BackgroundWith the increasing prevalence of metabolic syndrome (MS), there is a need to track and predict the development of MS. In this study, we established a Markov model to explore the natural history and predict the risk of MS.MethodsA total of 21,777 Chinese individuals who had at least two consecutive health check-ups between 2010 and 2015 were studied. MS was defined using the Chinese Diabetes Society criteria. Twelve metabolic abnormal states (the no component state, four isolated component states, six 2-component states, and the MS state) were contained in each Markov chain. The transition probability was the mean of five probabilities for the transition between any two states in 2 consecutive years.ResultsThe dyslipidemia or overweight/obesity components were most likely to initiate the progress of MS in individuals aged 18–49. However, for individuals over 50 years old, the most likely initiating component of MS was dyslipidemia or hypertension. People who initially had dyslipidemia were most likely to develop the combined state of dyslipidemia with overweight/obesity before the age of 50, but after 50 years of age, the state of dyslipidemia merged with hypertension was the most common. Subjects (with the exception of males over 50 years of age who initially had an isolated state of hyperglycemia) who initially had an isolated state of overweight/obesity, hypertension, or hyperglycemia were most likely to develop a combination of one of these initial states with dyslipidemia. Males who initially had isolated hyperglycemia tended to develop hypertension after age 50. There was a greater chance for subjects who initially had an isolated hyperglycemia state or 2-component state that contained hyperglycemia to develop MS within 10 years compared to those who initially had other abnormal metabolic states.ConclusionsThe occurrence of MS primarily began with overweight/obesity or dyslipidemia in people aged 18–49. However, for those over 50 years old, MS primarily initiated under the conditions of dyslipidemia or hypertension. When MS started under the conditions of overweight/obesity, hypertension or hyperglycemia, dyslipidemia tended to occur next. People who initially had isolated hyperglycemia or a 2-component state that contained hyperglycemia had a higher risk of developing MS than those with other initiating states.

Aim: To examine the reliability and validity of the Geriatric Depression and the Patient Health Questionnaire-9 (PHQ-9) for evaluating depression in older adults.Methods: A total of 1546 participants aged ≥60 years were investigated face-to-face with the PHQ-9 and GDS-15 anonymously. Internal consistency reliability was evaluated with Cronbach's α, and structural equation modeling was used to study the construct validity of the scale. Logistic regression was used to discusses the impact of demographic characteristics on the scale. Results:The consistency rate between the GDS-15 and PHQ-9 was 96.10%. The Cronbach's α and split-half reliability in the scales were >0.7. The model fit indices χ 2 /df., comparative fit index and root mean square error of approximation in the GDS-15 were 2.769, 0.815 and 0.077, respectively. The minimum fit function χ 2 in the PHQ-9 model was 93.742, with 27 df., the comparative fit index was acceptably low (comparative fit index 0.837) and the root mean square error of approximation was acceptably high (root mean square error of approximation 0.118). Item standardized path regression coefficients of the GDS-15 model varied between 0.07 and 0.76, among which the coefficients of item 2 and item 9 were 0.12 and 0.07, respectively. Whereas in the PHQ-9, the item standardized path regression coefficients were high (r > 0.45), except for item 3 (r = 0.34). The GDS-15 was affected by urbanrural distribution (OR = 2.104, P = 0.027), whereas the PHQ-9 was affected by sex (OR = 4.266, P = 0.007). Conclusions:The similar psychometric performance of the PHQ-9, along with its ease of use and relative brevity, makes it attractive compared with the longer GDS-15 for use in Chinese older adults, whereas the influence of sex distribution on the PHQ-9 should be paid attention to. Geriatr Gerontol Int 2020; 20: 138-143. . The results of the Geriatric Depression Scale-15 (GDS-15) and Patient Health Questionnaire-9 (PHQ-9) scales were used as dependent variables (1 = depression, 0 = non-depression); age (1 = 60-69, 2 = 70-79, 3 = ≥80), sex (1 = male, 2 = female), urban-rural distribution (1 = city, 2 = rural) and education level (1 = illiteracy, 2 = primary school, 3 = junior high school and above) were used as independent variables into the model for analysis. GDS-15 and PHQ-9 in older adults