Risk factors for suicidal behaviour in late-life depression: A systematic review.

BACKGROUND: Suicide is a leading cause of preventable death worldwide, with its peak of maximum incidence in later life. Depression often puts an individual at higher risk for suicidal behaviour. In turn, depression deserves particular interest in old age due to its high prevalence and dramatic impact on health and wellbeing. AIM: To gather integrated evidence on the potential risk factors for suicide behaviour development in depressive older adults, and to examine the effects of depression treatment to tackle suicide behaviour in this population. METHODS: A systematic review of empirical studies, published from 2000 onwards, was conducted. Suicidal behaviour was addressed considering its varying forms (i.e., wish to die, ideation, attempt, and completed suicide). RESULTS: Thirty-five papers were selected for review, comprising both clinical and epidemiological studies. Most of studies focused on suicidal ideation (60%). The studies consistently pointed out that the risk was related to depressive episode severity, psychiatric comorbidity (anxiety or substance use disorders), poorer health status, and loss of functionality. Reduced social support and loneliness were also associated with suicide behaviour in depressive older adults. Finally, the intervention studies showed that suicidal behaviour was a robust predictor of depression treatment response. Reductions in suicidal ideation were moderated by reductions in risk factors for suicide symptoms. CONCLUSION: To sum up, common and age-specific risk factors seem to be involved in suicide development in depressive older adults. A major effort should be made to tackle this serious public health concern so as to promote older people to age healthily and well.

The Structural and Intercultural Competence for Epidemiological Studies (SICES) guidelines: a 22-item checklist.

Structural and intercultural competence approaches have been widely applied to fields such as medical training, healthcare practice, healthcare policies and health promotion. Nevertheless, their systematic implementation in epidemiological research is absent. Based on a scoping review and a qualitative analysis, in this article we propose a checklist to assess cultural and structural competence in epidemiological research: the Structural and Intercultural Competence for Epidemiological Studies guidelines. These guidelines are organised as a checklist of 22 items and consider four dimensions of competence (awareness and reflexivity, cultural and structural validation, cultural and structural sensitivity, and cultural and structural representativeness), which are applied to the different stages of epidemiological research: (1) research team building and research questions; (2) study design, participant recruitment, data collection and data analysis; and (3) dissemination. These are the first guidelines addressing structural and cultural competence in epidemiological inquiry.

Metabolic dysregulation in older adults with depression and loneliness: The ATHLOS study.

This study aimed to examine how loneliness contributes to metabolic dysregulation among older adults with depression and determine the relative contribution of loneliness to the development of chronic diseases in late adulthood. Harmonised data from the Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) project were used. Concretely, the sample comprised 6195 participants (53.95% women; M = 61.30 years, SD = 7.11) from three European cohorts. Three groups were considered: control group (CG); depressive symptom episode group (DEP); and a group with depression and loneliness (DEP + LONE). A metabolic score was estimated using anthropometric and blood indicators, by means of multi-indicator multi-causes (MIMIC) modelling and after controlling for sociodemographic and health-related covariates. Group-comparison was based on measurement-invariance procedures. Multimorbidity development was predicted at follow-up considering the study group and relevant covariates. All the analyses were sex-specific. As a result, measurement invariance revealed the influence of group (ΔCFI = -0.017 for male participants and ΔCFI = -0.009 for female ones) on metabolic scores in both sexes. Metabolic scores were significantly lower (i.e., they had more metabolic risk) in DEP + LONE women in comparison to women from the other groups. DEP men showed the lowest metabolic scores but those from the DEP + LONE group showed meaningfully lower scores than CG men (d = 1.35). In terms of multimorbidity prediction, DEP + LONE group membership significantly predicted the outcome in both sexes; DEP group membership significantly predicted multimorbidity at follow-up in women. In summary, these results highlight the relevant contribution of loneliness in depression-related metabolic dysregulation in the short- (concurrent metabolic risk) and long-term (chronic condition development). Moreover, sex-specific mechanisms seem to be involved in metabolic alterations of depressed people showing loneliness feelings. This study calls for action to reduce the impact of loneliness in old age and to promote healthy ageing.

Exploring the effect of loneliness on all-cause mortality: Are there differences between older adults and younger and middle-aged adults?

OBJECTIVE: This study aims to investigate the association between loneliness and all-cause mortality over a six-year follow-up period using the overall sample and by age groups (18-59 years and 60+ years). METHOD: Data from a longitudinal, prospective study of a nationally-representative sample of the Spanish non-institutionalized adult population were analysed (n = 4467). Mortality was ascertained via linkage to the National Death Index or obtained during the household visits. The UCLA Loneliness Scale was used to measure loneliness. Sex, age, education, physical activity, tobacco consumption, body mass index, disability, depression, living situation, and social participation were also considered as covariates. Multivariable Cox proportional hazard models were carried out. RESULTS: A higher level of loneliness was not associated with mortality risk in fully covariate-adjusted models over the entire population (HR = 1.02; 95% CI = 0.94, 1.12). The interaction term between loneliness and age groups was significant, indicating that the rate for survival of loneliness varied by age (HR = 1.29; 95% CI = 1.02, 1.63 for young- and middle-aged individuals; HR = 0.96; 95% CI = 0.89, 1.04 for older adults). CONCLUSIONS: The development of interventions aimed at tackling loneliness among young- and middle-aged adults might contribute to a mortality risk reduction. Future research is warranted to test whether our results can be replicated.

Are loneliness and social isolation associated with cognitive decline?

OBJECTIVE: This study aimed to examine the association of loneliness and social isolation on cognition over a 3-year follow-up period in middle- and older-aged adults. METHODS: Data from a Spanish nationally representative sample were analyzed (n = 1691; aged 50 years or older). Loneliness, social isolation, and cognition (immediate recall, delayed recall, verbal fluency, forward digit span, backward digit span, and a composite cognitive score) were assessed both at baseline and at follow-up. Adjusted generalized estimating equations models were performed. RESULTS: Loneliness was significantly associated with lower scores in the composite cognitive score, immediate and delayed recall, verbal fluency, and backward digit span (B = -0.14 to B = -3.16; P < .05) and with a more rapid decline from baseline to follow-up in two out of six cognitive tests. Higher social isolation was associated with lower scores in the composite cognitive score, verbal fluency, and forward digit span (B = -0.06 to B = -0.85; P < .05). The effect of loneliness and social isolation on cognition remained significant after the exclusion of individuals with depression. CONCLUSIONS: Both loneliness and social isolation are associated with decreased cognitive function over a 3-year follow-up period. The development of interventions that include the enhancement of social participation and the maintenance of emotionally supportive relationships might contribute to cognitive decline prevention and risk reduction.

Association of loneliness with all-cause mortality: A meta-analysis.

INTRODUCTION: Loneliness has social and health implications. The aim of this article is to evaluate the association of loneliness with all-cause mortality. METHODS: Pubmed, PsycINFO, CINAHL and Scopus databases were searched through June 2016 for published articles that measured loneliness and mortality. The main characteristics and the effect size values of each article were extracted. Moreover, an evaluation of the quality of the articles included was also carried out. A meta-analysis was performed firstly with all the included articles and secondly separating by gender, using a random effects model. RESULTS: A total of 35 articles involving 77220 participants were included in the systematic review. Loneliness is a risk factor for all-cause mortality [pooled HR = 1.22, 95% CI = (1.10, 1.35), p < 0.001] for both genders together, and for women [pooled HR = 1.26, 95% CI = (1.07, 1.48); p = 0.005] and men [pooled HR = 1.44; 95% CI = (1.19, 1.76); p < 0.001] separately. CONCLUSIONS: Loneliness shows a harmful effect for all-cause mortality and this effect is slightly stronger in men than in women. Moreover, the impact of loneliness was independent from the quality evaluation of each article and the effect of depression.

Sociodemographic Factors Associated With Changes in Successful Aging in Spain: A Follow-Up Study.

OBJECTIVE: Successful aging (SA) refers to maintaining well-being in old age. Several definitions or models of SA exist (biomedical, psychosocial, and mixed). We examined the longitudinal association between various SA models and sociodemographic factors, and analyzed the patterns of change within these models. METHOD: This was a nationally representative follow-up in Spain including 3,625 individuals aged ≥50 years. Some 1,970 individuals were interviewed after 3 years. Linear regression models were used to analyze the survey data. RESULTS: Age, sex, and occupation predicted SA in the biomedical model, while marital status, educational level, and urbanicity predicted SA in the psychosocial model. The remaining models included different sets of these predictors as significant. In the psychosocial model, individuals tended to improve over time but this was not the case in the biomedical model. CONCLUSION: The biomedical and psychosocial components of SA need to be addressed specifically to achieve the best aging trajectories.

All-cause mortality and multimorbidity in older adults: The role of social support and loneliness.

OBJECTIVES: To determine whether the effect of multimorbidity on time to mortality is modified by level of social support and loneliness in a representative sample of 2113 participants aged 60+. METHODS: Vital status was ascertained through national registers or by asking participants' relatives. Baseline variables included number of illnesses, self-perceived social support (Oslo social support scale) and loneliness (UCLA loneliness scale). Kaplan-Meier survival curves were used to estimate the time to death by multimorbidity, social support and loneliness. Adjusted cox proportional hazards regression models were conducted to explore interactions between multimorbidity and social support and loneliness. RESULTS: Multimorbidity was associated with low probability of survival, whereas high loneliness and low social support were not related with time to death. Only the interaction multimorbidity∗social support was significant. Participants with low social support and 2 chronic diseases, compared with none, presented lower probability of survival (HR=2.43, 95%CI=1.14-5.18, p<0.05), whereas the effect of multimorbidity, in comparison with not having chronic conditions, did not affect mortality if participants had high social support. For participants with low social support, there were no differences between having one, two or more than two diseases. When there is high social support, the probability of death is significantly lower if one or two chronic diseases are present, compared with more than two. DISCUSSION: These findings indicate that having a supportive social environment increases the survival of people with physical illnesses, especially those with one or two. For those with more than two illnesses, survival remains unchanged regardless of the level of social support and other protective factors should be explored in future research. Geriatric health professionals are encouraged to evaluate social relationships and stimulate support given by relatives, friends or neighbors.

Loneliness and depression in the elderly: the role of social network.

PURPOSE: Loneliness and depression are associated, in particular in older adults. Less is known about the role of social networks in this relationship. The present study analyzes the influence of social networks in the relationship between loneliness and depression in the older adult population in Spain. METHODS: A population-representative sample of 3535 adults aged 50 years and over from Spain was analyzed. Loneliness was assessed by means of the three-item UCLA Loneliness Scale. Social network characteristics were measured using the Berkman-Syme Social Network Index. Major depression in the previous 12 months was assessed with the Composite International Diagnostic Interview (CIDI). Logistic regression models were used to analyze the survey data. RESULTS: Feelings of loneliness were more prevalent in women, those who were younger (50-65), single, separated, divorced or widowed, living in a rural setting, with a lower frequency of social interactions and smaller social network, and with major depression. Among people feeling lonely, those with depression were more frequently married and had a small social network. Among those not feeling lonely, depression was associated with being previously married. In depressed people, feelings of loneliness were associated with having a small social network; while among those without depression, feelings of loneliness were associated with being married. CONCLUSION: The type and size of social networks have a role in the relationship between loneliness and depression. Increasing social interaction may be more beneficial than strategies based on improving maladaptive social cognition in loneliness to reduce the prevalence of depression among Spanish older adults.

The Impact of Subjective Well-being on Mortality: A Meta-Analysis of Longitudinal Studies in the General Population.

OBJECTIVE: The aims of the study were to assess whether subjective well-being is a protective factor for mortality in the general population and to analyze the differential impact of evaluative, experienced, and eudaimonic well-being. METHODS: Systematic review of articles in the PsycINFO, Web of Science, and PubMed databases. Data on the studies' characteristics, quality, and the effects of variables were extracted. A meta-analysis was conducted on the studies included in the systematic review. RESULTS: A total of 62 articles that investigated mortality in general populations, involving 1,259,949 participants, were found, and added to those considered in a previously published review (n = 14). The meta-analysis showed that subjective well-being was a protective factor for mortality (pooled hazard ratio = 0.920; 95% confidence interval = 0.905-0.934). Although the impact of subjective well-being on survival was significant in both men and women, it was slightly more protective in men. The three aspects of subjective well-being were significant protective factors for mortality. The high level of heterogeneity and the evidences of publication bias may reduce the generalizability of these findings. CONCLUSIONS: Our results suggest that subjective well-being is associated with a decreased risk of mortality. Longitudinal studies examining changing levels of well-being and their relationship to longevity would be required to establish a cause-effect relationship. Establishing such a causal relationship would strengthen the case for policy interventions to improve the population subjective well-being to produce longevity gains combined with optimizing quality of life.

Loneliness, Social Networks, and Health: A Cross-Sectional Study in Three Countries.

OBJECTIVE: It is widely recognized that social networks and loneliness have effects on health. The present study assesses the differential association that the components of the social network and the subjective perception of loneliness have with health, and analyzes whether this association is different across different countries. METHODS: A total of 10 800 adults were interviewed in Finland, Poland and Spain. Loneliness was assessed by means of the 3-item UCLA Loneliness Scale. Individuals' social networks were measured by asking about the number of members in the network, how often they had contacts with these members, and whether they had a close relationship. The differential association of loneliness and the components of the social network with health was assessed by means of hierarchical linear regression models, controlling for relevant covariates. RESULTS: In all three countries, loneliness was the variable most strongly correlated with health after controlling for depression, age, and other covariates. Loneliness contributed more strongly to health than any component of the social network. The relationship between loneliness and health was stronger in Finland (|ß| = 0.25) than in Poland (|ß| = 0.16) and Spain (|ß| = 0.18). Frequency of contact was the only component of the social network that was moderately correlated with health. CONCLUSIONS: Loneliness has a stronger association with health than the components of the social network. This association is similar in three different European countries with different socio-economic and health characteristics and welfare systems. The importance of evaluating and screening feelings of loneliness in individuals with health problems should be taken into account. Further studies are needed in order to be able to confirm the associations found in the present study and infer causality.