Why Do Physicians Have Difficulty Diagnosing Depression in the Elderly?

Xie

et al. 2018

IJERPH

Background Very little research has been done to simultaneously investigate the effects of Tai Chi (TC) on depression and heart rate variability (HRV). This study, therefore, attempted to explore the effects of TC on depression and on HRV parameters. Methods Sixty older individuals with depression score of 10 or above (the Geriatric Depression Scale, GDS) were randomly assigned into two groups: TC (n = 30) and control group (n = 30). Participants in the experimental group participated in a 24-week TC training program (three 60-min sessions per week), whereas individuals in the control group maintained their unaltered lifestyle. Depression and HRV were measured using the GDS and digital electrocardiogram at baseline and after the 24-week intervention. Results The TC had produced significant positive chances in depression and some HRV parameters (mean heart rate, RMSSD, HF, LFnorm, and HFnorm) (p < 0.05), whereas these positive results were not observed in the control group. Conclusions The results of this study indicated that TC may alleviate depression of the elderly through modulating autonomous nervous system or HRV parameters. This study adds to a growing body of research showing that TC may be effective in treating depression of the elderly. Tai Chi as a mild to moderate mind-body exercise is suitable for older individuals who suffer from depression.

Section: Introductionmentioning

confidence: 99%

The Effects of Tai Chi on Heart Rate Variability in Older Chinese Individuals with Depression

Xie

et al. 2018

IJERPH

“…Moreover, many physical disorders are often observed as a result of advanced aging, such as chronic pain due to arthritis or reduced bone and cartilage density. The increased symptom overlap between mental and physical disorders may also further contribute to poor recognition and diagnosis of mental disorders amongst older individuals (Mitchell, 2011). Research also indicates that psychosocial factors such as loneliness and social isolation are more common with increasing age and can contribute to increased severity of mental disorders (Jylhä, 2004).…”

Section: Introductionmentioning

confidence: 99%

Comparing profiles of mental disorder across birth cohorts: Results from the 2007 Australian National Survey of Mental Health and Wellbeing

Sunderland

Carragher

Batterham

et al. 2013

Aust N Z J Psychiatry

Clinicians and researchers need to be cognisant that mental disorders manifest as highly heterogeneous constructs. The presentation of a disorder in a younger individual could be vastly different from the presentation of the same disorder in an older individual. The additional burden associated with these factors and how they apply to different birth cohorts must be taken into consideration when planning mental health services and effective treatment for the general population.

“…Primary care physicians are often the first, and not rarely the only, health professionals that are contacted by depressed patients [9]. However, the accuracy of depression recognition by primary care practitioners and other non-psychiatrist physicians is not satisfactory [10, 11]. Hence, improving diagnostic efficiency for depressive disorders in primary care and other non-psychiatric medical settings is an important public health objective.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy of the Primary Care Screener for Affective Disorder (PC-SAD) in Primary Care

Picardi

Adler²,

Rogers

et al. 2013

CPEMH

Background:Depression goes often unrecognised and untreated in non-psychiatric medical settings. Screening has recently gained acceptance as a first step towards improving depression recognition and management. The Primary Care Screener for Affective Disorders (PC-SAD) is a self-administered questionnaire to screen for Major Depressive Disorder (MDD) and Dysthymic Disorder (Dys) which has a sophisticated scoring algorithm that confers several advantages. This study tested its performance against a ‘gold standard’ diagnostic interview in primary care.Methods:A total of 416 adults attending 13 urban general internal medicine primary care practices completed the PC-SAD. Of 409 who returned a valid PC-SAD, all those scoring positive (N=151) and a random sample (N=106) of those scoring negative were selected for a 3-month telephone follow-up assessment including the administration of the Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I) by a psychiatrist who was masked to PC-SAD results. Results:Most selected patients (N=212) took part in the follow-up assessment. After adjustment for partial verification bias the sensitivity, specificity, positive and negative predictive value for MDD were 90%, 83%, 51%, and 98%. For Dys, the corresponding figures were 78%, 79%, 8%, and 88%. Conclusions:While some study limitations suggest caution in interpreting our results, this study corroborated the diagnostic validity of the PC-SAD, although the low PPV may limit its usefulness with regard to Dys. Given its good psychometric properties and the short average administration time, the PC-SAD might be the screening instrument of choice in settings where the technology for computer automated scoring is available.