Depression and its associated factors among elderly: A community-based study in Egypt

A study of the predictive value of different health indicators on the risk of all-cause mortality in older adults living in communities

OBJECTIVES

Intrinsic capacity(IC), self-rated health (SRH), and hand grip strength (HGS) reflect the health status from different aspects. This study aimed to investigate the relationship between IC, SRH, SRH combined with HGS and all-cause mortality among Chinese older adults living in communities.

METHODS

This study used data from the 2011 (baseline), 2013, 2015, 2018, and 2020 waves of the China Health and Retirement Longitudinal Study (CHARLS). We evaluated IC, SRH, and HGS using questionnaires. We assessed baseline levels of IC, SRH, and SRH combined HGS. Using the COX proportional hazards model, we investigated the associations between baseline IC, SRH, and SRH combined HGS and all-cause mortality. We used receiver operating characteristic curves (ROC) curves to compare the predictive effects of IC, SRH, and SRH combined HGS on all-cause mortality among Chinese older adults living in communities.

RESULTS

At baseline (2011), the study included a total of 4095 participants. The multifactorial Cox regression analysis results showed that older adults had a much higher risk of death from any cause compared to those who said they were in good health and had a normal hand grip strength, those who said they were in fair health and had a low hand grip strength [HR = 3.959, 95 % CI (2.892-5.421)], those who said they were in bad health and had a normal hand grip strength [HR = 3.150, 95 % CI (2.392-4.148)], and those who said they were in bad health and had a low hand grip strength [HR = 4.189, 95 % CI (3.123-5.618)]. The study looked at older adults who lived in the community. The area under the ROC curves (AUC) for IC and SRH combined HGS to predict death from any cause was 0.726 [95 % CI (0.708-0.744)] and 0.704 [95 % CI (0.683-0.725)], respectively.

CONCLUSION

Combining SRH and HGS improves older adults' health management by more accurately predicting the risk of all-cause mortality.

Burden of depression and its associated factors among older people living in Gondar town, Ethiopia: a community based cross-sectional study

OBJECTIVES

Depression is one of the main causes of disability worldwide and makes a major contribution to the global disease burden, especially in developing countries. It is also one of the most prevalent psychiatric disorders in the older people and a significant risk factor for both disability and death. Despite the fact that little research has been done on it among those who live in sub-Saharan Africa, especially Ethiopia, the aim of this study was to fill the above-mentioned gap among older people.

METHOD

A community-based cross-sectional study was conducted from April to June 2023. A total of 607 older people were included using the multistage sampling technique. An interview-administered questionnaire was used to assess depression using the Geriatric Depression Scale item 15 with a cut-off ≥5. For statistical analysis, the binary logistic regression model was employed.

RESULTS

The mean age of the study participants was 72.45 (SD ±9.08) years. The prevalence of depression was found to be 45%. Age 80 years and above, 70-79 years, widowed, retired, known chronic disease, and poor social support were associated factors with depression.

CONCLUSION

Compared to other studies conducted in different regions of Ethiopia, the prevalence of depression in this study was found to be high, at 45%. The results of this study may be taken as providing health professionals, health policymakers, and other pertinent stakeholders' early warning signs and guidance on how to take efficient control measures and conduct periodic monitoring among older people.

Depression in geriatrics: a systematic review and meta-analysis of prevalence and risk factors in Egypt

BACKGROUND

Depression is the most common psychiatric disorder in older adults, even though it is commonly misdiagnosed and undertreated, leading to exacerbations of preexisting medical conditions and even a higher mortality rate. In the present systematic review with meta-analysis, we quantify the magnitude of depression and its associated risk factors among the older adult population in Egypt.

METHODS

A thorough literature search was performed from 2010 up to October 2023. The results were presented as proportions or risk difference with a 95% confidence interval (CI) calculated using the random effects model. A sensitivity analysis was performed to examine the robustness of the results.

RESULTS

Our study included 14 articles with 5857 older adults published between 2011 and 2023. All the included studies assessed depression in geriatrics using the Geriatric Depression Scale. Of the 14 studies, 5 were for community-dwelling older adults, 3 were for older adults attending primary health care (PHC) centers, 2 were for hospitalized older adults, 3 were for residing in geriatric homes, and one for residing in geriatric homes, hospitalized older adults, and community-dwelling older adults. The overall prevalence of depression among Egyptian geriatrics was 64.6%. The pooled prevalence of depression was 59.6%, 67.0%, 67.0%, and 62.0% for community-dwelling older adults, older adults people attending PHC, hospitalized older adults, and older adults residing in geriatric homes, respectively. Older adults with chronic illness, female sex, and low-income elders and elders who were not employed had a higher risk for depression with pooled risk differences of 34.9%, 17.8%, 23.8%, and 15.1% (P < 0.05), respectively. In contrast, there was no significant difference in risk for depression in the older adults residing in urban areas compared to rural areas, the older adults aged + 70 compared to those less than 70, individuals with low levels of education or who are illiterate compared with those with higher levels of education and the older adults who live alone compared with those living with family.

CONCLUSION

More than half of the older adults in Egypt suffer from depressive symptoms. Chronic diseases, female sex, unemployment, and low-income inequality are the most significant factors contributing to depression among Egypt's older adults.

Fumaric acid protects rats from ciprofloxacin-provoked depression through modulating TLR4, Nrf-2, and p190-rho GTP

Depression is a persistent illness affecting health, behavior, and performance in life. Worldwide morbidity and mortality are caused by depression. The current study intended to explore fumaric acid's potential protective effect against ciprofloxacin-provoked depression in rats and to determine its mechanism of action by studying its antioxidant and anti-inflammatory properties. Five groups of male Wistar albino rats (120 g ± 20) were employed; the first group received physiological saline, the second group received fumaric acid (80 mg/kg/day; orally) for 3 weeks, the third group was administered ciprofloxacin (50 mg/kg/day; orally) for 3 weeks to induce depression, the fourth group received a daily low dose of fumaric acid (40 mg/kg; orally) concurrent with ciprofloxacin and the fifth group received a daily high dose of fumaric acid (80 mg/kg; orally) concurrent with ciprofloxacin for 21 days. Then, behavior tests, oxidative stress indicators, inflammatory biomarkers, neurotransmitters, p190 Rho GTP, and histopathological examination were evaluated. Ciprofloxacin significantly increased oxidative stress biomarkers [malondialdehyde (MDA) as a lipid peroxidation marker and nitric oxide (NO)] and biomarkers of inflammation [Toll-like receptor4 (TLR-4)] and tumor necrosis factor-alpha (TNF-α) with reduction in the activities of the nuclear factor erythroid 2-related factor 2 (Nrf-2) and catalase as well as brain contents of neurotransmitters and P190-RHO GTP. In addition, it causes necrosis of neurons and mild loss of Purkinje cells. Fumaric acid eliminates these effects of ciprofloxacin. Fumaric acid has beneficial effects as an anti-depressant in Wistar albino male rats that received ciprofloxacin.

Biopsychosocial Factors That Influence Depression, Anxiety, and Neuropsychological Functions in the Aging Process

BACKGROUND

Aging is a process inherent to the human condition that is characterized by various biological, psychological, and social changes that can lead to certain mental health problems.

OBJECTIVE

This study aimed to understand and characterize how biological, psychological, and social factors influence mental health symptoms and neuropsychological function in the aging process.

METHODS

A sample consisting of 616 participants (73.8% female) aged between 50 and 90 years, (mean [SD]: 69.6 [17.2] years). Data collection involved a neuropsychological assessment carried out by a psychologist in a clinical interview session and the self-completion of a questionnaire.

RESULTS

Regression models revealed that depressive symptoms are explained by anxiety, psychological and environmental quality of life, and sleep habits. Anxiety symptoms are explained by depression, physical quality of life, and sleep habits. Statistically significant differences were identified between participants with and without anxiety in neuropsychological terms at the level of agnosia and praxis. Statistically significant differences were identified between participants with and without depression in neuropsychological terms at the level of memory, language, agnosia and praxis, and executive function (eg, prefrontal tests).

CONCLUSIONS

Depression and anxiety symptoms are associated and could negatively influence the aging process. Aging should be understood in an ecological way taking into account the action of biological, psychological, social, and environmental factors, as well as the relationship and influence between the different levels and factors. This knowledge is important for diagnosis, for clinical practice, and for the development and definition of public policies to promote healthy aging.

Optimizing geriatric palliative care in Egypt: Comprehensive patient and family perspectives

OBJECTIVES

In Egypt, palliative care for geriatric patients is understudied, necessitating exploration for service optimization. Amidst rising chronic illnesses and aging, understanding perspectives of geriatric patients and families is crucial for targeted improvements. This study aims to explore geriatric patients' and their families' perspectives on palliative care in Egypt, seeking opportunities to optimize service delivery for the elderly.

METHODS

Employing a cross-sectional design with 110 geriatric patients and an equal number of family caregivers from the Damietta Oncology Institute and the pain treatment clinics for cancer patients at Zagazig University Hospital, the study focuses on a specialized pain clinic. Validated tools (Palliative Care Outcome Scale, Family Satisfaction with End-of-Life Care [FAMCARE] Scale, Edmonton Symptom Assessment System [ESAS], Caregiver Strain Index [CSI]) assess quality of life, family satisfaction, symptom severity, and caregiver strain.

RESULTS

Geriatric patients (mean age: 65.0 ± 8.1 years; 45.5% male, 55.5% female) have diverse diagnoses (e.g., breast cancer 22%). Palliative care outcomes reveal challenges: low emotional well-being (2.6 ± 0.0) and alarming overall quality of life (1.8 ± 0.0). Family dissatisfaction (FAMCARE) is pervasive (total mean score 2.6 ± 0.5). Symptom severity (ESAS) is high, and caregiver strain (CSI) is notable (8.5 ± 2.2).

SIGNIFICANCE OF THE RESULTS

The findings underscore the significance of the challenges faced by geriatric patients and caregivers in palliative care. Patients confront considerable symptom burdens and emotional distress, while caregivers experience notable strain. Urgently needed are targeted interventions designed to enhance patient well-being, alleviate caregiver burden, and elevate satisfaction. The critical importance of implementing these interventions promptly is highlighted, as they are instrumental in improving the overall care experience for geriatric patients and their caregivers. Moreover, the results underscore the imperative of developing comprehensive support mechanisms to address the intricate dimensions of palliative care, ultimately contributing to a more compassionate and effective care continuum.

Socioeconomic status and incident depressive symptoms among older adults: A 3-year longitudinal study from the Japan Gerontological Evaluation Study

OBJECTIVES

The association between socioeconomic status (SES) and the onset of depressive symptoms has attracted considerable attention. However, few studies have simultaneously examined the association of multiple SES indicators, including "assets," with the onset of depressive symptoms. Therefore, this study examined the association of four SES indicators in old age ('years of education' 'equivalent income,' 'equivalent assets,' and 'the longest-held job') with new-onset depressive symptoms in a large Japanese dataset.

METHODS

This longitudinal study used panel data of cognitively and physically independent older adults from the Japan Gerontological Evaluation Study (JAGES) conducted in 2013 and 2016. Multivariate logistic regression analysis was conducted to examine the association of each SES indicator with new-onset depressive symptoms, and odds ratios and 95% confidence intervals (CIs) were calculated.

RESULTS

We analyzed the data of 40,257 older adults, with a mean age (± standard deviation) of 72.9 (±5.5) years. In the follow-up survey, 4292 older adults had new-onset depression symptoms (10.7%). 39.3% had 10-12 years of education. 36.9% had an equivalent income of up to JPY 1.99 million. 24.4% had equivalent assets of JPY 4-17.99 million. Most had a clerical job for the long time. Furthermore, fewer years of education (males: OR = 1.42, 95% CI = 1.22-1.64, p-value <0.001/females: 1.26, [1.09-1.47], p = 0.002), lower income (males: 1.64, [1.34-2.01], p < 0.001/females: 1.82, [1.49-2.22], p < 0.001), and fewer assets (males: 1.40, [1.16-1.68], p < 0.001/females: 1.21, [1.02-1.42], p = 0.025) resulted in higher odds of having new-onset depressive symptoms, even when other SES indicators were entered simultaneously.

CONCLUSIONS

All four SES indicators have an independent association with the development of new-onset depressive symptoms among older adults, reflecting different aspects of SES. The association between the "longest-held job" and new-onset depressive symptoms can be largely explained by other SES indicators. A multifaceted and lifetime approach is required to prevent the onset of depressive symptoms in old age.

Loneliness, Psychological Well-being, Depression, and Social Participation in the Older Persons: Rural and Urban Differences

INTRODUCTION

The purpose of this study is to compare the loneliness, psychological well- being, depression, and social participation of elderly people living in Turkish society between rural and urban areas. The sample group of the study, in which a correlational survey model was used, consisted of 610 elderly adults.

METHOD

The study population consists of two groups: the first group consists of individuals over 65 years of age living in the city (Istanbul) (n= 291), and the second group consists of individuals over 65 years of age living in rural areas (rural areas of Ordu) (n= 319). Socio-demographic Information Form, Loneliness in the Elderly Scale, Geriatric Depression Scale, Psychological Well-Being in the Elderly Scale, and Social Inclusion Scale were applied online. Statistical analyses of the study were conducted using SPSS 27.00, and the Independent Samples t-test and ANOVA test were used.

RESULTS

According to the findings of this study, statistically significant results were found in psychological well-being, social inclusion, social relations, loneliness and depression, and place of residence. It was observed that the social isolation and social acceptance levels of those living in urban areas were higher than those living in rural areas. Social, loneliness, and depression scores of those living in the village/town were found to be higher than those living in the city centre. Furthermore, the social relationship scores of those living in the village/town were found to be higher than those living in the city centre.

CONCLUSION

The increasing elderly population worldwide has become an issue that requires global measures. Place of residence is one of the factors thought to affect older people's health and well- being. It is thought that the study data will contribute to new policies that will ensure the protection and promotion of elderly health and those working in this field. In addition, the study, which provides information about Turkish culture, will also enable intercultural comparisons.

Prevalence of Depression Among Older Adults Visiting the Primary Healthcare Centers in Jizan City, Saudi Arabia: An Analytical Cross-Sectional Study

Background and objective Older adults are susceptible to various disorders, including depression. Depression manifests as a disorder characterized by a persistent depressed mood, feelings of sadness and loneliness, sleep disturbances, and loss of interest lasting for two weeks or more. This condition can significantly affect the quality of life for older adults, resulting in adverse outcomes that have a negative impact on their overall well-being. In this study, our objective was to assess the prevalence of depression and identify associated risk factors among individuals aged 60 years and above who attended Primary Healthcare Centers (PHCCs) in Jizan City. Methodology We conducted an analytical cross-sectional study among older people attending PHCCs in Jizan City between May and December 2022. In this study, we interviewed 300 participants using the Patient Health Questionnaire-9 (PHQ-9) to assess depression. IBM SPSS Statistics for Windows, Version 25.0 (IBM Corp., Armonk, NY) was used for data entry and analysis. We used the chi-square test and binary logistic regression model to detect the associations and predictors of depression among older adults. Results One-third of the study participants experienced depression, with 49 (16%) exhibiting mild depression, 33 (11%) reporting moderate depression, and 17 (6%) individuals indicating moderately severe depression. Depression was more common among females (158, 52.7%) than males (142, 47.3%). The predictors of depression among the study participants were the dependency to perform daily tasks and abnormal sleep duration. Conclusions Depression is a prevalent health problem among older people in Jizan City, particularly among females, those who are divorced or widowed, individuals dependent on others for daily tasks, and those with abnormal sleep duration. We conclude that we need more research on older adults to assess their mental problems and fill in the literature gap.

Urban-rural and gender differential in depressive symptoms among elderly in India

Background

To date, evidence remained inconclusive explaining rural-urban and male-female differential in depression. Unlike other previous research on the association of several risk factors with depressive symptoms among the elderly, this study focussed on the socio-economic status-related inequality in the prevalence of depression among the elderly along with focussing urban-rural and male-female gradients of depression among the elderly.

Methods

This study used data from Longitudinal Ageing Study in India (LASI) Wave-I, 2017-18, survey. The outcome variable for this study was self-reported depression. Bivariate analysis was used to understand the prevalence by sociodemographic clusters. Fairlie decomposition analysis has been done to measures rural-urban inequalities for depression among older men and women.

Results

Results found that around 22 percent of urban elderly and 17 percent of rural elderly reported depression. A higher proportion of female elderly (22.6% vs. 18.4%) reported depression than male elderly. Almost one in every five elderly (20.6%) reported depression in India. The results found that a higher percentage of women in rural and urban areas reported depression than their male counterparts. While examining SES-related inequality in the prevalence of depression, education was a significant factor explaining the SES-related inequality in the prevalence of depression among female elderly and not in male elderly.

Conclusion

Given the large proportion of elderly reporting depression, this study highlights the need for improving health care services among the elderly. The increasing burden of depression in specific sub-populations also highlights the importance of understanding the broader consequences of depression among rural and female elderly.

Religiosity and Depression Among Community-Dwelling Older Adults in India: Results of a National Survey in 2017-2018

This study aimed to investigate the association between religiousness (affiliation, nonorganizational, organizational, and intrinsic religiosity) and major depressive disorder (MDD) and depressive symptoms among older adults in a national population survey in India. In total, 72,262 people (≥ 45 years) from the cross-sectional longitudinal aging study in India 2017-2018 responded to questions on religiosity, MDD, and depressive symptoms. Results indicate that 57.0% of participants were engaged in high nonorganizational (daily prayer) religiosity, 14.0% engaged in high (> 1/week or every day) organizational religiosity (attending religious services) and 34.9% had high intrinsic religiosity. In the adjusted logistic regression analysis, high nonorganizational religiosity (daily prayer), and high intrinsic religiosity were inversely associated with MDD. Similarly, high nonorganizational religiosity and high intrinsic religiosity were inversely associated with depressive symptoms. Organizational religiosity was not significantly associated with MDD or depressive symptoms. Compared to Hindus, Christians had lower odds of MDD and Sikhs had lower odds of depressive symptoms. High religiosity was observed among older adults in India. Nonorganizational and intrinsic religiosity were inversely associated with MDD and depressive symptoms.

Economic development, weak ties, and depression: Evidence from China

OBJECTIVES

Weak ties are becoming mainstream in daily relationships and play an essential role in the improvement of individuals' mental health. Despite growing concerns on depression, inclusion of weak ties is limited. To address the gap, this study empirically shed light on the role of weak ties on individual depression in the context of economic development.

METHOD

A cross-sectional study was conducted based on 2018 China Health and Retirement Longitudinal Study (CHARLS) with a sample of 16,545 individuals. A moderated mediation model is constructed to evaluate the impact of economic development (GDP) on the degrees of depression, the mediating effect of weak ties, and the moderating effect of residents' residence types (living in urban or rural areas).

RESULTS

Economic development exerts a significant direct impact on depression (β=-1.027, p<0.001). Weak ties are significantly negatively correlated with depression (β=-0.574, p<0.001), and act as a mediator between economic development and local individual depression. In addition, the residence type plays a moderating role between economic development and weak ties (β=0.193, p<0.001). That is, living in urban areas would introduce the higher the level of weak ties.

CONCLUSIONS

Higher economic development is largely conducive to alleviating the degrees of depression, weak ties play a mediating role in economic development and depression, and residence types have a positive moderating effect on the economic development and weak ties.

Prevalence of depression and anxiety in older people in low- and middle- income countries in Africa, Asia and South America: A systematic review and meta-analysis

BACKGROUND

There is rapid growth of older people in Low- and Middle- Income Countries (LMICs). The aim of this review was to assess the literature on prevalence of anxiety and depression in this demographic, which to our knowledge, has not yet been conducted.

METHODS

Databases including Medline, PsychInfo, Embase, Scielo and African Journals Online were searched for terms including "mental disorders", "neurotic disorders", "mood disorders" and "anxiety disorders". Studies published between 1990 and 2020 providing data on older people (≥50 years) in LMICs (defined by World Bank Criteria) were included and quality-assessed. Meta-analysis was conducted on a subset of higher-quality studies to derive pooled prevalence estimates of depression.

RESULTS

One hundred and forty relevant studies were identified, of which thirty-two were included in meta-analysis. One hundred and fifteen studies reported depression prevalence only, 19 reported both depression and anxiety, and six reported anxiety only. In all studies identified, depression prevalence ranged from 0.5 % to 62.7 %, and Generalised Anxiety Disorder prevalence ranged from 0.2 % to 32.2 %. The pooled prevalence of depression on meta-analysis was 10.5 % (95 % CI, 8.9 % - 11.2 %). Reported prevalence rates of depression were significantly different in studies using ICD-10 compared with DSM criteria, and between community and clinical settings.

LIMITATIONS

The search strategy contained bias towards English language papers and high income country (HIC) publications. There is significant heterogeneity within the meta-analysis.

DISCUSSION

A wide range of methodologies and clinical criteria are used in prevalence studies of depression and anxiety in older people. Studies using screening tools found higher prevalence rates; clinicians and researchers should ensure diagnosis is made with gold-standard clinical criteria. Meta-analysis data suggest that rates of depression are similar in older people in LMICs compared to HICs but mental healthcare resources are limited, suggesting a large potential treatment gap.

Asthma education and its impact on pediatric asthma severity: a prospective cohort study

OBJECTIVE

Asthma education has been shown to improve asthma control. Our goal was to evaluate the efficacy of asthma education on the frequency of utilization of health-care services, lung function results, degree of asthma severity, and quality of life (QOL) level in children with asthma.

METHODS

A single-arm prospective interventional trial was conducted in a tertiary facility. Thirty children with asthma and their parents were recruited for the research. Following an assessment of the participants' and caregivers' knowledge about asthma using an asthma knowledge questionnaire, degree of asthma control using asthma control test, inhaler technique using standardized inhaler technique checklists, and QOL using pediatric asthma QOL questionnaires, they participated in a three-month education program in the form of monthly live interactive sessions followed by weekly phone interviews. Measures taken before and after the intervention were compared.

RESULTS

The educational intervention improved asthma control dramatically including daytime asthma symptoms, night awakenings, and frequency of use of short-acting beta2- adrenergic receptor agonists. Furthermore, the number of emergency department visits and hospitalizations fell considerably after the intervention (p < 0.001 for all). Asthma education was also linked to better inhalation technique and lung function (p < 0.001). Furthermore, all quality-of-life measures increased (p < 0.001 for all).

CONCLUSIONS

Implementing an asthma education program that included both children with asthma and their parents improved asthma control levels, lung function measures, and overall quality of life. Furthermore, it increased asthma awareness, decreased the use of health-care resources, and reduced asthma severity, resulting in better asthma management.

Prevalence of depressive symptoms and their associated factors among older adults in Yirgalem town, Southern Ethiopia: A community-based cross-sectional study

Background

Depression is a serious mental health issue and the largest contributor to disability worldwide. Elderly people with depression are significantly more likely to experience negative outcomes such as poor physical health, strained social relationships, and decreased quality of life. Studies on geriatric depression are limited in developing nations like Ethiopia.

Objectives

The purpose of this study was to determine the prevalence of depressive symptoms and associated factors among older adults in Yirgalem, Southern Ethiopia, in 2022.

Methods

A community-based cross-sectional study was conducted on a sample of 628 older adults in Yirgalem town from May 15 to June 15, 2022. The study subjects were selected using a multi-stage systematic sampling technique. Data were collected using the 15-item Geriatric depression scale through face-to-face interviews. The collected data were edited, cleaned, coded, and entered into Epi data version 4.6 software and analyzed using STATA version 14. Bivariable and multivariate logistic regression analysis was computed to identify factors associated with depression, and statistical significance was declared at a 95% confidence interval with a P-value less than 0.05.

Results

A total of 620 older adults were included in the study, with a response rate of 97.8%. The prevalence of depressive symptoms among older adults was 51.77% (95% CI: 47.83-55.69). Being a woman (AOR = 2.3, 95% CI: 1.56-3141); being of more advanced age: 70-79 years old (AOR = 1.92, 95% CI: 1.20-3.07), 80-89 years old (AOR = 2.15, 95% CI: 1.27-3.65), 90 and older (AOR = 3.77, 95% CI: 1.95-7.79); living alone (AOR = 1.99, 95% CI = 1.17-3.41); having a chronic illness (AOR = 3.24, 95% CI: 1.06-4.46); having anxiety (AOR = 3.40; 95% CI: 2.25-5.14); and having poor social support (AOR = 3.56, 95% CI: 2.09-6.04) were statistically associated with depressive symptoms at a P-value of less than 0.05.

Conclusion

This study found that depression affects more than half of the elderly residents in the study area. More advanced age, being a woman, living alone, having a chronic illness, having anxiety, and having poor social support were all strongly linked to depression. There is a need to integrate counseling and psychiatric services into the community healthcare system.

Depression and Associated Factors Among the Elderly Population in an Urban Tertiary Geriatric Hospital in Bangladesh

Background: Geriatric depression becoming a serious concern worldwide, but no studies addressed depression among patients attending outpatient department of a tertiary geriatric care hospital in Bangladesh. Methods: This cross-sectional study was conducted in face-to-face interview using the Geriatric Depression Scale (GDS-15) to measure depression among 230 elderly outpatients (60-80 years old) who visited the hospital for medical reasons in Dhaka city; a variety of socio-demographic, behavioral, and psycho-social variables as well as history of chronic diseases were assessed to detect factors associated with depression. Results: The prevalence of depression was 81.7%; 52.6%, 25.2%, and 3.9% showed mild, moderate and severe depression (the GDS scores 5-8, 9-11, and 12-15), respectively. In logistic regression models, the associated factors included marital status, occupational status, educational status, physical activity, and history of cerebrovascular diseases or stroke. The prevalence of depression was generally higher than other reports elsewhere, and the reason behind this may include the use of the GDS-15 and the setting to carry out this study. Conclusion: Nationally representative investigations are warranted to further address depression among the elderly in Bangladesh; these findings would be helpful for future studies and intervention programs.

Evaluation of depression and obesity indices based on applications of ANOVA, regression, structural equation modeling and Taguchi algorithm process

Introduction

Depression and obesity are the main threat among women which have been considered by many research scholars in psychology studies. In their analysis for measuring and estimating obesity and depression they were involving statistical functions.

Methods

Regression, Analysis of Variance (ANOVA), and in the last two decades Structural Equation Modeling are the most familiar statistical methods among research scholars. Taguchi algorism process is one the statistical methods which mostly have been applying in engineering studies. In this study we are looking at two main objectives. The first one is to introduce Taguchi algorism process and apply it in a case study in psychology area. The second objective is challenging among four statistical techniques include ANOVA, regression, SEM, and Taguchi technique in a same data. To achieve those aims we involved depression and obesity indices with other familiar indicators contain socioeconomic, screen time, sleep time, and usage fitness and nutrition mobile applications.

Results and discussion

Outputs proved that Taguchi technique is able to analyze some correlations which are not achieved by applying ANOVA, regression, and SEM. Moreover, SEM has a special capability to estimate some hidden correlations which are not possible to evaluate them by using ANOVA, regression, and even Taguchi method. In the last, we found that some correlations are significant by SEM, however, in the same data with regression those correlation were not significant. This paper could be a warning for psychology research scholars to be more careful with involving statistical methods for measuring and estimating of their research variables.

Group-Based Trajectory Analysis for Postpartum Depression Symptoms among Chinese Primiparous Women

Background: Subgroups of individuals sharing similar patterns of postpartum depression (PPD) among Chinese women are unknown thus far. Using a group-based trajectory model, this study aimed to explore the subgroups of Chinese primiparous women that share similar patterns of PPD and to explore the predictors of PPD trajectory membership over the course of the first six months postpartum. Methods: In total, 674 first-time Chinese mothers were recruited, and their depression status was assessed using the Edinburgh Postnatal Depression Scale (EPDS) at four time points. Findings: Around 18.0% of participants belonging to Group 1 labeled as “few or no symptoms” remained stable, with an EPDS score of less than 5 during a six-month postpartum period. Almost one-third of subjects fell within the second trajectory, labeled “subclinical but present symptoms”, and peaked into the range of mild PPD but mostly stayed in the minimal range and had few or no PPD symptoms. Group 3 included 31.2% of women labeled “minor PPD status”, and their mean EPDS scores increased to a peak of 14.66 at six weeks postpartum. Group 4, with “major PPD status”, comprised 19.2% of the population, and the mean EPDS scores dramatically increased, reaching a peak of 19.59 at 12 weeks postpartum. Fewer types of support and not attending parenting training were associated with membership in the minor and major PPD status trajectories. Conclusions: Almost half of the Chinese new mothers in the study were found to fall into the two groups with minor or major PPD status trajectories, who should be given more attention and awareness from health professionals and researchers. Understanding predictors of group membership could help health providers to identify folks to prioritize getting connected to care as well as forming targeted interventions. Less degree of received support and not attending parenting training were identified to predict PPD trajectory membership. The regular, routine screening of PPD should be conducted at least 12 weeks postpartum, especially for new mothers in the major PPD status trajectory.

The associations of BMI, chronic conditions and lifestyle factors with insomnia symptoms among older adults in India

Background

The aim of the study was to estimate the prevalence of insomnia symptoms and to examine the associations of body mass index (BMI), chronic diseases, and lifestyle factors with self-reported insomnia symptoms among older people in India.

Methods

We conducted a cross-sectional study using data from the baseline wave of the Longitudinal Ageing Study in India (LASI) that was collected during 2017–18. A sample of 31,358 older adults aged 60 and above was included in the analyses. Descriptive statistics and bivariate and multivariable analyses were performed to obtain the results.

Results

In this study, insomnia symptoms were reported by around 36 percent of older adults aged 60 and above. After controlling for socio-demographic factors, insomnia symptoms were positively associated with the risk of being underweight [AOR: 1.289, CI: 1.211–1.372] and negatively associated with obesity/overweight [AOR: 0.928, CI: 0.872–0.990] as compared to older adults with normal BMI. The odds of insomnia symptoms were higher among those who reported the following chronic conditions, i.e., hypertension [AOR:1.356, CI:1.278–1.438], diabetes [AOR:1.160, CI:1.074–1.254], chronic lung diseases [AOR:1.485, CI:1.351–1.632], bone-related diseases [AOR:1.561, CI:1.458–1.670] and any psychiatric disorders [AOR:1.761, CI:1.495–2.074]. In addition, older adults who were physically active [AOR: 0.850, CI:0.804–0.900] were less likely to report insomnia symptoms.

Conclusions

The study suggests a high prevalence of insomnia symptoms among the older population in India. Early identification of the signs of insomnia in older population is crucial, as is timely treatment for any kind of sleep problems. In addition, nutrition-based interventions and individual disease-specific management programs may help minimize the stressful situations in later life and develop a good night’s sleep for the older population.

The Association between New-Onset Depressive Symptoms and Participating in Medical Check-Ups among Elderly Individuals

The association between adherence to medical check-ups and new-onset depressive symptoms, after adjusting for comprehensive risk factors such as social characteristics, remains unclear. This study aimed to assess the association between mental health and participating in medical check-ups. The survey data of participants aged 60 to 89 were recruited from the seventh Korean Longitudinal Study on Aging. The primary outcome was new-onset depressive symptoms within 2 years measured using the Center for Epidemiologic Studies Depression Scale. Participating in medical check-ups was defined as undergoing biennial medical check-ups. Multivariable logistic regression was performed to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) with consideration of a 2-year time lag. Among 4255 participants, the prevalence of new-onset depressive symptoms was 7.36% (n = 313). The prevalence of non-participation in medical check-ups was 11.96% (n = 509). The adjusted OR of new-onset depressive symptoms by non-participation in medical check-ups was 1.65 [95% CI 1.22-2.24; p = 0.001] after adjusting for various demographic, behavioral, occupational, and social participation characteristics. Our findings demonstrated a significant inverse relationship between participation in medical check-ups and new-onset depressive symptoms. It is necessary to monitor and manage depressive symptoms in vulnerable elderly individuals who do not participate in medical check-ups.

Depression among Older Adults in Indonesia: Prevalence, Role of Chronic Conditions and Other Associated Factors

Background

Depression is one of the most common illnesses worldwide, with a prevalence of 5.7% among older adults aged over 60. Depression is a severe health condition that can significantly affect the quality of life.

Objective

The objective of this study is to investigate the determinant factors of depression among older adults in Indonesia.

Methods

Data of 4236 adults of 60 years old and over were taken from the fifth wave of the Indonesian Family Life Survey (IFLS-5). Sociodemographic and multiple health-related variables collected through interviews and measurements were analyzed. Multivariate logistic regression was used to evaluate depression and its associated factors.

Results

The prevalence of depression assessed using ten questions from the Center for Epidemiologic Studies Depression Scale (CES-D 10) was 16.3%. Significant associated factors for depression were moderate and low subjective economic status, living in Java or other regions outside Sumatra and Java, no life satisfaction, self-perceived as having poor health, having dependency (IADL scores), and experienced falls and insomnia. Among chronic conditions, stroke, arthritis, and hearing impairment were also more common in depressed older adults.

Conclusion

Predictors of depression identified in this study may be used to help prevent and improve depression in Indonesian older adults, especially those who live on Java. Improvement in healthcare, especially in the prevention and rehabilitation of stroke, arthritis, possible frailty (falls and dependency), hearing impairment, and insomnia, concurrent with early detection of depression in these chronic conditions, may help create a better quality of life among Indonesian older adults.

Plasma proteomic signature of major depressive episode in the elderly

Depression is a complex and multifactorial disease, affecting about 6.5% of the elderly population in what is referred to as late-life depression (LLD). Despite its public health relevance, there is still limited information about the molecular mechanisms of LLD. We analyzed the blood plasma of 50 older adults, 19 with LLD and 31 controls, through untargeted mass spectrometry, and used systems biology tools to identify biochemical pathways and biological processes dysregulated in the disease. We found 96 differentially expressed proteins between LLD patients and control individuals. Using elastic-net regression, we generated a panel of 75 proteins that comprises a potential model for determining the molecular signature of LLD. We also showed that biological pathways related to vesicle-mediated transport and voltage-dependent calcium channels may be dysregulated in LLD. These data can help to build an understanding of the molecular basis of LLD, offering an integrated view of the biomolecular alterations that occur in this disorder. SIGNIFICANCE: Major depressive disorder in the elderly, called late-life depression (LLD), is a common and disabling disorder, with recent prevalence estimates of 6.5% in the general population. Despite the public health relevance, there is still limited information about the molecular mechanisms of LLD. The findings in this paper shed light on LLD heterogeneous biological mechanisms. We uncovered a potential novel biomolecular signature for LLD and biological pathways related to this condition which can be targets for the development of novel interventions for prevention, early diagnosis, and treatment of LLD.

Depression and associated factors among older adults in Bahir Dar city administration, Northwest Ethiopia, 2020: Cross-sectional study

Background

Depression is the most common psychiatric condition among older adults, and it goes unnoticed by individuals themselves and is under-diagnosed by clinicians due to the misconception that these are normal parts of aging. However, the problem is not properly addressed in Ethiopia. This study aimed to determine the prevalence and associated factors of depression among the older adults in Bahir Dar city.

Methods

A community-based cross-sectional survey was conducted among 423 older adults in Bahir Dar city. A simple random sampling technique was used to select the study participants. Depression was assessed using a 15-item Geriatric Depression Scale (GDS). A multivariable logistic regression analysis was used to explore the potential determinants of depression among the participants.

Results

The prevalence of depression among older adults was found to be 57.9% (95% CI: 53.2–62.6). This study showed that educational status with grades 5-8^th (AOR: 5.72, 95% CI: 2.87–11.34), and 9-12^th grade (AOR: 3.44, 95% CI: 1.59–7.41), income <2004 ETB (AOR = 1.89, 95% CI: 1.16–3.07), cognitive impairments (AOR: 3.54, 95% CI: 2.16–5.81), family history of mental illness (AOR:3.06, 95% CI: 1.03–9.04), and poor quality of life (AOR: 2.78, 95% CI: 1.74–4.46) were significantly associated with depression.

Conclusion

The prevalence of depression among older adults was found to be huge. Having low educational status, low monthly income, cognitive impairments, family history of mental illness, and poor quality of life were associated with depression. Therefore, raising community awareness of mental health, increasing social participation, providing supportive counseling and routine screening of depressive symptoms are essential in combating depression among Bahir-Dar city older adults.

Early versus late onset depression: sociodemographic and clinical characteristics

Background

Late-onset depression is different from early-onset depression in its sociodemographic and clinical characteristics and risk factors. This study aimed to demonstrate the differences in sociodemographic characteristics as well as clinical presentation between late-onset depression (after the age of 60 years) and early-onset depression (before the age of 45 years) and to determine the sociodemographic risk factors for late onset depression. Fifty-five patients between 18 and 45 years of age (group 1) and 55 patients aged 60 years and above (group 2) diagnosed for the first time with major depressive disorder were compared regarding sociodemographic and clinical characteristics. They were recruited from the psychiatric clinic at Sohag University Hospital. All participants were subjected to a Structured Clinical Interview for DSM-IV (SCID-IV), sociodemographic data form, Beck Depression Inventory-Second Edition (BDI-II), and Apathy Evaluation Scale (AES).

Results

The patients in group 2 were more commonly single (29%), employed (74.54%), living in rural areas (56.36%), and had high school education (41.81%). While the patients in group 2 were more commonly widows (18.18%), unemployed (61.81%), had less than high school education (47.27%), and had chronic diseases (78.81%). Significant risk factors for late onset depression are being widow, unemployed, having low socioeconomic status, and having a chronic medical disease. Patients with late-onset depression were more commonly presented with apathy, cognitive impairment, and somatic symptoms, as well as sleep disturbance (mean±SD 57±6, 70.9%, 61.81%, and 81.81%, respectively) than early-onset depression (mean±SD 49± 4, 47.27%, 36.36%, and 70.9%, respectively).

Conclusions

Cases with late onset depression are featured by being unemployed, widow, having low socioeconomic status and low educational level, suffering from a chronic medical condition and living in an urban area. In late onset depression, somatic symptoms, apathy, sleep disturbances, as well as cognitive impairment are prevalent presenting symptoms.

Health self-care practices among community older adults with morbidity

OBJECTIVES

to describe sociodemographic and health characteristics of older adults with morbidity, identify self-care practices and verify the association of sociodemographic variables with those related to health and self-care practices.

METHODS

a quantitative, analytical and cross-sectional household survey, developed in the urban area in the countryside of Minas Gerais, from 2017 to 2018. A total of 796 older adults were assessed using validated instruments, such as Geriatric Depression Scale: short form, Brazilian Questionnaire for Functional and Multidimensional Assessment, International Physical Activity Questionnaire, Instrument for Assessing Attitude Towards Taking Medications. Multiple logistic regression (p<0.05) was used.

RESULTS

negative self-perceived health was associated with low income and education. As for self-care in health, being physically active associated with the age group 60 |-| 79 years and higher education.

CONCLUSIONS

sociodemographic variables such as sex, age group, income, education, marital status, housing arrangement were related to health status and self-care practice.

Psychometric Properties of the Short-Form Geriatric Depression Scale (GDS-SF) and Its Associated Factors among the Elderly in Bangladesh

Background: This study aimed to (1) evaluate the psychometric properties of a Comprehensive Short-Form Geriatric Depression Scale (GDS-SF) and (2) examine the associated factors of GDS-SF among the elderly. Methods: A cross-sectional study was conducted from November 2019 to April 2020 in Dhaka City Corporation, Bangladesh. Data of 377 elderly were collected, including socio-demographic characteristics, social supports, comorbidities, sleep behaviours, and depression (as measured by the GDS-SF). We used the principal component analysis, correlation analysis, and logistic regression analysis to validate GDS-SF, and explore its associations. Results: The GDS-SF was reliable and homogeneous with Cronbach’s alpha = 0.836, and McDonald’s Omega = 0.841, with no floor/ceiling effects. The questionnaire demonstrated a good construct validity with item-scale convergent validity and KMO measure of sampling adequacy (0.869 for the total sample, 0.838 for the community subsample, and 0.851 for the slum subsample). In the multivariate model, older people had a higher likelihood of moderate and severe depression (OR, 1.06; 95% CI, 1.00, 1.12; p = 0.048). The likelihood of having moderate and severe depression was lower in men (OR, 0.48; 95% CI, 0.28, 0.85; p = 0.011) and those satisfied with their children’s support (OR, 0.17; 95% CI, 0.08, 0.35; p < 0.001), compared with their counterparts, respectively. Conclusions: The GDS-SF is a reliable and valid survey tool for evaluating depression in Bangladeshi older adults. Age, gender, and satisfaction with children’s support were predictors of depression.

Prevalence and influencing factors of depressive symptoms among rural-to-urban migrant workers in China: A systematic review and meta-analysis

BACKGROUND

Rural-to-urban migrant workers are a large group in China, and they are often more prone to mental health problems, especially depression. We expected to use meta-analysis to estimate the prevalence of depressive symptoms and the influencing factors of depressive symptoms among rural-to-urban migrant workers in China.

METHODS

PubMed, Web of Science, Embase, Scopus, CINAHL Complete, PsycARTICLES, CNKI, Wan Fang, CBM, and Cochrane were searched on October 16, 2021. The data were analyzed using OR and random effect model in Revman5.3 and STATA 15 Software.

RESULTS

We included 30 studies involving 43,884 rural-to-urban migrant workers. The prevalence of depressive symptoms among rural-to-urban migrant workers in China was 0.28 (95% CI:0.22, 0.34); Results of the meta-analysis showed that working hours, sleep status, self-rated health, financial condition, job satisfaction, marriage, and social support were correlated with depressive symptoms.

LIMITATIONS

The systematic review and meta-analysis included only cross-sectional studies, and more types of original studies on depressive symptoms of rural-to-urban migrant workers in China should be carried out in the future.

CONCLUSION

The prevalence of depressive symptoms among rural-to-urban migrant workers in China is 28%. Government departments can intervene early in the process to promote the mental health of this group based on influencing factors of depressive symptoms among rural-to-urban migrant workers in China.

Prevalence and correlates of depression among South Korean older adults living in relative poverty

This secondary analysis of the Tailored Health Visiting Service Program examined depression prevalence and associated factors among 1181 community-dwelling, South Korean older adults (range: 65 to 99 years) who live in relative poverty. Depression was assessed using the Geriatric Depression Scale short form. Generalized linear models with Poisson family and log link functions were employed to identify factors associated with depression. The overall depression prevalence was 46.3%, with most subjects mildly depressed. Better self-rated health and healthy activities were associated with lower depression prevalence, while having a disability was associated with higher prevalence. The factors identified in this study should be considered in community mental health interventions for older adults, especially those who experience economic disadvantage.

Estimate of the prevalence of depression among older people in Africa: a systematic review and meta-analysis

OBJECTIVE

The current systematic review and meta-analysis aimed to estimate the pooled prevalence of depression among elderly people in Africa.

METHOD

We have searched CINAHIL, PubMed, SCOPUS and Psych-INFO databases to identify important observational studies which reported the prevalence of depression among the elderly. We used a random-effects model due to reported heterogeneity among the included studies. The publication bias was examined by using Egger's test, visual inspection of the symmetry in funnel plots and adjusted using Duval and Tweedie's Trim and Fill analysis. We have meta-analysed the pooled estimates of depression from primary studies by adjusting for publication bias. We used Cochran's Q and the I²-tests to measure heterogeneity across the studies.

RESULT

A total of 23 studies conducted in Africa were included in the current systematic review and meta-analysis, representing a total of 14, 350 elderly population. The pooled prevalence of depression among elderly people in Africa was estimated to be 26.3% (95% CI; 22.2, 30.4%). The estimated pooled prevalence of depression among the elderly in Africa was much higher (43.1%) in studies that used a screening tool to measure depression when compared to studies that used a diagnostic tool (24.2%). Also, the prevalence of depression among female elderly participant (43.10%) was higher than that of male elderly participant (30.90%).

CONCLUSION

One in five elderly population in Africa were depressed, which poses serious health concerns. Timely and targeted screening of depression among the elderly and evidence-based interventions were highly recommended.

Religiosity/Spirituality and Mental Health in Older Adults: A Systematic Review and Meta-Analysis of Observational Studies

Objectives

The present study investigated the association between religious and spiritual (RS) practices with the prevalence, severity, and incidence of mental health problems in older adults.

Methods

We conducted a systematic review and meta-analysis of cross-sectional and longitudinal studies that investigated older adults aged 60+ years and assessed RS using valid scales and questions from valid scales, and mental health according to validated multidimensional or specific instruments. Studies were retrieved from MEDLINE, LILACS, SCOPUS, CINAHL, and AgeLine databases until July 31, 2021. The risk of bias was evaluated using the Newcastle-Ottawa Quality Assessment Scale (NOS). A pooled effect size was calculated based on the log odds ratio (OR) and Z-scores. This study is registered on PROSPERO.

Results

One hundred and two studies that investigated 79.918 community-dwellers, hospitalized, and institutionalized older adults were included. Results indicated that high RS was negatively associated with anxiety and depressive symptoms, while a positive association was observed with life satisfaction, meaning in life, social relations, and psychological well-being. Specifically, people with high spirituality, intrinsic religiosity, and religious affiliation had a lower prevalence of depressive symptoms. In relation to longitudinal analysis, most studies supported that high RS levels were associated with a lower incidence of depressive symptoms and fear of death, as well as better mental health status.

Conclusion

Findings of the present study suggest that RS are significantly associated with mental health in older adults. People with high RS levels had a lower prevalence of anxiety and depressive symptoms, as well as reported greater life satisfaction and psychological well-being, better social relations, and more definite meaning in life. Data provided by an increasing number of longitudinal studies have supported most of these findings.

Práticas de autocuidado em saúde entre pessoas idosas com morbidade da comunidade

RESUMO Objetivos: descrever as características sociodemográficas e de saúde dos idosos com morbidade, identificar as práticas de autocuidado e verificar a associação das variáveis sociodemográficas com as relacionadas à saúde e às práticas de autocuidado. Métodos: inquérito domiciliar quantitativo, analítico e transversal, desenvolvido na zona urbana no interior de Minas Gerais, de 2017 a 2018. Avaliados 796 idosos por instrumentos validados, como Escala de Depressão Geriátrica abreviada, Questionário Brasileiro de Avaliação Funcional e Multidimensional, Questionário Internacional de Atividade Física, Instrumento de Avaliação da Atitude Frente à Tomada de Remédios. Utilizou-se regressão logística múltipla (p<0,05). Resultados: a autopercepção de saúde negativa associou-se às baixas renda e escolaridade. Quanto ao autocuidado em saúde, ser ativo fisicamente associou-se à faixa etária 60 |-| 79 anos e à maior escolaridade. Conclusões: as variáveis sociodemográficas, como sexo, faixa etária, renda, escolaridade, estado conjugal, arranjo de moradia, relacionaram-se à condição de saúde e à prática de autocuidado.

Developing a nomogram for predicting the depression of senior citizens living alone while focusing on perceived social support

BACKGROUND

Although the number of senior citizens living alone is increasing, only a few studies have identified factors related to the depression characteristics of senior citizens living alone by using epidemiological survey data that can represent a population group.

AIM

To evaluate prediction performance by building models for predicting the depression of senior citizens living alone that included subjective social isolation and perceived social support as well as personal characteristics such as age and drinking.

METHODS

This study analyzed 1558 senior citizens (695 males and 863 females) who were 60 years or older and completed an epidemiological survey representing the South Korean population. Depression, an outcome variable, was measured using the short form of the Korean version CES-D (short form of CES-D).

RESULTS

The prevalence of depression among the senior citizens living alone was 7.7%. The results of multiple logistic regression analysis showed that the experience of suicidal urge over the past year, subjective satisfaction with help from neighbors, subjective loneliness, age, and self-esteem were significantly related to the depression of senior citizens living alone (P < 0.05). The results of 10-fold cross validation showed that the area under the curve of the nomogram was 0.96, and the F1 score of it was 0.97.

CONCLUSION

It is necessary to strengthen the social network of senior citizens living alone with friends and neighbors based on the results of this study to protect them from depression.

Latent class growth modeling of depression and anxiety in older adults: an 8-year follow-up of a population-based study

BACKGROUND

Depression and anxiety are common mental health conditions in the older adult population. Understanding the trajectories of these will help implement treatments and interventions.

AIMS

This study aims to identify depression and anxiety trajectories in older adults, evaluate the interrelationship of these conditions, and recognize trajectory-predicting characteristics.

METHODS

Group-based dual trajectory modeling (GBDTM) was applied to the data of 3983 individuals, aged 65 years or older who participated in the Korean Health Panel Study between 2008 and 2015. Logistic regression was used to identify the association between characteristics and trajectory groups.

RESULTS

Four trajectory groups from GBDTM were identified within both depression and anxiety outcomes. Depression outcome fell into "low-flat (87.0%)", "low-to-middle (8.8%)", "low-to-high (1.3%)" and "high-stable (2.8%)" trajectory groups. Anxiety outcome fell into "low-flat (92.5%)", "low-to-middle (4.7%)", "high-to-low (2.2%)" and "high-curve (0.6%)" trajectory groups. Interrelationships between depression and anxiety were identified. Members of the high-stable depression group were more likely to have "high-to-low" or "high-curved" anxiety trajectories. Female sex, the presence of more than three chronic diseases, and being engaged in income-generating activity were significant predictors for depression and anxiety.

CONCLUSIONS

Dual trajectory analysis of depression and anxiety in older adults shows that when one condition is present, the probability of the other is increased. Sex, having more than three chronic diseases, and not being involved in income-generating activity might increase risks for both depression and anxiety. Health policy decision-makers may use our findings to develop strategies for preventing both depression and anxiety in older adults.

The prevalence of depressive symptoms and associated factors in middle-aged and elderly Chinese people

BACKGROUND

This study aimed to evaluate the prevalence of depressive symptoms and associated factors in middle-aged and elderly people in China.

METHODS

Data were obtained from the China Family Panel Studies (CFPS) 2018. We selected 16,767 respondents over the age of 45 as samples for research and analysis. A short version of the Center for Epidemiological Research Depression Scale (CES-D) was used to assess depressive symptoms. Chi-square test and multiple logistic regression analysis were used to explore the related factors of depressive symptoms. Back Propagation neural network model was established to examine the ranking of influencing factors of depressive symptoms.

RESULTS

There was 24.1% prevalence of depressive symptoms among the respondents. The 14 important variables affecting depressive symptoms were screened out with the multivariable logistic regression. Based on the BP neural network to rank the degree of importance, the top five important variables were determined, which were subjective well-being (100.0%), self-reported health (92.0%), life satisfaction (83.4%), ADL disability (74.0%), and marital status (69.7%).

LIMITATIONS

This study was a cross-sectional study, and causality cannot be determined.

CONCLUSIONS

The prevalence of depressive symptoms in middle-aged and elderly Chinese people was high. Subjective quality of life evaluation, health condition and marital status were important factors that have an impact on depressive symptoms.

Prevalence and associated factors of depression among older adults in rural Tanzania

OBJECTIVES

Depression is the commonest mental disorder in older adults worldwide, affecting 7% of the world's older population and accounting for 5.7% of years lived with disability among adults aged over 60 years. We conducted a secondary data analysis to determine the point prevalence, associated risk factors and treatment gap for DSM-IV depression among older adults in the Hai District, rural Tanzania.

METHODS

The primary data source was a cross-sectional two-stage community-based dementia study where older adults aged ≥70 years (n = 296) were fully-assessed for dementia and depression in the second stage. Age-adjusted prevalence of depression was determined based on the WHO standard population using the Direct Method. Univariate and multivariate logistic regression models were performed.

RESULTS

Of the 296 older adults assessed for depression, 48 were diagnosed with depression based on Diagnostic and Statistical Manual of Mental Disorders-IV criteria. The median (Inter Quartile Range; QR) age was 80 (75-88) years. Age-adjusted point prevalence of depression was 21.2% (95% CI: 16.6-21.9) and the treatment gap for depression was 100%. There was reduced odds of depression in older adults who rated their physical health as good or very good (adjusted odds ratio [AOR] = 0.22; 95%CI: 0.10-0.46; p < 0.001), or moderate (AOR 0.26; 95%CI: 0.10-0.66; p = 0.005).

CONCLUSIONS

Depression in older adults is associated with physical health status and there is an alarmingly high treatment gap. Future research on depression in older adults should focus on effective interventions to address physical morbidity, psychosocial factors and the treatment gap.

Prevalence of Mental Disorders in the WHO Eastern Mediterranean Region: A Systematic Review and Meta-Analysis

Objectives: To synthesize the prevalence of mental and substance use disorders in countries of the Eastern Mediterranean Region (EMR) of the World Health Organization. Methods: The literature search was conducted across several databases in two phases. First, we searched for systematic reviews and/or meta-analyses published before 2014, reporting prevalence estimates for mental disorders in the EMR. Then, we identified new primary cross-sectional or longitudinal studies published between 2014 and 2020. Studies were included if they had a sample size of ≥ 450 and were conducted among the general adult population. Current, period and lifetime prevalence estimates for each disorder were pooled using random-effects meta-analyses, and subgroup analyses and meta-regressions were conducted. Findings: Prevalence estimates were extracted from 54 cross-sectional studies across 15 countries within the EMR. Pooled analyses of current, period and lifetime prevalence showed the highest prevalence for depression (14.8%, 95% confidence interval, CI: 10.7-20.1%), followed by generalized anxiety disorder (GAD) (10.4%, 95% CI: 7.1-14.7%), post-traumatic stress disorder (7.2%, 95% CI: 2.9-16.6%), substance use (4.0%, 95% CI: 3.1-5.2%), obsessive compulsive disorder (2.8%, 95% CI: 1.6-4.9%), phobic disorders (1.8%, 95% CI: 1.1-2.8%), panic disorders (1.1%, 95% CI: 0.6-2.2%), bipolar disorders (0.7%, 95% CI: 0.3-1.6%), and psychosis (0.5%, 95% CI: 0.3-0.9%). Populations exposed to adverse events had higher prevalence of mental disorders than the general population. Period and lifetime prevalence showed little difference across mental disorders. More pronounced differences in prevalence were seen for depression and GAD, specifically between current and lifetime prevalence (depression: current prevalence 20.5% (95% CI: 14.9-27.4%), vs. lifetime prevalence: 4.2% (95%CI: 1.8-9.6%); GAD: current prevalence 10.3% (95% CI: 6.1-17.0), vs. lifetime prevalence: 4.5% (95% CI: 2.4-8.3%). Differences between current and lifetime prevalence of mental disorders may be due to the use of different screening instruments and thresholds being applied. Conclusion: The prevalence of mental and substance use disorders in the EMR is high. Despite substantial inter-survey heterogeneity, our estimates align with previous global and regional data on mental disorders. Our meta-review provides new evidence on the burden of mental health problems in the EMR. Systematic Review Registration: PROSPERO, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020187388.

States Transitions Inference of Postpartum Depression Based on Multi-State Markov Model

Background: Postpartum depression (PPD) has been recognized as a severe public health problem worldwide due to its high incidence and the detrimental consequences not only for the mother but for the infant and the family. However, the pattern of natural transition trajectories of PPD has rarely been explored. Methods: In this research, a quantitative longitudinal study was conducted to explore the PPD progression process, providing information on the transition probability, hazard ratio, and the mean sojourn time in the three postnatal mental states, namely normal state, mild PPD, and severe PPD. The multi-state Markov model was built based on 912 depression status assessments in 304 Chinese primiparous women over multiple time points of six weeks postpartum, three months postpartum, and six months postpartum. Results: Among the 608 PPD status transitions from one visit to the next visit, 6.2% (38/608) showed deterioration of mental status from the level at the previous visit; while 40.0% (243/608) showed improvement at the next visit. A subject in normal state who does transition then has a probability of 49.8% of worsening to mild PPD, and 50.2% to severe PPD. A subject with mild PPD who does transition has a 20.0% chance of worsening to severe PPD. A subject with severe PPD is more likely to improve to mild PPD than developing to the normal state. On average, the sojourn time in the normal state, mild PPD, and severe PPD was 64.12, 6.29, and 9.37 weeks, respectively. Women in normal state had 6.0%, 8.5%, 8.7%, and 8.8% chances of progress to severe PPD within three months, nine months, one year, and three years, respectively. Increased all kinds of supports were associated with decreased risk of deterioration from normal state to severe PPD (hazard ratio, HR: 0.42-0.65); and increased informational supports, evaluation of support, and maternal age were associated with alleviation from severe PPD to normal state (HR: 1.46-2.27). Conclusions: The PPD state transition probabilities caused more attention and awareness about the regular PPD screening for postnatal women and the timely intervention for women with mild or severe PPD. The preventive actions on PPD should be conducted at the early stages, and three yearly; at least one yearly screening is strongly recommended. Emotional support, material support, informational support, and evaluation of support had significant positive associations with the prevention of PPD progression transitions. The derived transition probabilities and sojourn time can serve as an importance reference for health professionals to make proactive plans and target interventions for PPD.

Depression and associated factors among geriatric population in Moshi district council, Northern Tanzania

BACKGROUND

Depression in the elderly population has been identified as a significant public health problem associated with adverse outcomes such as decreased quality of life, cognitive decline, and increased rates of suicide. We aimed to determine the prevalence and factors associated with depressive symptoms among geriatric population in Moshi district council, northern Tanzania.

METHODS

This community-based cross-sectional study was conducted in Moshi rural district, northern Tanzania, between June and July 2019. A multi-stage sampling technique was used to recruit 304 elders aged 60 or more years. We used geriatric depression scale (GDS-15) to assess depression. Generalized linear model with Poisson family and log link function was used to estimate prevalence ratio (PR) and the corresponding 95% confidence intervals for factors associated with geriatric depressive symptoms.

RESULTS

A total of 304 participants were enrolled, the median age (interquartile range) 67 (62-75.5 years), and about half (51%) were females. The prevalence of geriatric depressive symptoms was 44.4%. Elders with a self-reported history of cognitive impairment had higher prevalence of depressive symptoms (PR = 1.66, 95%CI 1.16, 2.38) while elders with intermediate (PR = 0.56, 95%CI 0.38, 0.82) and strong social support (PR = 0.27, 95%CI 0.17, 0.44) were less likely to have depressive symptoms compared to those with no available social support.

CONCLUSIONS

Nearly one in every two elders had geriatric depressive symptoms. Depressive symptoms were associated with self-reported history of cognitive impairment and availability of social support. We recommend community screening, awareness creation, and social support interventions for early identification and management of depressive symptoms in this population.

Postpartum depression symptoms in survey-based research: a structural equation analysis

BACKGROUND

Since the last decade, postpartum depression (PPD) has been recognized as a significant public health problem, and several factors have been linked to PPD. Mothers at risk are rarely undetected and underdiagnosed. Our study aims to determine the factors leading to symptoms of depression using Structural Equation Modeling (SEM) analysis. In this research, we introduced a new framework for postpartum depression modeling for women.

METHODS

We structured the model of this research to take into consideration the Malaysian culture in particular. A total of 387 postpartum women have completed the questionnaire. The symptoms of postpartum depression were examined using the Edinburgh Postnatal Depression Scale (EPDS), and they act as a dependent variable in this research model.

RESULTS

Four hundred fifty mothers were invited to participate in this research. 86% of the total distributed questionnaire received feedback. The majority of 79.6% of respondents were having depression symptoms. The highest coefficients of factor loading analysis obtained in every latent variable indicator were income (β = 0.77), screen time (β = 0.83), chips (β = 0.85), and anxiety (β = 0.88). Lifestyle, unhealthy food, and BMI variables were directly affected by the dependent variable. Based on the output, respondents with a high level of depression symptoms tended to consume more unhealthy food and had a high level of body mass indexes (BMI). The highest significant impact on depression level among postpartum women was unhealthy food consumption. Based on our model, the findings indicated that 76% of the variances stemmed from a variety of factors: socio-demographics, lifestyle, healthy food, unhealthy food, and BMI. The strength of the exogenous and endogenous variables in this research framework is strong.

CONCLUSION

The prevalence of postpartum women with depression symptoms in this study is considerably high. It is, therefore, imperative that postpartum women seek medical help to prevent postpartum depressive symptoms from worsening.

Physical and Mental Health Level of the Elderly Living in Central Greece

Introduction

Elderly population is growing fast in the western world due to a reduction in birth rates and a marked increase in life expectancy with multiple co-morbidity that warrants greater attention by health care workers.

Aim

The purpose of the study is to investigate the levels of physical and mental health of elderly people living in Central Greece.

Methods

A cross-sectional study design was adopted with self completed questionnaires. Data collected, included socio-demographic and general health information using the Greek version of General Health Questionnaire 28. Kolmogorov-Smirnov test and regularity diagrams were employed.

Results

The sample included 230 elderly people with an average age of 73.1 years, women (53.5%), married (75.7%), with children (100%), primary school graduates (47.8%), residing in a city (72.2%), retired (90.9%), living with a spouse (68.3%), worked previously (96%) and 37.4% with a present monthly income of 301-600€. In the General Health Questionnaire, the internal consistency factor Cronbach's alpha for 'physical depressive symptoms' was 0.85, for 'anxiety and insomnia' 0.86, for 'social dysfunction' 0.86 and for 'depressive sentiment' 0.89, which indicates an excellent reliability of the questionnaire. The 'social malfunction' sub-scale showed the highest score (8.9) then 'anxiety and insomnia' (6.9) followed by 'physical symptoms of depression' (6.2) and 'depressive sentiment' (3.4). For the 'anxiety and insomnia' sub-scale, marital status shows another important correlation: unmarried elderly people had higher levels of stress. A lower educational level was associated with higher levels of anxiety and insomnia. Marital status appears to affect the manifestation of depressive symptoms as widows, singles and divorced showed a higher mean rate of depression than married people. [Table: see text] [Table: see text].

Conclusions

Various demographic as well as bio-psycho-social factors affecting health and particularly mental health are distributed unevenly between older men and women and between older people living in urban and rural areas. Therefore as our findings show, special care and priority should be granted to those who are single or widowed or divorced as they seem to be at greatest risk for overall declining mental health.

Prevalence and correlates of depressive symptoms among Rohingya (forcibly displaced Myanmar nationals or FDMNs) older adults in Bangladesh amid the COVID-19 pandemic

BACKGROUND

Depression is globally a crucial communal psychiatric disorder, which is more common in older adults. The situation is considerably worse among millions of older (forcibly displaced Myanmar nationals or FDMNs) Rohingya adults, and the coronavirus disease-2019 (COVID-19) pandemic may exacerbate the already existing precarious situation. The present study investigated depressive symptoms and their associated factors in older adult Rohingya FDMNs in Cox Bazar, Bangladesh, during the COVID-19 pandemic.

METHOD

A total of 416 older adults aged 60 years and above residing in Rohingya camps situated in the South Eastern part of Bangladesh were interviewed using a 15-item Geriatric Depression Scale (GDS-15) in Bengali language. Chi-square test was performed to compare the prevalence of depressive symptoms within different categories of a variable and a binary logistic regression model was performed to determine the factors associated with depressive symptoms.

RESULTS

More than 41% of Rohingya older adults had depressive symptoms (DS). Socio-demographic and economic factors such as living alone, dependency on family for living, poor memory, feelings of being left out, difficulty in getting medicine and routine medical care during COVID-19, perception that older adults are at highest risk of COVID-19 and pre-existing non-communicable chronic conditions were found to be significantly associated with developing DS. Higher DS was also evident among older female Rohingya FDMNs.

CONCLUSION

DS are highly prevalent in older Rohingya FDMNs during COVID-19. The findings of the present study call for immediate arrangement of mental health care services and highlight policy implications to ensure the well-being of older FDMNs.

Exploring depressive symptoms and its associates among Bangladeshi older adults amid COVID-19 pandemic: findings from a cross-sectional study

PURPOSE

Depression, one of the most common mental disorders, is up-surging worldwide amid the ongoing coronavirus disease 2019 (COVID-19) pandemic, especially among the older population. This study aims to measure prevalent depressive symptoms and its associates among older adults amid the COVID-19 pandemic in Bangladesh.

METHODS

This cross-sectional study was carried out among 1032 older Bangladeshi adults, aged 60 years and above, through telephone interviews in October 2020. We used a semi-structured questionnaire to collect data on participants' socio-demographic and lifestyle characteristics, pre-existing medical conditions, and COVID-19-related information. Meanwhile, depressive symptoms were measured using the 15-item Geriatric Depression Scale (GDS-15). The binary logistic regression model was used to identify the factors associated with depressive symptoms.

RESULTS

Two-in-five participants showed depressive symptoms on the GDS-15 scale. Poor socioeconomic characteristic such as low family income, dependency on the family for living, recipient of financial support during the pandemic was associated with higher odds of depressive symptoms. Participants with pre-existing medical conditions had 91% higher odds of depressive symptoms. Social isolation, captured in terms of living alone (aOR = 2.11, 95% CI 1.11-4.01), less frequent communication during pandemic (aOR = 1.55, 95% CI 1.07-2.26), perceived loneliness (aOR = 2.25, 95% CI 1.47-3.45), and isolation from others (aOR = 2.45, 95% CI 1.62-3.70) were associated with higher odds of depressive symptoms.

CONCLUSIONS

Our study found a sizeable proportion of study participants with depressive symptoms amidst the ongoing pandemic. The findings of the present study call for the urgent need for mental health support package targeting this vulnerable group of population.

Association between functional limitations and depression among community-dwelling older adults in Malaysia

AIM

This study aimed to assess the relationship between functional limitations and depression among community-dwelling older adults in Malaysia.

METHODS

Data from a nation-wide community-based cross-sectional study were analyzed. This study was conducted using a two-stage stratified random sampling design. In total, 3772 older adults aged ≥60 years responded to the survey. Depression was identified using a validated Malay version of the Geriatric Depression Scale (M-GDS-14), with those scored ≥6 categorized as having depression. Functional limitations were assessed using both Barthel's Activities of Daily Living (ADL) and Lawton's Instrumental Activities of Daily Living (IADL). The relationship was determined by multivariate logistic regression, adjusted for other variables.

RESULTS

The prevalence of depression was 11.5% (95% confidence interval [CI] 9.4, 13.4). Multiple logistic regression analysis found that older adults with limitations in ADL were 2.6 times more likely of having depression (adjusted odds ratio [aOR] 2.58, 95% CI 2.01, 3.32), while those with limitations in IADL the risk of having depression was almost doubled (aOR 1.68, 95% CI: 1.32, 2.14). Other significant factors were incontinence (aOR 3.33, 95% CI: 2.33, 4.74), chronic medical illness (aOR 1.44, 95% CI: 1.15, 1.81), current smoker (aOR 4.19, 95% CI: 1.69, 10.39), poor social support (aOR 4.30, 95% CI: 2.98, 6.20), do not have partner, ethnic minorities and low individual monthly income.

CONCLUSIONS

Older adults with functional limitation in both basic ADL and complex IADL are independently at higher risk of having depression. Geriatr Gerontol Int 2020; 20: 21-25.

Pharmaceutical Care in Depression: A Survey of Stigma, Confidence, Attitudes, and Barriers

Purpose

Patients with depression are in high need of optimal pharmaceutical care as they have poor quality of life and functioning. However, little is known about the delivery of pharmaceutical care to patients with depression in Egypt. This study aimed to detect pharmacists' stigma of patients with depression, assess attitudes toward providing depression care, evaluate pharmacists' confidence with depression medication consultation, and identify barriers in providing pharmaceutical care to patients with depression.

Methods

A cross-sectional survey was posted on the social media websites of Egyptian pharmacists' groups and associations. The survey collected pharmacists' demographic information, then measured their confidence in medication consultation through the Pharmacists' Confidence scale about Medication Consultation for Depressive Patients (PCMCD), with items to assess stigma of patients with depression and attitudes toward providing care to patients with depression compared with other physical conditions. The pharmacists were also asked about the barriers to providing pharmaceutical care to patients with depression.

Results

Totally, 86 pharmacists completed the survey: 56 (65.1%) were aged 30 years or older, and 64 (74.6%) had more than five years of experience. The stigma of patients with depression was generally low. The mean (SD) PCMCD score was 51.4 (6.6), reflecting that most pharmacists were confident about medication consultation for patients with depression. Attitudes toward providing pharmaceutical care to patients with depression were generally positive but significantly lower than those reported for patients with other conditions. Lack of education on mental health was the most commonly reported barrier (81.2%) to providing pharmaceutical care to patients with depression.

Conclusion

Participants were confident about medication consultation with a positive attitude toward providing pharmaceutical care. Frequent mental health educational courses, tools, and other methods of consistent engagement that enhance practice, behaviors, and outcomes should be considered for Egyptian pharmacists to improve pharmaceutical care provided to patients with depression.

Geriatric Mental Health and COVID-19: An Eye-Opener to the Situation of the Arab Countries in the Middle East and North Africa Region

While the detrimental ramifications of the COVID-19 outbreak on the mental wellbeing of the general public continue to unravel, older adults seem to be at high risk. As the geriatric population continues to grow in the Middle East and North Africa (MENA) region, it is essential to explore the influence of this outbreak on geriatric mental health, a topic often neglected. In this review, we depict the status of geriatric psychiatry in the Arab countries of the MENA region, exploring the variations from one nation to another. While some have a null exposure to the field, resources and expertise in other countries range from very limited to extensive. Furthermore, we highlight the measures implemented in the Arab region to address mental health during the COVID-19 outbreak; these tend to be insufficient when targeting the geriatric population. Finally, we provide short- and long-term recommendations to stakeholders that aim at enhancing the mental healthcare of older adults in the Arab countries of the MENA region, particularly during this pandemic.