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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↗

Past, present, and future roles of child protective services.

Contemporary social issues typically spring from historical roots, and, as this article points out, that is particularly true of the effort to find a balanced, fair, and helpful way of responding to child abuse and neglect. This article examines how today's child protective services system evolved from a past of almshouses, orphan trains, anticruelty societies, and legislation establishing the protection of children as a government function. The author finds that the history of child protection in the United States is marked by a continuing, unresolved tension between the aim of rescuing children from abusive homes and that of strengthening the care their families can provide. Against that backdrop, this article explains the structure of the typical child protective services (CPS) agency (the unit within a broader public child welfare department that focuses on abuse and neglect) and outlines the roles in child protection that are played by the police, the courts, private and public social service agencies, and the community at large. According to the author's analysis, the fundamental challenges facing CPS can be captured in two questions regarding appropriate boundaries for the agency: Which situations require the agency's intervention? And how can the broader resources of the community be mobilized in the effort to protect children?

Child↗

Social engagement and depressive symptoms in late life: longitudinal findings.

OBJECTIVE: The purpose is to investigate whether social engagement protects against depressive symptoms in older adults. METHOD: Three waves of data from a representative cohort study of community-dwelling adults aged 65 years and above from the New Haven Established Populations for the Epidemiologic Study of the Elderly are examined using random effects models. RESULTS: Social engagement (an index combining social and productive activity) is associated with lower CES-D scores after adjustment for age, sex, time, education, marital status, health and functional status, and fitness activities. This association is generally constant with time, suggesting a cross-sectional association. In addition, social engagement is associated with change in depressive symptoms, but only among those with CES-D scores below 16 at baseline. DISCUSSION: Social engagement is independently associated with depressive symptoms cross-sectionally. A longitudinal association is seen only among those not depressed at baseline.

Aged↗

Psychological and physiological responses to stress: the right hemisphere and the hypothalamo-pituitary-adrenal axis, an inquiry into problems of human bonding.

In addition to repeated reexperiencing of the event, the delayed effects of severe psychological trauma, i.e., post traumatic stress disorder (PTSD), present a paradoxical mix of symptoms. There is enhancement of the self-preservative catecholamine states; anger and fear with a contrasting sense of meaninglessness and a blunting of the emotional responses of the attachment behavior so critical for species preservation. Hormonally, there is a striking separation of the catecholamine response, which stays elevated and that of the hypothalamo-pituitary-adrenal (HPA) axis, which may remain at normal levels. Pathophysiologically, the reexperiencing of the trauma and the arousal may be associated with dysfunction of the locus coeruleus, amygdala and hippocampal systems. This article explores the consequences of an additional dysfunction: a dissociation of the hemispheres that appears to be responsible for the alexithymic avoidance and failure of the cortisol response that so often follow severe psychological trauma. There is neurophysiological evidence that the left and right hemispheres subserve different emotional sets that correspond to "control" and "appraisal," i.e., very approximately to the self and species preservative behavioral complexes, respectively. Several studies point to physiological dissociation of hemispheric functions during alexithymia. This raises the question: What has been lost if in this condition the right side no longer fully contributes to integrated cerebral function? Right hemispheric damaged children lose critical social skills and in adults the related sense of familiarity critical for bonding is lost. Such losses of social sensibilities may account for the lack of empathy and difficulties with bonding found in sociopathy and borderline personality: conditions now believed to result from repeated psychological trauma during development. On the other hand, systems that promote right hemispheric contributions provide solacing access to a "Higher Power." They also appear to protect against socially disordered behavior, substance abuse, the failure of the HPA axis and some aspects of the pathophysiology of chronic disease.

Brain↗

Psychological and physiological responses to stress: the right hemisphere and the hypothalamo-pituitary-adrenal axis, an inquiry into problems of human bonding.

In addition to repeated reexperiencing of the event, the delayed effects of severe psychological trauma, i.e., post traumatic stress disorder (PTSD), present a paradoxical mix of symptoms. There is enhancement of the self-preservative catecholamine states; anger and fear with a contrasting sense of meaninglessness and blunting of the emotional responses of the attachment behavior so critical for species preservation. Hormonally, there is a striking separation of the catecholamine response, which stays elevated and that of the hypothalamo-pituitary-adrenal (HPA) axis, which may remain at normal levels. Pathophysiologically, the reexperienceing of the trauma and the arousal may be associated with dysfunction of the locus coeruleus, amygdala and hippocampal systems. This article explores the consequences of an additional dysfunction: a dissociation of the hemispheres that appears to be responsible for the alexithymic avoidance and failure of the cortisol response that so often follow severe psychological trauma. There is neurophysiological evidence that the left the right hemispheres subserve different emotional sets that correspond to "control" and "appraisal," i.e., very approximately to the self and species preservative behavioral complexes, respectively. Several studies point to physiological dissociation of hemispheric functions during alexithymia. This raises the question: What has been lost if in this condition the right side no longer fully contributes to integrated cerebral function? Right hemispheric damaged children lose critical social skills and in adults the related sense of familiarity critical for bonding is lost. Such losses of social sensibilities may account for the lack of empathy and difficulties with bonding found in sociopathy and borderline personality: conditions now believed to result from repeated psychological trauma during development. On the other hand, systems that promote right hemispheric contributions provide solacing access to a "Higher Power." They also appear to protect against socially disordered behavior, substance abuse, the failure of the HPA axis and some aspects of the pathophysiology of chronic disease.

Adult↗

Does social identification harm or serve as a buffer? The impact of social identification on anger after experiencing social discrimination.

Research on targets' affective reactions to social discrimination has not yet addressed self- and other-directed anger at the same time. Four studies tested the hypothesis that the perceived cause of negative feedback moderates the impact of social identification on self-directed anger. In Studies 1 and 2, high levels of social identification led to less self-directed anger when negative feedback was attributed to social discrimination but not when it was attributed either to other external causes or internally. In Study 3, a cross-lagged design showed that higher identification led to less self-directed anger when negative feedback was attributed to social discrimination but not the other way around. This effect was found using scenarios (Studies 1-3) and also when using the recollection of personal experiences to manipulate attribution (Study 4). These results indicate that following social discrimination, social identification protects the self and does not increase individual vulnerability.

Adaptation, Psychological↗

Rules for the issuance of work report receipts, payment of benefits for trial work period service months after a fraud conviction, changes to the student earned income exclusion, and expansion of the reentitlement period for childhood disability benefits. Final rules.

We are revising our rules to reflect and implement sections 202, 208, 420A, and 432 of the Social Security Protection Act of 2004 (the SSPA). Section 202 of the SSPA requires us to issue a receipt each time you or your representative report a change in your work activity or give us documentation of a change in your earnings if you receive benefits based on disability under title II or title XVI of the Social Security Act (the Act). Section 208 changes the way we pay benefits during the trial work period if you are convicted by a Federal court of fraudulently concealing your work activity. Section 420A changed the law to allow you to become reentitled to childhood disability benefits under title II at any time if your previous entitlement to childhood disability benefits was terminated because of the performance of substantial gainful activity. Section 432 changes the way we decide if you are eligible for the student earned income exclusion. We will also apply the student earned income exclusion when determining the countable income of an ineligible spouse or ineligible parent. We are also changing the SSI student policy to include home schooling as a form of regular school attendance.

Adolescent↗

Proclamation No. 214, 3 February 1988.

This Proclamation declares the second week of February 1988 and every year thereafter as Respect and Care for Life Week. The text of the Proclamation, including its preamble, is as follows: "Whereas, the UN Declaration on Rights of the Child provides that 'the Child, by reason of his physical and mental immaturity, needs special safeguards and care, including appropriate legal protection, before as well as after birth'; Whereas, Section 12, Article 2 of the Constitution provides that it is the policy of the State to 'protect the life of the mother and the life of the unborn from conception'; Whereas, available statistics detail the frightening losses of innocent human lives by abortion; and Whereas, in pursuance of the above constitutional mandate and in support of the UN universal declaration and in order to instill the same, as well as the value and sacredness of human life, in the minds and hearts of the Filipino people and thereby help reverse the above statistical trend, it becomes imperative to set aside a period of time for them to ponder and focus attention on their moral and constitutional obligations to protect human life or one's inherent right to life; Now, Therefore, I, Corazon C. Aquino, President of the Philippines, by virtue of the powers vested in me by law, do hereby declare the second week of February 1988 and every year thereafter as "Respect and Care for Life Week" under the auspices of the Department of Social Welfare and Development and Pro-Life Philippines, and other involved entities or organization[s]."

Abortion, Induced↗

[Organization and functioning of health services of the IMSS-Solidaridad program].

In this report the organization and performance of the IMSS-Solidaridad Program of Mexico is described. This program is managed by the Mexican Institute for Social Security, which services 10.5 million inhabitants of the rural underserved areas, with federal government resources in 18 states. This study compares the structure and functioning of the IMSS-Solidaridad Program with Local Health Systems, as they have been proposed by the Panamerican Health Organization for country members and by the Ministry of Health of Mexico, particularly in relation to the decision-making process at local level. Some assets and limitations of the IMSS-Solidaridad Program are analyzed and, finally, concrete procedures to improve coordination between the IMSS-Solidaridad Program and other health services for similar populations (populations without social security protection) in Mexico are suggested, with the purpose of using resources more adequately and succeed in the national goal to achieve equity in health.

Health Services Administration↗

Social support, negative life events and mental health.

BACKGROUND: In a 10-year follow-up of a survey from Oslo, 503 persons were reinterviewed using the same questionnaire. METHOD: The questionnaire includes information about social support, 'locus of control' and mental health as well as negative life events and long-lasting mental strain during the year prior to the follow-up. RESULTS: The study confirms the "buffer hypothesis", that social support protects against the development of mental disorder only when the individual is exposed to stressors, like negative life events. This buffering effect was especially strong for depression. CONCLUSIONS: The buffering effect only applies to the 'externals'--those who have personality-related feelings of powerlessness and lack of control over their own lives. The 'internals' do not have the same need for social support to cope with life stressors, and have low symptom scores even when negative life events are combined with relative weak social support.

Adaptation, Psychological↗