four subscales from the CES-D 20 scale: somatic-retarded activity, depressed affect, positive affect, and interpersonal relations. Measures of religious activity include service attendance, religious devotion, and watching or listening to religious programs. RESULTS: The findings indicate that among Blacks with cancer, religious activity is related to lower levels of depressive symptomatology; no such relationship is found for respondent with other illnesses or no illness. Further, the effects of religious activity are stronger among Blacks than Whites. DISCUSSION: The analyses lend support to the hypothesis that religious activity is a strong predictor of depression in elderly adults with cancer. This finding, however, is not as strong as we had anticipated.

Adaptation, Psychological↗
PubMed1998

Religious coping and health status in medically ill hospitalized older adults.

Associations between specific religious coping (RC) behaviors and health status in medically ill hospitalized older patients were examined and compared with associations between nonreligious coping (NRC) behaviors and health status. The sample consisted of 577 patients age 55 or over consecutively admitted to the general medical inpatient services of Duke University Medical Center (78%) or the Durham VA Medical Center (22%). Information was gathered on 21 types of RC, 11 types of NRC, and 3 global indicators of religious activity (GIRA). Health measures included multiple domains of physical health, depressive symptoms, quality of life, stress-related growth, cooperativeness, and spiritual growth. Demographic factors, education, and admitting hospital were control variables. "Negative" and "positive" types of religious coping were identified. Negative RC behaviors related to poorer physical health, worse quality of life, and greater depression were reappraisals of God as punishing, reappraisals involving demonic forces, pleading for direct intercession, and expression of spiritual discontent. Coping that was self-directed (excluding God's help) or involved expressions reflecting negative attitudes toward God, clergy, or church members were also related to greater depression and poorer quality of life. Positive RC behaviors related to better mental health were reappraisal of God as benevolent, collaboration with God, seeking a connection with God, seeking support from clergy/church members, and giving religious help to others. Of 21 RC behaviors, 16 were positively related to stress-related growth, 15 were related to greater cooperativeness, and 16 were related to greater spiritual growth. These relationships were both more frequent and stronger than those found for NRC behaviors. Certain types of RC are more strongly related to better health status than other RC types. Associations between RC behaviors and mental health status are at least as strong, if not stronger, than those observed with NRC behaviors.

Adaptation, Psychological↗
PubMed1998

Use of hospital services, religious attendance, and religious affiliation.

BACKGROUND: We examined the relationship between religious attendance, religious affiliation, and use of acute hospital services by older medical patients. METHODS: Religious affiliation (n = 542) and church attendance (n = 455) were examined in a consecutive sample of medical patients aged 60 or older admitted to Duke University Medical Center. Information on use of acute hospital services during the year before admission and length of the current hospital stay was collected. Frequency of church attendance and religious affiliation were examined as predictors of hospital service use, controlling for age, sex, race, education, social support, depressive symptoms, physical functioning, and severity of medical illness as covariates using logistic regression. RESULTS: Patients who attended church weekly or more often were significantly less likely in the previous year to have been admitted to the hospital, had fewer hospital admissions, and spent fewer days in the hospital than those attending less often; these associations retained their significance after controlling for covariates. Patients unaffiliated with a religious community, while not using more acute hospital services in the year before admission, had significantly longer index hospital stays than those affiliated. Unaffiliated patients spent an average of 25 days in the hospital, compared with 11 days for affiliated patients; this association strengthened when physical health and other covariates were controlled. CONCLUSIONS: Participation in and affiliation with a religious community is associated with lower use of hospital services by medically ill older adults, a population of high users of health care services. Possible reasons for this association and its implications are discussed.

Aged↗
PubMed1998

Religiosity and remission of depression in medically ill older patients.

OBJECTIVE: The effects of religious belief and activity on remission of depression were examined in medically ill hospitalized older patients. METHOD: Consecutive patients aged 60 years or over who had been admitted to medical inpatient services at a university medical center were screened for depressive symptoms. Of 111 patients scoring 16 or higher on the Center for Epidemiologic Studies Depression Scale, 94 were diagnosed with depressive disorder (DSM-III major depression or subsyndromal depression) by a psychiatrist using a structured psychiatric interview. After hospital discharge, depressed patients were followed up by telephone at 12-week intervals four times. At each follow-up contact, criterion symptoms were reassessed, and changes in each symptom over the interval since last contact were determined. The median follow-up time for 87 depressed patients was 47 weeks. Religious variables were examined as predictors of time to remission by means of a multivariate Cox model, with controls for demographic, physical health, psychosocial, and treatment factors. RESULTS: During the follow-up period, 47 patients (54.0%) had remissions; the median time to remission was 30 weeks. Intrinsic religiosity was significantly and independently related to time to remission, but church attendance and private religious activities were not. Depressed patients with higher intrinsic religiosity scores had more rapid remissions than patients with lower scores. CONCLUSIONS: In this study, greater intrinsic religiosity independently predicted shorter time to remission. To the authors' knowledge, this is the first report in which religiosity has been examined as a predictor of outcome of depressive disorder.

Age Factors↗
PubMed1998

Use of health services by hospitalized medically ill depressed elderly patients.

OBJECTIVE: The authors examined whether depression is associated with greater use of health services by elderly medical patients before and during hospitalization. METHOD: Depression and recent use of health services were assessed in 542 patients aged 60 or over who were consecutively admitted to university medical services. Depression was measured by using the Center for Epidemiologic Studies Depression Scale, the Hamilton Depression Rating Scale, and the depressive disorders section of the National Institute of Mental Health Diagnostic Interview Schedule, which was administered by a psychiatrist. RESULTS: After age, sex, race, education, and severity of medical illness were controlled for, Hamilton depression score significantly predicted hospital days in the past year, hospital days and total inpatient days (hospital plus nursing home) in the past 3 months, and number of outpatient medical visits in the past 3 months. Depressed patients had more hospital days in the past year and had more hospital days, total inpatient days, and outpatient medical visits in the past 3 months than did nondepressed patients. Associations between depression and length of index hospital stay, home health visits, nursing home days, and number of prescription medications disappeared when severity of medical illness was controlled. Mental health visits were no more common among depressed than nondepressed patients. CONCLUSIONS: Depressed elderly medical inpatients used more hospital and outpatient medical services than nondepressed patients, but they did not receive more mental health services. Efforts by primary care physicians and third-party payers to identify and treat depression in this population are needed.

Age Factors↗
PubMed1998

Aging, health, and the "electronic church".

We tested whether elders substitute religious media use for church attendance when health declines (using multidimensional disengagement theory) with data from a multiracial, population-based sample in the Bible Belt (N = 2,971). In adjusted models, 3-year declines in functional status were significantly associated with concurrent reduction in frequency of church attendance but not with any change in rates of religious media (TV/radio) use. Age-related declines in church attendance were substantively explained by declining functional ability. Changes in religious media use were independent of age and less sensitive to declining functional status or service attendance than to cultural heritage such as race, socioeconomic status, and rural upbringing. Our data do not support the hypothesis that elders with deteriorating health substitute increased engagement with religious media as their participation in organizational religious activities is reduced. However, applicability of the substitution hypothesis to other dimensions of nonorganizational religiousness (e.g., prayer) awaits similar scrutiny.

Aged↗
PubMed1998

The relationship between religious activities and blood pressure in older adults.

OBJECTIVE: To examine the relationship between religious activities and blood pressure in community-dwelling older adults. METHOD: Blood pressure and religious activities were assessed in a probability sample of 3,963 persons age sixty-five years or older participating in the Duke EPESE survey. Participants were asked if their doctor had ever informed them that they had high blood pressure and if they were currently taking medication for high blood pressure. After the interview, systolic and diastolic blood pressure were measured following a standardized protocol. Data were available for three waves of the survey (1986, 1989-90, and 1993-94). Analyses were stratified by age (65-74 vs. over 75) and by race (Whites vs. Blacks) and were controlled for age, race, gender, education, physical functioning, body mass index, and, in longitudinal analyses, blood pressure from the previous wave. RESULTS: Cross-sectional analyses revealed small (1-4 mm Hg) but consistent differences in measured systolic and diastolic blood pressures between frequent (once/wk) and infrequent (< once/wk) religious service attenders. Lower blood pressures were also observed among those who frequently prayed or studied the Bible (daily or more often). Blood pressure differences were particularly notable in Black and younger elderly, in whom religious activity at one wave predicted blood pressures three years later. Among participants who both attended religious services and prayed or studied the Bible frequently, the likelihood of having a diastolic blood pressure of 90 mm Hg or higher was 40 percent lower than found in participants who attended religious services infrequently and prayed or studied the Bible infrequently (OR 0.60, 95% CI, 0.48-0.75, p < .0001). Among participants told they had high blood pressure, religiously active persons were more likely to be taking their blood pressure medication; this could not, however, explain the differences in blood pressure observed. While most religious activity was associated with lower blood pressure, those who frequently watched religious TV or listened to religious radio actually had higher blood pressures. CONCLUSIONS: Religiously active older adults tend to have lower blood pressures than those who are less active. This applies to attendance at religious services and private religious activities, but not to religious media. Physiological mechanisms are discussed.

Black or African American↗
PubMed1998

Depressive symptoms in elderly medical-surgical patients hospitalized in community settings.

The authors examined the rates and correlates of depressive symptoms in adults over age 60 admitted to community hospital settings and compared them with patients admitted to a tertiary-care medical center. Rates of depressive symptoms in patients admitted to five different community hospitals in North Carolina were compared with each other and with a sample of 542 elderly medical patients admitted to Duke University Medical Center (DUMC). Compared with patients at DUMC, community-hospital patients were older and had more cognitive impairment, but had less severe medical illness and shorter hospital stays. The proportion of depressed community patients was significantly higher than among patients admitted to DUMC. In four of the five community hospitals, rates of significant depressive symptoms exceeded 50%. Health correlates of depression were admitting diagnoses other than cardiovascular disease, poor cognitive functioning, and severe medical illness.

Academic Medical Centers↗
PubMed1998

Depression and physical disability outcomes in depressed medically ill hospitalized older adults.

The authors examined depression/disability outcomes in hospitalized older medical patients during the year after hospital discharge to assess the pattern and rate of changing depression and disability, the causal relationship between these variables, and to identify patients at greatest risk for poor outcomes. A group of 119 medical patients at Duke Hospital were both depressed and disabled; they were followed for a median of 47 weeks after hospital discharge. Time-series analyses showed that depression and disability tended to track together, and most changes occurred within the first 6 months after discharge. Blacks were more likely to remit from depression despite continued disability and less likely to experience continued depression despite decreased disability. Patients with a history of depression were less likely to experience improvement in depression unless disability improved. Number of medical diagnoses and depression severity independently predicted poorer depression outcomes. Certain characteristics of patients during hospitalization predict depression/disability outcomes after discharge.

Activities of Daily Living↗
PubMed1998

Depression.

Depression occurs in up to 45% of medically hospitalized older patients. The diagnosis of depression in this population is particularly difficult. Assessing for depression is made easier by the use of scales for screening and is best accomplished using the inclusive approach. These depressions can be divided into two groups: "reactive" depression and major depression. Depression is treatable using a variety of modalities that include psychotherapy, pharmacotherapy, and electroconvulsive therapy.

Aged↗
PubMed1997

Differences in psychosocial and health correlates of major and minor depression in medically ill older adults.

OBJECTIVES: To compare the differences in correlates of different levels of depression in medically ill hospitalized older adults. DESIGN, SETTING, AND PARTICIPANTS: A consecutive series of 542 patients aged 60 or older admitted to the medical inpatient services of Duke Hospital underwent a structured psychiatric evaluation administered by a psychiatrist. MEASUREMENT: A wide range of demographic, social, psychiatric, and physical health data were collected, and associations with major and minor depression were assessed. RESULTS: Compared with patients without depression, those with major depression were more likely to have a history of prior episodes of depression, higher dysfunctional attitude scores, greater overall severity of medical illness, cognitive impairment, and symptoms of pain or other somatic complaints. Specific medical diagnosis was less important a predictor of major depression than overall severity of medical illness. Compared with patients without depression, those with minor depression were more likely to report non-health-related stressors during the year before hospital admission, have a diagnosis of immune system disorder, and have greater severity of medical illness. When major and minor depression were compared directly, on the other hand, no significant differences were observed except for history of depression, and that relationship was weak and present only when the etiologic approach to diagnosis was used. CONCLUSION: During hospital admission, certain psychosocial, psychiatric, and physical health characteristics of older medical patients place them at high risk for different levels of depression. Patients with major and minor depression resemble each other more than they do patients without depression. These findings may help clinicians better understand the causes of different types of depression in this setting and lead to improved diagnosis and treatment.

Aged↗
PubMed1997

Marriage and family therapists and the clergy: a need for clinical collaboration, training, and research.

This article calls for greater collaboration between clergy and marriage and family therapists. It spells out the reasons for potential collaboration and suggests some specific ways it can occur. Marriage and family therapists acknowledge the highest rates of religious involvement of any mental health profession, placing them in a unique position to be involved in the continuing education of clergy. There is a clear need for research to understand how marriage and family therapists and clergy can more effectively work together. The dearth of research, training, and collaboration between the two vocations is all the more unfortunate given the clear evidence of the importance of religion in the personal lives of the clients we serve.

Adaptation, Psychological↗
PubMed1997

Use of antidepressants by nonpsychiatrists in the treatment of medically ill hospitalized depressed elderly patients.

OBJECTIVE: The purpose of this study was to examine antidepressant use by nonpsychiatrists in the treatment of depressed elderly medical inpatients. METHOD: Patients aged 60 or older who were admitted to medical services at Duke Hospital were evaluated by a geropsychiatrist who used a structured psychiatric interview to identify major or minor depressive disorder. Medical records of depressed patients were reviewed for use of antidepressants and benzodiazepines before admission, during hospitalization, and on discharge. After discharge, depressed patients were contacted four times by telephone at 12-week intervals to inquire about medication use (median follow-up time = 45 weeks). RESULTS: Of 153 depressed patients, 40.5% received antidepressants at some time during their hospital stay or follow-up period, 25.5% received only benzodiazepines, and 34.0% received neither. The most commonly prescribed antidepressant was amitriptyline (45.2% of treated patients), administered at an average maximum dose of 49 mg/day. Only 15 of 114 untreated depressed patients started antidepressant therapy during hospitalization (nine with amitriptyline). Of 91 depressed patients who did not receive antidepressants either before admission or during hospitalization, only 11% received any antidepressant therapy during the median 11-month follow-up; again, half were treated with amitriptyline at doses of 10-30 mg/day. Intensity of antidepressant therapy was predicted by severity of depressive symptoms, history of psychiatric problems, and higher income. CONCLUSIONS: A relatively low proportion of depressed older medical inpatients receive treatment with antidepressants. Patients treated with antidepressants often receive potentially dangerous tertiary tricyclics at inadequate doses. Unless depression is identified and treated during medical hospitalization, it is unlikely to be treated adequately after discharge.

Age Factors↗
PubMed1997

Depression in medically ill hospitalized older adults: prevalence, characteristics, and course of symptoms according to six diagnostic schemes.

OBJECTIVE: The purpose of this study was to examine and compare rates of depression, correlates, and course of symptoms in medically ill hospitalized elders through use of six diagnostic schemes (inclusive, etiologic, exclusive-inclusive, exclusive-etiologic, substitutive-inclusive, and substitutive-etiologic). METHOD: A consecutive series of 460 cognitively unimpaired patients aged 60 or over who were admitted to the medical inpatient services of Duke Hospital underwent a structured psychiatric evaluation administered by a psychiatrist. Patients with depression were contacted by telephone at 12-week intervals after discharge to assess weekly change in depressive symptoms (median follow-up time = 47 weeks). RESULTS: The prevalence of major depression varied from 10% to 21% depending on diagnostic scheme; similarly, minor depression varied from 14% to 25%. Diagnostic strategy made little difference in known psychological and health characteristics of patients with depression (predictive validity) or severity of depressive symptoms (convergent validity). The diagnostic strategy that best distinguished a severe and persistent major depression was the exclusive-etiologic approach; however, this strategy missed 49% of patients with major depression identified by the inclusive approach, almost 60% of whom continued to experience persistent symptoms of depression many weeks after discharge. CONCLUSIONS: Diagnostic strategy affects rates of major and minor depression, with about a twofold difference between the extremes. There is little reason, however, to choose one diagnostic scheme over another in all cases. Diagnostic strategy should be chosen on the basis of the specific goals and purposes of the examiner. While the exclusive-etiologic approach identifies the most severe and persistent depressions, the inclusive approach is the most sensitive and reliable approach and is an intermediate predictor of persistent depression.

Adult↗
PubMed1997

Attendance at religious services, interleukin-6, and other biological parameters of immune function in older adults.

OBJECTIVE: First, to examine and explain the relationship between religious service attendance and plasma Interleukin-6 (IL-6) levels, and second, to examine the relationship between religious attendance and other immune-system regulators and inflammatory substances. METHODS: During the third in-person interview (1992) of the Establishment of Populations for Epidemiologic Studies of the Elderly (EPESE) project, Duke site, 1718 subjects age sixty-five or over had blood drawn for analysis of immune regulators and inflammatory factors, including IL-6 measurements. IL-6 was examined both as a continuous variable and at a cutoff of 5 pg/ml. Information on attendance at religious services was available from the 1992 interview and two prior interviews (1986 and 1989). RESULTS: Religious attendance was inversely related to high IL-6 levels (> 5 pg/ml), but not to IL-6 measured as a continuous variable. Bivariate analyses revealed that high religious attendance in 1989 predicted a lower proportion of subjects with high IL-6 in 1992 (beta-.10, p = .01) High religious attendance in 1992 also predicted a lower proportion of subjects with high IL-6 levels in 1992 (beta-.14, p = .0005). When age, sex, race, education, chronic illnesses, and physical functioning were controlled, 1989 religious attendance weakened as a predictor of high IL-6 (beta-.07, p = .10), but 1992 religious attendance retained its effect (beta-.10, p = .02). When religious attenders were compared to non- attenders, they were only about one-half as likely to have IL-6 levels greater than 5 ng/ml (OR 0.58, 95% CI 0.40-0.84, p < .005). Religious attendance was also related to lower levels of the immune-inflammatory markers alpha-2 globulin, fibrin d-dimers, polymorphonuclear leukocytes, and lymphocytes. While controlling for covariates weakened most of these relationships, adjusting analyses for depression and negative life events had little effect. CONCLUSIONS: There is a weak relationship between religious attendance and high IL-6 levels that could not be explained by other covariates, depression, or negative life events. This finding provides some support for the hypothesis that older adults who frequently attend religious services have healthier immune systems, although mechanism of effect remains unknown.

Adaptation, Psychological↗