Depression among caregivers of the frail elderly in urban Japan

A cross-sectional study was conducted in order to investigate the various factors related to the depression in caregivers of the elderly in need of care in urban Japan. The caregivers answered a self-administered questionnaire about various factors that may affect their depression, and also completed a Center for Epidemiologic Studies Depression Scale evaluation (CES-D). Compared with non-depressed caregivers, depressed caregivers attended the elderly longer, while time spent for physical caregiving did not differ between the two groups. Even after controlling confounding factors, time of attending the elderly was an independent factor related to caregiver's depression.     

Risk factors for depression in elderly people: a prospective study.

In 1982-1983 a random sample of 1486 people aged 65 years and above was generated from general practitioner lists; 1070 were interviewed in the community using the Geriatric Mental State and a Social History questionnaire. The cohort was followed up by interview 3 years later. At year 3 the diagnostic computer program AGECAT diagnosed 44 incident cases of depression. Information from the depressed group's initial and further interviews was compared with a control group (which excluded cases of affective or organic mental illness). Univariate analysis yielded three factors that were significantly associated with the development of depression 3 years later: a lack of satisfaction with life; feelings of loneliness; and smoking. Multivariate analysis confirmed their independent effects and revealed 2 further factors attaining significance: female gender and a trigger factor, bereavement of a close figure within 6 months of the third-year diagnosis. Some other factors traditionally associated with depression, such as poor housing, marital status and living alone, failed to attain significance as risk factors.     

Depression in Chinese elderly populations

There is a scarcity of systematic reports on the prevalence of depression in Chinese elderly populations. The available reports used a variety of diagnostic and screening instruments to identify elderly depression. Furthermore, samples were drawn from different elderly populations. In spite of these difficulties, the reports are consistent in terms of the prevalence rates of severe depression which is lower than those reported in Western studies; though the prevalence rates of depressive symptoms approach those of most Western countries. However, the Chinese elderly showed a particular sensitivity to social factors either as vulnerability or protection factors for depression. There is a consistent social dimension in depressive complaints by Chinese elderly; hence the need to construct specific culturally sensitive instruments and to establish within ethnic group norms and diagnostic criteria for elderly depression. Current intervention efforts to prevent and ameliorate depression in the community‐dwelling elderly will be discussed.     

Depression in an elderly population in Turkey

The prevalence of depression was investigated in 2 groups of elderly people in Turkey living in a public old people's home and in their own home. Depression was assessed according to the Hamilton Rating Scale for Depression, not clinical diagnosis. The prevalence of depression was 35% (33% for men, 37% for women) for the total population, 41% (40% for men, 42% for women) for those living in an institution and 29% (24% for men, 33% for women) for those living at home. Not being able to work actively, poor religious interest, widowhood, alcohol consumption, older age and physical disability were significantly correlated with the prevalence of depression. Institutional care was also associated with depression. The prevalence of depression was not related to sex, education, occupation or economic status.     

Depression among caregivers of the elderly in need of care and their service utilization: A pilot study

Twenty-four community residing elderly people in need of care, who were registered with the municipal welfare center in Miyagi Prefecture, Japan, and their principal caregivers participated in the study. The principal caregivers completed a self-administered questionnaire involving their demographic status, provided data on their utilization of formal services and completed the Center for Epidemiologic Studies Depression Scale (CES-D). The health visitors examined the activities of daily living (ADL) and mental status of these 24 elderly individuals. More than half the caregivers appeared to be depressed. The non-depressed caregivers used significantly more services than the depressed caregivers even after the caregivers' age was statistically controlled.     

Depression in the elderly: A review and update

Depression is a major source of suffering and disability among the elderly. It may be overlooked among elders because of its co‐occurrence with the aging process, grief, dementia, and medical illness. The author reviewed the field in 1994, and in this paper describes important developments of the past two decades. These include evolving concepts in diagnosis such as minor depression, vascular depression, and the depression of Alzheimer's disease. Complex inter‐relationships among depression and medical diseases have been explored, especially cardiovascular and cerebrovascular disease. During this period selective serotonin reuptake inhibitors and serotonin/norepinephrine reuptake inhibitors have largely replaced tricyclic antidepressants and monoamine oxidase inhibitors, while electroconvulsive therapy has continued to be utilized. Repetitive transcranial stimulation is in its infancy and its role in geriatric depression is being defined. Developments in psychotherapy have solidified its place in the treatment of geriatric depression, particularly cognitive behavioral therapy.     

Living alone is associated with depression among the elderly in a rural community in Japan

Aim: This study aimed to investigate factors associated with depression in a sample of elderly Japanese individuals in a rural community and to examine differences among factors associated with individuals living alone or living with others. Methods: Using a population‐based sample from rural Japan, we assessed a total of 1552 participants aged 65 years or older by mailing a survey and evaluating responses based on the Geriatric Depression Scale. Factors associated with depression were also examined. Results: We received 964 valid responses. Depressed subjects comprised 20.5% of the sample. Living alone was significantly related to depression. In individuals living alone, depression was associated with loss of appetite, suicidal ideation, financial strain, and worries in life. However, multiple linear regression analyses revealed that the influence of living alone was negated by having a good social support system. Conclusion: These findings confirm that living alone is an important factor in depression among the elderly in a rural part of Japan. Results also confirm what others have found in Western cultures: high levels of social support, awareness of receiving social support, and willingness to receive assistance may reduce the risk of depression.     

Factor study of the Geriatric Depression Scale.

A sample of 234 people between the ages of 60 and 95 was studied using the Brink-Yesavage Geriatric Depression Scale (GDS). The GDS has good concurrent validity with the Hamilton Rating Scale for Depression with the Melancholia Scale (r = 0.77), which confirms the clinical utility of this scale. A factor analysis of principal components with an oblimin rotation was performed. The results obtained imply that structural validation cannot be made in relation to Beck's cognitive model of depression. It can be concluded that the elimination of the somatic items does not add any theoretical correspondence with the model, as the factors tend to group the various items into one dimension.     

The prevalence of depressive symptoms and predisposing factors in an elderly Chinese population

In a survey of elderly Chinese aged 70 years and over living in Hong Kong selected by stratified random sampling, the prevalence of depression was determined using the 15-item Geriatric Depression Scale using a cut-off point of 8 (sensitivity 96.3% and specificity 87.5% for this population). Subjects with moderate to severe cognitive impairment (CAPE I/O score ≤ 7) were excluded. There were 877 men and 734 women. The adjusted overall prevalence for this population was 29.2% for men and 41.1% for women. The prevalence increased with age in men and was higher in women than in men. Univariate analysis identified many factors in the following areas that were associated with depression: socioeconomic characteristics, functional ability, physical health and social support. Stepwise logistic regression identified 16 factors predictive of depression: socioeconomic characteristics, such as borderline living expenses and dissatisfaction with living arrangement; poor social support, such as absence of an informal carer when ill, few relatives to turn to, and infrequent contact with neighbours and friends; functional disability, as indicated by a Barthel Index < 15, urinary incontinence and inability to do housework; and poor physical health – poor self perceived health, poor vision, difficulty with chewing, history of mental illness, frequent hospital admissions and increased level of symptoms such as poor memory, constipation and dizziness. Some of these factors may be amenable to intervention, and such measures may be important in reducing the high prevalence of depression in elderly people.     

Depression among the rural elderly. A study of prevalence and correlates

A large sample (N = 3159) of noninstitutionalized older adults (aged 65 to 105 years) residing in two rural Iowa counties participated in an assessment of a wide range of health-related factors, including depression. Prevalences of significant depressive symptomatology (9.0%; based on a modified version of the Center for Epidemiological Studies Depression Scale [CES-D]) and clinical depression (2.9%; based on self-report of Research Diagnostic Criteria [RDC]-like criteria) were low. The relationships between several demographic measures and the depression indices were examined. While expected sex differences were obtained for the CES-D, they were not found for the depression RDC. Subjects who lived alone and subjects with lower incomes were more at risk for depression. There was also evidence that being married and having a higher educational level were associated with lower risk for depression as measured by the CES-D (but not the RDC). The role of social support in rural communities was discussed as a factor contributing to the low rate of depression found in this study. The importance of sex, social support, and economic resources in accounting for depression among the elderly was also discussed.     

Blood pressure as a risk factor for depression in elderly people: a prospective study

A total of 1070 men and women aged 65 years and over living in the community in Liverpool were interviewed using the Geriatric Mental State. Diagnoses of depression at case and subcase level were made using the GMS-AGECAT package from an initial interview and at follow-up three years later. Data relating to blood pressure at year 0 was available on 748 subjects. Men not taking anti-hypertensives or antidepressants with diastolic blood pressure greater than 85 mmHg were significantly less likely to be subcases than men with low or normal diastolic pressure. People in this group were also significantly less likely to be cases 3 years later. There were no other significant findings. These results do not support an association between low blood pressure and coincidental or future subcase- or case-level depressive illness.     

Social capital and depression: evidence from urban elderly in China

Objectives: To study the relationship between social capital and depression among older adults from urban China and the mediating effect of social support on the influence of social capital on depression.

Methods: Data were collected from face-to-face interviews targeting older adults (N = 928, response rate = 68.1%) aged over 60 years residing in Hangzhou, China, in 2013. Indicators of social capital included both cognitive (trust and reciprocity) and structural (social network and social participation) aspects. The dependent variable depression was measured by the Geriatric Depression Scale, social support was measured by the Multidimensional Scale of Perceived Social Support, and sociodemographic variables (age, education, and household income) and physical function were controlled for analysis. The data were analyzed by factor analysis and a hierarchical regression model.

Results: Trust, reciprocity, and social network were significantly associated with geriatric depression after controlling. Social participation was not correlated with geriatric depression. Social support partially mediated the relationships between social capital and geriatric depression.

Conclusion: This study provides new evidence that social capital effectively mediates geriatric depression directly and indirectly. The intervention of social capital on depression should therefore consider the two pathways. Future longitudinal studies should help further understand the mechanisms linking social capital and depression.     

Depression among caregivers of the disabled elderly in southern Japan

The present study was conducted in an attempt to investigate factors related to depression of caregivers who looked after the disabled elderly residing in a community in southern Japan. A questionnaire survey was carried out of 45 pairs of caregivers and the disabled elderly who received regular visits from a practice nurse, who was located in Onga County, Fukuoka, in southern Japan. Twenty-four out of 45 caregivers (53.3%) scored above the conventional cut-off of the Center for Epidemiologic Studies Depression Scale (CES-D). The proportion of children-in-law caregivers was significantly smaller (0% vs. 23.8%, P = 0.01) and the proportion of caregivers who had consulted a physician within 1 month prior to the study was greater in the depressed than that in the non-depressed (79.2% vs. 47.6%, P = 0.03). The elderly whose caregivers were depressed (group 1) had more behavioural disturbances than those of the non-depressed caregivers (group 2) (1.92+/-2.38 vs. 0.52+/-0.87, P = 0.01) A multiple logistic regression analysis revealed that only behavioural disturbance was positively related to depression (Odds ratio: 4.29, 95% confidence interval: 1.28-14.37). More behavioural disturbances led the caregivers to depression or the depressed caregivers failed to take care of the elderly, which resulted in an increase in the number of the behavioural disturbances of the elderly.     

De novo mania among elderly people.

De novo mania is defined as the occurrence of a first manic episode in a patient with no history of mood disorder, after exclusion of organic etiologies. Although it is believed to be rare in elderly populations, the authors nonetheless report 6 cases encountered over a 2-year period. The literature regarding mania among elderly people is reviewed, and the authors formulate their recommendations in view of more frequent recognition and better management of these patients.     

产后抑郁的有关心理、社会和生物学因素研究

目的调查产后抑郁的发生率以及相关的生物、心理、社会因素。方法对299名产妇在产后第3天用Edinburgh产后抑郁量表(EPDS)进行评定,并收集有关的心理社会因素以及产科因素。其中的117名完成产后第42天的EPDS评定。结果产后抑郁的发生率为23.08%,家庭支持等心理社会因素和产后抑郁密切相关。结论产后抑郁的发生具有一定的社会和心理因素。     

The botany survey: A longitudinal study of depression and cognitive impairment in an elderly population

An 8-year-long longitudinal study of elderly people in Botany (Sydney) has provided data on the prevalence, incidence and outcome of cognitive impairment and depression in this population. In 1985, a random sample of 146 persons aged 65 years or more, living in their own homes, were assessed using the Brief Assessment Schedule, depression ratings and cognitive tests. Follow-up interviews were conducted after 2, 4, 6 and 8 years. Data from separate hostel and nursing home studies were used when estimating prevalence rates. The estimated prevalence and annual incidence of definite dementia in Botany were, respectively, 14% (3.5% severe) and 2.5%. Among elderly people living at home the prevalence of definite dementia was 11%; 23% of our community sample suffered dementia during the 8 years. The prevalence and minimum annual incidence of depressive disorders were, respectively, 12.5% and 2.0%. Among those living at home the prevalence was 12.3%. Dementia was associated with a high mortality rate, but the apparently increased mortality of depressed subjects did not reach significance, probably because numbers were relatively small; a high proportion of the deceased had comorbid cognitive impairment. Some depressions eventually remitted.     

Prevalence and correlates of late-life depression compared between urban and rural populations in Korea

BACKGROUND: The aetiology of late-life depression has received relatively little research in developing countries. Urban and rural populations have rarely been sampled in the same study. OBJECTIVES: To investigate demographic factors associated with depression and depressive symptoms in an urban and rural sample of older Korean people. METHODS: A community survey of residents aged 65 or over was conducted in an urban and a rural area within Kwangju, South Korea. The Korean Form of the Geriatric Depression Scale (KGDS) was administered. Associations with demographic, socio-economic factors and cognitive function (MMSE) were investigated for depression categorised according to a previously validated cut-off. RESULTS: The sample comprised 485 urban-dwelling and 649 rural-dwelling participants. No difference was found between urban and rural samples for prevalence rates of depression. However associations with independent variables varied between the areas. In the urban sample, increased age, low education, manual occupation and current rented accommodation were independently associated with depression. Only low education was associated with depression in the rural sample. The interaction with sample area was strongest for age (p < 0.01) and persisted after further adjustment for cognitive function. CONCLUSIONS: Adverse socio-economic status was strongly associated with depression and appeared to operate across the life-course. While no evidence was found for urban-rural differences in prevalence rates of depression, factors associated with depression differed between these populations.