Psychogeriatric Assessment Scales A. F. Jorm, A. F. Jorm NHMRC Psychiatric Epidemiology Research Centre, Australian National University, Canberra, ACT 0200, AustraliaSearch for more papers by this author A. F. Jorm, A. F. Jorm NHMRC Psychiatric Epidemiology Research Centre, Australian National University, Canberra, ACT 0200, AustraliaSearch for more papers by this author Book Editor(s):John R. M. Copeland, John R. M. Copeland Department of Psychiatry, Royal Liverpool University Hospital, Liverpool L69 3GA, UKSearch for more papers by this authorMohammed T. Abou-Saleh, Mohammed T. Abou-Saleh Department of Addictive Behaviour and Psychological Medicine, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, UKSearch for more papers by this authorDan G. Blazer, Dan G. Blazer Department of Psychiatry and Behavioral Sciences, Box 3003, Duke University Medical Center, Durham, NC 27710, USASearch for more papers by this author First published: 15 April 2002 https://doi.org/10.1002/0470846410.ch27(v) AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Principles and Practice of Geriatric Psychiatry, Second Edition RelatedInformation

Background: In randomized controlled trials Internet sites have been shown to be effective in the treatment of depression and anxiety. However, it is unclear if the positive effects demonstrated in these trials transfer to community users of such sites.Objective: To compare anxiety and depression outcomes for spontaneous visitors to a publicly accessible cognitive behavior therapy website (MoodGYM) (http://moodgym.anu.edu.au) with outcomes achieved through a randomized controlled efficacy trial of the same site.Methods: All community visitors to the MoodGYM site between April 2001 and September 2003 were sampled: 182 participants in the BlueMood Trial who had been randomly assigned to the MoodGYM site as part of a large trial and 19607 visitors (public registrants) to the site. Symptom assessments (quizzes) were repeated within the website intervention to allow the examination of change in symptoms across modules. Outcome variables were (1) age, gender, initial depression severity scores, and number of assessments attempted, and (2) symptom change measures based on Goldberg anxiety and depression scores recorded on a least two occasions.Results: Public registrants did not differ from trial participants in gender, age, or initial level of depression, which was high for both groups relative to previously published epidemiological data sets. Trial participants completed more assessments. No significant differences in anxiety or depression change scores were observed, with both public registrants and trial participants improving through the training program.Conclusions: Public registrants to a cognitive behavior therapy website show significant change in anxiety and depression symptoms. The extent of change does not differ from that exhibited by participants enrolled on the website for a randomized controlled trial.

The idea that activity, both physical and mental, may be a protective factor against cognitive decline in later life has enjoyed currency in both the popular and general medical literature. However, considerable uncertainty remains about the relationship between activity and cognitive performance due to differing definitions of activity and to the use of select samples. The current report analysed data from a probability sample of 887 participants recruited from the community, aged 70-93 years in 1991 and followed up in 1994 and 1998. Activity was assessed using a six-item scale comprising activities that are both commonly undertaken and relevant to old age. Latent growth curves were fitted to longitudinal outcomes including activity, cognitive performance and health measures. Reduction in activity over the course of the study was observed in most participants. Substantial correlations between rates of change in activity and cognitive and health measures were observed. Decline in cognitive performance was also observed in a sub-sample of participants who maintained activity over the three waves of measurement. It was concluded that decline in mental and physical activity in older age is paralleled by decline in cognitive functioning and health. The results do not preclude the possibility that introduced modifications in activity might change the course of cognitive performance later in the life span. Further research is required to establish the causal nature of the relationship between activity and cognition.

OBJECTIVE:To investigate the association of obesity with anxiety, depression and emotional well-being (positive and negative affect) in three age groups.METHODS:A cross-sectional survey was carried out in Canberra and the neighbouring town of Queanbeyan, Australia, with a random sample from the electoral roll of 2,280 persons aged 20-24, 2,334 aged 40-44, and 2,305 aged 60-64.RESULTS:Self-reported height and weight were used to classify participants as underweight (body mass index of less than 18.5), acceptable weight (18.5 to less than 25), overweight (25 to less than 30) or obese (30 and over). Obesity in women was associated with more anxiety and depression symptoms and less positive affect, but there were only weak and inconsistent associations in men. When factors that might mediate any association were controlled (physical ill health, lack of physical activity, poorer social support, less education and financial problems), a different picture emerged, with the underweight women having more depression and negative affect and the obese and overweight women tending to have better mental health than the acceptable weight group. Controlling for physical ill health alone accounted for the association of obesity with anxiety and depression in women.CONCLUSIONS:Obesity has an association with anxiety, depression and lower well-being in women, but not in men. The results are consistent with physical ill health playing a mediating role.IMPLICATION:Reducing obesity in the population is unlikely to have any direct effect on mental health or emotional well-being.

BACKGROUND:Many people who are depressed do not receive any professional help and their beliefs about the helpfulness of treatment do not always correspond with those of health professionals. To facilitate choices about treatment, the present study examined the effects of providing depressed people in the community with evidence on whether various treatment options work.METHOD:A randomized controlled trial was carried out with 1094 persons selected at random from the community who screened positive for depressive symptoms and agreed to participate. Participants were mailed either an evidence-based consumer guide to treatments for depression or, as a control, a general brochure on depression. Outcomes were the rated usefulness of the information provided, changes in attitudes to depression treatments, actions taken to reduce depression, and changes in depressive symptoms, anxiety symptoms and disability.RESULTS:Participants rated the evidence-based consumer guide as more useful than the control brochure. Attitudes to some treatments changed. Improvements in symptoms and disability did not differ significantly between interventions.CONCLUSION:Providing people who are depressed with evidence on which treatments work produces some changes in attitudes and behaviour. However, this intervention may need to be enhanced if it is to produce symptom change.

This study sought to determine whether the augmentation of cognitive testing with an informant report questionnaire could improve accuracy in screening for dementia in a community setting. The sample consisted of 646 subjects aged 70–93 years. Cognitive state was assessed using the Mini-Mental State Examination (MMSE). Informants completed the 16-item short form of the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE). Dementia was diagnosed according to DSM-III-R criteria. Combination of the IQCODE with the MMSE resulted in more accurate prediction of caseness than either test alone. Receiver Operating Characteristic analysis demonstrated the superior screening performance of a logical “or” rule and a weighted sum of scores on the two tests over other methods of combination, replicating previous clinically based research. The findings also suggest that the appropriate combination of existing tests may be a fruitful method of improving screening accuracy in a variety of situations.

BackgroundCommunity surveys have reported a higher rate of mental health problems in combined groups of homosexual and bisexual participants, but have not separated these two groups.AimsTo assess separately the mental health of homosexual and bisexual groups compared with heterosexuals.MethodA community survey of 4824 adults was carried out in Canberra, Australia. Measures covered anxiety depression, suicidality alcohol misuse, positive and negative affect and a range of risk factors for poorer mental health.ResultsThe bisexual group was highest on measures of anxiety depression and negative affect, with the homosexual group falling between the other two groups. Both the bisexual and homosexual groups were high on suicidality. Bisexuals also had more current adverse life events, greater childhood adversity, less positive support from family, more negative support from friends and a higher frequency of financial problems. Homosexuals reported greater childhood adversity and less positive support from family.ConclusionsThe bisexual group had the worst mental health, although homosexual participants also tended to report more distress.

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The influence of a genetic risk factor, apolipoprotein E (apoE) epsilon4 variant, was assessed in older adults aged 70 to 94 on 3 occasions over 7 years. The results of latent growth curve analyses are reported for individuals genotyped for apoE at the 2nd measurement occasion (n = 601) and for a subsample of individuals without probable or definite dementia during the 1st or 2nd occasion (n = 434). ApoE-epsilon4 status was a significant predictor of level and change in memory performance and change in speed performance in the full sample, and of initial level and change in memory performance in the nondemented subsample. These results support previous findings that apoE-epsilon4 is associated with accelerated memory deterioration in individuals without clinical dementia.

AIMS:Recent epidemiological findings indicate that non-drinkers as well as hazardous/harmful drinkers experience higher levels of distress than moderate drinkers. Little is known about the age at which this develops. This paper examines levels of affect, depression and anxiety over the full range of alcohol consumption in young adults.DESIGN:Cross-sectional findings from the first wave of a prospective, longitudinal study are presented.PARTICIPANTS:The general population sample comprised of 2404 young adults (aged 20-24 years). living in the Canberra region. Measures included: the Goldberg Depression and Anxiety scales, the Positive and Negative Affect Schedule, and the Alcohol Use Disorders Identification Test.FINDINGS:For men, both non/occasional and hazardous/harmful consumption were associated with lower levels of positive affect and higher levels of anxiety and depression. The higher levels of distress evident for male abstainers were related to being less extroverted and less healthy and not to past hazardous/harmful alcohol consumption, current tobacco or marijuana use. For women, only hazardous/harmful drinkers were found to have higher levels of depression and negative affect. Hazardous/harmful consumption was related to using marijuana, tobacco and recent stressful events in both men and women.CONCLUSIONS:Higher levels of distress are already evident in male non-drinkers in early adulthood. The findings counter theories that distress in non-drinkers is due to past hazardous/harmful alcohol consumption, marijuana or tobacco use, or characteristics in common with hazardous/harmful drinkers. Alcohol use disorders and mental health problems are pertinent issues for young adults. However, more understanding is needed of the experiences of non-drinkers in an alcohol consuming culture.

Objective. The Cognitive Decline scale of the Psychogeriatric Assessment Scales (PAS)(1) uses informant data to assess retrospectively change from earlier in life. Data from a 7-8-year longitudinal study were used to assess the validity of this scale against changes in cognitive performance and mortality.Design and measures. PAS data were collected on three occasions, with gaps of 3.6 and 4.1 years between the waves. The Cognitive Decline score at Wave 3 was validated retrospectively against actual change on a brief test of current cognitive status (the PAS Cognitive Impairment scale) over the three waves, while the Cognitive Decline score at Wave I was assessed for predictive validity against future mortality and cognitive change.Setting. A community survey in the Australian cities of Canberra and Queanbeyan.Participants. Participants were aged 70+ at the beginning of the study. The sample size varied from 729 to 279, depending on the number of waves involved.Results. Participants with scores of 4+ on the Cognitive Decline scale at Wave 3 showed substantial deterioration over the previous 7-8 years. Scores of 4+ at Wave 1 predicted mortality and further cognitive deterioration.Conclusions. The Cognitive Decline scale allows a valid retrospective assessment of change and has predictive validity for subsequent cognitive deterioration and increased mortality. Copyright (C) 2001 John Wiley & Sons, Ltd.

Background. There is considerable dispute about the validity of memory complaints. While some studies find that complaints are an early indicator of dementia or cognitive decline, there are also many studies showing that complaints are more closely associated with negative affect (depression, anxiety and neuroticism). The present paper used three-wave longitudinal data to test three hypotheses: (1) that memory complaints reflect an evaluation of present and past memory performance; (2) that memory complaints predict future memory performance; and (3) that memory complaints predict current and future negative affect.Methods. A longitudinal study was carried out with a community sample of people aged 70 and over. Participants were assessed for memory complaints, memory performance and negative affect at three waves separated by 3·6 years and 4·0 years. There were 331 persons with data on all relevant variables. The data were analysed using structural equation modelling.Results. Significant paths in the structural model were found from memory performance to future memory complaints, as well as from memory complaints to future memory performance, supporting hypotheses 1 and 2. Memory complaints were associated with current negative affect, but did not predict future negative affect.Conclusions. Memory complaints do reflect perceptions of past memory performance and are also an early manifestation of memory impairment. However, current negative affect (anxiety and depression symptoms) shows the greatest association with memory complaints.

Background. Higher education has been posited to protect against cognitive decline, either because the rate of decline is slower in the more highly educated or the start of decline is delayed. Latent growth models provide improved methodology to examine this issue. Methods. The sample consisted of 887 participants aged 70–93 years in 1991 and followed up in 1994 and 1998. Latent growth models and standard regression techniques were used to examine the rate of cognitive decline in four cognitive measures while controlling for health status and sex. A delayed start model was examined by incorporating interaction effects in a regression model. Results. Neither the latent growth models nor the regression techniques revealed a slower rate of decline for the more highly educated. The proportion of the highly educated showing no change was no larger than the proportion of the less well educated. There were no significant age by education interaction effects, no chronologically later accelerations in the rate of change as a function of education, and no differences in rate of decline between the first measurement interval and the second. Conclusions. Education may not protect against cognitive decline although it is associated with long-term individual differences in level of functioning. The discrepancy between our study and others may be attributable to attrition effects, follow-up length, sample age, scaling artefacts and negative publication bias. Most importantly, practice effects may favour the better educated and hence account for the supposed protective effect in many longitudinal studies of cognitive change.

Objective: To determine whether people's attitudes towards a person who has experienced depression influence them in (i) the types of actions they take to help themselves if they experience common psychiatric symptoms, and (ii) the degree to which their symptoms improve. Method: A postal survey was carried out with 3109 adults to assess attitudes and symptoms of anxiety and depression. Attitudes were assessed by questions on a depressed person's likely long-term outcome in various areas of life and whether the respondents thought the depressed person was likely to experience discrimination. A follow-up survey was carried out 6 months later with 422 persons who had a high level of symptoms at baseline. These individuals were asked about whether they had taken various actions to relieve their symptoms. Results: The attitude measures did not predict use of actions which involved someone else having to know that the person had psychiatric symptoms, nor use of actions which did not. The attitude measures also did not predict change in anxiety and depression symptoms. Conclusions: The attitude measures did not predict patterns of help-seeking or outcome for people with common psychiatric symptoms. However, attitudes towards depression were quite benign and the situation could be different for people with severe mental disorders.

Background. Informant questionnaires on cognitive decline are increasingly used as screening tests for dementia. Informants can provide a longitudinal perspective that is not possible with cognitive screening tests administered at one point in time. However, there are limited data on the validity of such questionnaires when judged against longitudinal change on cognitive tests.Methods. A community sample of elderly people aged [ges ] 70 was assessed on cognitive tests at baseline and after a follow-up of 7–8 years. The participants were given the Mini-Mental State Examination and tests of episodic memory and mental speed. At follow-up, the short-form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) was completed by informants for 287 of the participants.Results. Elderly people who were rated by informants as having moderate or severe decline had declined significantly on cognitive tests. The IQCODE correlated as highly with cognitive test change scores as these change scores correlated with each other.Conclusions. The IQCODE is a valid way of assessing cognitive decline when assessment can be carried out only at one point in time.

Using data collected over two waves, 3.6 years apart, this study examined dementia-related personality problems in a general population sample of persons aged 70 years and older, including both those living in the community and those in residential care. The aim of this study was to examine personality problems across a range of cognitive function, from those who were unimpaired to those with a diagnosis of dementia. A further aim was to look at the association between the emergence of personality problems and other characteristics of the respondent (physical and mental health) and the informant (relationship to the respondent, mental health). Increase in personality problems was found to be positively correlated to cognitive impairment, with dementia sufferers showing the emergence of significantly more personality problems than those not suffering from dementia. A positive association was also found between an increase in personality problems and poorer physical and mental health in the respondent as well as poorer mental health of the informant. After accounting for these other Wave 1 variables, cognitive impairment contributed to the prediction of an increase in personality problems. The best individual predictors of personality problems were having had a stroke or symptoms of a stroke prior to Wave 2 and the informant's level of anxiety at Wave 1. This suggests that the informant's emotional state needs to be taken into account when interpreting data based on informant reports.

In a longitudinal study of college students, B. S. Gershuny and K. J. Sher (1998) found that high neuroticism and low extraversion had a synergistic effect in predicting anxiety and depression 3 years later. This article attempted to replicate their finding using data from 2 community samples: (a) a cross-sectional survey of 2,677 persons aged 18-79 years, and (b) a longitudinal study in which 441 persons aged 70 or older were followed over 3-4 years. Both studies found that neuroticism predicted anxiety and depression, but there were no Neuroticism x Extraversion interaction effects. These results cast doubt on the generalizability of the original findings.

AIMS:To identify risk factors for depression and anxiety that are more prevalent in abstainers than in moderate drinkers and to estimate their contribution to U-shaped relationships of depression and anxiety with alcohol consumption.DESIGN:Cross-sectional general population sample.SETTING:Canberra, Australia.PARTICIPANTS:2725 subjects completed questionnaires, including 1128 men and 1258 women aged 18-59 years.MEASUREMENTS:Consumption categories from AUDIT quantity/frequency items: (1) non-drinkers (no alcohol in the past year), (2) occasional drinkers (monthly or less), (3) lower-level drinkers (up to 14 standard drinks per week for men and seven for women), (4) higher-level drinkers (up to 28 and 14 standard drinks per week, respectively), and (5) those drinking at hazardous or harmful levels (over 28 and 14 standard drinks per week, respectively). Goldberg and DSSI/sAD depression and anxiety scales. A range of demographic, socio-economic, socio-environmental and personality factors.FINDINGS:Non-drinkers were more likely than lower-level drinkers to have low status occupations, poor education, current financial hardship, poor social support and recent stressful life events, and scored lower on extraversion, fun-seeking and drive. Many of these characteristics also applied to hazardous/harmful drinkers. In multivariate models, these risk factors accounted for a substantial part of the higher depression and anxiety scores of non-drinkers and occasional drinkers relative to lower-level drinkers.CONCLUSIONS:Abstainers have a range of characteristics known to be associated with anxiety, depression and other facets of ill health, and these factors may contribute significantly to their elevated levels of depression and anxiety.

Background: Previous research has found that there are major differences between public and professional beliefs about the helpfulness of interventions for depression. The public appear to be guided by general belief systems about the helpfulness of medical, psychological and lifestyle interventions rather than by specific knowledge about what interventions are effective for depression. The present paper examines the effect that experiencing depression and receiving treatment might have on these beliefs. Method: The study involved a postal survey of 3109 adults from a region of New South Wales, Australia. Respondents were presented with a vignette describing a person with depression. They were asked to rate the likely helpfulness of various types of professional and non-professional help and of pharmacological and non-pharmacological interventions for the person described in the vignette. Respondents also completed the Goldberg Depression Scale and were asked whether they had ever had an episode of depression and whether they had seen a counsellor or a doctor for it at the time. Structural equation modelling was used to investigate the associations of history of depression and professional help-seeking with belief systems. Results: A three-factor model was found to fit the helpfulness ratings, with factors reflecting beliefs in medical, psychological and lifestyle interventions. People who had sought help for depression were less likely to believe in the helpfulness of lifestyle interventions and more likely to believe in medical interventions. As well as these general associations with belief systems, having sought help for depression had a number of specific associations with beliefs. Controlling for general belief systems, those who had sought help were more likely to rate antidepressants, holidays, massage and new recreational pursuits as helpful, and were less likely to rate ECT and family as helpful. Those who had a history of depression but had not sought help were more likely to rate counselling as helpful, and less likely to rate family as helpful. Those with current depressive symptoms were less likely to rate telephone counselling, family and friends as helpful. Conclusion: Having sought help for depression is associated with general belief systems about the helpfulness of lifestyle and medical interventions and also has some associations with specific beliefs that may reflect experiences with treatment (e.g. the helpfulness of antidepressants). Those currently depressed or with a history of depression are less likely to regard family as helpful, possibly due to poorer social support. Generally speaking, having sought help is associated with beliefs closer to those of professionals.