Prevalência de sintomatologia depressiva em idosos brasileiros: uma revisão sistemática com metanálise

Prevalence of depressive symptoms and associated factors in Brazilian older adults: 2019 Brazilian National Health Survey

This study aimed to describe the prevalence of depressive symptoms and associated factors among older adults. A cross-sectional population-based study using data from the 2019 Brazilian National Health Survey was carried out. The prevalence of depressive symptoms was determined using the 9-item Patient Health Questionnaire (PHQ-9), and associations were tested according to sociodemographic, health and behavioral variables. Crude and adjusted prevalence ratios (PR) with 95% confidence intervals (95%CI) were calculated using Poisson's regression. The overall prevalence of depressive symptoms was 10.7% (95%CI: 9.9; 11.5). Higher PHQ-9 scores were associated with female gender (PR = 2.11, 95%CI: 1.82; 2.44), lack of participation in religious activities (PR = 1.20, 95%CI: 1.07; 1.35), nonsmoking status (PR = 1.55, 95%CI: 1.32; 1.83), poor or very poor self-perceived health (PR = 7.55, 95%CI: 5.82; 9.80), and multimorbidity (PR = 2.26, 95%CI: 1.85; 2.75). Higher education (PR = 0.55, 95%CI: 0.42; 0.73), income (PR = 0.68, 95%CI: 0.54; 0.85), and physical activity (PR = 0.72, 95%CI: 0.57; 0.90) were found to be negatively associated with the outcome. The most prevalent depressive symptoms were: sleeping problems (24.8%, 95%CI: 23.8; 25.8), not feeling rested or willing/feeling without energy (14.5%, 95%CI: 13.7; 15.4), and being depressed/down/without perspective (10.5%, 95%CI: 9.7; 11.2). These findings highlight the importance of prioritizing the identification and treatment of depressive symptoms in older Brazilian populations, particularly given that one in ten older Brazilians experience depressive symptoms.

Association between Falls, Fear of Falling and Depressive Symptoms in Community-Dwelling Older Adults

BACKGROUND

Longevity increases pose public health challenges, especially in managing falls and their psychological impacts on older adults. Limited evidence exists on the relationship between a fear of falling (FOF), previous falls, and depressive symptoms among community-dwelling older adults.

OBJECTIVE

To evaluate the association between falls, FOF, and depressive symptoms in community-dwelling older adults.

METHODS

This cross-sectional study, conducted in 2018, included 400 older adults from a Basic Health Unit in São Paulo, Brazil. The Geriatric Depression Scale (GDS-15) and the International Falls Efficacy Scale (FES-I) were used, along with self-report questionnaires on fall history. Linear and logistic regression were used to analyze the relationships between variables.

RESULTS

The mean age was 75.2 (SD = 8.53) years, with 63.2% being female. Depressive symptoms were observed in 18.3% of the participants, while 90.5% reported a fear of falling (FOF). More than half (63.0%) experienced falls, with 49.5% occurring in the last year. Factors such as the female gender, negative health perceptions, and functional dependence were associated with depressive symptoms. Adjusted analyses indicated that both a fear of falling (FOF) (B = 0.043; p = 0.012) and a history of falls (B = 0.725; p = 0.015) were associated with depressive symptoms.

CONCLUSIONS

Falls, FOF, and depressive symptoms are interlinked among older adults, underscoring the need for targeted interventions to improve their mental and physical health.

Depressive symptoms and sleep in aged caregivers in a context of high social vulnerability

OBJECTIVE

To evaluate the relationship between depressive symptoms and sleep quality in aged caregivers of elderly people, in a context of high social vulnerability.

METHODS

A Cross-sectional study conducted between July 2019 and March 2020 with 65 aged caregivers of elderly people that were treated in five Family Heath Units from São Carlos, São Paulo. Instruments to characterize the caregivers and to evaluate the depressive symptoms and sleep quality were used in data collection. The Kruskal Wallis and Spearman Correlation tests were adopted.

RESULTS

73.9% of the caregivers presented poor sleep quality and 69.2% did not have depressive symptoms. In the caregivers with severe depressive symptoms, the mean sleep quality score was 11.4; in those with mild depressive symptoms, it was 9.0; and in those without depressive symptoms, it was 6.4. There was a direct and moderate correlation between sleep quality and depressive symptoms.

CONCLUSION

There is a relationship between depressive symptoms and sleep quality in aged caregivers.

Prevalence of depressive symptoms and its association with social support among older adults: The Brazilian National Health Survey

BACKGROUND

The study aimed to assess the association between depressive symptoms and social support measures among non-institutionalized Brazilian older adults.

METHODS

A cross-sectional study was carried out with data from the last National Health Survey, conducted in 2019. A descriptive analysis of the study variables was performed, followed by a multiple regression analysis to teste the association between the dependent variable (depressive symptoms, assessed by the Patient Health Questionnaire (PHQ-9) and independent variables (household arrangement, marital relationship, leisure activities, voluntary activity, religious activity, activities in associations/leaderships, work and receiving social support (friends and family).

RESULTS

The sample comprised 22,723 older adults and 13.1 % had depressive symptoms. There was a positive relationship between the number of people in the household and the prevalence of depressive symptoms. Individuals with support from family members only (PR 0.69; 95 % CI 0.51; 0.92) and those with support from family and friends (PR 0.53 95 % CI 0.40; 0.70) had a lower prevalence of depressive symptoms than those without support. Participation in leisure and religious activities was inversely associated with depressive symptoms. A negative association was found between work and the presence of depressive symptoms (PR 0.83; 95 % CI 0.70; 0.99).

LIMITATIONS

The cross-sectional design limits causal inferences and the survey did not include institutionalized individuals.

CONCLUSIONS

The lower prevalence of the outcome among older adults with social support highlights the importance of evaluating these measures and practicing activities that allow personal and social interactions among this age group.

How much time of sedentary behavior is associated with depressive symptoms in community-dwelling older adults in southern Brazil?

AIMS

Identify sedentary behavior (SB) cut-off points to screen for depressive symptoms in older adults and verify the association between these conditions.

METHODS

A cross-sectional survey of 308 community-dwelling older adults was conducted. The outcome was the presence of depressive symptoms (≥6 points on the Geriatric Depression Scale-15). The exposure was SB using the self-reported time on a weekday and weekend (International Physical Activity Questionnaire). The cut-off points for SB categorization were determined by the receiver operating characteristic curve and multivariate logistic regression to verify the association.

RESULTS

Older adults who spent ≥4.5 hours/day in SB (sensitivity = 48.8%; specificity = 67.8%) were 1.81 times more likely (95%CI: 1.03;3.15) to have depressive symptoms compared to those who stayed for shorter periods.

CONCLUSIONS

There was an association between SB and depressive symptoms; therefore, older adults must have SB <4.5 hours/day to reduce the chances of developing depressive symptoms.

Sintomatologia depressiva e mortalidade em idosos da América Latina: uma revisão sistemática com metanálise

Objetivo.

Averiguar a associação entre sintomatologia depressiva e mortalidade em idosos da América Latina.

Métodos.

Realizou-se uma revisão sistemática com metanálise de estudos indexados nas bases PubMed, Scientific Electronic Library Online (SciELO), Web of Science, Cochrane Library, Scopus e Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). O estudo foi registrado na base PROSPERO (International Prospective Register of Systematic Reviews) e estruturado de acordo com o referencial metodológico PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). A metanálise foi realizada usando modelos de efeitos aleatórios, e os dados analisados incluíram as medidas de risco relativo (RR) bruto e heterogeneidade, com estimativas pontuais e intervalos de confiança de 95% (IC95%).

Resultados.

Cinco estudos, realizados no Brasil e no México, foram incluídos na metanálise, abrangendo 8 954 idosos. O RR para mortalidade na presença de sintomatologia depressiva foi de 1,44 (IC95%: 1,16; 1,78). A heterogeneidade encontrada foi de 80,87%. As metarregressões mostraram que quanto maior a proporção de mulheres nas amostras dos estudos, maior o risco de mortalidade associada à sintomatologia depressiva, e quanto maior o tempo de acompanhamento do estudo, menor o risco de mortalidade associada à sintomatologia depressiva.

Conclusão.

A presença de sintomatologia depressiva associou-se positivamente à mortalidade em idosos latino-americanos, com RR de óbito 44% maior em relação aos idosos sem sintomatologia depressiva. As principais limitações do estudo foram o pequeno número de trabalhos encontrados na revisão sistemática e a variação entre as escalas utilizadas para determinar a presença de sintomatologia depressiva.

Depressive and subthreshold depressive symptomatology among older adults in a socioeconomically deprived area in Brazil

Depressive and subthreshold depressive symptomatology are common but often neglected in older adults.

OBJECTIVE

This study aimed to assess rates of depressive and subthreshold depressive symptomatology, and the characteristics associated, among older adults living in a socioeconomically deprived area of Brazil.

METHODS

This study is part of the PROACTIVE cluster randomised controlled trial. 3356 adults aged 60+ years and registered in 20 primary health clinics were screened for depressive symptomatology with the Patient Health Questionnaire-9 (PHQ-9). Depressive status was classified according to the total PHQ-9 score and the presence of core depressive symptoms (depressed mood and anhedonia) as follows: no depressive symptomatology (PHQ-9 score 0-4, or 5-9 but with no core depressive symptom); subthreshold depressive symptomatology (PHQ-9 score 5-9 and at least one core depressive symptom); and depressive symptomatology (PHQ-9 score ≥ 10). Sociodemographic information and self-reported chronic conditions were collected. Relative risk ratios and 95% CIs were obtained using a multinomial regression model.

RESULTS

Depressive and subthreshold depressive symptomatology were present in 30% and 14% of the screened sample. Depressive symptomatology was associated with female gender, low socioeconomic conditions and presence of chronic conditions, whereas subthreshold depressive symptomatology was only associated with female gender and having hypertension.

CONCLUSIONS

Depressive and subthreshold depressive symptomatology is highly prevalent in this population registered with primary care clinics. Strategies managed by primary care non-mental health specialists can be a first step for improving this alarming and neglected situation among older adults.

Frailty, depression and mortality in a cohort of community-dwelling older adults

Abstract Objective To estimate the risk represented by the combined conditions of frailty and depression in relation to mortality in a cohort of older adults in a prospective measure. Method Prospective cohort study derived from baseline (2008/2009) and follow-up (2016/2017) measurements of the FIBRA Study - Polo Unicamp. Data from 739 older adults (67,2% female; 73,1+5.87 years) living in two urban centers in the state of São Paulo (Brazil) were analyzed to examine survival curves and to estimate mortality risk. The analyzes included four conditions resulting from the combination of depression (presence x absence of symptoms) and frailty (frail x robust) and the covariates sex, age, education, cognitive performance and comorbidities. Results The percentage of deaths was 25.7%. There were significant differences between the survival curves regarding the combinations between frailty and depression. Male sex, age over 75 years, low education, low cognitive performance and the combinations “depression-robust”, “depression-frail” and “no depression-frail” presented independent risks for mortality. In the multivariate model, the highest risks were given, respectively, by older ages, the combinations “depression-robust”, “depression-frail”, “no depression-frail”, male sex and lower cognitive performance. Conclusion Combinations between frailty and depression can result in differences in survival and mortality among older adults. In the nine-year period, depression proved to be the ordering variable of the groups in relation to risk estimates, even in the presence of important covariates. Investments in the prevention of both syndromes and their associations may result in a decrease in mortality in older people from general causes.

Fragilidade, depressão e mortalidade em uma coorte de pessoas idosas residentes na comunidade

Resumo Objetivo Estimar o risco representado por condições combinadas de fragilidade e depressão em relação à mortalidade de uma coorte de idosos em medida prospectiva. Método Estudo de coorte prospectivo derivado das medidas de linha de base (2008/2009) e seguimento (2016/2017) do Estudo Fibra - Polo Unicamp. Foram analisados dados de 739 idosos (67,2% feminino; 73,1+5,87 anos) residentes em dois centros urbanos do estado de São Paulo (Brasil) para o exame de curvas de sobrevida e para estimar risco de mortalidade. As análises incluíram quatro condições resultantes da combinação entre depressão (presença x ausência de sintomas) e de fragilidade (frágil x robusto) e as covariáveis sexo, idade, escolaridade, desempenho cognitivo e comorbidades. Resultados A porcentagem de óbitos foi de 25,7%. Houve diferenças significativas entre as curvas de sobrevida referentes às combinações entre fragilidade e depressão. Sexo masculino, idade acima de 75 anos, baixa escolaridade, baixo desempenho cognitivo e as combinações “depressão-robusto”, “depressão-frágil” e “sem depressão-frágil” apresentaram riscos independentes para mortalidade. No modelo multivariado, os maiores riscos foram dados, respectivamente, por idades mais avançadas, as combinações “depressão-robusto”, “depressão-frágil”, “sem depressão-frágil”, sexo masculino e menor desempenho cognitivo. Conclusão Combinações entre fragilidade e depressão podem resultar em diferenças em sobrevida e mortalidade entre idosos. No período de nove anos, depressão revelou ser a variável de ordenação dos grupos em relação às estimativas de risco, mesmo na presença de covariáveis importantes. Investimentos na prevenção de ambas as síndromes e de suas associações podem resultar diminuição na mortalidade de idosos por causas gerais.

Depressão em mulheres idosas

O envelhecimento populacional é uma realidade mundial. A depressão é uma das doenças psiquiátricas mais frequentes em idosos, acometendo principalmente mulheres, relacionando-se com estado civil, baixa escolaridade, solidão, dentre outros fatores sociais. O presente estudo objetivou investigar as Representações Sociais (RS) de idosas sobre a depressão. Participaram da pesquisa 10 mulheres com idade média de 68,2 anos (DP=5). Foi realizada a técnica de grupos focais, com a utilização de um roteiro de entrevista semiestruturado e a realização de duas sessões, sendo uma com idosas participantes de grupos de convivência e outra com idosas não participantes de grupos prévios a este. Os resultados apontaram um conhecimento simplista sobre a manifestação da depressão e uma associação de representações mais negativas entre as idosas viúvas. As idosas participantes de grupos demonstraram um maior conhecimento sobre o tratamento da depressão, enquanto as não participantes de grupos mostraram uma crença na religiosidade e na fé.

Cognitive and behavioral factors associated to probable sarcopenia in community-dwelling older adults

Background: Sarcopenia has a high prevalence in older adults and is associated with chronic aggravations to health, so therefore it is important to identify older adults who are affected by sarcopenia in order to establish preventative strategies or early interventions.Objective: To estimate the prevalence of probable sarcopenia and verify its association with cognitive impairment, fear of falling, depressive symptoms and health self-perception in community-dwelling older adults.Methods: A cross-sectional study with simple random sampling including 306 older adults of both genders. The outcome variable was probable sarcopenia evaluated by the Five times sit-to-stand test (5XSST) considering probable sarcopenia when the measured time was > 15 seconds, following the recommendation of the European Working Group on Sarcopenia in Older People. The predictor variables were cognitive impairment, fear of falling, depressive symptoms and self-perception of health. Multivariate Logistic Regression was performed to verify associations between the variables.Results: The prevalence of probable sarcopenia was 50.00%. The older adults had significantly higher chances of presenting probable sarcopenia when displaying cognitive impairment (OR 2.49; 95%CI 1.46-4.24), fear of falls (OR 4.23; 95%CI 2.51-7.12), depressive symptoms (OR 2.20; 95%CI 1.32-3.67), poor (OR 2.48; 95%CI 1.19-5.16) and fair self-perception of health (OR 2.11; 95%CI 1.22-3.63) when compared to those who did not have the same conditions.Conclusion: The prevalence of probable sarcopenia in this study was 50.00%, and was associated with the presence of depressive symptoms, cognitive impairment, fear of falls and negative self-perception of health.

Marcadores de fragilidade física preditivos de sintomas depressivos em pessoas idosas da atenção primária à saúde

Resumo Objetivo identificar quais os marcadores de fragilidade física predizem os sintomas depressivos (SD) em pessoas idosas assistidas na Atenção Primária à Saúde. Método estudo quantitativo de corte transversal e correlacional desenvolvido em uma Unidade Básica de Saúde em Curitiba, (PR), Brasil, com amostra de 389 pessoas idosas. Coletaram-se os dados de janeiro a outubro de 2019, por meio de questionário sociodemográfico e clínico, escala de depressão (Center for Epidemiological Studies) e testes que compõem o fenótipo da fragilidade física. Para as análises, utilizou-se estatística descritiva, inferencial (qui-quadrado de Pearson), nível de significância de p≤0,05), e regressão logística reportado a estimativa, valor p (teste de Wald). Razão de Prevalência com intervalo de confiança 95%. Resultados das 389 pessoas idosas, 103 (26,5%) apresentaram SD; entre eles 63 (61,2%) eram pré-frágeis, 19 (18,4%) frágeis e 21 (20,4%) não frágeis. Associaram-se aos SD os marcadores fadiga/exaustão (p≤0,001), redução do nível de atividade física (p≤0,001), perda de peso não intencional (p=0,003) e a condição de pré-fragilidade e fragilidade (p≤0,001). O modelo preditivo para os SD incluiu os marcadores fadiga/exaustão (RP: 5,12; IC95%; 3,81-6,87; p<0,0001) e redução do nível de atividade física (RP: 2,16, IC95%; 1,45- 3,22; p<0,0001). Conclusão os marcadores do fenótipo fadiga/exaustão e redução da atividade física são preditores dos SD em pessoas idosas. Esse resultado ressalta a importância e a necessidade da avaliação desses marcadores e da efetividade de ações para o combate ao sedentarismo em pessoas idosas da atenção primária à saúde.