{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T07:35:14Z","timestamp":1793086514358,"version":"4.5.0"},"reference-count":50,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2023,2,13]],"date-time":"2023-02-13T00:00:00Z","timestamp":1676246400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Center for Geriatrics and Gerontology, Tokyo, Japan","award":["no. 28-30"],"award-info":[{"award-number":["no. 28-30"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Frailty and depression may play important roles in the management of older patients with cardiometabolic diseases. We explored the determinants of depressive symptoms and their association with frailty among patients with cardiometabolic diseases (hypertension, diabetes, and atrial fibrillation) in a cross-sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 633 outpatients aged 65 years or older with cardiometabolic disease and suspected symptoms of frailty participated in this study. Depressive symptoms, physical activity, and social network were assessed using the Geriatric Depression Scale (GDS)-15, International Physical Activity Questionnaire, and Lubben Social Network Scale-6 (LSNS-6), respectively. Frailty was evaluated using the Kihon Checklist (KCL) based on the Comprehensive Geriatric Assessment (CGA), the modified Cardiovascular Health Study (mCHS), and the Clinical Frailty Scale (CFS). Binomial logistic regression analysis was used to examine the determinants of depressive symptoms and their association with frailty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Depressive symptoms with GDS-15 scores \u2265 5 were present in 43.6% of the patients. In logistic regression, after adjusting for covariates, the determinants of depressive symptoms in all patients were lack of social network, low years of education, and frailty. In contrast, in logistic regression with frailty as the dependent variable, depressive symptoms were independently associated KCL-defined frailty (OR = 6.28, 95% CI: 4.13\u20139.55) and mCHS-defined frailty (OR = 2.66, 95% CI: 1.70\u20134.17), but not with CFS. Similarly, significant associations between depression and frailty were observed in patients with hypertension, diabetes, or atrial fibrillation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Lack of social networks, low education, and frailty based on the KCL and mCHS were important determinants of depressive symptoms in all patients. The relatively strong associations between depressive symptoms and frailty based on CGA in patients with hypertension, diabetes, or atrial fibrillation suggest that the assessment of depressive symptoms is of great importance in clinical practice in those patients at high risk of frailty.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0281465","type":"journal-article","created":{"date-parts":[[2023,2,13]],"date-time":"2023-02-13T14:55:49Z","timestamp":1676300149000},"page":"e0281465","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Determinants of depressive symptoms in older outpatients with cardiometabolic diseases in a Japanese frailty clinic: Importance of bidirectional association between depression and 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prevalence of comorbid depression in adults with diabetes: a meta-analysis","volume":"24","author":"RJ Anderson","year":"2001","journal-title":"Diabetes Care"},{"issue":"1","key":"pone.0281465.ref002","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1111\/j.1525-1497.2005.00269.x","article-title":"Prevalence of depression in survivors of acute myocardial infarction","volume":"21","author":"BD Thombs","year":"2006","journal-title":"J Gen Intern Med"},{"issue":"23","key":"pone.0281465.ref003","doi-asserted-by":"crossref","first-page":"2396","DOI":"10.1001\/jama.2020.23068","article-title":"Association Between Depressive Symptoms and Incident Cardiovascular Diseases","volume":"324","author":"Lisa Pennells Eric L Harshfield","year":"2020","journal-title":"JAMA"},{"issue":"10","key":"pone.0281465.ref004","doi-asserted-by":"crossref","first-page":"1052","DOI":"10.1001\/jamapsychiatry.2020.1351","article-title":"Association of Symptoms of Depression With Cardiovascular Disease and Mortality in Low-, Middle-, and High-Income Countries","volume":"77","author":"S Rajan","year":"2020","journal-title":"JAMA Psychiatry"},{"issue":"9","key":"pone.0281465.ref005","doi-asserted-by":"crossref","first-page":"2222","DOI":"10.2337\/dc07-0158","article-title":"Depression, self-care, and medication adherence in type 2 diabetes: relationships across the full range of symptom severity","volume":"30","author":"JS Gonzalez","year":"2007","journal-title":"Diabetes Care"},{"issue":"5","key":"pone.0281465.ref006","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1111\/j.1440-1819.2005.01415.x","article-title":"Association between social support and depression status in the elderly: results of a 1-year community-based prospective cohort study in Japan.","volume":"59","author":"Y Koizumi","year":"2005","journal-title":"Psychiatry Clin Neurosci"},{"key":"pone.0281465.ref007","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.puhe.2021.06.023","article-title":"The relationship between depressive symptoms and activity of daily living disability among the elderly: results from the China Health and Retirement Longitudinal Study (CHARLS).","volume":"198","author":"Z Feng","year":"2021","journal-title":"Public Health"},{"key":"pone.0281465.ref008","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.exger.2018.09.004","article-title":"Associations of physical activity and depression: Results from the Irish Longitudinal Study on Ageing","volume":"112","author":"CP McDowell","year":"2018","journal-title":"Exp Gerontol"},{"key":"pone.0281465.ref009","doi-asserted-by":"crossref","first-page":"e11695","DOI":"10.7717\/peerj.11695","article-title":"Depression and low physical activity are related to sarcopenia in hemodialysis: a single-center study.","volume":"9","author":"K Yuenyongchaiwat","year":"2021","journal-title":"PeerJ."},{"key":"pone.0281465.ref010","article-title":"1 and Zhi\u2010Jie Zhengcorresponding author 1, 2","author":"LG Shuduo Zhou","year":"2021","journal-title":"Socioeconomic status and depressive symptoms in older people with the mediation role of social support: A population\u2010based longitudinal study"},{"issue":"5","key":"pone.0281465.ref011","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1002\/gps.4495","article-title":"Loneliness, depression and cognitive function in older U.S. adults.","volume":"32","author":"NJ Donovan","year":"2017","journal-title":"Int J Geriatr Psychiatry"},{"issue":"3","key":"pone.0281465.ref012","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/j.eurpsy.2004.09.036","article-title":"Risk factors of major depression in the elderly.","volume":"20","author":"R Heun","year":"2005","journal-title":"Eur Psychiatry"},{"key":"pone.0281465.ref013","doi-asserted-by":"crossref","first-page":"280","DOI":"10.3389\/fpubh.2020.00280","article-title":"The Relationship Between Health Literacy, Social Support, Depression, and Frailty Among Community-Dwelling Older 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countryside-dwelling older Chinese patients with hypertension","volume":"27","author":"Chunhua Ma","journal-title":"J Clin Nurs. 2018"},{"issue":"2","key":"pone.0281465.ref020","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1007\/s40615-019-00665-x","article-title":"Prevalence and Predictors of Co-occurring Hypertension and Depression Among Community-Dwelling Older Adults.","volume":"7","author":"Cicily A Gray","journal-title":"J Racial Ethn Health Disparities. 2020"},{"key":"pone.0281465.ref021","first-page":"7408129","article-title":"Anxiety and Depression in Patients with Permanent Atrial Fibrillation: Prevalence and Associated Factors.","volume":"2018","author":"Maria Polikandrioti","year":"2018","journal-title":"Cardiol Res Pract."},{"issue":"5","key":"pone.0281465.ref022","doi-asserted-by":"crossref","first-page":"593","DOI":"10.3390\/healthcare9050593","article-title":"The Reciprocal Relationship between Frailty and Depressive Symptoms among Older Adults in Rural China: A Cross-Lag Analysis.","volume":"9","author":"Xuehui Wang","year":"2021","journal-title":"Healthcare (Basel)"},{"key":"pone.0281465.ref023","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.arr.2017.03.005","article-title":"Relationship between depression and frailty in older adults: A systematic review and meta-analysis.","volume":"36","author":"P Soysal","year":"2017","journal-title":"Ageing Res Rev"},{"key":"pone.0281465.ref024","doi-asserted-by":"crossref","first-page":"101353","DOI":"10.1016\/j.pmedr.2021.101353","article-title":"Associations between depressive symptoms and geriatric syndromes in community-dwelling older adults in Japan: A cross-sectional study.","volume":"22","author":"M Imaoka","year":"2021","journal-title":"Prev Med Rep"},{"key":"pone.0281465.ref025","doi-asserted-by":"crossref","first-page":"104448","DOI":"10.1016\/j.archger.2021.104448","article-title":"The relationship between frailty and diabetes: An investigation of self-rated health, depression symptoms and quality of life in the Study of Health Aging and Retirement in Europe.","volume":"96","author":"M O\u2019Donovan","year":"2021","journal-title":"Arch Gerontol Geriatr."},{"key":"pone.0281465.ref026","doi-asserted-by":"crossref","first-page":"1595","DOI":"10.2147\/CIA.S90077","article-title":"The relationship between frailty, anxiety and depression, and health-related quality of life in elderly patients with heart failure","volume":"10","author":"I Uchmanowicz","year":"2015","journal-title":"Clin Interv Aging"},{"key":"pone.0281465.ref027","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.2147\/CIA.S258634","article-title":"Assessment of Frailty and Occurrence of Anxiety and Depression in Elderly Patients with Atrial Fibrillation.","volume":"15","author":"I Uchmanowicz","year":"2020","journal-title":"Clin Interv Aging."},{"issue":"4","key":"pone.0281465.ref028","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1080\/07317115.2016.1199452","article-title":"A Validity and Reliability Study of the Japanese Version of the Geriatric Depression Scale 15 (GDS-15-J).","volume":"40","author":"K Sugishita","year":"2017","journal-title":"Clin Gerontol."},{"issue":"2","key":"pone.0281465.ref029","doi-asserted-by":"crossref","first-page":"149","DOI":"10.3143\/geriatrics.48.149","article-title":"[Reliability and validity of the Japanese version of the abbreviated Lubben Social Network Scale].","volume":"48","author":"A Kurimoto","year":"2011","journal-title":"Nihon Ronen Igakkai Zasshi"},{"issue":"6","key":"pone.0281465.ref030","doi-asserted-by":"crossref","first-page":"459","DOI":"10.2188\/jea.JE20110003","article-title":"Reliability and validity of the International Physical Activity Questionnaire (IPAQ) in elderly adults: the Fujiwara-kyo Study.","volume":"21","author":"K Tomioka","year":"2011","journal-title":"J Epidemiol."},{"issue":"3","key":"pone.0281465.ref031","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1111\/j.1447-0594.2010.00585.x","article-title":"Brief screening tool for mild cognitive impairment in older Japanese: validation of the Japanese version of the Montreal Cognitive Assessment.","volume":"10","author":"Y Fujiwara","year":"2010","journal-title":"Geriatr Gerontol Int"},{"issue":"6","key":"pone.0281465.ref032","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1111\/ggi.12543","article-title":"Validity of the Kihon Checklist for assessing frailty status.","volume":"16","author":"S Satake","year":"2016","journal-title":"Geriatr Gerontol Int."},{"issue":"1","key":"pone.0281465.ref033","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1186\/s12877-018-0955-4","article-title":"Prevalence of frailty, cognitive impairment, and sarcopenia in outpatients with cardiometabolic disease in a frailty clinic.","volume":"18","author":"Y Tamura","year":"2018","journal-title":"BMC Geriatr."},{"issue":"5","key":"pone.0281465.ref034","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1503\/cmaj.050051","article-title":"A global clinical measure of fitness and frailty in elderly people.","volume":"173","author":"K Rockwood","year":"2005","journal-title":"CMAJ"},{"key":"pone.0281465.ref035","unstructured":"2017. ICR. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp."},{"issue":"11","key":"pone.0281465.ref036","first-page":"1508","article-title":"The prevalence of diabetes-specific emotional distress in people with Type 2 diabetes: a systematic review and meta-analysis.","volume":"34","author":"N E Perrin","year":"2017"},{"issue":"11","key":"pone.0281465.ref037","doi-asserted-by":"crossref","first-page":"1268","DOI":"10.1016\/j.jagp.2019.04.014","article-title":"Social Support and Depression Related to Older Adults\u2019 Hypertension Control in Rural China.","volume":"27","author":"T Zhu","year":"2019","journal-title":"Am J Geriatr Psychiatry"},{"issue":"1","key":"pone.0281465.ref038","first-page":"34","article-title":"Social support and self-care activities among the elderly patients with diabetes in Kelantan.","volume":"10","author":"SK Ahmad Sharoni","year":"2015","journal-title":"Malays Fam Physician"},{"issue":"6","key":"pone.0281465.ref039","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1038\/mp.2015.50","article-title":"The association between lower educational attainment and depression owing to shared genetic effects? Results in ~25,000 subjects","volume":"20","author":"WJ Peyrot","year":"2015","journal-title":"Mol Psychiatry"},{"key":"pone.0281465.ref040","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/j.jad.2019.04.002","article-title":"Hypertension, socioeconomic status and depressive symptoms in Chinese middle-aged and older adults: Findings from the China health and retirement longitudinal study","volume":"252","author":"Yinzi Jin","year":"2019","journal-title":"J Affect Disord"},{"issue":"4","key":"pone.0281465.ref041","doi-asserted-by":"crossref","first-page":"e105","DOI":"10.1097\/jnr.0000000000000379","article-title":"Patients With Type 2 Diabetes Mellitus: Obstacles in Coping.","volume":"28","author":"FI O","year":"2020","journal-title":"J Nurs Res"},{"key":"pone.0281465.ref042","doi-asserted-by":"crossref","first-page":"573","DOI":"10.3389\/fpsyg.2020.00573","article-title":"Relationship Between Mental Health and the Education Level in Elderly People: Mediation of Leisure Attitude.","volume":"11","author":"P Belo","year":"2020","journal-title":"Front Psychol."},{"issue":"6","key":"pone.0281465.ref043","doi-asserted-by":"crossref","first-page":"e0252723","DOI":"10.1371\/journal.pone.0252723","article-title":"Association between Kihon check list score and geriatric depression among older adults from ORANGE registry.","volume":"16","author":"Yu Kume","year":"2021","journal-title":"PLoS One"},{"issue":"3","key":"pone.0281465.ref044","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1080\/13607863.2017.1416332","article-title":"Prevalence of frailty and its association with depressive symptoms among older adults in Singapore.","volume":"23","author":"L Ge","year":"2019","journal-title":"Aging Ment Health"},{"issue":"5","key":"pone.0281465.ref045","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1016\/j.biopsych.2009.09.033","article-title":"A meta-analysis of cytokines in major depression","volume":"67","author":"Y Dowlati","year":"2010","journal-title":"Biol Psychiatry"},{"key":"pone.0281465.ref046","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.arr.2016.08.006","article-title":"Inflammation and frailty in the elderly: A systematic review and meta-analysis","volume":"31","author":"P Soysal","year":"2016","journal-title":"Ageing Res Rev"},{"issue":"3","key":"pone.0281465.ref047","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/j.pscychresns.2006.11.002","article-title":"HPA axis dysfunction in unmedicated major depressive disorder and its normalization by pharmacotherapy correlates with alteration of neural activity in prefrontal cortex and limbic\/paralimbic regions.","volume":"155","author":"M Aihara","year":"2007","journal-title":"Psychiatry Res."},{"issue":"14","key":"pone.0281465.ref048","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1080\/15287394.2019.1654639","article-title":"Serum cortisol but not oxidative stress biomarkers are related to frailty: results of a cross-sectional study in Spanish older adults","volume":"82","author":"D Marcos-Perez","year":"2019","journal-title":"J Toxicol Environ Health A"},{"issue":"1","key":"pone.0281465.ref049","doi-asserted-by":"crossref","first-page":"11343","DOI":"10.1038\/s41598-019-47731-2","article-title":"The association between frailty and MRI features of cerebral small vessel disease.","volume":"9","author":"IMJ Kant","year":"2019","journal-title":"Sci Rep."},{"issue":"7","key":"pone.0281465.ref050","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1001\/jamapsychiatry.2017.0984","article-title":"Association of Microvascular Dysfunction With Late-Life Depression: A Systematic Review and Meta-analysis","volume":"74","author":"MJM van Agtmaal","year":"2017","journal-title":"JAMA Psychiatry"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0281465","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,13]],"date-time":"2023-02-13T14:56:19Z","timestamp":1676300179000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0281465"}},"subtitle":[],"editor":[{"given":"Arista","family":"Lahiri","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,2,13]]},"references-count":50,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,2,13]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0281465","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,13]]}}}