When Shepherds Shed: Trajectories of Weight-Related Behaviors in a Holistic Health Intervention Tailored for US Christian Clergy.

Maintaining healthy behaviors is challenging. Based upon previous reports that in North Carolina (NC), USA, overweight/obese clergy lost weight during a two-year religiously tailored health intervention, we described trajectories of diet, physical activity, and sleep. We investigated whether behavior changes were associated with weight and use of health-promoting theological messages.

The Gap in Mental Health Service Utilization Among United Methodist Clergy with Anxiety and Depressive Symptoms.

Clergy are tasked with multiple interpersonal administrative, organizational, and religious responsibilities, such as preaching, teaching, counseling, administering sacraments, developing lay leader skills, and providing leadership and vision for the congregation and community. The high expectations and demands placed on them put them at an increased risk for mental distress such as depression and anxiety. Little is known about whether and how clergy, helpers themselves, receive care when they experience mental distress.

Age differences in trajectories of depressive, anxiety, and burnout symptoms in a population with a high likelihood of persistent occupational distress.

Objectives: Work in occupations with higher levels of occupational stress can bring mental health costs. Many older adults worldwide are continuing to work past traditional retirement age, raising the question whether older adults experience depression, anxiety, or burnout at the same or greater levels as younger workers, and whether there are differences by age in these levels over time.

Design/setting/participants: Longitudinal survey of 1161 currently employed US clergy followed every 6-12 months for up to 66 months.

Are changes in positive mental health associated with increased likelihood of depression over a two year period? A test of the mental health promotion and protection hypotheses.

This paper investigates the mental health promotion and protection (MHPP) model of reducing depression. Data are from the Clergy Health Initiative Longitudinal Survey of United Methodist ministers in North Carolina that included the Mental Health Continuum Short Form (MHC-SF) for positive mental health and the Patient Health Questionnaire (PHQ-9) for depression in 2014 and 2016 (N = 955). The promotion hypothesis predicts reduced risk of depression in 2016 among clergy whose mental health increased to flourishing and the increased risk of depression in 2016 for clergy who stayed not flourishing.

Persistent Depressive Symptoms in a Population With High Levels of Occupational Stress: Trajectories Offer Insights Into Both Chronicity and Resilience.

Religious participation and spirituality are linked to good mental health. However, clergy may experience more depression than is observed in the general population, which may be due in part to high job strain. The objectives of this study were to identify distinct longitudinal trajectories of depressive symptoms in clergy and to identify variables associated with each course.

Acculturation, depression and oral health of immigrants in the USA.

Objectives: The objectives were to describe the oral health status of immigrants in the USA, describe the association between acculturation and oral health by accounting for the effects of depression and to explore the effects of interaction between acculturation and depression on the oral health of immigrants.

Methods: Data were from the 2011-2012 National Health and Nutrition Examination Survey (NHANES). Oral health status was assessed by both self-rated oral health and clinically diagnosed periodontitis, each coded as a binary outcome.

Trends in decayed teeth among middle-aged and older adults in the United States: socioeconomic disparities persist over time.

Objectives: While trends in tooth loss among older adults have been well documented and show a decline over the last few decades, little is known about trends in tooth decay which may lead to tooth loss. The study aim was to examine trends in tooth decay among adults ages 50 years and older in the United States and determine whether these trends were consistent across demographic and socioeconomic subgroups of middle-aged and older adults.

Methods: Secondary analysis of data collected through detailed oral health examinations in the National Health and Nutrition Examination (NHANES) surveys 1988-1994 and 1999-2004.

Heterogeneity in the three-year course of major depression among older adults.

Objective: The objective of this research was to identify distinct trajectories of recovery in older depressed patients in order to identify optimal samples and points for interventions.

Methods: The sample was 368 patients ages 60 years and older diagnosed with major depression and enrolled in a naturalistic treatment study and followed for up to 3 years.

Results: A model with four trajectory classes fit the data best: a quick recovery class (43%), a persistent moderate symptom class (27%), a persistent high symptom class (15%), and a slow recovery class (15%).

Trajectories of depressive symptoms and oral health outcomes in a community sample of older adults.

Objective: Adverse outcomes associated with chronic depressive symptoms are of clinical importance. The objective was to identify subgroups of older adults based on their trajectories of depressive symptoms over a 10-year period and determine if these subgroups predicted oral health outcomes.

Methods: The sample was 944 adults aged 65+ who participated in the oral health module of the the Health and Retirement Survey in 2008.

Late-life Depression Modifies the Association Between Cerebral White Matter Hyperintensities and Functional Decline Among Older Adults.

Objective: Vascular lesions seen through brain imaging as hyperintensities are associated with both depression and functional impairment in older adults. Our objective was to determine if the relationship between the volume of cerebral white matter hyperintensities (WMHs) and functional decline differed in the presence of late life depression.

Design: Secondary analysis of data collected through the Neurocognitive Outcomes of Depression Study.

Social stratification and tooth loss among middle-aged and older Americans from 1988 to 2004.

Objectives: Tooth retention has improved over the past few decades, but it is not known whether these trends have been observed across all demographic/socioeconomic subgroups. We examined number of missing teeth among dentate individuals (n = 9,113) as well as edentulism and systematically modeled their trends over time by using clinical examination data.

Methods: We investigated the association between social stratification and trends in tooth retention among adults ages 50+ from 1988 to 2004, using four waves of the National Health and Nutrition Examination Surveys (NHANES) (n = 11,812).

Vascular lesions and functional limitations among older adults: does depression make a difference?

Background: The association between disability and depression is complex, with disability well established as a correlate and consequence of late life depression. Studies in community samples report that greater volumes of cerebral white matter hyperintensities (WMHs) seen on brain imaging are linked with functional impairment. These vascular changes are also associated with late life depression, but it is not known if depression is a modifier in the relationship between cerebrovascular changes and functional impairment.

Inflammation and Coagulation as Mediators in the Relationships Between Religious Attendance and Functional Limitations in Older Adults.

Objective: The aim of this study was to examine inflammation and coagulation, which are positively linked to disability and inversely linked to increased religious attendance, as mediators in the cross-sectional relationships between religious attendance and functional status.

Method: Frequency of attendance and limitations in basic activities of daily living (ADLs), instrumental activities (IADLs), and mobility were assessed in 1,423 elders.

Results: More frequent attendance was associated with fewer ADL, IADL, and mobility limitations, and with lower levels of inflammation and coagulation including interleukin-6, soluble vascular cell adhesion molecule, and D-dimer.

Latent subtypes of depression in a community sample of older adults: can depression clusters predict future depression trajectories?

Identifying sources of heterogeneity in late life depression remains an important focus of psychiatric investigation. Community samples are particularly informative since many older adults have clinically significant depressive symptoms but fail to meet criteria for major depression and older adults generally do not seek treatment for their depressive symptoms. The primary data used for these analyses were those collected in a community-based survey of over 3000 adults age 65 or older followed for up to ten years.

The complex association between religious activities and functional limitations in older adults.

Purpose Of The Study: To examine the longitudinal associations between 3 dimensions of religious involvement-religious attendance, use of religious media, and private religious activities-and 3 domains of functional status-limitations in basic activities of daily living (ADL), instrumental activities of daily living (IADL), and mobility in older adults.

Design And Methods: Using the data from a survey of 2,924 adults aged 65+, with self-reported religious involvement and functional status collected at baseline, 3, 6, and 10 years postbaseline, we used repeated measures mixed models to predict functional change by religious status at the prior interview.

Results: Increased religious attendance was associated with fewer ADL, IADL, and mobility limitations 3-4 years later, controlling for demographic, health, and social variables as well as prior functional status.

Age differences in symptom expression in patients with major depression.

Objective: The aim of the study was to compare symptom expression in primarily middle-aged (<60) and older (60+) patients who were depressed and determine if symptom profiles differed by age.

Methods: Patients diagnosed with major depression (N = 664) were screened using the Center for Epidemiologic Studies--Depression scale and sections of the Diagnostic Interview Schedule. Patients were separated into homogeneous clusters based on symptom endorsement using latent class analysis.

Change in stress and social support as predictors of cognitive decline in older adults with and without depression.

Objective: The relationship between stress, social support, and cognition in geriatric depression is complex. In this study, we sought to examine whether an increase in stressful life events or a decrease in social support would lead to subsequent cognitive decline among older adults with and without depression.

Methods: The sample consisted of 112 depressed and 101 non-depressed older adults who enrolled in the Neurocognitive Outcomes of Depression in the Elderly (NCODE) study.

Social support modifies the relationship between personality and depressive symptoms in older adults.

Objective: To explore the relationship between personality, social support, and depression in older adults, identify the personality trait and social support dimension most closely associated with depression, and determine whether the relationship between personality and depression varies by level of social support.

Design: Cross-sectional analysis within longitudinal study.

Participants: Older patients originally diagnosed with major depression (n = 108) and never-depressed comparison group of older adults (n = 103).

Heterogeneity in symptom profiles among older adults diagnosed with major depression.

Background: Late-life depression may be undiagnosed due to symptom expression. These analyses explore the structure of depressive symptoms in older patients diagnosed with major depression by identifying clusters of patients based on their symptom profiles.

Methods: The sample comprised 366 patients enrolled in a naturalistic treatment study.

Shortness of breath as a predictor of depressive symptoms in a community sample of older adults.

Objectives: Physical symptoms are known to be associated with late life depression both cross-sectionally and over time. We attempted to determine if self-reported shortness of breath (SoB) is associated with depressive symptoms at long-term (3-year) follow-up in a community sample of older (65+) adults.

Methods: A sample of 2926 elderly subjects from the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE) were evaluated at baseline and at 3-year follow-up.

Trajectories of mobility and IADL function in older patients diagnosed with major depression.

Objective: Research has shown an association between depression and functional limitations in older adults. Our aim was to explore the latent traits of trajectories of limitations in mobility and instrumental activities of daily living (IADL) tasks in a sample of older adults diagnosed with major depression.

Methods: Participants were 248 patients enrolled in a naturalistic depression treatment study.

Profiles of depressive symptoms in older adults diagnosed with major depression: latent cluster analysis.

Objective: To explore the underlying structure of symptom presentation in older adults with major depression by identifying homogeneous clusters of individuals based on symptom profiles.

Design: Secondary data analysis using latent class cluster analysis.

Setting: Clinical Research Center for the Study of Depression in Later Life conducted at Duke University.

The course of depressive symptoms in older adults with comorbid major depression and dysthymia.

Objective: To examine the course of depressive symptoms in older patients with comorbid major depression and dysthymia.

Design: Secondary data analysis using both proportional hazards modeling and a repeated measures mixed model.

Setting: Clinical Research Center for the Study of Depression in Later Life conducted at Duke University.

The combined effect of visual impairment and cognitive impairment on disability in older people.

Objectives: To determine the risk of disability in individuals with coexisting visual and cognitive impairment and to compare the magnitude of risk associated with visual impairment, cognitive impairment, or the multimorbidity.

Design: Prospective cohort.

Setting: North Carolina.