Social support functions as an effective buffer against depression, especially among older adults with limited social networks. For the current study, we examined longitudinal bidirectional associations between social support and depression among those 75+ years of age. We recruited and followed a sample of Israeli adults 75+ years of age (N = 824; M = 80.84; range 75–96 years). Structured interviews were conducted in the homes of participants at three annual points of measurement. Participants reported depressive symptoms and emotional and instrumental support received from friends and family. We examined a cross-lagged, longitudinal structural equation model (SEM) in which social support and depressive symptoms predict each other over time, covarying for previously reported social support and depressive symptoms. We found that both depressive symptoms and social support are largely consistent in late life. Depressive symptoms and social support reported at baseline predict levels reported 1 and 2 years thereafter. Cross-over effects emerged over time. Depressive symptoms predicted lower social support in future, and social support at baseline predicted depressive symptoms 2 years later. These findings suggest that associations between depressive symptoms and social support are bidirectional in late life. Further research is needed to replicate findings in other cultures and over longer periods, ideally until end of life.

Background Studies in adults suggest that fatigue is amongst the most commonly reported symptoms, reaching ~50% of patients, often even while the patients enter clinical remission. However, fatigue has been rarely discussed in children and no study hitherto determined the rate of fatigue in pediatric IBD (PIBD). We aimed to perform a systematic review of the literature in children with either CD or UC and to explore the rate of fatigue in a prospective inception cohort of PIBD. Methods A systematic review of the literature was conducted for pediatric studies of any design reporting fatigue as an outcome. Manuscripts were reviewed by 2 authors, inclusion was based on consensus. Next, children with new onset IBD were asked to complete the IMPACT-III, a health-related quality of life (QOL) questionnaire at 4 months after diagnosis, to capture response to treatment. Children <9 years who are unable to reliably report fatigue by themselves were excluded. Four fatigue-related questions were analyzed (Table 1). Each question has 5 response options each assigning 25 points according to the users’ guide (i.e. 0, 25, 50, 75, 100 points when the latter implies higher QOL and lack of fatigue). Remission was defined as wPCDAI<12.5 for CD and PUCAI<10 for UC. Explicit clinical and demographic data were prospectively recorded. Results In the systematic review only 12 studies reported on fatigue in pediatric IBD were identified,8 of which reported fatigue as primary outcome and 1 was an intervention trial. None provided rate of fatigue,also since unlike in adults,no PIBD-specific fatigue measuring scale was available. A total of 86 children were included in the inception cohort (median age 14.5[IQR 12.8-15.9] years,39[45%] females;59[69%] CD,27[31%] UC;47(55%) in clinical remission). At 4 months, only 4 patients (4.6%) selected the highest score (100) for all 4 questions, i.e. no fatigue). Forty four children (53%) had min 2 questions with a score <100,of whom 27 (61%) were in clinical remission. Twenty-eight children (33%) did not score 100 in neither of the 4 questions and 12(14%) had scored all 4 questions≤50. Of the 47 children who were in clinical remission,33(70%) had at least 2 of the 4 questions scored<100. Conclusion The reporting and assessment of fatigue among pediatric IBD literature is extremely limited. This study is the first to report fatigue rate in children. We show that after induction treatment fatigue rate of any severity may be as high as 53%, moderate fatigue as 33% and severe fatigue as 14%. Fatigue was common also in those in clinical remission. Our results call for a more standardized tool of measuring fatigue in PIBD since its quantification can facilitate a more methodical management of this disabling and underreported symptom.