Skip to main content

Table 1 Resident Level Covariates & Justification

From: Depressive symptoms in long term care facilities in Western Canada: a cross sectional study

OutcomeRAI-MDS 2.0 variable(s) 
Resident Demographics
 AgeCalculated as difference between assessment reference date (A3) and birth date (AA3a) 
 Marital statusA5 
ComorbiditiesJustification for Covariates
 Cardiovascular diseasesEither of arteriosclerotic heart disease (I1d), cardiac dysrhythmia (I1e), congestive heart failure (I1f), deep vein thrombosis (I1g), peripheral vascular disease (I1j), other cardiovascular disease (I1k)Major depression effects 19% of patients post myocardial infarction1. 14 to 60% of patients with heart failure experience depressive symptoms2. In peripheral vascular disease between 12 and 24% have depression, however this increases with amputation3. A UK study found 18.1% of patients had depressive symptoms4. Deep vein thrombosis and post thrombotic syndrome are known to negatively effect health related quality of life5, 6.Where DVT was associated with higher anxiety and depression compared to control on the EQ-5D6.
 Renal failureI1uuAcross the 5 stages of chronic kidney disease the prevalence of depression 21.4%7
 Diabetes mellitusI1aThe relative risk of depression in diabetes is RR 1.278.
 Stroke or transient ischemic attackI1u or I1ddThe prevalence of any depressive disorder in stroke is 33.5%9.
 Seizure disorderI1ccEpilepsy has 22.9% prevalence of depressive disorders10
 Neurodegenerative diseaseEither of amyotrophic lateral sclerosis (I1q), Huntington’s chorea (I1x), multiple sclerosis (I1y), or Parkinson’s disease (I1aa)In Parkinson’s disease, 35% experience clinically relevant depressive symptoms11. For Multiple Sclerosis 30.5% have depression12. Those with Amyotrophic Lateral Sclerosis have a OR of depression of 1.713. Approximately 31.7% of those with Huntington’s disease experience major depression14.
 Traumatic brain injuryI1eeTraumatic brain injury has a 43% prevalence of depressive disorders15
 Anxiety disorderI1ffAnxiety is common in LTC, with 29.7% of patients reporting anxiety symptoms16.
 Bipolar disorderI1hhBipolar disorder17 includes depressive symptoms as part of the diagnosis
 SchizophreniaI1iiDepressive symptoms are common (~ 7–75%) patients with schizophrenia18, 19, with depression also being part of the diagnostic criteria for schizoaffective disorders17.
 CancerI1rr8–24% of Cancer patients experience depression20.
 Respiratory diseaseAsthma (I1jj) or emphysema/chronic obstructive pulmonary disease (I1kk)Pulmonary diseases have been associated with depression21, 22 and depression in LTC23.
 Gastrointestinal diseaseI1ss21.6% of Inflammatory bowel disease patients experience symptoms of depression24.
 Liver diseaseI1ttLiver diseases, for e.g. non-alcoholic cirrhosis, has an incidence risk ratio for depression of 1.76.25
Other impairments
 Physical dependencyActivities of Daily Living – Hierarchical26 score > 3Depression is associated with a decline in function (e.g. poor self sufficiency)27
 Visual impairmentEither of cataracts (I1ll), diabetic retinopathy (I1mm), glaucoma (I1nn), or macular degeneration (I1oo)Poor vision in seniors is associated with an 1.94 odds of depression (95% CI1.68, 2.25)28
 Hearing impairmentC1 = 2 (hears in special situations only) or C1 = 3 (hearing highly impaired)Loss of hearing is associated with depression, OR 1.71 (95%CI 1.28,2.27)28.
 PainEither J2a = 2 (daily pain) or J2b = 3 (phases of excruciating pain regardless of frequency)Pain and depression are highly correlated across multiple settings29.
OutcomeTREC survey variableJustification for covariates
Unit typeCare units are either general long term care, non secure dementia, secure dementia, secure mental health/ psychiatric, or otherOur research has demonstrated that quality issues within LTC facilities vary substantially among care units and that unit-level measurement in addition to facility0level measurement is crucial to account for this variance.30
Unit staffingFor each care unit TREC collects information on care staffing by care provider group that allows to calculate the care hours per resident day for care aides, licensed practical nurses and registered nurses.31Systematic reviews suggested a link between higher staffing levels and better quality of care (including detection and management of depressive symptoms).32–34
Facility locationFacility is located in either the Edmonton or Calgary Health Zone, in the Fraser or Interior Health Authority, or in the Winnipeg Regional Health AuthorityThe Canadian Health Act requires public payment only for medical services provided in hospitals or by physicians.35 Provinces/territories determine individually which services are paid publicly (and how much is paid) and which services clients must cover themselves. Policies regulating LTC differ substantially among Canadian provinces, and so do quality of care issues.36 Therefore, and because this is one of the stratification variables to sample TREC facilities, we adjusted our models for facility location.
Facility sizeFacility is small (<  80 beds), medium (80–120 beds) or large (>  120 beds)Evidence suggests that an LTC facility’s size affects quality of care.37 Therefore, we adjusted our models for facility location. Therefore, and because this is one of the stratification variables to sample TREC facilities, we adjusted our models for facility location.
Facility owner-operator modelFacility owner operator model is either public not-for-profit, voluntary not-for-profit (e.g., faith based) or private for-profitEvidence suggests that an LTC facility’s ownership model affects quality of care.37 Therefore, we adjusted our models for facility location. Therefore, and because this is one of the stratification variables to sample TREC facilities, we adjusted our models for facility location.
Mental health/geriatric services provided in facilityTREC collects data on whether or not mental health and geriatric services are available in each TREC facility. Services include geriatric mental health consulting, geriatrician, psychiatrist or geriatric psychiatrist, each coded as 1 (available) or 0 (not available)Availability of mental health services is key to detection and appropriate management of depressive symptoms in older adults38.
  1. 1. Forrester, AW, Lipsey, JR, Teitelbaum, ML, et al. Depression following myocardial infarction. Int J Psychiatry Med 1992;22 (1):33–46
  2. 2. Delville, CL, McDougall, G. A systematic review of depression in adults with heart failure: instruments and incidence. Issues Ment Health Nurs 2008;29 (9):1002–1017
  3. 3. Pratt, AG, Norris, ER, Kaufmann, M. Peripheral vascular disease and depression. J Vasc Nurs 2005;23 (4):123–127; quiz 128–129
  4. 4. Ismail, H, Coulton, S. Arrhythmia care co-ordinators: Their impact on anxiety and depression, readmissions and health service costs. Eur J Cardiovasc Nurs 2016;15 (5):355–362
  5. 5. Kahn, SR, Hirsch, A, Shrier, I. Effect of postthrombotic syndrome on health-related quality of life after deep venous thrombosis. Arch Intern Med 2002;162 (10):1144–1148
  6. 6. Utne, KK, Tavoly, M, Wik, HS, et al. Health-related quality of life after deep vein thrombosis. Springerplus 2016;5 [1]:1278
  7. 7. Palmer, S, Vecchio, M, Craig, JC, et al. Prevalence of depression in chronic kidney disease: systematic review and meta-analysis of observational studies. Kidney Int 2013;84 (1):179–191
  8. 8. Hasan, SS, Mamun, AA, Clavarino, AM, et al. Incidence and risk of depression associated with diabetes in adults: evidence from longitudinal studies. Community Ment Health J 2015;51 (2):204–210
  9. 9. Mitchell, AJ, Sheth, B, Gill, J, et al. Prevalence and predictors of post-stroke mood disorders: A meta-analysis and meta-regression of depression, anxiety and adjustment disorder. Gen Hosp Psychiatry 2017;47:48–60
  10. 10. Scott, AJ, Sharpe, L, Hunt, C, et al. Anxiety and depressive disorders in people with epilepsy: A meta-analysis. Epilepsia 2017;58 (6):973–982
  11. 11. Reijnders, JS, Ehrt, U, Weber, WE, et al. A systematic review of prevalence studies of depression in Parkinson’s disease. Mov Disord 2008;23 (2):183–189; quiz 313
  12. 12. Boeschoten, RE, Braamse, AMJ, Beekman, ATF, et al. Prevalence of depression and anxiety in Multiple Sclerosis: A systematic review and meta-analysis. J Neurol Sci 2017;372:331–341
  13. 13. Roos, E, Mariosa, D, Ingre, C, et al. Depression in amyotrophic lateral sclerosis. Neurology 2016;86 [24]:2271–2277
  14. 14. Slaughter, JR, Martens, MP, Slaughter, KA. Depression and Huntington’s disease: prevalence, clinical manifestations, etiology, and treatment. CNS Spectr 2001;6 (4):306–326
  15. 15. Scholten, AC, Haagsma, JA, Cnossen, MC, et al. Prevalence of and Risk Factors for Anxiety and Depressive Disorders after Traumatic Brain Injury: A Systematic Review. J Neurotrauma 2016;33 (22):1969–1994
  16. 16. Smalbrugge, M, Pot, AM, Jongenelis, K, et al. Prevalence and correlates of anxiety among nursing home patients. J Affect Disord 2005;88 (2):145–153
  17. 17. American_Psychiatric_Association. Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C: American Psychiatric Association, 2013
  18. 18. Hasan, A, Falkai, P, Wobrock, T, et al. World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia. Part 3: Update 2015 Management of special circumstances: Depression, Suicidality, substance use disorders and pregnancy and lactation. The world journal of biological psychiatry: the official journal of the World Federation of Societies of Biological Psychiatry 2015;16 (3):142–170
  19. 19. Gregory, A, Mallikarjun, P, Upthegrove, R. Treatment of depression in schizophrenia: systematic review and meta-analysis. Br J Psychiatry 2017;211 (4):198–204
  20. 20. Krebber, AM, Buffart, LM, Kleijn, G, et al. Prevalence of depression in cancer patients: a meta-analysis of diagnostic interviews and self-report instruments. Psychooncology 2014;23 (2):121–130
  21. 21. Bozek, A, Rogala, B, Bednarski, P. Asthma, COPD and comorbidities in elderly people. J Asthma 2016;53 [9]:943–947
  22. 22. Matte, DL, Pizzichini, MM, Hoepers, AT, et al. Prevalence of depression in COPD: A systematic review and meta-analysis of controlled studies. Respir Med 2016;117:154–161
  23. 23. Barca, ML, Selbaek, G, Laks, J, et al. Factors associated with depression in Norwegian nursing homes. Int J Geriatr Psychiatry 2009;24 (4):417–425
  24. 24. Neuendorf, R, Harding, A, Stello, N, et al. Depression and anxiety in patients with Inflammatory Bowel Disease: A systematic review. J Psychosom Res 2016;87:70–80
  25. 25. Perng, CL, Shen, CC, Hu, LY, et al. Risk of depressive disorder following non-alcoholic cirrhosis: a nationwide population-based study. PLoS One 2014;9 (2):e88721
  26. 26. Morris, JN, Fries, BE, Morris, SA. Scaling ADLs within the MDS. Journals of Gerontology Series A, Biological Sciences and Medical Sciences 1999;54 (11):M546-M553
  27. 27. Canadian_Institute_for_Health_Information. Depression Among Seniors in Residential Care. 2010
  28. 28. Huang, CQ, Dong, BR, Lu, ZC, et al. Chronic diseases and risk for depression in old age: a meta-analysis of published literature. Ageing Res Rev. 2010;9 (2):131–141
  29. 29. Bair, MJ, Robinson, RL, Katon, W, et al. Depression and pain comorbidity: a literature review. Arch Intern Med 2003;163 [20]:2433–2445
  30. 30. Norton, PG, Murray, M, Doupe, MB, et al. Facility versus unit level reporting of quality indicators in nursing homes when performance monitoring is the goal. BMJ Open 2014;4 (2):e004488
  31. 31. Cummings, GG, Doupe, M, Ginsburg, L, et al. Development and Validation of A Scheduled Shifts Staffing (ASSiST) Measure of Unit-Level Staffing in Nursing Homes. Gerontologist 2017;57 (3):509–516
  32. 32. Bostick, JE, Rantz, MJ, Flesner, MK, et al. Systematic review of studies of staffing and quality in nursing homes. Journal of the American Medical Directors Association 2006;7 (6):366–376
  33. 33. Castle, NG. Nursing home caregiver staffing levels and quality of care - A literature review. J Appl Gerontol 2008;27 [4]:375–405
  34. 34. Spilsbury, K, Hewitt, C, Stirk, L, et al. The relationship between nurse staffing and quality of care in nursing homes: a systematic review. Int J Nurs Stud 2011;48 (6):732–750
  35. 35. Deber, R, B., Laporte, A. Funding long-term care in Canada: Who is responsible for what? HealthcarePapers 2016;15 [4]:36–40
  36. 36. Health Canada. Long-term facilities-based care; Accessed 2017-04-06
  37. 37. Tanuseputro, P, Chalifoux, M, Bennett, C, et al. Hospitalization and Mortality Rates in Long-Term Care Facilities: Does For-Profit Status Matter? J Am Med Dir Assoc 2015;16 (10):874–883
  38. 38. MacCourt, P, Wilson, K, Tourigny-Rivard, M-F. Guidelines for Comprehensive Mental Health Services for Older Adults in Canada. Calgary, Alberta: Mental Health Commission of Canada; 2011