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1.
Int J Aging Hum Dev ; 85(4): 438-455, 2017 12.
Article in English | MEDLINE | ID: mdl-29098890

ABSTRACT

The relationship between financial constraints and depressive symptomatology among adults aged 50 and greater was examined. The mediating effect of perceived control over one's financial circumstances on this relationship was assessed. Ordinary least square hierarchical regression models were estimated using data from the Health and Retirement Study. As an aggregated measure, financial constraints were positively associated with depression in mid-age and late life, and this relationship was partially accounted for by the pathway of perceived control over one's financial circumstances. When disaggregated as a measure, financial constraints at the individual level had a significant effect on depression, while financial constraints at the family and public levels did not have a significant effect. When added to the model, perceived control over one's financial circumstances had a significant effect on depressive symptomatology, financial constraints remained significant at the individual level.


Subject(s)
Aging/psychology , Depression/epidemiology , Internal-External Control , Socioeconomic Factors , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , United States/epidemiology
2.
Int J Aging Hum Dev ; 81(1-2): 54-82, 2015 Jul.
Article in English | MEDLINE | ID: mdl-26552834

ABSTRACT

The cost and prevalence of chronic health conditions increase in late life and can negatively impact accumulated wealth. Based on the financial challenges midaged and older adults face, we sought to understand the evolution of distinctive sequences of chronic health conditions and how these sequences affect retirement savings. We used 10 waves of the Health and Retirement Study and tracked the health states and changes in wealth of 5,540 individuals. We identified five typical sequences of chronic health conditions, which are defined as follows: Multimorbidity, Comorbidity, Mild Disease, Late Event, and No Disease. Wealth accumulation differed across the five sequences. Multimorbidity and Comorbidity were the most costly sequences. Individuals with these health patterns, respectively, had $91,205 and $95,140, less net worth than respondents identified with No Disease. Our findings suggest policy makers consider sequential disease patterns when planning for the health-care needs and expenditures of older Americans.


Subject(s)
Chronic Disease/economics , Comorbidity , Health Status , Income , Retirement/economics , Aged , Female , Humans , Male , Middle Aged , Socioeconomic Factors
3.
J Gerontol B Psychol Sci Soc Sci ; 69(3): 461-9, 2014 May.
Article in English | MEDLINE | ID: mdl-24637231

ABSTRACT

OBJECTIVES: Unsecured consumer debt may affect well-being negatively. We evaluated the association between unsecured debt and two distinct outcomes: depressive symptomatology and psychological well-being. METHOD: Data were obtained from the 2006 Health and Retirement Study. There were 5,817 adults aged ≥ 51 who responded to a core survey and psychosocial leave-behind questionnaire. Depressive symptoms were assessed using the revised 8-item Center for Epidemiologic Studies Depression Scale. Psychological well-being was evaluated in a leave-behind questionnaire that had 3 dimensions: self-acceptance, personal growth, and purpose in life. RESULTS: Thirty percent of the respondents had unsecured debt. The magnitude or amount of unsecured debt and the occurrence of unsecured debt were significant predictors of depressive symptoms and lower psychological well-being. Perceived control over personal financial circumstances was a significant predictor of higher psychological well-being. DISCUSSION: In middle-aged and older Americans, unsecured debt has negative effects on mental health because of the associated depressive symptoms and decreased psychological well-being. The deleterious effects of unsecured debt on mental health are largely accounted for by perceived control over personal financial circumstances. Interventions enhancing older adults' control over personal financial circumstances may protect against the psychological decrements experienced by those grappling with unsecured debt.


Subject(s)
Depression/economics , Mental Health/economics , Retirement/economics , Aged , Aged, 80 and over , Depression/epidemiology , Depression/psychology , Female , Health Surveys , Humans , Longitudinal Studies , Male , Mental Health/statistics & numerical data , Middle Aged , Quality of Life , Random Allocation , Retirement/psychology , Retirement/statistics & numerical data , Self Concept , Social Class , Socioeconomic Factors , United States/epidemiology
4.
Int J Aging Hum Dev ; 79(4): 302-21, 2014.
Article in English | MEDLINE | ID: mdl-25888536

ABSTRACT

We examine whether spousal caregivers face difficulties in meeting their basic household expenses compared to nonspousal caregivers and whether social support mechanisms ameliorate any financial strain from caregiving responsibilities. We use data for caregivers aged 45 and over drawn from a nationally representative, cross-sectional Canadian Community Health Survey--Healthy Aging (N = 5,067). Spousal caregiving is associated with a 35% increase in the likelihood of experiencing difficulties in meeting basic expenses compared to other types of caregiving. Each of social support mechanisms (affectionate, emotional/informational, and positive social interaction), singularly and combined, lessens financial strain from caregiving. Our findings suggest that spousal caregivers are particularly vulnerable because they have fewer resources to draw on for support and perform much more intensive care. Our results highlight the importance of developing appropriate policies and programs to support caregivers.


Subject(s)
Caregivers/economics , Cost of Illness , Income/statistics & numerical data , Poverty/economics , Poverty/psychology , Spouses/psychology , Aged , Canada , Cross-Sectional Studies , Female , Health Surveys , Humans , Interpersonal Relations , Male , Middle Aged , Social Support
5.
Am J Public Health ; 102(2): 319-28, 2012 Feb.
Article in English | MEDLINE | ID: mdl-22390446

ABSTRACT

OBJECTIVES: We investigated racial/ethnic disparities in the diagnosis and treatment of depression among community-dwelling elderly. METHODS: We performed a secondary analysis of Medicare Current Beneficiary Survey data (n = 33,708) for 2001 through 2005. We estimated logistic regression models to assess the association of race/ethnicity with the probability of being diagnosed and treated for depression with either antidepressant medication or psychotherapy. RESULTS: Depression diagnosis rates were 6.4% for non-Hispanic Whites, 4.2% for African Americans, 7.2% for Hispanics, and 3.8% for others. After we adjusted for a range of covariates including a 2-item depression screener, we found that African Americans were significantly less likely to receive a depression diagnosis from a health care provider (adjusted odds ratio [AOR] = 0.53; 95% confidence interval [CI] = 0.41, 0.69) than were non-Hispanic Whites; those diagnosed were less likely to be treated for depression (AOR = 0.45; 95% CI = 0.30, 0.66). CONCLUSIONS: Among elderly Medicare beneficiaries, significant racial/ethnic differences exist in the diagnosis and treatment of depression. Vigorous clinical and public health initiatives are needed to address this persisting disparity in care.


Subject(s)
Antidepressive Agents/therapeutic use , Depression/therapy , Depressive Disorder, Major/therapy , Ethnicity/statistics & numerical data , Psychotherapy , Racial Groups/statistics & numerical data , Age Factors , Aged , Aged, 80 and over , Depression/ethnology , Depressive Disorder, Major/ethnology , Female , Healthcare Disparities/ethnology , Humans , Male , Medicare/statistics & numerical data , Residence Characteristics/statistics & numerical data , Sex Factors , Socioeconomic Factors , United States/epidemiology
6.
J Am Geriatr Soc ; 59(6): 1042-51, 2011 Jun.
Article in English | MEDLINE | ID: mdl-21649631

ABSTRACT

OBJECTIVE: To examine evolving patterns of depression diagnosis and treatment in older U.S. adults in the era of newer-generation antidepressants. DESIGN: Trend analysis using data from the Medicare Current Beneficiary Survey, a nationally representative survey of Medicare enrollees, from 1992 to 2005. SETTING: Community, usual care. PARTICIPANTS: Older Medicare fee-for-service beneficiaries. MEASUREMENTS: Depression diagnoses and psychotherapy use identified from Medicare claims; antidepressant use identified from detailed medication inventories conducted by interviewers. RESULTS: The proportion of older adults who received a depression diagnosis doubled, from 3.2% to 6.3%, with rates increasing substantially across all demographic subgroups. Of those diagnosed, the proportion receiving antidepressants increased from 53.7% to 67.1%, whereas the proportion receiving psychotherapy declined from 26.1% to 14.8%. Adjusting for other characteristics, odds of antidepressant treatment in older adults diagnosed with depression were 86% greater for women, 53% greater for men, 89% greater for whites, 13% greater for African Americans, 84% greater for metropolitan-area residents, and 55% greater for nonmetropolitan-area residents. Odds of antidepressant treatment were 54% greater for those diagnosed with major depressive disorder (MDD) and 83% greater for those with other depression diagnoses, whereas the odds of receiving psychotherapy was 29% lower in those with MDD diagnoses and 74% lower in those with other depression diagnoses. CONCLUSION: Overall diagnosis and treatment rates increased over time. Antidepressants are assuming a more-prominent and psychotherapy a less-prominent role. These shifts are most pronounced in groups with less-severe depression, in whom evidence of efficacy of treatment with antidepressants alone is less clear.


Subject(s)
Antidepressive Agents/therapeutic use , Depressive Disorder/diagnosis , Depressive Disorder/drug therapy , Independent Living , Social Environment , Aged , Aged, 80 and over , Antidepressive Agents/adverse effects , Antidepressive Agents/classification , Combined Modality Therapy , Cross-Sectional Studies , Depressive Disorder/epidemiology , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/drug therapy , Depressive Disorder, Major/epidemiology , Drug Utilization/statistics & numerical data , Female , Health Surveys , Humans , Male , Medicare/statistics & numerical data , Psychotherapy/statistics & numerical data , Treatment Outcome , United States
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