%0 Journal Article %J Preventative Medicine %D 2019 %T Insomnia symptoms predict both future hypertension and depression. %A Dong, Yutong %A Frances Margaret Yang %K Blood pressure %K Depressive symptoms %K Sleep %X The prevalence of hypertension and depression is high in older populations. Moreover, their comorbidity may significantly increase morbidity and mortality. However, the risk factors contributing to both health conditions are not well understood. Older individuals are prone to insomnia; thus we hypothesized that having more insomnia symptoms increases risk for incident hypertension and depression over time. The sample consisted of a longitudinal population-based study of community-dwelling older individuals, from the 2008-2016 waves of the Health and Retirement Study, sampled across the United States. A total of 18,123 subjects, aged 50+, were stratified into three age groups, ages 50-60, 61-74, and 75 and older years. Subjects were excluded for reporting baseline hypertension or depression at the first wave 2008. Center for Epidemiologic Studies-Depression (CES-D) score ≥ 4 was the cutoff for elevated depressive symptomatology. Subjective insomnia symptoms were evaluated. Cox proportional hazards regression revealed that SBP (1.02[1.01, 1.02]) and more insomnia symptoms (1.11[1.01, 1.21]) were significant predictors of hypertension for all age groups. For depression, only insomnia symptoms were significant predictors (9.91[6.37, 15.41]). Kaplan-Meier curves revealed that 9.2% of the overall cohort had both hypertension and depression within 8 years and more insomnia symptoms predicted greater incidences of both conditions (p-values <0.001). In this older prospective cohort, insomnia symptoms are consistent predictors of future hypertension and depression in all age groups, who were not hypertensive and depressed at baseline. Insomnia may contribute to the etiology and comorbidity of hypertension and depression in older individuals. %B Preventative Medicine %V 123 %P 41-47 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/30742871?dopt=Abstract %R 10.1016/j.ypmed.2019.02.001 %0 Journal Article %J Shanghai Archives of Psychiatry %D 2014 %T Item response theory for measurement validity %A Frances Margaret Yang %A Solon T. Kao %K Health Conditions and Status %K Methodology %X Summary: Item response theory (IRT) is an important method of assessing the validity of measurement scales that is underutilized in the field of psychiatry. IRT describes the relationship between a latent trait (e.g., the construct that the scale proposes to assess), the properties of the items in the scale, and respondents' answers to the individual items. This paper introduces the basic premise, assumptions, and methods of IRT. To help explain these concepts we generate a hypothetical scale using three items from a modified, binary (yes/no) response version of the Center for Epidemiological Studies-Depression scale that was administered to 19, 399 respondents. We first conducted a factor analysis to confirm the unidimensionality of the three items and then proceeded with Mplus software to construct the 2-Parameter Logic (2-PL) IRT model of the data, a method which allows for estimates of both item discrimination and item difficulty. The utility of this information both for clinical purposes and for scale construction purposes is discussed. Copyright 2014 by Editorial Department of the Shanghai Archives of Psychiatry. %B Shanghai Archives of Psychiatry %I 26 %V 26 %P 171-177 %G eng %U http://www.scopus.com/inward/record.url?eid=2-s2.0-84904168760andpartnerID=40andmd5=0d61baede66c3f2ba9dbc676ec6738e3 %N 3 %4 CES-D/Health and Retirement Study/Item Response Theory/Latent variable modeling/methodology %$ 999999 %R 10.3969/j.issn.1002-0829.2014.03.010 %0 Journal Article %J Arch Intern Med %D 2011 %T Development and validation of a brief cognitive assessment tool: the sweet 16. %A Tamara G Fong %A Richard N Jones %A James L Rudolph %A Frances Margaret Yang %A Tommet, Douglas %A Habtemariam, Daniel %A Edward R Marcantonio %A Kenneth M. Langa %A Sharon K Inouye %K Aged %K Aged, 80 and over %K Cognition Disorders %K Cohort Studies %K Dementia %K Female %K Humans %K Male %K Neuropsychological tests %K Surveys and Questionnaires %X

BACKGROUND: Cognitive impairment is often unrecognized among older adults. Meanwhile, current assessment instruments are underused, lack sensitivity, or may be restricted by copyright laws. To address these limitations, we created a new brief cognitive assessment tool: the Sweet 16.

METHODS: The Sweet 16 was developed in a cohort from a large post-acute hospitalization study (n=774) and compared with the Mini-Mental State Examination (MMSE). Equipercentile equating identified Sweet 16 cut points that correlated with widely used MMSE cut points. Sweet 16 performance characteristics were independently validated in a cohort from the Aging, Demographics, and Memory Study (n=709) using clinical consensus diagnosis, the modified Blessed Dementia Rating Scale, and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE).

RESULTS: The Sweet 16 correlated highly with the MMSE (Spearman r, 0.94; P<.001). Validated against the IQCODE, the area under the curve was 0.84 for the Sweet 16 and 0.81 for the MMSE (P=.06). A Sweet 16 score of less than 14 (approximating an MMSE score <24) demonstrated a sensitivity of 80% and a specificity of 70%, whereas an MMSE score of less than 24 showed a sensitivity of 64% and a specificity of 86% against the IQCODE. When compared with clinical diagnosis, a Sweet 16 score of less than 14 showed a sensitivity of 99% and a specificity of 72% in contrast to an MMSE score with a sensitivity of 87% and a specificity of 89%. For education of 12 years or more, the area under the curve was 0.90 for the Sweet 16 and 0.84 for the MMSE (P=.03).

CONCLUSIONS: The Sweet 16 is simple, quick to administer, and will be available open access. The performance of the Sweet 16 is equivalent or superior to that of the MMSE.

%B Arch Intern Med %I 171 %V 171 %P 432-7 %8 2011 Mar 14 %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/21059967?dopt=Abstract %3 21059967 %4 Older people/Cognition/reasoning/Correlation analysis/Medical diagnosis/Dementia/Hospitalization %$ 25220 %R 10.1001/archinternmed.2010.423 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2010 %T Physical health and depression: a dyadic study of chronic health conditions and depressive symptomatology in older adult couples. %A Brian J Ayotte %A Frances Margaret Yang %A Richard N Jones %K Age Factors %K Aged %K Chi-Square Distribution %K Chronic disease %K Cohort Studies %K depression %K Female %K Health Status %K Humans %K Hypertension %K Least-Squares Analysis %K Male %K Marriage %K Middle Aged %K Psychiatric Status Rating Scales %K Risk Factors %K Sex Factors %K Socioeconomic factors %K Spouses %K Stroke %X

This study examined the associations among chronic health conditions, sociodemographic factors, and depressive symptomatology in older married couples. Data from the 2004 wave of the Health and Retirement Study (n = 2,184 couples) were analyzed. Results indicated a reciprocal relationship in depressive symptoms between spouses. Additionally, post hoc analyses indicated that husbands' stroke and high blood pressure were related to increased depressive symptomatology among wives. Beyond the reciprocal relationship, husbands were unaffected by wives' health. These results suggest sex differences underlying psychological distress in the context of physical health among older adults and that older women with husbands who have high levels of depressive symptomatology, high blood pressure, or a history of stroke may be at particular risk of experiencing depressive symptoms.

%B J Gerontol B Psychol Sci Soc Sci %V 65 %P 438-48 %8 2010 Jul %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/20498455?dopt=Abstract %2 PMC2883871 %4 Chronic Disease/depression/Stroke/Stress/Sex Differences %$ 22560 %R 10.1093/geronb/gbq033 %0 Journal Article %J Alzheimers Dement %D 2009 %T Telephone interview for cognitive status: Creating a crosswalk with the Mini-Mental State Examination. %A Tamara G Fong %A Michael A Fearing %A Richard N Jones %A Peilin Shi %A Edward R Marcantonio %A James L Rudolph %A Frances Margaret Yang %A Dan K Kiely %A Sharon K Inouye %K Aged %K Aged, 80 and over %K Alzheimer disease %K Cognition Disorders %K Disability Evaluation %K Female %K Geriatric Assessment %K Health Status %K Humans %K Interviews as Topic %K Male %K Mass Screening %K Models, Statistical %K Neuropsychological tests %K Predictive Value of Tests %K Psychiatric Status Rating Scales %K Remote Consultation %K Reproducibility of Results %K Sensitivity and Specificity %X

BACKGROUND: Brief cognitive screening measures are valuable tools for both research and clinical applications. The most widely used instrument, the Mini-Mental State Examination (MMSE), is limited in that it must be administered face-to-face, cannot be used in participants with visual or motor impairments, and is protected by copyright. Screening instruments such as the Telephone Interview for Cognitive Status (TICS) were developed to provide a valid alternative, with comparable cut-point scores to rate global cognitive function.

METHODS: The MMSE, TICS-30, and TICS-40 scores from 746 community-dwelling elders who participated in the Aging, Demographics, and Memory Study (ADAMS) were analyzed with equipercentile equating, a statistical process of determining comparable scores based on percentile equivalents for different forms of an examination.

RESULTS: Scores from the MMSE and TICS-30 and TICS-40 corresponded well, and clinically relevant cut-point scores were determined. For example, an MMSE score of 23 is equivalent to 17 and 20 on the TICS-30 and TICS-40, respectively.

CONCLUSIONS: These findings indicate that TICS and MMSE scores can be linked directly. Clinically relevant and important MMSE cut points and the respective ADAMS TICS-30 and TICS-40 cut-point scores are included, to identify the degree of cognitive impairment among respondents with any type of cognitive disorder. These results will help in the widespread application of TICS in both research and clinical practice.

%B Alzheimers Dement %I 5 %V 5 %P 492-7 %8 2009 Nov %G eng %N 6 %L newpubs20091013_Fong_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19647495?dopt=Abstract %2 PMC278332 %4 Cognitive Function/Survey Methods %$ 19960 %R 10.1016/j.jalz.2009.02.007 %0 Journal Article %J Psychosom Med %D 2008 %T Measurement differences in depression: chronic health-related and sociodemographic effects in older Americans. %A Frances Margaret Yang %A Richard N Jones %K Aged %K Aged, 80 and over %K Chronic disease %K Cohort Studies %K Comorbidity %K Confounding Factors, Epidemiologic %K Culture %K depression %K Diabetes Mellitus %K Educational Status %K ethnicity %K Factor Analysis, Statistical %K Female %K Heart Diseases %K Humans %K Hypertension %K Interviews as Topic %K Lung Diseases %K Male %K Self-Assessment %K Sex Factors %K Stroke %K United States %X

OBJECTIVE: To evaluate the influence of five chronic health conditions (high blood pressure, heart conditions, stroke, diabetes, and lung diseases) and four sociodemographic characteristics (age, gender, education, and race/ethnicity) on the endorsement patterns of depressive symptoms in a sample of community-dwelling older adults.

METHOD: Participants were adults aged >or=65 years from the 2004 Health and Retirement Study (n = 9448). Depressive symptoms were measured with a nine-item Center for Epidemiologic Studies-Depression scale. Measurement differences attributable to health and sociodemographic factors were assessed with a multidimensional model based on item response theory.

RESULTS: Evidence for unidimensionality was equivocal. We used a bifactor model to express symptom endorsement patterns as resulting from a general factor and three specific factors ("dysphoria," "psychosomatic," and "lack of positive affect"). Even after controlling for the effects of health on the psychosomatic factor, heart conditions, stroke, diabetes, and lung diseases had significant positive effects on the general factor. Significant effects due to gender and educational levels were observed on the "lack of positive affect" factor. Older adults self-identifying as Latinos had higher levels of general depression. On the symptom level, meaningful measurement noninvariance due to race/ethnic differences were found in the following five items: depressed, effort, energy, happy, and enjoy life.

CONCLUSIONS: The increased tendency to endorse depressive symptoms among persons with specific health conditions is, in part, explained by specific associations among symptoms belonging to the psychosomatic domain. Differences attributable to the effects of health conditions may reflect distinct phenomenological features of depression. The bifactor model serves as a vehicle for testing such hypotheses.

%B Psychosom Med %I 70 %V 70 %P 993-1004 %8 2008 Nov %G eng %N 9 %L newpubs20090126_Yang-Jones %1 http://www.ncbi.nlm.nih.gov/pubmed/18981269?dopt=Abstract %2 PMC2746732 %4 Chronic Disease/Demographics/Depressive Symptoms/Psychology %$ 19680 %R 10.1097/PSY.0b013e31818ce4fa %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2008 %T Within-group differences in depression among older Hispanics living in the United States. %A Frances Margaret Yang %A Cazorla-Lancaster, Yamileth %A Richard N Jones %K Aged %K Culture %K Depressive Disorder, Major %K Female %K Hispanic or Latino %K Humans %K Insurance, Health %K Male %K Middle Aged %K Prevalence %K Severity of Illness Index %K Socioeconomic factors %K United States %X

Using the Health and Retirement Study, we examine the prevalence of depression in different groups of Hispanic older adults. Respondents (n = 759) were aged 59 and older and identified themselves as Mexican American (56%), Cuban American (13%), Puerto Rican (8%), other (8%), or not specified (15%). We used a modified version of the Center for Epidemiologic Studies-Depression scale and the Composite International Diagnostic Interview to assess depressive symptoms and the presence of major depression. Relative to Puerto Ricans, each Hispanic group had significantly lower levels of depressive symptoms, except for Cuban Americans; and each Hispanic group had lower prevalence rates for major depression, except for other Hispanics, even after we adjusted for sociodemographic, cultural factors, socioeconomic, functional limitations, and chronic health conditions.

%B J Gerontol B Psychol Sci Soc Sci %I 63B %V 63 %P P27-32 %8 2008 Jan %G eng %N 1 %L newpubs20080411_YangJoG.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18332191?dopt=Abstract %2 PMC2366970 %4 Hispanic Americans/Depression %$ 18810 %R 10.1093/geronb/63.1.p27