The discovery, by investigators from the Washington University School of Medicine in St. Louis, was published in The American Journal of Psychiatry.

Experts emphasize the importance of early treatment of depression in childhood: Children as young as 3 can be clinically depressed, and often that depression recurs as kids get older and go to school. It also can reappear during adolescence and throughout life.

“By identifying depression as early as possible and then helping children try to change the way they process their emotions, we believe it may be possible to change the trajectory of depression and perhaps reduce or prevent recurrent bouts of the disorder later in life,” said principal investigator Joan L. Luby, MD, director of the university’s Early Emotional Development Program.

According to a news release from the university, Luby’s team adapted a treatment known as Parent-Child Interaction Therapy (PCIT) that was developed in the 1970s to correct disruptive behavior in preschoolers. This latest adaptation involved adding a series of sessions focused on emotions.

“We consider depression to be an impairment of the ability to experience and regulate emotions,” said Luby, the Samuel and Mae S. Ludwig Professor of Psychiatry.

The 18-week, 20-session therapy program begins with a truncated version of the traditional PCIT program, then focuses more on enhancing emotional development.

“For example, we coach parents how to manage a child’s emotional responses to stressful situations,” Luby said.

Among the ways of doing so is an activity in which researchers place a package for a child in a room and then make the child wait to open it. The parent wears an earpiece and is coached by a therapist observing through a one-way mirror. The idea is to give children tools to keep their emotions under control, and to train parents to help their children reinforce those tools.

Luby’s team studied 229 parent-child pairs. Children in the study were 3 to 7 years old and had been diagnosed with depression. Half received the adapted therapy, called PCIT-ED.

Compared with children who were placed on a wait list before starting the therapy, those who received the intervention right away had lower rates of depression after 18 weeks and less impairment overall. If depression continued after the treatment, it tended to be less severe than that seen in the kids who had not yet received therapy.

Luby said children in the study will be followed to see how long the effects of the therapy last. Her team is analyzing data gathered three months after treatment ended to see whether improvements were maintained or whether any depression symptoms had returned by that point. The researchers hope to follow the children into adolescence to see whether intervention in early childhood provides sustained benefits.

They also are conducting brain-imaging as part of the study. In previous research, Luby and her colleagues found that brain changes linked to depression can alter the brain’s structure and function, making the children potentially vulnerable to future problems. Now they want to learn whether this interactive therapy might prevent or reverse those previously identified brain changes.

Additionally, the researchers also found that symptoms of clinical depression improved in the parents who worked with their children during the study.

“Even without targeting the parent directly, if a parent has been depressed, his or her depression improves,” Luby said. “It previously had been demonstrated that if you treat a parent’s depression, a child’s depression improves, but this is powerful new data suggesting that the reverse also is true.”

The news release said that the therapy program doesn’t require a psychiatrist and can be delivered by master’s degree-level clinicians.

“This is a therapy that could be widely disseminated,” Luby said. “Since it only takes 18 weeks and doesn’t require a child psychologist or psychiatrist, we think it would be highly feasible to deliver in community clinics from a practical standpoint and in terms of cost.”

Dr. Eliseo J. Pérez-Stable, director of the National Institute on Minority Health and Health Disparities (NIMHD) and the senior study author, also found that African Americans and Latinos were more likely to have higher levels of chronic stress and more unhealthy behaviors. NIMHD is part of the National Institutes of Health (NIH).

The findings were published in the May 2018 issue of Preventive Medicine.

To examine the relationship between unhealthy behaviors, chronic stress, and risk of depression by race and ethnicity, researchers used data collected on 12,272 participants, aged 40 to 70 years, from 2005 to 2012. These data were part of the National Health and Nutrition Examination Survey (NHANES), a nationally representative health interview and examination survey of U.S. adults. This age range population was selected for this study to capture the effects of chronic stress over the lifetime of the participants.

The unhealthy behaviors examined were current cigarette smoking, excessive or binge drinking, insufficient exercise, and fair or poor diet. The researchers measured chronic stress using 10 objective biological measures, including blood pressure, body mass index, and total cholesterol. The researchers assessed risk for depression using results from the Patient Health Questionnaire (PHQ-9).

Chronic stress during adulthood may be an important factor in depression. According to a news release from NIH, this effect may be worse among racial and ethnic minorities due to the stress experienced from social and economic inequalities, but the relationships between race/ethnicity, stress, behavior, and depression are not well understood. A theoretical framework called the Environmental Affordances model has been proposed to explain how chronic stress and risk behaviors interact to affect health. This model proposes, for example, that engaging in unhealthy behaviors actually reduces the effects of chronic stress on depression in African Americans.

The investigators designed this research to gain a better understanding of the relationship between chronic stress and chance for depression by race and ethnicity. The study asked whether unhealthy behaviors (current smoking, excessive or binge drinking, insufficient exercise, and fair or poor diet) reduce the chance for depression due to chronic stress in African Americans but increase the chance for depression due to chronic stress in Latinos, compared with Whites.

On average, Latinos and African Americans had more chronic stress, more unhealthy behaviors, and more chance for depression. However, the study found that engaging in more unhealthy behaviors was strongly associated with greater chance for depression only in African Americans and Whites.

The study also found that for all three groups:

• the level of chronic stress did not affect the relationship between unhealthy behavior and chance for depression
• unhealthy behaviors did not alter the association between stress and chance for depression
• more education offered more protection against depression

Contrary to previous research, this study found that in all three racial/ethnic groups, chronic stress levels were inversely related to excessive or binge drinking (i.e., more stress, less excess drinking). This study also found no evidence—as some previous research has suggested—that African Americans engage in unhealthy behaviors as a way to cope with chronic stress and reduce depression or that unhealthy behaviors interact with chronic stress in Latinos to increase depression. According to the researchers the Environmental Affordances model was not supported for any of the racial/ethnic groups analyzed.

The scientists point to differences in their research design and their use of physiological measures of chronic stress instead of self-reported measures as possibly contributing to their different findings. They note that their results highlight the complex relationships between chronic stress, unhealthy behaviors, and mental health among different racial and ethnic groups.

“Understanding the social and behavioral complexities associated with depression and unhealthy behaviors by race/ethnicity can help us understand how to best improve overall health,” said Pérez-Stable.

Support groups have proved to be a helpful resource for those dealing with grief, but for older individuals, obstacles such as geographic location and physical immobility can sometimes make it difficult to attend support groups in person.

An effective option for older adults, according to University of Arizona research, might be an online virtual reality support group that allows widows and widowers to interact in real time with mental health professionals and other bereaved people, via a computer-generated avatar. The findings were published in May 2017 the journal Computers in Human Behavior.

A release from the university notes that Lindsey Knowles, a graduate student in clinical psychology at the UA, set out with her colleagues to test the effectiveness and acceptability of two web-based support resources for older adults who have lost a spouse.

In a study of 30 widows and widowers older than 50, some were assigned to be part of a virtual reality support group twice a week, while others instead were instructed to do once-weekly readings from a grief education website. The same topics — including physical health, mental well-being, sleep, dating, and parenting, among others — were addressed in both the interactive virtual group and the static online readings.

In follow-up assessments at the end of the eight-week study period and two months later, researchers found that participants in both groups showed improvements in stress, loneliness and sleep quality, but only participants in the virtual reality group showed self-reported improvement in symptoms of depression.

Researchers think the social support provided by the group, along with its interactive nature, helped with depression.

The release quotes Knowles as saying, “One of the best treatments for depression is behavioral activation. People who are depressed, or have more depressive symptoms, often remove themselves from their environment and from doing things that provide positive reinforcement and give them a sense of value. Showing up for a group twice a week — even if it is virtual — is a way for them to engage in the world that they haven’t been.”

Researchers used the online platform Second Life to create a private virtual living room in a seaside cabin, where small groups of three to six people could gather. Participants, who all had lost a partner in the last one to three years, chose avatars — or animated figures — to represent them in the space. Then, from the comfort of their own homes, they communicated with one another by typing in a chat program.

In the first hourlong virtual support group meeting each week, Knowles’ co-author, UA assistant professor of psychology Mary Frances-O’Connor, presented on a grief education topic by typing to those in the room. O’Connor previously had found virtual support groups to be an effective tool in her work with caregivers of individuals with Alzheimer’s disease and dementia.

Knowles moderated the second hourlong meeting each week, in which participants got to know one another and share their personal stories, often delving into feelings they might not be comfortable expressing in person.

“Group members often shared things like: ‘Right now I’m crying at my keyboard, and I would never do this in person, but because I feel like there’s this anonymity, I can break down, while my avatar looks perfectly fine,'” Knowles said.

In follow-up assessments, participants in the virtual reality group said they felt as if they were in a real room during the sessions, with real people who were going through similar experiences.

“There’s something to be said for getting into a group and showing up for that group every week, as well as being able to share your experience in a validating and normalizing environment,” Knowles said.

Those in the other study group — the ones assigned to do weekly readings from a grief education website — did not show improvement in depression. However, like the support group participants, they did report better sleep and less stress and loneliness after the intervention, which means the website could still be an effective tool for those who are grieving. It also requires fewer resources than a support group, which needs a dedicated moderator, Knowles said.

Overall, both interventions were well received by participants, Knowles said.

Future studies should consider how the effectiveness of virtual support groups and educational websites compares to that of in-person groups and the simple passage of time, Knowles said, noting that the aging population makes this as an especially important area of research.

“With the graying of America that is happening, we expect that more people are going to be widowed as baby boomers age,” Knowles said. “Losing a spouse is a huge life transition and a profoundly stressful event. All of us will experience different types of grief in our lives, and having accessible resources that are evidence-based is really important.”

In her new book Depression in Later Life: An Essential Guide, Dr. Deborah Serani says depression affects an estimated 15 percent of Americans aged 65 and older, but the mood disorder is often mistaken for normal signs of aging, and many seniors can experience symptoms of depression but not meet the clinical diagnosis.

“Given their advanced age, many mistake this mood disorder for other conditions associated with getting older, like memory loss, muscle or joint weakness, or side effects from medication,” Serani says. “As a result, upwards of 90 percent of seniors living with depression don’t receive adequate care, and 78 percent don’t receive any treatment at all.”

Another startling factor is that seniors have the highest death by suicide rate—according to a 2010 Centers for Disease Control and Prevention report, the rate of late-life suicide is 14.3 per 100,000. Put another way, a senior dies by suicide every 97 minutes. And one out of every two suicide attempts by seniors succeeds, compared to one out of 200 for those under age 25.

Recognizing suicide risk in seniors can be difficult, but getting treatment is essential in living a fuller life in later years. Serani points out five main domains that raise the risk of suicide in later life: major psychiatric illness, personality traits and coping styles, physical illness and pain, social disconnectedness, and functional impairment (not being able to physically take care of oneself).

“Depression and confusion is not a normal part of aging. Caregivers need to know the warning signs, because by the time an older adult or loved one is in the throes of depression, they may not have the means to get the help that they need,” says Serani. “The more we know, the more we can prevent it.”

Some warning signs to look out for include agitation, loss of happiness in things that were once pleasurable, apathy, decreased ability to care for oneself, the feeling of being a burden or being hopeless, loss of self-confidence, and increased anxiety, among others.

Depression can also have physical symptoms like excessive aches and pains, increase or decrease in appetite or weight, increase or decrease in sleeping, slowness in movements or gait, and vascular changes in the brain or body. Cognitive symptoms include distractibility, foggy thinking, indecisiveness, memory loss, negative thinking, and thoughts of death or suicide.

“Depression in seniors is differently experienced than in younger ages,” says Serani. “Most older adults aren’t aware they are depressed, and often report more physical and cognitive difficulties than sadness, per se.”

But living with depression in later life doesn’t mean that you can’t still live a full life, says Serani.

“If you think having depression in later life means the last chapter of your life will be limited, think again,” she says. “Although there will be many seniors whose level of depression will impair their quality of life, there will be many more who can recover. What science says about living well in spite of having a chronic illness like depression is this one simple word: perspective.”

The research, from the Bruce Hammock laboratory at the University of California, Davis, was published in the journal Proceedings of the National Academy of Sciences, involves studies of an inhibitor of soluble epoxide hydrolase in rodents. Soluble epoxide hydrolase, or sEH, is emerging as a therapeutic target that acts on a number of inflammatory or inflammation-linked diseases.

“The research in animal models of depression suggests that sEH plays a key role in modulating inflammation, which is involved in depression,” said Hammock, a distinguished professor of entomology with a joint appointment at the UC Davis Comprehensive Cancer Center. “Inhibitors of sEH protect natural lipids in the brain that reduce inflammation and neuropathic pain. Thus, these inhibitors could be potential therapeutic drugs for depression.”

Researchers from Hammock’s laboratory, collaborating with depression expert Kenji Hashimoto and colleagues at the Chiba University Center for Forensic Mental Health, Japan, examined the role of the potent sEH inhibitor known as TPPU, in a rodent model of depression, “social defeat.”

They found that TPPU displayed rapid effects in both inflammation and social-defeat-stress models of depression. Expression of sEH protein was higher in key brain regions of chronically stressed mice than in control mice, they found.

“Most drugs for psychiatric diseases target how neurons communicate; here we are targeting the wellness and environment of the neurons,” said UC Davis researcher Christophe Morisseau.

In further explaining the significance of the findings, UC Davis researcher Karen Wagner said: “The rapid antidepressant action of the sEH inhibitor in these murine (mouse) models of depression is truly noteworthy because current antidepressants used in humans and animal models take weeks to have full effects.”

The researchers also discovered that postmortem brain samples of patients with psychiatric diseases, including depression, bipolar disorder and schizophrenia, showed a higher expression of sEH than controls.

The researchers found that pretreatment with TPPU prevented the onset of depression-like behaviors in mice after induced inflammation or repeated social-defeat stress. Mice lacking the sEH gene did not show depression-like behavior after repeated social-defeat stress.

“All these findings suggest that sEH plays a key role in the pathophysiology of depression and that epoxy fatty acids, and their mimics as well as sEH inhibitors, are potential therapeutic or prophylactic drugs for depression,” Hashimoto said.

A release from Massachusetts General Hospital quotes Maurizio Fava, MD, executive director of the Clinical Trials Network & Institute in the MGH Department of Psychiatry and lead author of the study, as saying, “We know that more than half of patients with major depression won’t respond to the first antidepressant they try, and almost 40 percent will continue to have symptoms even after switching to or adding different drugs. Opioids have actually been used for centuries to treat mood disorders, and while opioid drugs must be used cautiously because of their potential for abuse, studies have shown that levels of the endogenous opioids released by the central nervous system may be reduced in important brain areas of patients with major depression.”

Opioid drugs produce their effects by binding to receptors in the endogenous opioid system, which the body uses to suppress pain and to reward biologically beneficial activities. Two prominent opioid receptors are the mu and kappa receptors, which have overlapping but somewhat different effects. ALKS-5461 is a combination of buprenorphine, which suppresses kappa receptor activity and weakly activates mu receptors, and samidorphan, which blocks mu receptor activity. While buprenorphine is FDA-approved to help treat opioid addiction by easing withdrawal symptoms, samidorphan is an experimental drug being developed by Alkermes for several potential uses. The combination of the two drugs is an effort to balance the opioid system activity while avoiding adverse effects, including the potential for abuse.

The current study, a phase 2 clinical trial, enrolled 142 patients with treatment-resistant depression at 31 sites in the U.S. Since depression treatment trials are likely to have a large placebo response, this study used a design developed in 2003 by Fava and David Schoenfeld, PhD, an MGH biostatician, to reduce the impact of the placebo effect. Using this sequential parallel comparison design (SPCD), the trial was conducted in two stages. In stage 1, 98 participants were randomized to receive placebo doses while 43 participants received ALKS-5461 in daily dosages containing either 2 mg or 8 mg of each of the two drugs.

After the first four-week treatment period, placebo group members who did not show a response to treatment were re-randomized either to receive one of the two dosages of the active drug or to continue receiving a placebo for stage 2. Fava explains that, by manipulating the expectations of both participants and investigators — neither of which knew whether and when an individual was receiving the active drug — SPCD minimizes the likelihood of a placebo response, while reducing the need for a much large group of participants.

While both dosage levels of ALKS-5461 produced a greater reduction in depression symptoms than did the placebo, as measured by several standard scales, the lower dosage of 2 mg of each drug had effects that were stronger and met statistical significance. Fava notes that it is not unusual for lower doses of psychotropic drugs to be more effective, since higher doses may have more side effects. The most common reported adverse events were nausea, vomiting and dizziness, most of which occurred during the first few days of treatment; and there was no evidence of withdrawal after the treatment period ended or of the likelihood of abuse of ALKS-5461.

“The robust treatment effect seen in this clinical study suggests that many patients with depression may have a dysregulation of the endogenous opioid system, which may be why they do not respond to monoamine-based antidepressants that target the serotonin system,” says Fava, who is director of the Division of Clinical Research of the MGH Research Institute and the Slater Family Professor of Psychiatry at Harvard Medical School. “For the substantial percentage of patients who do not respond to monoamine based medications, this combination may represent an important new approach to the treatment of depression.” Alkermes has been conducting three phase 3 studies of ALKS-5461, two of which have been completed but their results not yet reported in scientific journals.

###

Additional co-authors of the American Journal of Psychiatry paper are Michael Thase, MD, University of Pennsylvania; Alexander Bodkin, MD, McLean Hospital; Madhukar Trivedi, MD, University of Texas Southwestern Medical Center; and Asli Memisoglu, ScD, Marc de Somer, MD, MPH, Yangchun Du, PhD, Richard Leigh-Pemberton, MD, Lauren DiPetrillo, PhD, Bernard Silverman, MD, and Elliot Ehrich, MD, Alkermes, Inc.

“We now have decades of research showing that when people are chronically treated differently, unfairly or badly, it can have effects ranging from low self-esteem to a higher risk for developing stress-related disorders such as anxiety and depression,” said Vickie Mays, UCLA Fielding School of Public Health professor in the department of health policy and management. Mays has done research in collaboration with Susan Cochran, a professor in the department of epidemiology at UCLA, that has helped document those links.

And when the mental health of one person is affected, it can produce a domino effect extending beyond that individual. “We know that when people have a psychiatric disorder, it’s not good for any of us,” Mays says. “For example, it can affect parenting — a depressed mom might not be able to interact with her child in a way that best promotes that child’s development, leaving the child more vulnerable to certain behavioral disorders. In that sense, we all suffer from the effects of discrimination.”

Gilbert Gee, professor in the Fielding school’s Department of Community Health Sciences, did a 2007 study to determine the extent to which Asian Americans who reported being the victims of discrimination were more vulnerable to developing clinically diagnosable mental disorders. “Much of the research has focused on symptoms of sadness and anxiety resulting from the mistreatment, and that’s very important, but we wanted to look at clinical outcomes,” Gee says.

Even after taking into account other potential causes of stress, Gee found a clear relationship between discrimination and increased risk of mental disorders.

Since that study, other researchers have reported similar results in African-American and Latino populations, as well as in other populations around the world, Gee says. He also found in a 2014 study of Latinas/os, that discrimination was significantly associated with increased risk of alcohol abuse among women and increased risk of drug abuse among men. In 2015, Gee and colleagues performed an analysis drawing from approximately 300 studies conducted around the world over the last three decades. This meta-analysis concluded that self-reported racial discrimination is consistently related to poor mental health.

Discrimination is incredibly complex and experienced in so many different ways that it can be difficult to pinpoint the process by which it undermines mental health, researchers say. “There are so many different routes, some of them direct and some of them indirect,” Gee explains. He points out that while a hate crime occurring in a community is certain to affect the mental health status of the victim and the victim’s family, it can also have a spillover effect for acquaintances and non-acquintances in the community.

Poor treatment based on race, ethnicity, sexual orientation and other factors can occur through interpersonal insults as well as through more insidious routes. “If you don’t get a job and you’re left to wonder whether it had to do with your race or gender, that can have an impact on your mental health,” Gee says.

A release from the university reports that the odds that an American woman was diagnosed with depression in the past year are nearly twice that of men. However, this disparity looks very different when accounting for the wage gap: Among women whose income was lower than their male counterparts, the odds of major depression were nearly 2.5 times higher than men; but among women whose income equaled or exceeded their male counterparts, their odds of depression were no different than men.

Results were similar for generalized anxiety disorder. Overall, women’s odds of past-year anxiety were more than 2.5 times higher than men’s. Where women’s incomes were lower than their male counterparts, their odds of anxiety disorder were more than four times higher. For women whose income equaled or exceeded their male counterparts, their odds of anxiety disorder were greatly decreased.

The findings are based on data from a 2001-2002 U.S. population-representative sample of 22,581 working adults ages 30-65. Researchers tested the impact of structural wage disparities on depression and anxiety outcomes, according to criteria in the Diagnostic and Statistical Manual, version IV (DSM-IV).

The release quotes first author Jonathan Platt, a PhD student in the Department of Epidemiology, as saying, “Our results show that some of the gender disparities in depression and anxiety may be due to the effects of structural gender inequality in the workforce and beyond. The social processes that sort women into certain jobs, compensate them less than equivalent male counterparts, and create gender disparities in domestic labor have material and psychosocial consequences.”

While the U.S. has passed legislation to address some of the most overt forms of gender discrimination faced by working women, less conspicuous forms of structural discrimination persist. As examples, the researchers refer to the norms, expectations, and opportunities surrounding the types of jobs women occupy and the way those jobs are valued and compensated relative to men.

“If women internalize these negative experiences as reflective of inferior merit, rather than the result of discrimination, they may be at increased risk for depression and anxiety disorders,” says Platt.

“Our findings suggest that policies must go beyond prohibiting overt gender discrimination like sexual harassment,” said Katherine Keyes, PhD, assistant professor of Epidemiology and senior author. “Further, while it is commonly believed that gender differences in depression and anxiety are biologically rooted, these results suggest that such differences are much more socially constructed that previously thought, indicating that gender disparities in psychiatric disorders are malleable and arise from unfair treatment .”

According to Keyes, policies such as paid parental leave, affordable childcare, and flexible work schedules may ameliorate some of this burden, although more research into understanding the ways in which discrimination plays a role in mental health outcomes is needed.

“Structural forms of discrimination may explain a substantial proportion of gender disparities in mood and anxiety disorders in the U.S. adult population,” said Keyes. “Greater attention to the fundamental mechanisms that perpetuate wage disparities is needed, not only because it is unjust, but so that we may understand and be able to intervene to reduce subsequent health risks and disparities.”

Caregiving for a loved one is stressful and the physical and emotional effects longstanding. Caregivers experience anxiety, depression, declines in health, and a number of other conditions as the result of the role of caregiving. If you find the effects of caregiving difficult to believe the example I share is Christopher Reeve and his wife Dana. Christopher was injured in a horseback riding accident and was cared for by his devoted wife and family for many years. After Christopher passed in October 2004, his wife, Dana, was diagnosed with lung cancer the following August—never having smoked a cigarette. Dana passed away in March of 2006.

What happens to caregivers who already have chronic diseases including a prior diagnosis of cancer? Should individuals already diagnosed with a chronic disease be more cautious about their health when caring for another person?

I recently consulted with a wife who had knee replacement surgery only to learn at the time of surgery that her breast cancer returned; the only treatment available was palliative chemotherapy. The wife came to me because she was the caregiver for her husband diagnosed with Alzheimer’s disease and she wanted to make a long term plan for his care.

After receiving the news that her cancer had returned the plan changed from being her husband’s long-term caregiver to planning for her husband’s care without her in his life and making plans for her own care. It was evident that the stress of caring for a loved one with Alzheimer’s disease was taking its toll on my client in addition to the emotional stress of learning about a terminal diagnosis of cancer with a defined time limit. For this couple the experience of being diagnosed with cancer and the role of caregiving and care-receiving posed similar but sometimes opposite experiences.

The many effects of caregiving—while often not immediately life threatening—have much in common with the effects of a cancer diagnosis and treatment. Individuals with cancer experience declines in health, episodes of anxiety, fatigue, loss of appetite and body changes, sleep problems, confusion and feelings of overwhelm, anger, and sadness.

My discussion with this woman revolved around practical considerations for bill paying and identifying a companion for her husband’s safety as well as a caregiver to provide general support on days she would not be feeling well after chemotherapy treatments. Even more practical discussions were held about his and her end of life care, legally responsible parties to serve as medical and financial power of attorney, cremation plans, and how to discuss her advancing condition with a husband diagnosed with Alzheimer’s disease who likely would not understand.

The options of receiving in home care versus moving to a care community where her husband might adjust and make new acquaintances that would support him after her death was a timely and important subject. At least she would be comforted to know where her husband would live and who would provide for his care after her passing. Caregiving is challenging when one person requires care, however when both spouses require care and the death of one spouse is imminent the challenges seem to rapidly multiply.

Some spouses are unable to have these important discussions and are at a loss to make plans. This emotional distress results in “overwhelm,” and that makes planning difficult; many individuals in these situations feel immobilized. Children may or may not be supportive or available depending on proximity to parents and the busyness of their own lives.

In the case of this couple, the husband was the one who managed the finances and was now experiencing an inability to organize and comprehend the documents that arrived in the mail. Agreeing to allow his wife to act in the role of financial manager was damaging to the husband’s self-esteem and he struggled with comprehending that he was no longer able to complete this activity with the ease experienced prior to his diagnosis of Alzheimer’s disease.

Years ago, I became the guardian for a woman whose husband died from cancer and failed to make plans for her care, assuming that somehow, someone would care for her after his death. Through the court system I was appointed to be the person who coordinated and made certain that she received care. Fortunately her husband did leave sufficient financial resources to support his wife’s care in the lifestyle they were accustomed to prior to his passing.

I imagine that the last several months of his life were overwhelming, attempting to care for his wife and for himself. There were no in home caregivers at the time that I became involved and I can only assume that due to his health and the corresponding pain and symptoms that making it through a single day was considered a success.

For cancer patients, discussion of managing pain and symptoms through practical methods of medications and alternative treatments like massage, relaxation, and other techniques is important. Many caregivers, not facing a terminal diagnoses, experience anxiety: feelings of being tense or nervous, a rapid heartbeat, sweating, sudden feelings of doom, trouble breathing and butterflies or nervousness in the stomach. Individuals with cancer often experience anxiety. Medication, exercise and self-care are mandatory for both the care recipient and the care receiver.

Fatigue is a common among individuals diagnosed with cancer as well as caregivers working 24 hours a day, 7 days a week, to care for loved ones. Monitoring nutrition, planning daily activities and identifying others to help is important to managing care situations. Naps are also beneficial but not too much so that that one is awake all night. Caregivers often sleep lightly as they are listening for their loved one to wake from a sound sleep. Individuals with cancer and other medical concerns often have trouble falling asleep, wake up and are unable to fall back asleep and sleep for short periods of time.

Loss of appetite and changes in the body are common: weight loss, weight gain, constipation, nausea and vomiting affect individuals diagnosed with cancer. How comforting might it be to have an individual to help with the practicalities of grocery shopping and preparation of meals to support a topsy-turvy stomach? Caregivers also experience similar events as the result of caregiver stress and exhaustion.

Confusion, memory loss, and an inability to focus are also common to caregivers as well as people experiencing cancer. Being a care recipient and a caregiver has similar stressors of different natures. Care recipients worry about their own health and well-being as well as sometimes feeling that their care might be a burden for family members. Caregivers worry about loved ones and mourn the loss of free time, spending time with friends, and dream of living a life without so many complications and daily responsibilities.

Cancer and other chronic and life threatening diseases change the life of individuals seemingly overnight and result in the role of care receiver. These life changing events also result in the role of caregiver. It is important to understand that the effects of conditions leading to a need for care are similar to the experiences of caregivers caring for a loved one. In both roles compassion, understanding, patience, and grace support positive relationships and allow individuals to make practical plans for care needs today and in the future.

A recent study led by a lecturer at the University of Bradford, UK, suggests that people get more depressed from age 65 onwards.

The study, led by psychology lecturer Dr Helena Chui and recently published in the international journal Psychology and Aging, builds on a 15-year project observing over 2,000 older Australians living in the Adelaide area.

Previous studies have shown an increase in depressive symptoms with age but only until the age of 85. This is the first study to examine the issue beyond that age.

Both men and women taking part in the study reported increasingly more depressive symptoms as they aged, with women initially starting with more depressive symptoms than men. However, men showed a faster rate of increase in symptoms so that the difference in the genders was reversed at around the age of 80.

Key factors in these increases include levels of physical impairment, the onset of medical conditions, particularly chronic ones, and the approach of death. Half of those in the study suffered with arthritis and both men and women with the chronic condition reported more depressive symptoms than those without.

Chui said: “These findings are very significant and have implications for how we deal with old age. It’s the first study to tell us depressive symptoms continue to increase throughout old age. We are in a period of unprecedented success in terms of people living longer than ever and in greater numbers and we should be celebrating this, but it seems that we are finding it hard to cope.

“It seems that we need to look carefully at the provision of adequate services to match these needs, particularly in the area of mental health support and pain management. Social policies and ageing-friendly support structures, such as the provision of public transport and access to health care services are needed to target the ‘oldest-old’ adults as a whole.”