Aims To investigate the relationship between depression and self-care behaviours in older individuals with multimorbidity.Design Cross-sectional study. Data were collected between April 2017 - June 2019.Methods Patients were enrolled from community and outpatient settings and included if they were >= 65 years, affected by heart failure, diabetes mellitus or chronic obstructive pulmonary disease and at least another chronic condition. They were excluded if they had dementia and/or cancer. Patient Health Questionnaire-9 was used to measure depression and Self-Care of Chronic Illness Inventory was used to measure self-care maintenance, monitoring, and management. The relationship between depression and self-care was evaluated by performing two sets of univariate analyses, followed by multivariate and step-down analyses. The second set was performed to control for the number of chronic conditions, age, and cognitive function.Results The sample (N = 366) was mostly female (54.2%), with a mean age of 76.4 years. Most participants (65.6%) had mild to very severe depressive symptoms. Preliminary analysis indicated a significant negative association between depression and self-care maintenance and monitoring and a significant negative association between depression and multivariate self-care. Step-down analysis showed that self-care maintenance was the only dimension negatively associated with depression, even after controlling for the number of chronic conditions, age, and cognitive function.Conclusion In multimorbid populations, depression is more likely to be associated with self-care maintenance than the other self-care dimensions. Therefore, self-care maintenance behaviours (e.g., physical activity and medication adherence) should be prioritized in assessment and focused on when developing interventions targeting depressed older adults with multimorbidity.Impact The results of this study may help guide clinical practice. In patients with depressive symptoms, self-care maintenance behaviours should be assessed first, as a potential first indicator of poor self-care.
Depression and self-care in older adults with multiple chronic conditions: A multivariate analysis
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2020/03/2525-Mar-2020
Re: JAN-2019-1227.R1: DEPRESSION AND SELF-CARE IN OLDER ADULTS WITH MULTIPLE CHRONIC CONDITIONS: A MULTIVARIATE ANALYSIS
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2020/03/19Good job, You have addressed all my comments. Good luck with your publication.
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- pre-publication peer review (ROUND 1)
Decision Letter
2020/02/0707-Feb-2020
Re: JAN-2019-1227: DEPRESSION AND SELF-CARE IN OLDER ADULTS WITH MULTIPLE CHRONIC CONDITIONS: A MULTIVARIATE ANALYSIS
Dear Dr Iovino,
Thank you for sending us the above manuscript. It has been considered with care and the editor and reviewer comments are shown at the end of this email. As these comments indicate, the paper does need revision before we can consider it further, and I look forward to receiving your revised version as soon as possible, and no later than 09-Mar-2020. If this poses any problems, please contact me at jan@wiley.com.
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REVIEWER COMMENTS:
Reviewer: 1
Comments to the Author
The paper mostly relies on descriptive summaries. The statistical methods and data analyses summarized are suitable and sound. Yet I have one comment that needs to be addressed to improve the statistical presentation, as indicated below:• Pages 7-8, 23, “Data analysis” section, Table 3: The terminology “independent” variables should be avoided, since the authors do not seem to define any concept of “independence.” When this refers to a linear regression model or ANOVA, the terminology “explanatory” variables can be used. Generally, the explanatory variables are not strictly independent variables. Similarly, instead of “dependent” variable or outcome, the terminology “response” or “outcome” variable should be used for the same reasons.
Reviewer: 2
Comments to the Author
1. Introduction and background
The justification for studying the two main study variables, depression and self-care, is not strong. The authors repeatedly mentioned that ‘depression affects negatively the self-care behaviors’. I think the relationship between these two variables is bidirectional. Poor self-care may lead to depressive symptoms. The theoretical base for this study is not sound to support this research topic.
2. Methods
For data collection, the authors isolated several pieces of data from the whole study for this manuscript. It is a little hard to assess the quality of the study. No information prescribed how participants were recruited, where the data were collected, and why 369 people recruited.
3. Results
1) The descriptive analysis of depression and self-care was missed, which was often required before inferencial tests.
2) More demographic and disease factors shoud be included in the mulvariate analysis.
2)The presentation of the main results is disorder.- Discussion
Given a cross-sectional study, some conclusions from the discussion are very subjective. For example:
“depression impairs self-care maintenance behaviors”; the word ‘impair’ is very strong for the relationship between variables. The same situation exists in the following two points:
‘Self-care monitoring was not influenced by depression’
‘Self-care management behaviors were not affected by depression’
Reviewer: 3
Comments to the Author
Thank you for your well written, focused manuscript. This provided a concise summary of the state of the science related to the BDNF SNP related to exercise and cognitive function. The review is well presented and the tables provide the necessary information to follow along with the results and discussion. I only have a few minor suggestions. Well done authors!
1. You should spell out the acronyms for the first time, although these acronyms are well known for readers. For example, you should spell out HF as heart failure.
2. The authors did not follow the APA format in the reference list.
3. Background and introduction data should be more up to data. This needs to be addressed throughout but I provide some examples. For example, in the first paragraph of the manuscript the statement is made that the burden of MCC and the citations used are from 2012 and 2011. There is more recent support in the literature for this statement. The authors should retrieve the latest evidence to support your data. While this reviewer appreciates that you can’t cite every manuscript to support statements in the background, the citations and the information provided should be the most up to date.To revise your manuscript, log on to ScholarOne Manuscripts: http://mc.manuscriptcentral.com/jan
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Journal of Advanced NursingDecision letter by
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Reviewer report
2020/01/17Thank you for your well written, focused manuscript. This provided a concise summary of the state of the science related to the BDNF SNP related to exercise and cognitive function. The review is well presented and the tables provide the necessary information to follow along with the results and discussion. I only have a few minor suggestions. Well done authors!
1. You should spell out the acronyms for the first time, although these acronyms are well known for readers. For example, you should spell out HF as heart failure.
2. The authors did not follow the APA format in the reference list.
3. Background and introduction data should be more up to data. This needs to be addressed throughout but I provide some examples. For example, in the first paragraph of the manuscript the statement is made that the burden of MCC and the citations used are from 2012 and 2011. There is more recent support in the literature for this statement. The authors should retrieve the latest evidence to support your data. While this reviewer appreciates that you can’t cite every manuscript to support statements in the background, the citations and the information provided should be the most up to date.Reviewed by
Cite this review
Reviewer report
2019/12/02- Introduction and background
The justification for studying the two main study variables, depression and self-care, is not strong. The authors repeatedly mentioned that ‘depression affects negatively the self-care behaviors’. I think the relationship between these two variables is bidirectional. Poor self-care may lead to depressive symptoms. The theoretical base for this study is not sound to support this research topic. - Methods
For data collection, the authors isolated several pieces of data from the whole study for this manuscript. It is a little hard to assess the quality of the study. No information prescribed how participants were recruited, where the data were collected, and why 369 people recruited. Results
1) The descriptive analysis of depression and self-care was missed, which was often required before inferencial tests.
2) More demographic and disease factors shoud be included in the mulvariate analysis.
2)The presentation of the main results is disorder.Discussion
Given a cross-sectional study, some conclusions from the discussion are very subjective. For example:
“depression impairs self-care maintenance behaviors”; the word ‘impair’ is very strong for the relationship between variables. The same situation exists in the following two points:
‘Self-care monitoring was not influenced by depression’
‘Self-care management behaviors were not affected by depression’
Reviewed by
Cite this review
Reviewer report
2019/11/28The paper mostly relies on descriptive summaries. The statistical methods and data analyses summarized are suitable and sound. Yet I have one comment that needs to be addressed to improve the statistical presentation, as indicated below:
• Pages 7-8, 23, “Data analysis” section, Table 3: The terminology “independent” variables should be avoided, since the authors do not seem to define any concept of “independence.” When this refers to a linear regression model or ANOVA, the terminology “explanatory” variables can be used. Generally, the explanatory variables are not strictly independent variables. Similarly, instead of “dependent” variable or outcome, the terminology “response” or “outcome” variable should be used for the same reasons.
Reviewed by
Cite this review
