Prevalence and risk factors of depression in the elderly nursing home residents in Singapore

Objectives: Depression is a common health problem in elderly nursing home (NH) residents and is often under-recognized and under-treated. This study aimed to determine the prevalence rates of depression and identify the risk factors associated with depression in the elderly NH population in Singapore.

Methods: A sample of 375 residents in six NHs in Singapore, aged 55 years and above, was assessed with the Structural Clinical Interview (SCID), based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria. The association of demographic, functional and health-related characteristics with depression was examined using multivariate logistic regression analyses.

Results: Overall point prevalence for depression in the elderly NH residents was found to be 21.1% (95% confidence intervals (CI): 17.1%–25.6%). The prevalence rate for minor depression in the elderly NH residents was 14.4% (95% CI: 11.1%–18.5%) and 6.7% (95% CI: 4.5%–9.8%) for major depression. Significant risk factors that were found to be associated with depression were length of stay for more than 2 years, known history of depression, pain, and no or lack of social contact.

Conclusion: The prevalence rates for depression were high among NH residents in Singapore. More attention is needed to care for the psychosocial needs of elderly NH residents in Singapore.     

Comorbidity of depression and anxiety in nursing home patients

OBJECTIVES: To assess the occurrence and risk indicators of depression, anxiety, and comorbid anxiety and depression among nursing home patients and to determine whether depression and anxiety are best described in a dimensional or in a categorical classification system. METHODS: DSM and subthreshold anxiety disorders, anxiety symptoms, major and minor depression and depressive symptoms were assessed in 333 nursing home patients of somatic wards of 14 nursing homes in the north west of the Netherlands with the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and the Geriatric Depression Scale (GDS). Comorbidity was studied along a severity gradient. Logistic regression analyses were carried out to identify demographic, health-related, psychosocial and care-related correlates of anxiety and depression. RESULTS: The prevalence of pure depression (PD) was 17.1%, of pure anxiety (PA) 4.8%, and of comorbid anxiety and depression (CAD) 5.1%. Comorbidity increased dependent on severity of both anxiety and depression. Different patterns of risk indicators were demonstrated for PA, PD and CAD for the investigated baseline characteristics. CONCLUSIONS: Comorbidity of anxiety and depression is most prevalent in the more severe depressive and anxious nursing home patients. The gradual increase of comorbidity of anxiety and depression dependent on the levels of severity of depression and anxiety suggests that for nursing home patients a dimensional classification of depression and anxiety is more appropriate than a categorical one. The observed differences in patterns of risk indicators for PA, PD and CAD support a distinguishing of anxiety and depression. Future studies are needed to assess the effect of treatment of PA, PD and CAD in nursing home patients.     

团体归因训练对抑郁症、焦虑症和强迫症的疗效

目的：验证团体归因训练对抑郁症、焦虑症和强迫症患者的临床治疗效果。方法：54例抑郁症、焦虑症和强迫症患者按照入组到开始治疗的时间分为3个基线组,每组进行为期8周的归因训练团体治疗,采用多基线实验设计,每隔2周评定汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HA-MA）,治疗前后评定抑郁自评量表（SDS）、焦虑自评量表（SAS）和社会功能缺陷筛选量表（SDSS）,强迫症组加测Yale-Brown强迫症量表（Y-BOCS）。结果：所有被试者治疗前后HAMD、HAMA、SDS、SAS量表得分差异均有统计学意义（t=18.41,19.85,6.33,6.97,P〈0.01）;强迫症组治疗前后Y-BOCS得分差异有统计学意义（t=5.47,P〈0.001）;所有被试治疗前后社会功能改善显著（Z=-6.41,P〈0.001）。结论：团体归因训练对抑郁症、焦虑症和强迫症患者治疗有效。     

Psychosis, depression and behavioural disturbances in Sydney nursing home residents: prevalence and predictors

BACKGROUND: There is wide variation in the rates of behavioural and psychological symptoms of dementia (BPSD) reported in nursing homes. AIMS: This study aimed to investigate: (1) the prevalence of BPSD in nursing home residents using the BEHAVE-AD; (2) the relationships of BPSD with (a) demographic, (b) dementia, (c) diurnal and (d) nursing home variables; and (3) the inter-relationships between different types of BPSD, as measured by subscales of the BEHAVE-AD. RESULTS: Over 90% of residents exhibited at least one behavioural disturbance. Specifically, there was evidence of psychosis in 60%, depressed mood in 42% and activity disturbances or aggression in 82% of residents. Younger, more functionally impaired residents with a chart diagnosis of psychosis had higher BPSD rates, as did those residing in larger nursing homes. Individual BPSD were significantly intercorrelated. CONCLUSIONS: BPSD are ubiquitous in nursing home residents. Behavioural disturbances are frequently associated with psychosis and/or depression. The findings suggest the need for psychogeriatric services to nursing homes and smaller facilities.     

The effect of fluoxetine on anxiety and depression symptoms in cancer patients

Little has been done to study the effectiveness of antidepressants in controlling anxiety/depression in a population of cancer patients. A double-blind placebo-controlled study was therefore designed to assess the effectiveness of 20 mg fluoxetine. Of 115 cancer patients who fulfilled entry criteria for levels of distress, 45 patients were randomized to a fluoxetine treatment group (FA) and 46 patients to a placebo group (PA) after a 1-week placebo period designed to exclude placebo responders. The Montgomery and Asberg Depression Scale (MADRS), the Hamilton Anxiety Scale (HAS), the Hospital Anxiety and Depression Scale (HADS), the Revised Symptom Checklist (SCL90-R) and the Spitzer Quality of Life Index (SQOLI) were used to assess the efficacy of fluoxetine. The response rate, defined by a HADS score lower than 8 after 5 weeks of treatment, was not significantly higher in the FA group (11%) compared to the PA group (7%). Compared to the PA group, patients in the FA group showed a significantly greater decrease in SCL90-R mean total score after 5 weeks, but not a greater decrease in HADS mean score. No difference between the two groups was found in observer-reported assessments (MADRS, HAS and SQOLI). Significantly more drop-outs were observed in the FA group (n=15) than in the PA group (n=7), although the frequencies of side-effects were not significantly different.     

The effect of music therapy on depression and physiological parameters in elderly people living in a Turkish nursing home: a randomized-controlled trial

Objective: This study was carried out in an effort to determine the effect of music therapy on depression and physiological parameters in elderly people who were living in a nursing home.

Method: The study was a randomized controlled trial. The study sample consisted of 64 elderly people who complied with the criteria of inclusion for the study. The data were collected using the ‘Elderly Information Form’ and ‘Geriatric Depression Scale’. The music group listened to music three days in a week during 8 weeks. The depression levels were assessed at baseline (week 0) and follow-up in the eight week.

Results: It was found that the difference between post-test depression scores of the two groups was found to be statistically significant (t = ?2.86, p <.01). The mean scores of post-test systolic blood pressure in the music group were found to be significantly lower than those of the control group (t = ?3.11, p < .05).

Conclusion: It was concluded that music therapy decreased the depression level and systolic blood pressure in elderly people. The study results implies that music therapy can be an effective practice for public health and home care nurses attempting to reduce depression and control physiological parameters of elderly people.     

The impact of depression and anxiety on well being, disability and use of health care services in nursing home patients

OBJECTIVE: To determine the impact of depression and anxiety on well being, disability and use of health care services among nursing patients. METHODS: The study-population consisted of 350 elderly nursing home patients from 14 nursing homes in the Netherlands. Well being, disability, use of health care services (i.e. assistance in ADL, paramedical care, number of medications) and depression and anxiety and other relevant characteristics (gender, age, education, marital status, urbanization, cognition, morbidity, social support) were measured cross-sectionally. Associations of well being, disability and use of health care services with independent baseline characteristics were assessed with bivariate and with multivariate analyses. RESULTS: Presence of depression and/or anxiety was associated with significantly less well being, but not with more disability. Presence of depression and/or anxiety was also significantly associated with four of the seven indicators of health care service use measured in this study: less assistance in ADL, more consultation of medical specialists, a higher mean number of medications and more use of antidepressants. CONCLUSION: Presence of depression and/or anxiety has a statistically and clinically significant negative impact on well being, but not on disability. Future studies should focus on interventions for improving the detection, diagnosis and treatment of depression and/or anxiety in the nursing home.     

Prevalence and predictors of depressive symptoms in a nursing home

The aim of the study was to identify the prevalence of depressive symptoms (GDS score) and predictors of mood changes over a 12-month period in 56 nursing home residents (13 males and 43 females; mean age 81.1 ± 8.6). At baseline, 48.2% of the residents who scores above 11 on the MMSE had a GDS score > 15. GDS score was associated with pain, disabling diseases and self-evaluation of health, and independently with dissatisfaction with the nursing home environment, low level of nursing home social activities and younger age. Five depressed residents became non-depressed, eight non-depressed became depressed and 14 residents remained persistently depressed 12 months after baseline. After controlling for potential confounders, increasing GDS score was independently associated with decreasing basic activities of daily living, increasing number of clinical problems and younger age. Our data support the hypothesis that specific emotional adjustments can be found even in the apparently static environment of the nursing home.     

The prevalence and socio-demographic correlations of depression,anxiety and stress among a group of university students

BACKGROUND: The mental health of university students is an area of increasing concern worldwide. The objective of this study is to examine the prevalence of depression, anxiety and stress among a group of Turkish university students. METHODS: Depression Anxiety and Stress Scale (DASS-42) completed anonymously in the students' respective classrooms by 1,617 students. RESULTS: Depression, anxiety and stress levels of moderate severity or above were found in 27.1, 47.1 and 27% of our respondents, respectively. Anxiety and stress scores were higher among female students. First- and second-year students had higher depression, anxiety and stress scores than the others. Students who were satisfied with their education had lower depression, anxiety and stress scores than those who were not satisfied. CONCLUSIONS: The high prevalence of depression, anxiety and stress symptoms among university students is alarming. This shows the need for primary and secondary prevention measures, with the development of adequate and appropriate support services for this group.     

Dementia and depression among nursing home residents in Lebanon: a pilot study

BACKGROUND: The proportion of elderly in the Lebanese population is 7.1% and this is expected to increase to 10.2% by the year 2025. The nursing home (NH) population in Lebanon has not been studied. The aim of this study was to investigate the prevalence of dementia and depression among a portion of nursing home residents (NHR) in Lebanon and describe the characteristics of NHR afflicted with dementia and depression. METHOD: Of 200 NHR from three NH in Lebanon, 117 were selected by random sampling. Data on demographics and medical history were collected. An Arabic version of the Mini-Mental Status Examination and Geriatric Depression Scale (GDS) were administered. RESULTS: Our final sample consisted of 102 NHR. Sixty-one (59.8%) had dementia of some kind. Seventeen (27.9%) had mild dementia, 14 (22.9%) had moderate dementia, and 30 (49.2%) had severe dementia. Forty-five (57.7%) of the NHR tested had depression as measured by a GDS score of more than 10. CONCLUSIONS: Dementia and depression were present in more than half of the NHR in our sample. Our results have important implications, being the first to be collected in the Lebanese community. Screening NHR for dementia and depression on admission and at regular time intervals is a must. More studies targeting all aspects of the elderly population in Lebanon are needed.     

Depression in older nursing home residents: the influence of nursing home environmental stressors, coping, and acceptance of group and individual therapy

Based on in-depth interviews with 65 older nursing home residents, this study examined the residents' own understanding and perceptions of depressive symptoms, causes of their depression, their self-reported coping strategies, and their preferences for acceptable depression interventions. About half (n = 32) of all interviewees stated that they were either feeling depressed or experiencing negative affects. The major themes related to the causes of their depression were loss of independence, freedom and continuity with their past life; feelings of social isolation and loneliness; lack of privacy and frustration at the inconvenience of having a roommate and sharing a bathroom; loss of autonomy due to the institutional regimen and regulations; ambivalence toward cognitively impaired residents; ever-present death and grief; staff turnover and shortage; and stale programming and lack of meaningful in-house activities. Self-reported coping mechanisms included religion and stoicism, a sense of reality, positive attitude and family support. In regard to depression treatment, the interviewees appeared to prefer nursing home programs that reduce their isolation over group or individual psychotherapy.