American Journal of Geriatric Psychiatry最新文献

Objective: Tinnitus has been linked to mental health concerns, including suicidal ideation. This study, using data from the National Health and Nutrition Examination Survey (NHANES), investigates the association between tinnitus and suicidal ideation in postmenopausal women, aiming to identify tinnitus as a potential risk factor for suicidal thoughts in this population.

Method: A total of 1,792 postmenopausal women were included after excluding males, premenopausal women, and participants with missing data on tinnitus, suicidal ideation, or key covariates. Multivariable logistic regression models were used to examine the relationship between tinnitus and suicidal ideation, with adjustments for relevant confounders. Data were drawn from the NHANES database, specifically from the 2011 to 2012, 2015 to 2016, and 2017 to 2018 survey cycles.

Results: Of the 1,792 postmenopausal women, 4.41% reported suicidal ideation. Tinnitus prevalence was significantly higher in women with suicidal ideation (P = 0.007). Weighted multivariable logistic regression revealed that women with tinnitus had 2.43 times higher odds of reporting suicidal ideation compared to those without tinnitus (OR: 2.43, 95% CI: 1.07-5.52, P = 0.035).

Conclusion: Tinnitus appears to be a significant factor associated with suicidal ideation in postmenopausal women. These findings underscore the importance of considering tinnitus in mental health assessments, especially among individuals at risk for suicidal thoughts.

Objectives: To investigate the associations between accelerometer-measured physical activity and sedentary behavior with depression and anxiety.

Methods: We used accelerometer data from the UK biobank. Time spent in moderate-to-vigorous physical activity (MVPA) was classified into four categories: very-low (0-74.9 min/week), low (75-149.9 min/week), moderate (150-299.9 min/week), and high (≥300 min/week). Associations were examined using Cox proportional hazard regression models. Restricted cubic splines were used to evaluate dose-response associations.

Results: A total of 71556 adults (mean [SD] age, 62.11 [7.83] years; 54.5% were female) were included. When stratified by MVPA, 10562 participants were in the very-low group (14.8%), 11578 were in the low group (16.2%), 20700 were in the moderate group (28.9%), and 28716 were in the high group (40.1%). Both MVPA and total physical activity showed nonlinear associations with the risk of depression and anxiety. Compared with very-low level MVPA, moderate MVPA might reduce the risk of depression (HR, 0.71; 95% CI, 0.63-0.79) and anxiety (HR, 0.80; 95% CI, 0.71-0.90). High MVPA was associated with a 30% lower risk of depression (HR, 0.70; 95% CI, 0.62-0.78) and anxiety (HR, 0.70; 95% CI, 0.62-0.79). For sedentary behavior, quartile 4 (≥10.60 h/d) was associated with a 19% higher risk of depression (HR, 1.19; 95% CI, 1.05-1.35) compared to quartile 1 (<8.21 h/d).

Conclusion: The WHO guideline of 150-300 min/week of MVPA may reduce the risk of depression by 29% and anxiety by 20% compared to less than 75 min/week. Prolonged sedentary behavior was associated with a higher risk of depression.

Objectives: To improve assessment of neuropsychiatric symptoms (NPS) by expanding the measurement properties of the Neuropsychiatric Inventory Questionnaire (NPI-Q).

Design: Multicenter, longitudinal observational study.

Setting: Several Alzheimer's Disease Research Centers (ADRCs).

Participants: Individuals (n = 45,274) who presented to an ADRC with a collateral and completed the NPI-Q.

Measurements: The NPI-Q total severity score, four NPI-Q subscales, dementia stage, expert NPS rating, consensus rating of dementia syndrome, global cognitive screening, collateral rating of daily functioning, and self-rating of depression.

Results: There was strong evidence of criterion validity with both dementia stage and expert NPS rating for the NPI-Q total severity index, which informed cutoffs and interpretive ranges. Furthermore, subscales had adequate classification of dementia syndromes and appropriate convergent relationships with cognition, daily functioning, and mood. There was good-to-excellent evidence of reliability for the NPI-Q total severity index over several years, and subscales had adequate-to-good reliability.

Conclusions: This is the first study to provide empirically established cutoffs, interpretive ranges, and evidence of reliability over a period longer than a month on the NPI-Q and its subscales. This will improve assessment of NPS in clinical and research contexts.

Article summary: Neuropsychiatric symptoms of neurodegeneration are increasingly understood as early disease markers with tremendous functional impact later in disease, but are often missed or misdiagnosed. The most common measure of these symptoms, the Neuropsychiatric Inventory Questionnaire (NPI-Q), does not have clinically actionable guidance, which this article provided. We established cutscores for several conditions and test-retest reliability over longer periods for the total score and subscales using a multicenter database.

Objectives: Vietnam faces an unprecedented increase in people living with dementia but lacks evidence-based family dementia caregiver interventions. We tested the efficacy of a culturally adapted family caregiver intervention (REACH VN) in Northern Vietnam.

Methods: In this randomized controlled trial, clusters (communes) were assigned to¹ REACH VN (a multicomponent intervention consisting of 4-6 one-hour sessions delivered over 1-3 months) or² enhanced control (one session of dementia education). Primary outcomes were caregiver perceived psychological distress (PHQ-4) and burden (ZBI-12). Secondary outcomes were caregiver perceived stress (PSS-10) and somatic symptoms (PHQ-15). Mixed effects analysis was performed with 3-month and 6-month assessments as the outcomes and baseline assessment as a covariate.

Results: Overall, 350 caregivers from 40 clusters (21 intervention, 19 enhanced control) enrolled and 330 (94.3%) completed 3-month assessments. At 3 months, the REACH VN intervention group had lower PHQ-4 (p <0.001) but not ZBI-12 (p = 0.05) scores compared to control. At 6 months, the intervention group had lower ZBI-12 (p = 0.002) but not PHQ-4 (p = 0.5) scores. PSS-10 and PHQ-15 scores were also improved at 3 months (p = 0.007, p <0.001 respectively) for the REACH VN intervention group compared with control but not at 6 months.

Conclusions: REACH VN improved outcomes in family caregivers in Vietnam at 3 months although improvement was not sustained for most outcomes at 6 months.

Objectives: The COVID-19 pandemic caused substantial disruptions in geriatric psychiatry education. In response, the AAGP created the "AAGP COVID-19 Online Trainee Curriculum" (Curriculum) a free online resource consisting of 33 recorded lectures. This study examined the uptake and impact of the Curriculum.

Methods: Administrative data established the number of unique users. Surveys assessed demographics, prior AAGP engagement, prior experiences working with older adults, and each lecture's impact on participant knowledge, enthusiasm and confidence related to the module's topic area.

Results: From May 2020 through April 2023, 860 individuals utilized the Curriculum. Of 251 survey respondents, 54% were general psychiatry residents (37%, n = 91) or medical students (16%, n = 41). Surveys from the two most-accessed lectures showed an increase in knowledge and confidence in clinical skills.

Conclusions: The Curriculum reached medical students and general psychiatry residents. Postpandemic, the Curriculum may serve as a valuable resource to enhance geriatric psychiatry education and knowledge.

Objectives: The objective of this study was to assess the impact of the pandemic on the health, well-being, and access to services of paid staff and unpaid caregivers of persons living with dementia.

Design: Questionnaires were developed to capture the experiences of paid staff and unpaid caregivers throughout the pandemic, leveraging a pre-existing clinical trial collaborative.

Setting: Community and long-term care locations in Miami, Florida, Boston, Massachusetts, and the greater Baltimore, Maryland, and D.C. areas.

Participants: Paid staff from Miami Jewish and Benchmark who worked with patients with dementia during the first two years of the pandemic. Unpaid caregivers who lived within the catchment area of the study sites and provided care for community-based persons with dementia.

Measurements: Measures included the Coronavirus Impact Scale, the Herth Hope Index, NPI-Q, the Modified Caregiver Strain Index, PHQ-8, items about workplace changes, caregiving relationship, and changes to caregiver support.

Results: Paid staff were statistically more likely to have been exposed to, tested for, hospitalized, or seriously ill with COVID-19 and indicated moderate to severe impacts to medical and mental health services compared to unpaid caregivers. Unpaid caregivers exhibited significantly higher rates of depressive symptom severity and overall lower scores on the Herth Hope Scale compared to paid staff.

Conclusions: Our findings suggest that the pandemic had significant impacts on the mental health and general well-being of unpaid caregivers. While notable that paid staff suffered from increased exposure and decreased access to services, policies supporting both workforces should respond to the unique outcomes that each faced, post-pandemic.