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The Beyond Ageing Project

The beyond ageing project aims to determine whether mental health literacy, physical activity or folate prevents depression in older individuals. The Beyond Ageing project is a randomised controlled trial which commenced in 2006 and will be complete in 2008.

*Update: 29 January 2007*

Who is involved in the Beyond Ageing Project?

Why is the research being done?

What will the research involve?

Previous findings: Using folate and vitamin B12 to prevent depression

Previous findings: Physical activity to prevent depression in older people

Previous findings: Improving knowledge about depression in older people

References

Who is involved in the Beyond Ageing Project?

beyondblue: the national depression initiative in conjunction with researchers at the Centre for Mental Health Research (CMHR) at the Australian National University, the Brain and Mind Research Institute at the University of Sydney, and CSIRO will conduct a randomised control trial over a two-year period.

Chief Investigators

Prof. Anthony Jorm, Orygen Research Centre, University of Melbourne

Prof. Helen Christensen, Centre for Mental Health Research, ANU

Prof. Ian Hickie, Brain and Mind Research Institute, University of Sydney

Project Coordinator

Dr Janine Walker, Centre for Mental Health Research, ANU

Survey Coordinator

Ms Kim Pullen, Centre for Mental Health Research, ANU

PhD Candidate

Ms Affrica Jenkins, Centre for Mental Health Research, ANU

Medical Advisors

Prof. Marjan Kljakovic, Academic Unit of General Practice and Community Health, Medical School, ANU

Dr Jeff Looi, Medical School, ANU

Interviewers

Ms Beverley Butterfield

Ms Kay Bowman

Ms Shaaron Glynn

Ms Karen Halliday

Ms Rose Jurd

Ms Jan McKergow

Ms Cathy Muggleton

Ms Elizabeth Parkes

Ms Heather Wilson

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Why is the research being done?

Efforts to prevent depression have largely focused on young people. Given that first episodes of depression often occur in adolescence or early adulthood, this emphasis is justified. However, depression occurs also later in life. For older people, there are certain risk factors, which may make individuals more vulnerable to depression. These risk factors may require preventive action.

The primary aim of the study is to determine what works in terms of preventing older individuals from developing serious problems with depression on a large population scale. The study will incorporate a healthy ageing program and include components such as: folate and vitamin B12; physical activity; information about depression; information on healthy eating, and information on arthritis and pain management.

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What will the research involve?

It is anticipated that 1000 participants aged 60-74 will be randomly assigned to receive one of the above-mentioned interventions, a combination of these interventions, or a placebo. Participants will be randomly selected from the electoral roll and will come from two capital cities (i.e., Canberra and Sydney), and Wagga Wagga as the rural site.

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Previous findings: Using folate and vitamin B12 to prevent depression

Beyond Ageing will use folate and vitamin B12 as preventive interventions. There are several lines of evidence supporting this intervention. The first is that folate-deficient patients suffer from a number of mental health problems, including depression. There are also treatment studies showing that folate enhances the effects of antidepressant treatment or has an antidepressant effect in its own right.

Folate also plays an important role in the metabolism of homocysteine. Many studies have supported total plasma homocysteine as a risk factor for cardiovascular disease. In recent years, there have been links shown between depression and cerebrovascular disease with the term “vascular depression” being coined. Folic acid intake is known to reduce plasma homocysteine, and B12 also has a modest additional effect. Given the importance of vascular depression in older people, it is also possible that folic acid and B12 supplementation may help prevent depression via the lowering of homocysteine. One researcher has concluded: “ The best way forward may be to undertake large scale community-based studies of folate supplementation or food fortification to explore the preventive potential of the vitamin for mood and cognitive disorders” (Reynolds, 2002).

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Previous findings: Physical activity to prevent depression in older people

Physical activity has been extensively evaluated as a treatment for depression and interventions reduce depression symptoms substantially. A recent meta-analysis of exercise trials, including trials of older participants, indicated that exercise when compared to no treatment reduced symptoms of depression. This compares favourably to the effects of anti-depressants, cognitive behaviour therapy and depression education. Although physical activity has been used for the treatment of depression, Beyond Ageing will be the first trial in the world to study its role in the prevention of depression.

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Previous findings: Improving knowledge about depression in older people

Another approach to preventing depression in older Australians may be to improve their knowledge about depression; in other words, improve their mental health literacy. Improving knowledge about depression has been shown to reduce problems with depression, and increase individuals' understanding about what depression is and what works for managing depression (Christensen et al., 2004; Jorm et al., 2001).

The Beyond Ageing Project will extend this earlier work by looking at the preventive effects of increasing mental health literacy for older people with depressive symptoms. By providing information to these high-risk individuals, it will be possible to determine if the information encourages effective self-help, early professional help-seeking, and whether it actually reduces the future prevalence of depression.

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References

Alexopoulos, G.S., Meyers, B.S., Young, R.C., Campbell, S., Silbersweig, D. & Charlson, M. (1997). ‘Vascular depression' hypothesis. Archives of General Psychiatry , 54, 915-922.

Alpert, J.E., Mischoulon, D., Nierenberg, A.A. & Fava, M. (2000). Nutrition and depression: Focus on folate. Nutrition , 16, 544-581.

Andrews, G. & Wilkinson, D.D. (2002). The prevention of mental disorders in young people. Medical Journal of Australia , S97-S100.

Bostom, A.G., Selhub, J., Jacques, P.F. & Rosenberg, I.H. (2001). Power shortage: Clinical trials testing the “homocysteine hypothesis” against a background of folic acid-fortified cereal grain flour. Annals of Internal Medicine , 135, 133-137.

Bottiglieri, T., Laundy, M., Crellin, R., Toone, B.K., Carney, M.W.P. & Reynolds, E.H. (2000). Homocysteine, folate, methylation, and monoamine metabolism in depression. Journal of Neurology Neurosurgery and Psychiatry , 69, 228-232.

Christensen, H., Griffiths, K.M. & Jorm, A.F. (2004). Delivering depression interventions using the Internet: Positive results from a large randomised controlled trial. British Medical Journal , 328, 265.

De Groot, J.C., de Leeuw, F.E., Oudkerk, M., Hofman, A., Jolles, J., Breteler, M.M.B. (2000). Cerebral white matter lesions and depressive symptoms in elderly adults. Archives of General Psychiatry , 57, 1071-1076.

Henderson, S., Andrews, G. & Hall, W. (2000). Australia's mental health: An overview of the general population survey. Australian and New Zealand Journal of Psychiatry , 34, 197-205.

Highet, N.J., Hickie, I.B. & Davenport, T.A. (2002). Monitoring awareness and attitudes to depression in Australia. Medical Journal of Australia , 176, S63-S68.

Homocysteine Lowering Trialists' Collaboration (1998). Lowering blood homocysteine with folic acid based supplements: Meta-analysis of randomised trials. British Medical Journal , 316, 894-898.

Jensen, E., Dehlin, O., Erfurth, E.M., Hagberg, B., Samuelsson, G., Svensson, T. & Hultberg, B. (1998). Plasma homocysteine in 80-year olds: Relationships to medical, psychological and social variables. Archives of Gerontology and Geriatrics , 26, 215-226.

Jorm, A.F. (2000). Mental health literacy: Public knowledge and beliefs about mental disorders. British Journal of Psychiatry , 177, 396-401.

Jorm, A.F., Christensen H., Griffiths, K.M., Korten, A.E. & Rodgers, B. (2001). Help for Depression: What Works (and What Doesn't) . Canberra: Centre for Mental Health Research.

Lawlor DA and Hopker SW. (2001). The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials. BMJ; 322: 763.

Lindeman, R.D., Romero, L.J., Koehler, K.M., Liang, H.C., LaRue, A., Baumgartner, R.N. & Garry, P.J. (2000). Serum vitamin B12, C and folate concentrations in the New Mexico elder health survey: Correlations with cognitive and affective status. Journal of the American College of Nutrition , 19, 68-76.

Reutens, S. & Sachdev, P. (2002). Homocysteine in neuropsychiatric disorders of the elderly. International Journal of Geriatric Psychiatry , 17, 859-864.

Tiemeier, H., van Tuijl, H.R., Hofman, A., Meijer, J., Kiliaan, A.J. & Breteler, M.M.B. (2002). Vitamin B12, folate, and homocysteine in depression: The Rotterdam study. American Journal of Psychiatry , 159, 2099-2101.

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*Update* 29 January 2007 Recruitment into the healthy ageing program is now complete. An invitation to participate in the program was sent to a sample of 105,000 people aged 60 to 74 years living in Sydney, Canberra, Queanbeyan and Wagga Wagga. 22% of people returned surveys, and 909 people were invited to join the trial. These invitees were healthy, mobile, not currently physically active; not taking folate or vitamin B12 tablets; and had experienced feelings of distress. The recruitment process has taken almost 12 months. On behalf of the Beyond Ageing Team, I would like to thank everyone who has supported the project and given their time and energy so generously to this important study. Best wishes, Prof. Helen Christensen Director, Centre for Mental Health Research, ANU.

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