Prevalence of geriatric depression in a community sample in Ghana: Analysis of associated risk and protective factors

BackgroundAgeing comes with its own associated physical and psychosocial challenges. Depression is reported as one of the most prevalent psychopathology found among elderly people. However, there is dearth of literature in Ghana regarding mental health and its associated risk and protective factors among Ghanaians who are aged 65years and above. This study examined the prevalence and factors associated with depression among the aged in Ghana.MethodsA cross-sectional survey design was employed and a total of 262 elderly people (65+years) were sampled. The Geriatric Depression Scale, Brief COPE and demographic questionnaires were administered to the participants.ResultsThere was 37.8% prevalence of depression among the participants. Socio-demographic characteristics such as religion, living status and presence of chronic illness independently predicted depression among the participants. The use of religion, acceptance and active coping were the most commonly reported coping strategies among the participants while denial, behavioural disengagement and substance use were the least used coping strategies among the participants. The use of active coping predicted decreased depression levels whereas the use of behavioural disengagement and self-blame significantly predicted increased depression levels among the participants.ConclusionsDepression is a major challenge among the aged in this study and therefore, mental health screening should form part of the routine health screening practices for the elderly. The findings call for interventions aimed at promoting healthy ageing among the elderly in Ghana.     

Association of comorbidity with depressive symptoms in community-dwelling older persons

BACKGROUND: Depression in later life poses a serious threat to mental health and well-being of older persons burdened with medical illnesses. Comorbid medical conditions independently, as well as through interactions, may influence the degree of depressive symptoms manifested by the elderly. Insight into the role medical comorbidity plays in the manifestation of depression may help to better address both physical and mental health care needs of the depressed elderly. OBJECTIVE: To examine independent and synergistic effects of comorbid medical conditions in the presentation of depressive symptoms among older adults living in the community. METHODS: Data from a national survey of community-dwelling older persons aged 60 years and over (n = 2,058) in Korea were used. The levels of depression were assessed using an eleven-item Center for Epidemiological Studies Depression Scale. Comorbidity was defined as the number of chronic medical conditions and the combination of disease pairs. Sociodemographic characteristics, self-rated health, physical functioning, history of hospital admission in the past year, frequency of contact with friends or neighbors, and emotional support were used as covariates. RESULTS: Overall, persons with a medical condition compared to those without tended to show a higher depressive symptom score. Comorbidity, in terms of the number of medical conditions, tended to show a significant linear association with depression, controlling for confounders. More important, independent effects of medical conditions as well as a tendency to synergy among specific medical conditions were found, with notable gender differences. CONCLUSION: Given the significant but complex association of comorbid medical conditions with depressive symptoms in aged persons, clinicians should exercise care to address their physical and mental health needs within a common therapeutic context.     

The role of depression in the association between self-rated physical health and clinically defined illness.

We enrolled 543 elderly participants of a managed care organization in a cross-sectional study to test whether the association between self-rated physical health and clinically defined illness differs for persons who are not depressed compared with persons with minor or serious depression. Depression was measured with the Diagnostic Interview Schedule (DIS). Clinically defined illness was measured with the Chronic Disease Score (CDS), a pharmacy-based measure. Additional variables included age, sex, and self-reported pain and physical function. Self-rated physical health was associated with both minor and serious depression, independent of clinically defined illness; minor depression was no longer significant when self-reported pain and physical function were added to the model. A significant negative correlation between self-rated physical health and clinically defined illness was observed for minor and no depression, but no correlation was seen for serious depression. These results confirm the association between depression and self-rated physical health and emphasize that, for persons with serious depression, self-rated health provides a less accurate picture of clinically defined illness at both ends of the spectrum. Also, a diagnosis of minor depression should not forestall investigation of inconsistencies between patient report and clinical evidence.     

What is the relevance of mental health to HIV/AIDS care and treatment programs in developing countries? A systematic review

The expansion of AIDS treatment initiatives in resource-poor settings provides an opportunity for integrating mental health care into these programs. This systematic review of the literature on HIV and mental illness in developing countries examines the mental health risk factors for HIV, mental health consequences of HIV, psychosocial interventions of relevance for HIV-infected and affected populations, and highlights the relevance of these data for HIV care and treatment programs. We reviewed seven studies that measured the prevalence of HIV infection among clinic and hospital-based populations of people with mental illness or assessed sexual risk behavior in these populations; 30 studies that described the mental health consequences of HIV infection; and two reports of psychosocial interventions. The review demonstrates the need for methodologically sound studies of mental health throughout the course of HIV, including factors that support good mental health, and interventions that employ identified variables (e.g. coping, family support) for efficacy in reducing symptoms of mental illness. Promising intervention findings should encourage investigators to begin to study the implementation of these interventions in HIV service settings.     

南通市老年人抑郁状况及其影响因素分析

目的了解南通市老年人抑郁的患病现状及其影响因素。方法采用整群随机抽样的方法,以老年抑郁量表(GDS)及自制量表为调查工具,对南通市60岁以上老年人群进行调查,共收集有效问卷714份。结果南通市老年人群老年抑郁症状发生率为16.11%,其中中重度抑郁占2.24%。多因素Logistic回归分析显示,睡眠、家庭/亲友/邻里关系、个性是否乐观、体育锻炼是老年抑郁症状发生的影响因素。结论抑郁症状是老年人常见的心理健康问题,受生理、心理、家庭、社会等诸多因素的综合影响,应加强老年精神卫生服务,提供相应预防措施。     

HIV and chronic mental illness

The literature on HIV seroprevalence, risk, knowledge, and behavior is reviewed, and suggestions for treating seropositive people with chronic mental illness is outlined. In general, people with chronic mental illness have higher rates of HIV than people within the general population. Within this chronic mental illness population, seroprevalence is more prevalent among injection drug users and men who have sex with men. Homelessness is a risk factor for HIV infection and disease progression. Research indicates that mentally ill patients do not score well on assessments of their HIV-related knowledge, attitudes, and risk behavior. The provision of physical and mental health care for seropositive people with mental illness is a complex process that must take into account the full range of needs and obstacles faced by this high risk group.     

Gender and rural-urban differences in reported health status by older people in Bangladesh

The study aims to (i) describe regional variation and gender differences in health status of older people (60 years and older) in Bangladesh, indicated by self-reported health problems and functional ability; (ii) explore influence of socio-economic factors on health status of older people. In a cross-sectional study in rural and urban Bangladesh, 696 older persons were asked about their health problems and ability to manage activities of daily living (ADL). More than 95% of older people reported health problems. Approximately 80% of elderly women in both the regions reported having four or more health problems compared with 42% and 63% elderly men in the urban and rural regions, respectively. More women (urban: 55%; rural: 36%) than men (urban: 32%; rural: 22%) also reported difficulties with ADL. Irrespective of age, sex and area of residence, those reporting greater number of health problems were more likely to report difficulty with at least one ADL task. Reporting pattern of specific health problems varied between urban and rural regions. Socio-economic indicators were found to have little influence on reporting of health problems, particularly in the rural region. Observed regional difference may be related to the influence of social and environmental factors, and level of awareness concerning certain health conditions.     

Comparison of nutritional risk between urban and rural elderly

Urban and rural elderly face a multitude of barriers to healthy aging and maintaining adequate nutrition. Looking at commonalties and differences between urban and rural elderly that are associated with nutritional risk is an important first step in identifying and correcting nutritional insufficiencies. To examine health behaviors and nutritional information associated with nutritional risk in urban and rural areas and to develop a profile of nutritional risk for rural and urban elderly, data from one retrospective and two prospective studies were analyzed. One hundred, eighty-three (183) urban-living and 167 rural-living older adults (average age 77 years old) participated in the studies. More than 60% of participants were women. Overall health ratings were significantly higher for urban than for rural elderly. Rural dwellers had significantly fewer dental visits (41% versus 76%) but higher albumin values than their urban counterparts. Results from the synthesis of these four studies indicate that as people become more physically debilitated and lose independence in daily activities, their risk for malnutrition increases and their quality of life decreases. Although rural residents are believed to be at higher risk of malnutrition, these results suggest that this may not be the case. Physical, social, and environmental factors may affect the nutritional status of seniors regardless of where they reside.     

Depression in adults with congenital heart disease-public health challenge in a rapidly expanding new patient population

There is a growing population of adults with congenital heart disease (CHD) due to improved survival beyond childhood. It has been suggested that adults with CHD may be at increased risk for mental health problems, particularly depression. The reported incidence of depression in CHD varies from 9% to 30%. This review examines the evidence for a higher depression rate in CHD vs general population. Possible explanations are offered from a variety of disease models, ranging from brain injury to the psychoanalytical approach. Risk factors for an abnormal emotional adjustment and depression include early exposure to stress from illness and medical interventions in infancy, separation from the parents during hospitalizations and brain organic syndromes. Later in life, patients often have to cope with physical limitations. Recent improvements in care may be protective. Current patients may benefit from an earlier age at first surgical intervention, fewer reoperations and inclusion to the mainstream schooling, among other factors. At this point, there is little systematic knowledge about evidence-based therapeutic interventions for depression in adults with CHD. Health care providers of patients with CHD should be aware of mental health challenges and may take a more proactive approach to identifying patients at risk for depression.     

Predictors of suicide in the old elderly

BACKGROUND: Seniors aged 75 and above have the highest suicide rates of all age groups in most industrialized countries. However, research concerning risk factors for suicide in the old elderly is sparse. OBJECTIVE: The purpose was to determine predictors for suicide among the old elderly (75+). Data concerning the young elderly (65-74 years) are shown for comparison. METHODS: 85 consecutive cases of suicide that occurred in western Sweden and 153 control persons with the same sex, birth year, and zip code as the suicide cases were randomly selected from the tax register. The old elderly group included 38 cases and 71 controls; the young elderly group included 47 cases and 82 controls. Data concerning the suicide cases were collected through interviews with close informants; controls were interviewed in person. The interview included questions on past-year life events and mental and physical health. Medical records were reviewed for cases and controls. The Cumulative Illness Rating Scale - Geriatrics was used to rate illness burden. RESULTS: Family conflict, serious physical illness, loneliness, and both major and minor depressions were associated with suicide in the 75+ group. Economic problems predicted suicide in the younger but not in the older elderly. Old elderly suicide victims with depression (major or minor) were less likely to have received depression treatment than their younger counterparts. CONCLUSIONS: Better recognition and treatment of both major and minor depression should constitute an important target for the prevention of suicide in the old elderly. Intervention studies with large numbers of senior participants are sorely needed.     

Health and Health Care System for Older Persons

Thailand has now reached a new demographic turning point with the advent of an ageing society. Improvements in the health care system and technology advancement over recent decades mean that Thais can now enjoy better health in old age than previously. Life expectancy at birth for the Thai population has been increasing steadily, and there has been an improvement among older persons in all aspects of health behaviors. Even though the majority of Thai elderly are sufficiently healthy to take care of themselves, there are an increasing number of elderly people who have difficulty with essential daily activities, leading to problems with disability and dependency. Non communicable diseases such as hypertension, diabetes mellitus, dyslipidemia, osteoarthritis, cardio-cerebrovascular diseases and tumor are some of the major health problems confronting older Thais. Due a higher incidence of illness and chronic conditions as compared to young people, the elderly typically require different types of care and health services. As Thailand becomes an ageing society, health services and proper care systems specifically for the elderly group need to be prepared and well established. Given the far greater likelihood of chronic conditions and disabilities among older persons compared to the rest of population, pressures on long-term care facilities and services will increase enormously. The issue of ageing should be given a high priority in both local and national government agendas. All sectors should be involved in adjusting care systems and programs to accommodate the rapid growth of older persons and the relative balance of age groups within the population. It will be crucial for the health sectors to provide services oriented towards geriatric and long-term care issues.     

Depressive symptoms and mortality in elderly persons.

Studies on the relationship between depression and mortality in elderly community populations have yielded contradictory findings, although an association frequently is found in studies of elderly psychiatric patients. These different results may be due to differences in the measures of depression, the populations under study, the covariates in the analysis, or to sample attrition. In this study of elderly residents of an urban neighborhood, depressive symptoms are measured at two time points. People are classified as consistently nonsymptomatic (N-N), with emergent symptoms (N-D), in remission (D-N), or persistently symptomatic (D-D). Symptoms of depression, sociodemographic characteristics, and measures of changes in health, functional status, number of chronic medical conditions, and social support are examined in relation to mortality in multivariate Cox regression models. Although symptoms of depression are not found to be related to time-to-death, older people, those with declines in health and functional status, and men have greater relative risks of mortality over a three-year follow-up.     

Social integrations related to institutionalized and noninstitutionalized forms of care of elderly people

This is a report about a research project analyzing costs and effectiveness of institutionalized and ambulatory care of older people. For this analysis economic factors as well as social factors are considered. On the sociological part multiple objective conditions (e.g. state health, financial situation and family relations) were correlated with subjective factors as feelings of well-being and various personal attitudes. To this purpose approximately 900 elderly persons (3 samples: 1. inhabitants of homes of the aged, 2. ambulant served (meals on wheels, home help and community nurses), 3. random sample of persons living at their own home. The 3 samples were taken in an urban, semiurban and rural area. Some remarkable differences between the 3 samples could be shown referring to the general physical and mental status and rate of impairment, in the state of care, familiar situation, social integration and subjective attitude (e.g. demonstrating that the inhabitants of homes for the aged were less socially integrated and less satisfied.     

Prevalence and predictors of depression in elderly Canadians: The Canadian Study of Health and Aging

Depression in elderly Canadians is an important but often unrecognized public health problem. Numerous studies have examined depression in the general community, but studies of depression in the elderly have generally been small and limited. The Canadian Study of Health and Aging (CSHA) includes a large and national representation of both the cognitively intact and the cognitively impaired elderly. The current analyses of 2,341 participants from the CSHA who completed a clinical rating scale for depression have two objectives: 1) to determine the prevalence of minor and major depression and 2) to examine the importance of several risk factors. The prevalences of major and minor depression were 2.6 percent and 4.0 percent, respectively, and were higher for females, specifically those in institutions, those who reported that their health problems limited activities, and those with chronic health conditions. Women were more likely to exhibit depression (OR = 3.5; 95% CI: 1.4-8.8) than men, and those with dementia more likely to exhibit depression than those without (OR = 2.4; 95% CI: 0.9-3.1). Depression is a significant mental health problem among elderly Canadians, particularly among women and those with physical limitations. More attention should be paid to the detection and treatment of depression in the elderly, particularly among those most at risk.     

Gastrointestinal toxicity associated with nonsteroidal anti-inflammatory drugs. Epidemiologic and economic issues.

The large body of literature on the gastrointestinal side effects of NSAIDs has shown consistently that populations can be identified that have a markedly elevated risk for these iatrogenic conditions. These groups include the elderly, persons with prior history of peptic ulcer disease and its complications, persons receiving anticoagulant and corticosteroid therapy, and persons who require long-term NSAID therapy, especially at high dose. It is possible that several comorbidities (e.g., rheumatoid arthritis) predispose patients to gastrointestinal complications caused by NSAIDs, but few studies have adjusted carefully for the possibility that concomitant medication use (e.g., oral anticoagulants, corticosteroids) or increased NSAID dose may account best for apparent association of comorbidities as a risk factor for serious gastrointestinal events. The role of H. pylori infection in affecting the risk of complicated ulcer disease among NSAID users remains to be fully elucidated. Low-dose aspirin for cardioprotective use is associated with an increased risk for PUBs; when used concomitantly with NSAIDs, this increases the risk of PUBs above that of the NSAID itself. Apart from the physical toll NSAID-related gastrotoxicity places on the patient, there are considerable economic consequences to patients, providers, and society. This cost presents a subject for research for those interested not only in improving the quality of patient care, but also in the prudent use of health care resources.     

Young Malawians on the interaction between mental health and HIV/AIDS

Previous research has identified high levels of mental health problems among people affected by HIV. This study surveys specifically adolescents in southern Malawi on their experience of the impacts of living with HIV or AIDS on one's mental health. At the same time, the study explores the link between mental health problems and subsequent HIV-risk behaviour. Short texts relating everyday scenarios that depicted symptoms of three mental health problems (i.e.depression, anxiety and HIV-related brain impairment) formed the basis of in-depth discussions in 12 existing groups of secondary school students, orphans and vulnerable children, teenage mothers, and out-of-school youths, in both rural and urban settings. The responses show that these young people recognised the mental health sequelae of HIV/AIDS as impacting upon many aspects of one's life. The young people traced these 'interruptions' and 'disruptions' through deteriorating psychological and socio-economic conditions. They showed awareness of a two-way interaction between HIV/AIDS and mental illness, indicating that the latter can increase thoughts of suicide and HIV risk-taking behaviour. More importantly, they identified a number of locally derived community interventions, which if supported by statutory health and education services, can significantly ameliorate their situations. The findings provide avenues for practical integration of mental health provision within HIV prevention, education and care initiatives.     

The health status and the health care problems of the aged in an Italian community.

This study had the purpose of identifying the health needs of the elderly population of a small urban Italian community for the purpose of planning sociomedical services. The data were collected by interviewing a stratified random sample of 1291 individuals over sixty years of age. About one third sample reported poor health. However, health complaints, both physical and mental, were particularly common among the persons living in disadvantaged social and economic conditions. The great majority of the respondents were found to be self-sufficient, and ambulatory. The results indicate that the present health needs of the elderly living in the community require new health services, such as home care, which will permit the elderly to avoid future hospitalization.     

Health status and medical consumption of the elderly in urban and rural areas in The Netherlands; a secondary analysis of CBS-data

Data of the life situation survey of the Central Bureau of Statistics (CBS) of 1982 have been analysed. This secondary analysis has been carried out to study differences in health and medical consumption between urban and rural elderly. Two contrasting groups of elderly have been used: urban and rural elderly. It has been found that there are no differences in the prevalence of chronic disorders. More mental complaints have been found among male urban elderly compared to male rural elderly. The same relationship, although not significant, exists for women. For women it has been found that urban elderly feel less healthy than rural elderly. Male urban elderly aged 55-74 year pay more visits to the general practitioner than rural elderly of the same age. The same holds for women aged 75 year and over who also pay more visits to the physician.     

Mental Health Attitudes Among Rural and Urban Older Adults

This study compared samples of rural (n = 107) and urban older adults (n = 126), to explore differences in their attitudes toward mental health and mental health services. The moderating role that personality may play in accounting for rural versus urban differences in these variables was also explored. Each person completed a multidimensional measure of mental health attitudes and a trait measure of personality. Older adults in urban areas expressed more positive attitudes about mental health services than their rural counterparts, even when controlling for the poorer health of rural aged persons. In both groups, older adults who had sought mental health care held more positive views about such help than those who had not. There was an interaction between personality and the rural/urban dichotomy, such that NEO Neuroticism and, to a lesser extent, NEO Openness to Experience impacted mental health attitudes and help-seeking differentially among rural and urban older adults. These findings suggest that public policy makers and mental health providers should consider the interactive roles of culture-environment, personality, and attitudes toward mental health services when designing mental health programs for older adults.