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.

Risk Factors and Gender Differences for Depression in Chilean Older Adults:A Cross-Sectional Analysis from the National Health Survey 2016–2017

Depressive disorders are recognized as one of the most common mental health conditions across different age groups.However,the risk factors associated with depression among older people from low-and middle-income countries remains unclear.This study aims to identify socio-demographic,health and psychosocial-related factors associated with depression in Chilean older adults.A cross-sectional study was carried out in a representative sample of 1,765 adults aged≥60 years participants from the Chilean National Health Survey 2016–2017.Depres-sion was assessed with the Composite International Diagnostic Interview(CIDI-SF).Associations between the exposure variables and depression were investigated using Poisson regression analyses.The mainfindings indi-cated that women showed higher likelihood of depression than men(Prevalence Ratio(PR)=2.6[95%CI:1.40;4.89]).An increased likelihood of depression was found in older adults with chronic pain,multimorbidity(≥2 diseases),previous diagnose of depression,high perception of stress,financial stress,and difficulties for social par-ticipation.In women,higher likelihood of depression was found for those with the frailty phenotype(PR:8.53[95%CI:1.68;43.32]),rheumatoid arthritis(PR:2.41[95%CI:1.34;4.34]),insomnia(PR:2.99[95%CI:1.74;5.12])and low self-rated well-being(PR:4.94[95%CI:2.26;10.79]).Men who were divorced(PR:7.10[95%CI:1.44;34.90])or widowed(PR:10.83[95%CI:3.71;31.58]),obese(PR:5.08[95%CI:1.48;17.42])and who had asthma(PR:7.60[95%CI:2.31;24.99])were associated with higher odds of depression.The currentfindings may have clinical implications for the early identification of older adults more susceptible to depression and also suggest the need to implement cultural and age-sensitive strategies to promote mental health in late life.

Differences in olfactory functional connectivity in early-onset depression and late-onset depression

Background:Late-onset depression(LOD)and early-onset depression(EOD)exhibit different pathological mechanisms and clinical phenotypes,including different extents of olfactory dysfunction.However,the brain abnormalities underlying the differences in ol-factory dysfunction between EOD and LOD remain unclear.Objective:The aim of this study was to compare the functional connectivity(FC)patterns of olfactory regions between EOD patients and LOD patients and examine their relationship with cognitive function.Methods:One hundred and five patients with EOD,101 patients with LOD and 160 normal controls(NCs)were recruited for the present study.Participants underwent clinical assessment,olfactory testing,cognitive assessments,and magnetic resonance imaging.Eight regions of the primary and secondary olfactory regions were selected to investigate olfactory FC.Results:Patients with LOD exhibited decreased odor identification(OI)compared with patients with EOD and NCs.The LOD group exhibited decreased FC compared with the EOD and NC groups when primary and secondary olfactory regions were selected as the regions of interest(the piriform cortex,lateral entorhinal cortex,and orbital-frontal cortex).Additionally,these abnormal olfactory FCs were associated with decreased cognitive function scores and OI,and the FC between the left orbital-frontal cortex and left amygdala was a partial mediator of the relationship between global cognitive scores and OI.Conclusion:Overall,patients with LOD exhibited decreased FC in both the primary and secondary olfactory cortices compared with patients with EOD,and abnormal olfactory FC was associated with OI dysfunction and cognitive impairment.The FC between the orbital-frontal cortex and amygdala mediated the relationship between global cognitive function and OI.

基于数据挖掘技术分析针刺治疗老年抑郁症的选穴规律

【目的】运用现代数据挖掘技术分析针刺治疗老年抑郁症的选穴规律及特点,为临床治疗老年抑郁症提供参考。【方法】采用计算机检索中国期刊全文数据库(CNKI)、万方学术期刊全文数据库(Wanfang)、维普中文科技期刊数据库(VIP)、中国生物医学文献数据库(SinoMed)、美国医学在线(PubMed)、荷兰医学文献数据库(Embase)及核心合集数据库(Web of Science)等数据库,从建库至2021年11月2日收录的针刺治疗老年抑郁症的相关文献,采用Microsoft Excel 2013软件建立老年抑郁症针刺处方数据库并进行描述性分析,运用IBM SPSS Modeler 18.0软件及IBM SPSS Statistics 24.0软件进行关联规则分析和系统聚类分析。【结果】共纳入41篇文献,52组针刺处方,涉及34个腧穴,总频次为344次。针刺治疗老年抑郁症最常使用的穴位分别是百会、印堂、内关、太冲、三阴交,最常取用督脉、足太阳膀胱经、手厥阴心包经的腧穴,临床针刺治疗部位多选用头部、四肢、背部。由关联规则分析表明,针刺治疗老年抑郁症的核心腧穴组为百会-印堂-三阴交-内关,最后对高频穴位进行聚类分类获得两个聚类群,分别是“百会、印堂、内关、三阴交、太冲、合谷、神门、风池、足三里、四神聪、太阳”和“肝俞、肾俞、心俞、脾俞”。【结论】针刺老年抑郁症取穴多选取督脉、足太阳膀胱经,以头部以及背部穴位为主,建议以百会-印堂-三阴交-内关作为核心穴位,配合辨证取穴。

Study of the hippocampus and the anterior cingulate gyrus by proton MR spectroscopy in patients with post-traumatic stress disorder

Objective:To explore the characteristics of metabolic changes in patients with post-traumatic stress disorder through 1H-MRS in neuroanatomical circuit comparing with age-matches controls.Methods:Fifty patients with post-traumatic stress disorder and SO gender-and agematched normal controls were involved.The neurochemical abnormalities including the levels of choline(Cho)/ creatine(Cr) and N-acetylaspartate(NAA)/Cr were measured respectively in hippocampus and the anterior cingulate gyrus with three-dimension 1H-proton specrroscopy(3D 1H-MRS).Results:The values of NAA/Cr ratios in hippocampus and the anterior cingulate gyrus were significant lower in patients with post-traumatic stress disorder(1.71±0.32,left l.58±0.29, right 1.55±0.31) than that in controls(2.24±0.41,left 1.98±0.27,right 2.02±0.36)(P【0.05).but the values of Cho/Cr in hippocampus(left 1.64±0.23,right 1.66±0.34) were no significant with that of controls(left 1.48±0.29,right 1.54±0.38).Values of Cho/Cr in cingulate gyrus were significant higher in post-traumatic stress disorder patients(I.88±0.44) than that in controls(1.37.±0.32) (P【0.05).Conclusions:The results indicate some special neurochemical and histological structure changes in post-traumatic stress disorder patients,which might occurre earlier in anterior cingulate gyrusthe than in hippocampus.