Abdominal aortic diameter and cardiovascular status in patients with idiopathic retroperitoneal fibrosis.

Although much debated, an exaggerated inflammatory response to advanced atherosclerosis has been implicated in the pathogenesis of idiopathic retroperitoneal fibrosis (RPF). Clinical presentation, infrarenal abdominal aortic diameter and RPF mass thickness were retrospectively analyzed in 166 patients with idiopathic RPF seen at our referral center between April 1998 and December 2019. Patients were stratified to their infrarenal abdominal aortic diameter at presentation (i.e., non-ectatic [< 25 mm]; ectatic [25-29 mm]; and aneurysmal [≥ 30 mm]) to compare characteristics across groups with an undilated or dilated aorta. Ectatic or aneurysmal aortic dilatation was present in 34% of patients. Most clinical characteristics did not differ across abdominal aortic diameter stratified groups, but RPF mass thickness was greater in patients presenting with aortic aneurysmal dilatation compared to that in patients with an undilated aorta (49.0 mm [IQR 34.0-62.0] vs 32.5 mm [IQR 25.3-47.8]; P < 0.001). A positive linear association was found between aortic diameter on a continuous scale and RPF mass thickness (ß 0.32 [95% CI 0.34-0.96]; P < 0.001). This association remained significant after adjusting for age, sex and acute-phase reactant levels (ß 0.28 [95% CI 0.15-0.95]; P < 0.01). Treatment success across aortic diameter stratified groups did not differ (P = 0.98). Treatment induced RPF mass regression was not associated with an increase in aortic expansion rate (P = 0.44). Aortic dilatation was prevalent among patients. Infrarenal abdominal aortic diameter was independently associated with RPF mass thickness. Findings support the concept that at least in a subset of patients, RPF may be secondary to advanced atherosclerosis.

Chronic disease in elderly couples: are women more responsive to their spouses' health condition than men?

OBJECTIVE: The aim of the present study is to increase knowledge regarding associations between couples' health condition and psychological distress in both spouses considering gender as well as patient/spouse status. METHOD: We examined a community-based sample of 995 elderly couples in which either both spouses were healthy, one of them suffered from chronic disease or both spouses were ill. Both spouses filled out the Hospital Anxiety and Depression Scale. RESULTS: In line with our hypotheses, the results showed an association between women's psychological distress and their own as well as their spouse's health condition, whereas men's psychological distress was associated only with their own health condition. CONCLUSION: The findings demonstrate the need for awareness of gender and patient/spouse differences in psychological distress among elderly couples confronted with chronic disease.

Functional disability and neuroticism as predictors of late-life depression.

The authors investigated the association of premorbidly-assessed disability and neuroticism with the onset of late-life depression in 86 depressed and 72 randomly selected control persons, originating from a 1993 Dutch community study of elderly people. Compared with elderly people with average levels of disability and neuroticism, people with low levels were significantly less likely to develop a depressive disorder. High scorers, on the other hand, did not differ significantly from the average group. Furthermore, the data tend to suggest that the increased risk for depression associated with disability was larger for patients with higher levels of neuroticism.

Life events, difficulties and onset of depressive episodes in later life.

BACKGROUND: The importance of stressful life events and long-term difficulties in the onset of episodes of unipolar depression is well established for young and middle-aged persons, but less so for older people. METHOD: A prospective case-control study was nested in a large community survey of older people. We recruited 83 onset cases during a 2-year period starting 2 1/2 years after the survey, via screening (N = 59) and GP monitoring (N = 24), and 83 controls, a random sample from the same survey population. We assessed depression with the PSE-10 and life stress exposure with the LEDS. RESULTS: Risk of onset was increased 22-fold by severe events and three-fold by ongoing difficulties of at least moderate severity. Severe events accounted for 21% of all episodes but ongoing difficulties for 45%. The association of onset with life stress, often health-related such as death, major disability and hospitalization of subject or someone close, was most pronounced in the cases identified by screening. While a clear risk threshold for events was found between threat 2 and 3 (on a scale of 1-4), the risk associated with difficulties increased more gradually with severity of difficulty. Compared with controls, severe events involved a larger risk for cases without a prior history of depression (OR = 39.48) than for cases with (OR = 8.86). The opposite was found for mild events (OR = 2.94 in recurrent episodes; OR = 1.09 in first episodes). The impact of ongoing difficulties was independent of severity of episode and history of depression. CONCLUSION: Although the nature of life stress in later life, in particular health-related disability and loss of (close) social contacts, is rather different from that in younger persons, it is a potent risk factor for onset of a depressive episode in old age. Severe events show the largest relative risk, but ongoing difficulties account for most episodes. The association of severe events with onset tends to be stronger in first than in recurrent episodes. Mild events can trigger a recurrent episode but not a first one.

The interplay and etiological continuity of neuroticism, difficulties, and life events in the etiology of major and subsyndromal, first and recurrent depressive episodes in later life.

OBJECTIVE: Stressful life events, long-term difficulties, and high neuroticism are established risk factors for depression. Less is known about their role in late-life depression, how they modify or mediate one another's effects, and whether this differs between major and subsyndromal, first and recurrent episodes. METHOD: The authors used a prospective case-control design nested in a community survey of elderly subjects that included a measure of neuroticism. They compared 83 survey participants who subsequently developed a depressive episode with 83 randomly selected comparison participants. The authors determined dates of onset, history, and severity of episodes and dates of occurrence and severity of stressful life events and difficulties. RESULTS: Stressful life events did not mediate the effects of high neuroticism and difficulties at onset, possibly because of the uncontrollable nature of common stressful life events in later life. Without both high neuroticism and difficulties, stressful life events did not increase risk. High neuroticism and difficulties increased risk, even without a stressful life event. In the presence of high neuroticism and/or difficulties, the depressogenic effect of stressful life events was substantial, suggesting effect modification. The authors found no evidence to suggest etiological discontinuity between major and subsyndromal episodes. First and recurrent episodes showed a discontinuous pattern of associations. Severe stressful life events had weaker associations, but high neuroticism and mild stressful life events had stronger associations with recurrent than with first episodes. CONCLUSIONS: This study demonstrated the usefulness of a dynamic stress-vulnerability model for understanding late-life depression. Evidence was found suggesting etiological discontinuity between first and recurrent but not between major and subsyndromal episodes.

Depression in later life: three etiologically different subgroups.

BACKGROUND: Various studies support the notion that early onset depression and late onset depression have different etiological pathways. Late onset depression has been found to be a heterogeneous group. This study attempts to divide the late onset group in two subgroups with different aetiology and find evidence for the vascular depression hypothesis. METHODS: Subjects were 132 depressed elderly persons from the general population, general practitioners and mental health care outpatient clinics. Sixty-four had early-onset depression (< 60), 69 had late-onset depression (> or = 60). The latter group was divided into subjects with (n = 15) and without (n = 15) severe life stress. The groups were compared with respect to a variety of variables including vascular risk factors RESULTS: Early-onset depression was associated with neuroticism and parental history. Subjects with late-onset depression and no severe life stress had higher vascular risk factors than whose depression was preceded by a severe stressor did. CONCLUSIONS: Our findings suggest that late life depression can be divided into subgroups with different etiological pathways: (1) early-onset with longstanding psychobiological vulnerability; (2) late-onset as reaction to severe life stress; and (3) late-onset with vascular risk factors.

Correlates of symptomatic, minor and major depression in the elderly.

BACKGROUND: Associations between different types of depression with clinical characteristics and putative vulnerability factors from several domains (health, disability, personality, familial psychopathology) were studied in a sample of elderly subjects, in order to find arguments that support or discard the notion of discontinuity in correlates of depression. METHODS: Subjects were 183 depressed elderly persons from the general population, general practitioners and mental health care outpatient clinics, and a random elderly control group (n=74). Depression was subdivided into symptomatic (n=45), DSM-IV minor (n=73), and DSM-IV major (n=65) depression. The groups were compared with respect to a variety of variables from different domains. RESULTS: Most variables showed a marked difference between the control group and the depressive groups, and smaller or no differences between depressive subtypes. LIMITATIONS: The data were collected cross-sectionally. CONCLUSIONS: With a few notable exceptions, all subtypes of depression were significantly different from the control group, while differences between depressive subtypes were generally smaller. Depressive subtypes showed no discontinuum with respect to the associated variables. Similar associations in different subtypes of depression may indicate common vulnerability factors.

Morbidity and quality of life and the moderating effects of level of education in the elderly.

The moderating effect of level of education (as an indicator of socioeconomic status) on the associations between chronic medical morbidity and six domains of health-related quality of life (physical function, role function, social function, health perceptions, bodily pain and mental health) is studied in a large community-dwelling elderly sample (N = 5279). The results showed that health-related quality of life is substantially affected by chronic medical morbidity, and that level of education has weak, but significant unique contributions to physical function, social function, health perceptions, and mental health. We did not find substantial evidence for the differential vulnerability hypothesis. At best, low education might amplify the negative effects of the number of chronic medical conditions on mental health only, but this result was not confirmed in four specific disease groups.

[The Groningen longitudinal aging study. An evaluation of functional status, well-being and need of care by others]. / Groningen longitudinal aging study. Een onderzoek naar het dagelijks functioneren, het welbevinden en de zorgbehoefte van ouderen.

The central objectives of GLAS are (a) to study the associations between pathology--and related impairments and disability--on the one hand, and well-being and utilization of care among older people on the other, and (b) how these associations are affected by person-bound and environmental factors. The present paper describes the main research questions, the design and some preliminary results of GLAS. In addition, an explanatory model for well-being, derived from the theory of social-production functions (spf) is elaborated. Two major conclusions can be drawn from these results. (1) The hypotheses derived from spf are mainly supported by the results of several substudies of GLAS. (2) The cross-sectional analyses showed main effects of psychological attributes--independent of pathology and impairments--on disability and well-being; we hardly found any empirical support for the hypothesized moderating effects of psychological attributes on the associations between these concepts. We conclude with some suggestions for future research.

Functioning, well-being, and health perception in late middle-aged and older people: comparing the effects of depressive symptoms and chronic medical conditions.

OBJECTIVES: To expand the landmark Medical Outcomes Study (MOS) and World Health Organization (WHO) findings on the unique association of symptoms of depression with multiple domains of functioning, health perception, and well-being in consulting populations to the late middle-aged and older community-dwelling population and to contrast this unique association to that of specific chronic medical conditions and sensory and cognitive impairment (collectively denoted as medical conditions (MCs)). DESIGN: Population-based, cross-sectional health survey. SETTING AND PARTICIPANTS: A total of 5279 noninstitutionalized late middle-aged and older persons living independently or in residential homes for older people housing in the northern part of The Netherlands. MEASUREMENTS: Behavioral: physical functioning, (Independent) Activities of Daily Living ((1)ADL), and role functioning. Subjective: health perception, life satisfaction and well-being. Mixed: discretionary activities and activity level. Two aspects of the association were examined: the unique risk (adjusted difference in mean outcome between those with the condition and those without, expressed in SD units) and the unique contribution (adjusted proportion of variance in outcome accounted for by the condition). The latter takes the prevalence of the condition into account. RESULTS: Among both individuals with MCs and those without, persons with symptoms of depression did worse on all outcomes than those without. Depressive symptoms were more consequential for subjective and mixed outcomes compared with behavioral outcomes. For all outcomes, none of the unique contributions of MCs exceeded that of depressive symptoms, whereas the unique contribution of depressive symptoms typically outranked those of the MCs. For behavioral outcomes, the unique risks associated with neurological conditions, persistent back problem, arthritis, and stroke exceeded that of depressive symptoms, but risk associated with depressive symptoms exceeded that of nine of 18 MCs, on average. For the mixed and subjective outcomes, none of the unique risks associated with MCs exceeded that of depressive symptoms, but risks of depressive symptoms exceeded those of 16 of the 18 MCs, on average. The effects of depressive symptoms and medical conditions were largely additive although depressive symptoms amplified the effect of some medical conditions on (I)ADL. The pattern of unique risks and contributions was similar across all ages (57-64, 65-74, 75+). CONCLUSION: The unique contribution of depressive symptoms in dysfunction, poor health perception, and well-being typically exceeds that of medical conditions because depressive symptoms combine a moderately large unique risk with a rather high prevalence. Results expand the MOS and WHO findings to the community-dwelling late middle-aged and older population and to additional outcomes as well. Results underscore the importance of detection and management of (comorbid) symptoms of depression in older people.

Chronic medical conditions and mental health in older people: disability and psychosocial resources mediate specific mental health effects.

BACKGROUND: This study describes the differences in psychological distress, disability and psychosocial resources between types of major medical conditions and sensory impairments (collectively denoted as CMCs); and tests whether disability and psychosocial resources mediate CMC-specific mental health effects. METHODS: Data were obtained from a population-based, cross-sectional survey of 5078 non-institutionalized, late middle-aged and older Dutch persons. The predictors were 16 types of CMCs, including all major chronic medical diseases as well as impairment of hearing, vision, and cognition. The outcomes were assessed in terms of psychological distress as measured by the Hospital Anxiety and Depression Scale. Two aspects of disability were measured (namely, physical and role functioning) and also three psychosocial resources (namely, mastery, self-efficacy and social support). RESULTS: Level of psychological distress varied across type of CMC. Hearing impairment, neurological disease, vision impairment, and lung and heart disease had particularly strong associations with distress. The level of distress in patients with hearing impairment was 0.45 standard deviation higher than in those without hearing impairment (adjusted for demographics and all other CMCs). Roughly similar patterns of association were found between type of CMC and disability, and also, but to a lesser extent, mastery and self-efficacy. Stepwise multiple regression revealed that type of CMC accounted for 9% of the variance in distress initially, but this fell to 1% after the variance due to disability, mastery and self-efficacy was taken out. Social support was not a mediator. Disability and psychosocial resources accounted for 13% and 14% of the variance in distress, respectively. CONCLUSION: These results support the conventional wisdom that it is not the nature of the condition that determines psychological distress, but instead the severity of the disability and loss of psychological resources associated with the condition on the one hand and the psychological characteristics of the patient on the other.

Adaptive responses among Dutch elderly: the impact of eight chronic medical conditions on health-related quality of life.

OBJECTIVES: This study analyzed the impact of eight common chronic medical conditions on functional, social, and affective domains of health-related quality of life among community-based Dutch elderly (n = 5279). METHODS: Health-related quality of life was measured with six domains of the MOS Short-Form General Health Survey. The impact of the selected chronic conditions on health-related quality of life was analyzed by means of Student's t tests, analyses of variance, and multiple regression analyses. RESULTS: Compared with other domains of health-related quality of life, mental health was the least affected by chronic medical conditions. Back problems and rheumatoid arthritis/other joint complaints accounted for relatively high proportions of the variance in health-related quality of life (from 35.5% to 68.3%), except for health perceptions (22.6%), indicating that health-related quality of life is most affected by these two conditions. CONCLUSIONS: Subjective well-being is by far the domain least affected by chronic medical conditions, while physical functioning and health perceptions are most affected. Back problems and rheumatoid arthritis/other joint complaints affect health-related quality of life strongly.

[The Mini Mental Status Examination. Normative data and a comparison of a 12-item and 20-item version in a sample survey of community-based elderly]. / De Mini-Mental State Examination. Normeringsgegevens en een vergelijking van een 12- en 20-item versie in een steekproef ouderen uit de bevolking.

The results of a study on the comparison of the original 20-item Mini-Mental State Examination with a shortened 12-item version as a brief screening test for cognitive impairments in a community based older sample are presented. The scores on the MMSE decrease with higher ages and lower levels of education. The results show that a threshold value of 24 on the MMSE-20 (Cohen's kappa .70), which supports previous Norwegian findings. In case of the identification of older people with severe cognitive impairments -threshold value 17 or 18 on the MMSE-20-, we found a corresponding threshold on the MMSE-12 of 7 (Cohen's kappa .87 and .91, respectively). Although the Norwegian researchers made no direct comparison between the MMSE-20 and MMSE-12 for these lower thresholds, a threshold 7 on the MMSE-12 resulted in a lower level of misclassifications of cognitively impaired patients by a psychogeriatrician compared to a threshold of 18 on the MMSE-20. It may be concluded that the MMSE-12, which is simpler to use and takes less time, has the same diagnostic properties as a screening tool for mild and severe cognitive impairments.

Outcome of depression and anxiety in primary care. A three-wave 3 1/2-year study of psychopathology and disability.

BACKGROUND: We evaluated the long-term outcome of depression and anxiety and associated disability among primary-care attenders with common psychiatric disorders and symptoms (n = 201) using binary and multicategorical, interview-based outcome measures of psychiatric illness and disability. METHODS: A two-stage design was used. In the first stage, 1994 consecutive attenders of 25 general practitioners were screened on psychiatric illness with the General Health Questionnaire and by their physicians. A stratified random sample (n = 292) with differing probabilities was selected for second-stage interview (Present State Examination and Groningen Disability Schedule). Patients with psychiatric symptoms (n = 201) were reassessed 1 (n = 182) and 3 1/2 (n = 154) years later. RESULTS: At 1- and 3 1/2-year follow-ups, many cases no longer met the criteria of their baseline diagnosis and disability levels had substantially dropped. However, partial remission, not full recovery, was the rule, and was associated with residual disability. Depression had better outcomes than anxiety and mixed anxiety-depression. CONCLUSIONS: We concluded that a multicategorical, rather than a binary, outcome measure better reflects patient outcomes, since it highlights partial remission, mild symptoms, and residual disability, and as such, stresses the need to supplement short-term treatment. A multicategorical caseness model may be advantageous for research and clinical practice. We suggest a dynamic-equilibrium model to account for residual symptoms and disability. This study is a follow-up to two earlier reports on the recognition, treatment, and 1-year course of common psychiatric illnesses in general practice.

Depression, anxiety, and social disability show synchrony of change in primary care patients.

OBJECTIVES: The purposes of this study were to (1) characterize the social disability associated with the common psychiatric illnesses of primary care patients in terms of role dysfunction (self-care, family role, social role, occupational role) and (2) establish whether severity of psychiatric illness and disability level show synchrony of change. METHODS: A two-stage sample design was employed. In the first stage, 1994 consecutive attenders of 25 general practitioners were screened on psychiatric illness by their physicians and with the General Health Questionnaire. A stratified random sample (n = 285) with differing probabilities was selected for a second-stage interview. Patients with psychiatric symptoms were reinterviewed 1 and 3.5 years later (n = 143). RESULTS: (1) Disability level among patients was increased (moderately for depression, mildly for anxiety) and was associated with severity of psychiatric illness. (2) Most disability was found in occupational and social roles. (3) Change in severity of psychiatric illness was concordant with change in level of disability and was largely invariant across diagnosis (depression, anxiety, mixed anxiety/depression). At follow-up, disability among improved patients had returned to normal levels. CONCLUSIONS: Psychiatric illness in primary care patients is associated with mild to moderate disability, and severity of psychiatric illness and disability show synchrony of change.

The role of perceived parental rearing practices in the aetiology of phobic disorders: a controlled study.

The perceived parental rearing practices and attitudes of social phobics, agoraphobics, height phobics and non-patient normal controls were investigated, employing the EMBU, an inventory for assessing memories of upbringing. Findings revealed that, as compared with the controls, social phobics and height phobics scored both parents not only as lacking in emotional warmth, but also as having been rejective and overprotective. Agoraphobics reported both parents as having lacked emotional warmth, but only their mothers as being rejecting. Interestingly, the perception of negative rearing practices of parents appeared to be stronger in height phobics than in either social phobics or agoraphobics.

Psychometric evaluation of an inventory for assessment of parental rearing practices. A Dutch form of the EMBU.

The EMBU, an instrument which was designed to assess one's memories of parental rearing behaviour, was psychometrically evaluated. Principal component factor analysis of data of a mixed sample of 841 non-institutionalized phobic individuals revealed four factors which were termed Rejection, Emotional warmth, Over-protection and Favouring subject, thereby contributing to the convergent (cross-national) reliability and validity of the structural model of perceived parental behaviour. Besides the utilization of data from aforementioned phobic sample, the scales' internal consistency was assessed in data of five additional samples, which consisted of 277 'normals', 40 agoraphobics, 29 social phobics, 21 height phobics and 38 obsessive-compulsive neurotics, and found to be very satisfactory. In the normal and mixed phobic sample, validity measures were shown to be acceptable and to be independent of the parent's sex. Furthermore, findings suggested that the fact that retrospective data is being measured with the scales does not threaten the reliability and validity of gathered information due to faulty recall or falsified accounts.