Scholars@Duke
Celia F. Hybels

Celia F. Hybels

Associate Professor Emerita in Psychiatry and Behavioral Sciences
Psychiatry & Behavioral Sciences, Adult Psychiatry & Psychology
celia.hybels@duke.edu
Box 3003 Med Ctr, Durham, NC 27710
Room 1505 Blue Zone, Durham, NC 27710

Selected Publications

When Shepherds Shed: Trajectories of Weight-Related Behaviors in a Holistic Health Intervention Tailored for US Christian Clergy.

Journal Article J Relig Health · June 2024 Maintaining healthy behaviors is challenging. Based upon previous reports that in North Carolina (NC), USA, overweight/obese clergy lost weight during a two-year religiously tailored health intervention, we described trajectories of diet, physical activity ... Full text Link to item Cite

The Gap in Mental Health Service Utilization Among United Methodist Clergy with Anxiety and Depressive Symptoms.

Journal Article J Relig Health · June 2023 Clergy are tasked with multiple interpersonal administrative, organizational, and religious responsibilities, such as preaching, teaching, counseling, administering sacraments, developing lay leader skills, and providing leadership and vision for the congr ... Full text Link to item Cite

Changes in Sabbath-Keeping and Mental Health Over Time: Evaluation Findings From the Sabbath Living Study

Journal Article Journal of Psychology and Theology · June 1, 2022 Work-related stress is experienced at a high level in the United States. Clergy are particularly likely to over-extend themselves to act on their sacred call. Sabbath-keeping may offer a practice that is beneficial for mental health, yet many Protestant cl ... Full text Cite

Age differences in trajectories of depressive, anxiety, and burnout symptoms in a population with a high likelihood of persistent occupational distress.

Journal Article International psychogeriatrics · January 2022 ObjectivesWork in occupations with higher levels of occupational stress can bring mental health costs. Many older adults worldwide are continuing to work past traditional retirement age, raising the question whether older adults experience depress ... Full text Cite

Are changes in positive mental health associated with increased likelihood of depression over a two year period? A test of the mental health promotion and protection hypotheses.

Journal Article J Affect Disord · June 1, 2020 This paper investigates the mental health promotion and protection (MHPP) model of reducing depression. Data are from the Clergy Health Initiative Longitudinal Survey of United Methodist ministers in North Carolina that included the Mental Health Continuum ... Full text Link to item Cite

A prospective study of clergy spiritual well-being, depressive symptoms, and occupational distress.

Journal Article Psychology of Religion and Spirituality · January 1, 2020 Work, when stressful, can be dispiriting. There are bidirectional and longitudinal links between occupational stress and depressive symptoms. Also, higher levels of religious participation are associated with lower levels of depressive symptoms and work di ... Full text Cite

Persistent Depressive Symptoms in a Population With High Levels of Occupational Stress: Trajectories Offer Insights Into Both Chronicity and Resilience.

Journal Article J Psychiatr Pract · November 2018 Religious participation and spirituality are linked to good mental health. However, clergy may experience more depression than is observed in the general population, which may be due in part to high job strain. The objectives of this study were to identify ... Full text Link to item Cite

Acculturation, depression and oral health of immigrants in the USA.

Journal Article Int Dent J · August 2018 OBJECTIVES: The objectives were to describe the oral health status of immigrants in the USA, describe the association between acculturation and oral health by accounting for the effects of depression and to explore the effects of interaction between accult ... Full text Link to item Cite

Trends in decayed teeth among middle-aged and older adults in the United States: socioeconomic disparities persist over time.

Journal Article J Public Health Dent · September 2016 OBJECTIVES: While trends in tooth loss among older adults have been well documented and show a decline over the last few decades, little is known about trends in tooth decay which may lead to tooth loss. The study aim was to examine trends in tooth decay a ... Full text Link to item Cite

Heterogeneity in the three-year course of major depression among older adults.

Journal Article Int J Geriatr Psychiatry · July 2016 OBJECTIVE: The objective of this research was to identify distinct trajectories of recovery in older depressed patients in order to identify optimal samples and points for interventions. METHODS: The sample was 368 patients ages 60 years and older diagnose ... Full text Link to item Cite

Late-life Depression Modifies the Association Between Cerebral White Matter Hyperintensities and Functional Decline Among Older Adults.

Journal Article Am J Geriatr Psychiatry · January 2016 OBJECTIVE: Vascular lesions seen through brain imaging as hyperintensities are associated with both depression and functional impairment in older adults. Our objective was to determine if the relationship between the volume of cerebral white matter hyperin ... Full text Link to item Cite

Trajectories of depressive symptoms and oral health outcomes in a community sample of older adults.

Journal Article Int J Geriatr Psychiatry · January 2016 OBJECTIVE: Adverse outcomes associated with chronic depressive symptoms are of clinical importance. The objective was to identify subgroups of older adults based on their trajectories of depressive symptoms over a 10-year period and determine if these subg ... Full text Link to item Cite

Epidemiology of psychiatric illness

Chapter · January 1, 2016 The science of epidemiology has much to offer in assisting clinical investigators and practicing psychiatrists to place the work on inpatient units and outpatient clinics into context. Epidemiologists first emphasize the importance of case identification a ... Full text Cite

Social stratification and tooth loss among middle-aged and older Americans from 1988 to 2004.

Journal Article Community Dent Oral Epidemiol · December 2014 OBJECTIVES: Tooth retention has improved over the past few decades, but it is not known whether these trends have been observed across all demographic/socioeconomic subgroups. We examined number of missing teeth among dentate individuals (n = 9,113) as wel ... Full text Link to item Cite

Vascular lesions and functional limitations among older adults: does depression make a difference?

Journal Article Int Psychogeriatr · September 2014 BACKGROUND: The association between disability and depression is complex, with disability well established as a correlate and consequence of late life depression. Studies in community samples report that greater volumes of cerebral white matter hyperintens ... Full text Link to item Cite

Inflammation and Coagulation as Mediators in the Relationships Between Religious Attendance and Functional Limitations in Older Adults.

Journal Article J Aging Health · June 2014 OBJECTIVE: The aim of this study was to examine inflammation and coagulation, which are positively linked to disability and inversely linked to increased religious attendance, as mediators in the cross-sectional relationships between religious attendance a ... Full text Link to item Cite

Latent subtypes of depression in a community sample of older adults: can depression clusters predict future depression trajectories?

Journal Article J Psychiatr Res · October 2013 Identifying sources of heterogeneity in late life depression remains an important focus of psychiatric investigation. Community samples are particularly informative since many older adults have clinically significant depressive symptoms but fail to meet cr ... Full text Link to item Cite

The complex association between religious activities and functional limitations in older adults.

Journal Article Gerontologist · October 2012 PURPOSE OF THE STUDY: To examine the longitudinal associations between 3 dimensions of religious involvement-religious attendance, use of religious media, and private religious activities-and 3 domains of functional status-limitations in basic activities o ... Full text Link to item Cite

Age differences in symptom expression in patients with major depression.

Journal Article Int J Geriatr Psychiatry · June 2012 OBJECTIVE: The aim of the study was to compare symptom expression in primarily middle-aged (<60) and older (60+) patients who were depressed and determine if symptom profiles differed by age. METHODS: Patients diagnosed with major depression (N = 664) were ... Full text Link to item Cite

Trajectory classes of depressive symptoms in a community sample of older adults.

Journal Article Acta Psychiatr Scand · June 2012 OBJECTIVE: To identify trajectories of depressive symptoms in older community residents. METHOD: Depressive symptomatology, based on a modified Center for Epidemiological Studies-Depression scale, was obtained at years 0, 3, 6, and 10, in the Duke Establis ... Full text Link to item Cite

Change in stress and social support as predictors of cognitive decline in older adults with and without depression.

Journal Article Int J Geriatr Psychiatry · December 2011 OBJECTIVE: The relationship between stress, social support, and cognition in geriatric depression is complex. In this study, we sought to examine whether an increase in stressful life events or a decrease in social support would lead to subsequent cognitiv ... Full text Link to item Cite

Heterogeneity in symptom profiles among older adults diagnosed with major depression.

Journal Article Int Psychogeriatr · August 2011 BACKGROUND: Late-life depression may be undiagnosed due to symptom expression. These analyses explore the structure of depressive symptoms in older patients diagnosed with major depression by identifying clusters of patients based on their symptom profiles ... Full text Link to item Cite

Epidemiology and Geriatric Psychiatry

Journal Article · April 19, 2011 Full text Cite

Social support modifies the relationship between personality and depressive symptoms in older adults.

Journal Article Am J Geriatr Psychiatry · February 2011 OBJECTIVE: To explore the relationship between personality, social support, and depression in older adults, identify the personality trait and social support dimension most closely associated with depression, and determine whether the relationship between ... Full text Link to item Cite

Shortness of breath as a predictor of depressive symptoms in a community sample of older adults.

Journal Article Int J Geriatr Psychiatry · October 2010 OBJECTIVES: Physical symptoms are known to be associated with late life depression both cross-sectionally and over time. We attempted to determine if self-reported shortness of breath (SoB) is associated with depressive symptoms at long-term (3-year) follo ... Full text Link to item Cite

Trajectories of mobility and IADL function in older patients diagnosed with major depression.

Journal Article Int J Geriatr Psychiatry · January 2010 OBJECTIVE: Research has shown an association between depression and functional limitations in older adults. Our aim was to explore the latent traits of trajectories of limitations in mobility and instrumental activities of daily living (IADL) tasks in a sa ... Full text Link to item Cite

The complex relationship between depressive symptoms and functional limitations in community-dwelling older adults: the impact of subthreshold depression.

Journal Article Psychol Med · October 2009 BACKGROUND: Depressive symptoms above screening thresholds have been shown to predict functional decline in older adults. Less is known about the impact of subthreshold depression, and whether more symptoms confer significantly greater risk compared to few ... Full text Link to item Cite

Epidemiology and geriatric psychiatry.

Journal Article Am J Geriatr Psychiatry · August 2009 Full text Link to item Cite

Profiles of depressive symptoms in older adults diagnosed with major depression: latent cluster analysis.

Journal Article Am J Geriatr Psychiatry · May 2009 OBJECTIVE: To explore the underlying structure of symptom presentation in older adults with major depression by identifying homogeneous clusters of individuals based on symptom profiles. DESIGN: Secondary data analysis using latent class cluster analysis. ... Full text Link to item Cite

The course of depressive symptoms in older adults with comorbid major depression and dysthymia.

Journal Article Am J Geriatr Psychiatry · April 2008 OBJECTIVE: To examine the course of depressive symptoms in older patients with comorbid major depression and dysthymia. DESIGN: Secondary data analysis using both proportional hazards modeling and a repeated measures mixed model. SETTING: Clinical Research ... Full text Link to item Cite

Profiles of Functional Impairment in Older Patients Treated for Major Depression

Conference AMERICAN JOURNAL OF GERIATRIC PSYCHIATRY · March 1, 2008 Link to item Cite

Epidemiology of psychiatric illness

Journal Article · January 1, 2008 The science of epidemiology has much to offer in assisting clinical investigators and practicing psychiatrists to place the work on inpatient units and outpatient clinics into context. Epidemiologists first emphasize the importance of case identification a ... Full text Cite

The combined effect of visual impairment and cognitive impairment on disability in older people.

Journal Article J Am Geriatr Soc · June 2007 OBJECTIVES: To determine the risk of disability in individuals with coexisting visual and cognitive impairment and to compare the magnitude of risk associated with visual impairment, cognitive impairment, or the multimorbidity. DESIGN: Prospective cohort. ... Full text Link to item Cite

The combined impact of cognitive and visual impairment on disability.

Conference JOURNAL OF THE AMERICAN GERIATRICS SOCIETY · April 1, 2007 Link to item Cite

Perception of unmet basic needs as a predictor of depressive symptoms among community-dwelling older adults.

Journal Article J Gerontol A Biol Sci Med Sci · February 2007 BACKGROUND: In previous studies we found that, among older adults (>64 years), perception that basic needs were not being met increased mortality risk and risk for functional decline. In this study, we determined, controlling for reported income and functi ... Full text Link to item Cite

Response letter to Dr. Cheng [2]

Journal Article Journal of the American Geriatrics Society · January 1, 2007 Full text Cite

Vascular nutritional correlates of late-life depression.

Journal Article Am J Geriatr Psychiatry · September 2006 OBJECTIVE: The authors sought to examine the association of vascular nutritional factors and depression in an elderly cohort of depression (currently and recently depressed) and comparison (never depressed) subjects. METHOD: Nutrient intake over the past y ... Full text Link to item Cite

Provider characteristics related to antidepressant use in older people.

Journal Article J Am Geriatr Soc · June 2006 OBJECTIVES: To determine whether the characteristics of the usual medical care providers of older antidepressant users changed between 1986 and 1997 with the introduction of selective serotonin reuptake inhibitors. DESIGN: Longitudinal study. SETTING: Five ... Full text Link to item Cite

Sociodemographic characteristics of the neighborhood and depressive symptoms in older adults: using multilevel modeling in geriatric psychiatry.

Journal Article Am J Geriatr Psychiatry · June 2006 OBJECTIVE: Neighborhood sociodemographic characteristics may be important to the mental health of older adults who have decreased mobility and fewer resources. Our objective was to examine the association between neighborhood context and level of depressiv ... Full text Link to item Cite

Partial remission. A common outcome in older adults treated for major depression.

Journal Article Geriatrics · April 2006 Major depression can affect up to 10% of older adults in clinical samples. Longitudinal studies of older adults with major depression report that a significant proportion of patients do not fully recover. Partial remission or symptoms of major depression t ... Link to item Cite

Metabolic syndrome predicts mobility decline in a community-based sample of older adults.

Journal Article J Am Geriatr Soc · March 2006 OBJECTIVES: To determine whether metabolic syndrome is an independent predictor of decline in mobility in an elderly community sample. DESIGN: Biracial community-based prospective cohort study. SETTING: Urban and rural areas of central North Carolina. PART ... Full text Link to item Cite

Residual symptoms in older patients treated for major depression.

Journal Article Int J Geriatr Psychiatry · December 2005 OBJECTIVE: The purpose of this study was to identify residual symptoms in a sample of older adults treated for major depression and compare individual symptoms present at baseline with those at three months by remission status. METHODS: The sample was comp ... Full text Link to item Cite

Origins of depression in later life.

Journal Article Psychol Med · September 2005 BACKGROUND: Despite the burden of depression in late life, its origins present a paradox to investigators and clinicians alike. METHOD: We review biological (genetics and heredity factors, neurotransmitter dysfunction, endocrine changes, vascular disorders ... Full text Link to item Cite

Predictors of partial remission in older patients treated for major depression: the role of comorbid dysthymia.

Journal Article Am J Geriatr Psychiatry · August 2005 OBJECTIVE: The authors studied demographic, clinical, social, and perceived health and well-being factors as predictors of partial remission in older patients treated for major depressive disorder (MDD). METHODS: The sample included 186 patients who met DS ... Full text Link to item Cite

Predictors of antidepressant use among older adults: have they changed over time?

Journal Article Am J Psychiatry · April 2005 OBJECTIVE: Antidepressant use increased substantially among older adults with the introduction of the new-generation medications such as the selective serotonin reuptake inhibitors. The authors analyzed data from two follow-up intervals-1986-1987 to 1989-1 ... Full text Link to item Cite

Perception of unmet basic needs as a predictor of mortality among community-dwelling older adults.

Journal Article Am J Public Health · February 2005 OBJECTIVES: We sought to determine whether, among older adults (>65 years), a perception that their basic needs are not being met increased mortality risk and whether this risk varied by race/ethnicity. METHODS: We used Cox proportional hazards modeling to ... Full text Link to item Cite

What symptoms of depression predict mortality in community-dwelling elders?

Journal Article J Am Geriatr Soc · December 2004 OBJECTIVES: To determine which symptoms of depression are most likely to increase the risk of mortality in a biracial sample of older adults. DESIGN: Cross-sectional and longitudinal study. SETTING: Baseline and mortality follow-up in urban and rural North ... Full text Link to item Cite

Black-white differences in antidepressant use in an elderly community sample.

Conference JOURNAL OF THE AMERICAN GERIATRICS SOCIETY · April 1, 2004 Link to item Cite

Epidemiology of late-life mental disorders.

Journal Article Clin Geriatr Med · November 2003 This article reviews the prevalence and incidence of mental disorders in older adults. The authors outline the epidemiologic challenges in determining the frequency of mental disorders in late-life and discuss issues that are critical for understanding the ... Full text Link to item Cite

Apolipoprotein E genotype and subcortical vascular lesions in older depressed patients and control subjects.

Journal Article Biol Psychiatry · October 1, 2003 BACKGROUND: Several studies have linked geriatric depression with cerebrovascular disease. The apolipoprotein E gene (APOE) epsilon 4 allele has been associated with a variety of late-life neuropsychiatric disorders, including Alzheimer's disease, vascular ... Full text Link to item Cite

The association of depression and mortality in elderly persons.

Journal Article J Gerontol A Biol Sci Med Sci · February 2002 Full text Link to item Cite

Sex differences in the relationship between subthreshold depression and mortality in a community sample of older adults.

Journal Article Am J Geriatr Psychiatry · 2002 The authors investigated the increased risk of mortality from subthreshold depression and examined differences in risk by gender. Data from the Duke University Established Populations for Epidemiologic Studies of the Elderly (EPESE) longitudinal study of 4 ... Link to item Cite

The association of depression and mortality in elderly persons: a case for multiple, independent pathways.

Journal Article J Gerontol A Biol Sci Med Sci · August 2001 BACKGROUND: The evidence for an association between depression and mortality among community-dwelling elderly persons remains inconclusive, although it is well established for younger individuals. Extant studies suggest that this association weakens when a ... Full text Link to item Cite

Toward a threshold for subthreshold depression: an analysis of correlates of depression by severity of symptoms using data from an elderly community sample.

Journal Article Gerontologist · June 2001 PURPOSE: The prevalence of depressive symptoms in elderly adults is high, yet the criteria to identify clinically significant depression may leave many elders undiagnosed and untreated. We explored the demographic and risk factor profiles of two groups, on ... Full text Link to item Cite

Antidepressant use by race.

Journal Article Am J Psychiatry · June 2001 Full text Link to item Cite

Sedative, hypnotic, and antianxiety medication use in an aging cohort over ten years: a racial comparison.

Journal Article J Am Geriatr Soc · September 2000 OBJECTIVES: Prescriptions of sedatives, hypnotics, and antianxiety medications have decreased over the past 15 years. However, racial differences have not been well investigated in controlled analyses. DESIGN: A prospective cohort study. SETTINGS AND PARTI ... Full text Link to item Cite

Marked differences in antidepressant use by race in an elderly community sample: 1986-1996.

Journal Article Am J Psychiatry · July 2000 OBJECTIVE: Prescriptions of antidepressant medications have increased significantly over the past 15 years across the life cycle. One overall correlate of medication use in older adults is race, with African Americans using fewer medications than whites. G ... Full text Link to item Cite

Social and personal resources and the prevalence of phobic disorder in a community population.

Journal Article Psychol Med · May 2000 BACKGROUND: Phobic disorder is one of the most prevalent psychiatric disorders in community populations and much attention has focused on the association of sociodemographic factors and social resources with the disorder. There has been little investigatio ... Full text Link to item Cite

Abbreviating the Duke Social Support Index for use in chronically ill elderly individuals.

Journal Article Psychosomatics · 1993 The 35-item Duke Social Support Index (DSSI) measures multiple dimensions of social support and has been used extensively in cross-sectional and longitudinal studies of aging. Epidemiological studies of chronically ill, frail elderly individuals often wish ... Full text Link to item Cite

Perceived social support, received social support, and depression among clergy

Journal Article Journal of Social and Personal Relationships We argue perceived support is best conceptualized as more a measure of how an individual appraises their situation rather than a true reflection of how much support they receive. To test this theory, we used survey data from the Clergy Health Initiative Pa ... Cite