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      Depression in middle and older adulthood: the role of immigration, nutrition, and other determinants of health in the Canadian longitudinal study on aging

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          Abstract

          Background

          Little is known about depression in middle-aged and older Canadians and how it is affected by health determinants, particularly immigrant status. This study examined depression and socio-economic, health, immigration and nutrition-related factors in older adults.

          Methods

          Using weighted comprehensive cohort data from the baseline Canadian Longitudinal Study on Aging ( n = 27,162) of adults aged 45–85, gender-specific binary logistic regression was conducted with the cross-sectional data using the following variables: 1) Depression (outcome) measured using the Center for Epidemiologic Studies Short Depression (CESD-10) rating scale; 2) Immigration status: native-born, recent and mid-term (< 20 years), and long-term immigrants (≥20 years); and 3) covariates: socioeconomic status, physical health (e.g., multi-morbidity), health behavior (e.g., substance use), over-nutrition (e.g., anthropometrics), under-nutrition (e.g., nutrition risk), and dietary intake.

          Results

          The sample respondents were mainly Canadian-born (82.6%), women (50.6%), 56–65 years (58.9%), earning between C$50,000–99,999 (33.2%), and in a relationship (69.4%). When compared to Canadian-born residents, recent, mid-term (< 20 years), and longer-term (≥ 20 years) immigrant women were more likely to report depression and this relationship was robust to adjustments for 32 covariates (adjusted ORs = 1.19, 2.54, respectively, p < 0.001). For women, not completing secondary school (OR = 1.23, p < 0.05), stage 1 hypertension (OR = 1.31, p < 0.001), chronic pain (OR = 1.79, p < 0.001), low fruit/vegetable intakes (OR = 1.33, p < 0.05), and fruit juice (OR = 1.80, p < 0.001), chocolate (ORs = 1.15–1.66, p’s < 0.05), or salty snack (OR = 1.19, p < 0.05) consumption were associated with depression. For all participants, lower grip strength (OR = 1.25, p < 0.001) and high nutritional risk (OR = 2.24, p < 0.001) were associated with depression. For men, being in a relationship (OR = 0.62, p < 0.001), completing post-secondary education (OR = 0.82, p < 0.05), higher fat (ORs = 0.67–83, p’s < 0.05) and omega-3 egg intake (OR = 0.86, p < 0.05) as well as moderate intakes of fruits/vegetables and calcium/high vitamin D sources (ORs = 0.71–0.743, p’s < 0.05) predicted a lower likelihood of depression. For men, chronic conditions (ORs = 1.36–3.65, p’s < 0.001), chronic pain (OR = 1.86, p < 0.001), smoking (OR = 1.17, p < 0.001), or chocolate consumption (ORs = 1.14–1.72, p’s < 0.05) predicted a higher likelihood of depression.

          Conclusions

          The odds of developing depression were highest among immigrant women. Depression in middle-aged and older adults is also associated with socioeconomic, physical, and nutritional factors and the relationships differ by sex. These results provide insights for mental health interventions specific to adults aged 45–85.

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          Most cited references98

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          Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale).

          We derived and tested a short form of the Center for Epidemiologic Studies Depression Scale (CES-D) for reliability and validity among a sample of well older adults in a large Health Maintenance Organization. The 10-item screening questionnaire, the CESD-10, showed good predictive accuracy when compared to the full-length 20-item version of the CES-D (kappa = .97, P or = 16 for the full-length questionnaire and > or = 10 for the 10-item version. We discuss other potential cutoff values. The CESD-10 showed an expected positive correlation with poorer health status scores (r = .37) and a strong negative correlation with positive affect (r = -.63). Retest correlations for the CESD-10 were comparable to those in other studies (r = .71). We administered the CESD-10 again after 12 months, and scores were stable with strong correlation of r = .59.
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            Epidemiology of women and depression.

            R Kessler (2003)
            Depression is the leading cause of disease-related disability among women in the world today. Depression is much more common among women than men, with female/male risk ratios roughly 2:1. Recent epidemiological research is reviewed. Implications are suggested for needed future research. The higher prevalence of depression among women than men is due to higher risk of first onset, not to differential persistence or recurrence. Although the gender difference first emerges in puberty, other experiences related to changes in sex hormones (pregnancy, menopause, use of oral contraceptives, and use of hormone replacement therapy) do not significantly influence major depression. These observations suggest that the key to understanding the higher rates of depression among women than men lies in an investigation of the joint effects of biological vulnerabilities and environmental provoking experiences. Advancing understanding of female depression will require future epidemiologic research to focus on first onsets and to follow incident cohorts of young people through the pubertal transition into young adulthood with fine-grained measures of both sex hormones and gender-related environmental experiences. Experimental interventions aimed at primary prevention by jointly manipulating putative biological and environmental risk factors will likely be needed to adjudicate between contending causal hypotheses regarding the separate and joint effects of interrelated risk factors.
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              Management of Depression in Older Adults: A Review.

              Depression in older adults is a common psychiatric disorder affecting their health-related quality of life. Major depression occurs in 2% of adults aged 55 years or older, and its prevalence rises with increasing age. In addition, 10% to 15% of older adults have clinically significant depressive symptoms, even in the absence of major depression.
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                Author and article information

                Contributors
                esme.fuller.thomson@utoronto.ca
                Journal
                BMC Psychiatry
                BMC Psychiatry
                BMC Psychiatry
                BioMed Central (London )
                1471-244X
                6 November 2019
                6 November 2019
                2019
                : 19
                : 329
                Affiliations
                [1 ]ISNI 0000 0001 2188 0957, GRID grid.410445.0, Faculty of Social Science, , University of Hawaii, ; Honolulu, Hawaii USA
                [2 ]ISNI 0000 0000 9606 4172, GRID grid.258778.7, Faculty of Science and Horticulture (Health Science), , Kwantlen Polytechnic University, ; Surrey, British Columbia Canada
                [3 ]ISNI 0000 0001 2157 2938, GRID grid.17063.33, Factor-Inwentash Faculty of Social Work, , University of Toronto, ; Toronto, Ontario Canada
                [4 ]ISNI 0000 0004 0398 5853, GRID grid.418296.0, Faculty of Health and Community Studies, , MacEwan University, ; Edmonton, Alberta Canada
                [5 ]ISNI 0000 0004 1936 9465, GRID grid.143640.4, Faculty of Social Science, , University of Victoria, ; Victoria, British Columbia Canada
                [6 ]ISNI 0000 0001 2157 2938, GRID grid.17063.33, Institute for Life Course & Aging, , University of Toronto, ; Toronto, Ontario Canada
                Article
                2309
                10.1186/s12888-019-2309-y
                6833158
                31690283
                6aa8c450-c36a-400c-a48b-858b7644f8d7
                © The Author(s). 2019

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 3 April 2019
                : 9 October 2019
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100010081, Fulbright Canada;
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Clinical Psychology & Psychiatry
                older adults,middle-age,immigration,determinants of health,nutrition,clsa,depression

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