Literature Collection

Depression is a prevalent and increasing concern in primary care, particularly among adolescents. Evidence supports routine screening, which improves remission and symptom reduction in adults and perinatal populations. Both psychotherapy and pharmacotherapy are effective first-line treatments, with similar efficacy in reducing symptoms. Selective serotonin reuptake inhibitors (SSRIs) remain the preferred outpatient antidepressant, demonstrating superiority over placebo and comparable outcomes to other agents. Generally safe for pregnant, breastfeeding, and geriatric patients, SSRIs require thoughtful selection based on side effects, contraindications, and patient preferences. Primary care clinicians are central to providing individualized, evidence-based, and patient-centered management of depression.

PURPOSE OF REVIEW: This review describes the complex relationships between depression, anxiety, and bipolar disorder with atherosclerosis by discussing epidemiological evidence, implicated mechanisms, and the impact of psychiatric interventions on cardiovascular outcomes. RECENT FINDINGS: Depression, anxiety, and bipolar disorder convey independent risk for atherosclerosis. Further, the presence of cardiovascular disease often contributes to worsened psychiatric symptoms. Current evidence supports a rising prevalence of psychiatric disorders in association with atherosclerosis and demographic disparities, with stronger links in women and African Americans. Shared biological mechanisms include autonomic dysfunction, hypothalamic-pituitary-adrenal axis overactivity, inflammation, and vascular effects. Pharmacological treatments and behavioral therapies, such as psychotherapy, have the potential to reduce cardiovascular events and improve physiological markers. The expanding understanding of the bidirectional link between depression, anxiety, and bipolar disorder and atherosclerosis calls for integrated care. Early screening and management of these psychiatric disorders may help to slow cardiovascular disease progression.

BACKGROUND: Depression and hearing loss (HL) commonly occur in the aging population and may arise from shared mechanisms. AIMS: To investigate the observational associations between depression and HL. STUDY DESIGN: Observational study. METHODS: Adults aged ≥ 55 years from three nationally representative study cohorts were included: the National Health and Nutrition Examination Survey, the Health and Retirement Study, and the English Longitudinal Study of Ageing. Multiple linear regression was applied to examine the association between depressive severity and audiometric thresholds. Cox regression models were applied to evaluate the associations between depressive symptoms and HL. RESULTS: Cross-sectional analyses revealed that depression was significantly associated with higher pure-tone average thresholds. In pooled longitudinal analyses of 6,956 participants, individuals with baseline depression exhibited a higher incidence of HL when compared to their non-depressed counterparts. Longitudinal trajectory analyses identified three significant patterns: increasing [hazard ratio (HR) 1.48, 95% confidence interval (CI) 1.09-2.21] and fluctuating (HR 1.25, 95% CI 1.12-1.39) depressive symptom trajectories as independent predictors of HL, whereas decreasing trajectories indicated no significant association. CONCLUSION: Depression and specific longitudinal trajectories are associated with elevated risk of HL. To further understand this association, integrated care models that synergistically address depression and HL in older adults are warranted.

PURPOSE: To explore the relationship between depressive symptoms and fear of falling (FoF) to identify shared risk factors and inform integrated prevention strategies. METHOD: A cross-sectional correlational design was conducted in three phases to examine relationships between depressive symptoms and FoF in 354 community-dwelling older adults. Depressive symptoms were assessed with the Patient Health Questionnaire-9, FoF with the Short Falls Efficacy Scale-International, and individual differences in behavioral inhibition and action with the Behavioral Inhibition System and Behavioral Activation System. RESULTS: Depressive symptoms were significantly associated with falls and FoF beyond other factors. The regression model showed that FoF independently predicted depressive symptoms, indicating a direct role in depression. Other factors (age, living alone) may operate through shared pathways. CONCLUSION: Findings support existing research, suggesting that psychological factors, such as FoF, play a key role in the mental health of older adults.