Archives of Gerontology and Geriatrics 59 (2014) 150–154
Contents lists available at ScienceDirect
Archives of Gerontology and Geriatrics journal homepage: www.elsevier.com/locate/archger
Prevalence and risk factors of depression among community dwelling elderly Erdem Yaka a,*, Pembe Keskinoglu b, Reyhan Ucku c, Go¨rsev Gu¨lmen Yener a,d, Zeliha Tunca e Dokuz Eylu¨l University, Faculty of Medicine, Department of Neurology, I˙zmir, Turkey Dokuz Eylu¨l University, Faculty of Medicine, Department of Biostatistics and Medical Informatics, I˙zmir, Turkey c Dokuz Eylu¨l University, Faculty of Medicine, Department of Public Health, I˙zmir, Turkey d ˙ Istanbul Kultur University, Beyinmer, I˙stanbul, Turkey e Dokuz Eylu¨l University, Faculty of Medicine, Department of Psychiatry, I˙zmir, Turkey a
b
A R T I C L E I N F O
A B S T R A C T
Article history: Received 5 August 2013 Received in revised form 26 March 2014 Accepted 28 March 2014 Available online 5 April 2014
Depression in the elderly is associated with increased morbidity and mortality. The purpose of this study was to determine the prevalence and risk factors of depression among community-dwelling older population in an urban setting in Turkey. This cross-sectional study was conducted among 482 elderly individuals 65 years and over in an urban area. Cluster sampling method was used for sample size. Depression in the elderly had been diagnosed by a clinical interview and Geriatric Depression Scale. Data were collected by door-to-door survey. Chi square test was used for statistical analysis. P value, which was calculated by the results of chi square test and coefficient of phi (w), below 0.05 was included in the analysis of logistic regression. Depression was significantly associated with female gender, being single or divorced, lower educational status, low income, unemployment, and lack of health insurance. However, logistic regression analysis revealed higher depression rates in the elderly with chronic obstructive pulmonary disease, psychiatric disease, cerebrovascular disease, low income and being dependent. Depression is common among community-dwelling older people in an urban area of Izmir, Turkey. Older adults living in community should be cautiously screened to prevent or manage depression. ß 2014 Elsevier Ireland Ltd. All rights reserved.
Keywords: Depression Prevalence Risk factor Older adult Turkey
1. Introduction Although some studies demonstrate that healthy, normally functioning older adults may be at no greater risk of depression than younger adults, depression in late life remains as an important public health problem. Depression in the elderly is associated with increased medical morbidity and mortality, increased risk of deteriorating physical health, social and cognitive decline, suicide and self-neglect (Buys, Roberto, Miller, & Blieszner, 2008; Djernes, 2006; McDougall et al., 2007; Roberts, Kaplan, Shema, & Strawbridge, 1997; Stevens et al., 1999; Valvanne, Juva, Erkinjuntti, & Tilvis, 1996). In addition, depression increases the
* Corresponding author. Tel.: +90 232 4124050/533 3481733; fax: +90 232 2777721. E-mail addresses: [email protected], [email protected] (E. Yaka). http://dx.doi.org/10.1016/j.archger.2014.03.014 0167-4943/ß 2014 Elsevier Ireland Ltd. All rights reserved.
utilization of health care services. It is also projected to be the second leading cause of disease burden in older populations by the year 2020 (Chapman & Perry, 2008). Estimates of the prevalence of depression among older population depends on many factors including community, nursing home and hospital, as well as on methodological factors such as utilized depression screening tools, clinical diagnosis, and concomitant diseases. The prevalences of depressive disorders vary widely from one elderly population to another. The total prevalence of major depression and dysthymia among persons aged >65 years old in developed communities ranges widely from 2.3% to 25%. The prevalence of depression among older population in Europe is reported as 0.4–35%, with weighted average for major depression of 1.8% and for minor depression of 9.8% (Evers et al., 2002; Lobo, Saz, Marcos, Dı´a, & De-la-Ca´mara, 1995; McCall, Parks, Smith, Pope, & Griggs, 2002; Newman, Sheldon, & Bland, 1998; Ohayon, Priest, Guilleminault, & Caulet, 1999; Snowdon & Lane,
E. Yaka et al. / Archives of Gerontology and Geriatrics 59 (2014) 150–154
1995). Data from 74 studies showed us that the median prevalence rate (MPR) of depressive disorders in the world for the elderly population was 10.3% with inter-quartile range (IQR) varying between 4.7% and 16.0%. The ratio of depression among elderly individuals was lower in Asia (4.2%) than Europe (10.9%) and America (8.4%). Some studies from the developing countries had reported a very high prevalence rate of 21.9% with IQR ranging from 11.6% to 31.1% (Barua, Ghosh, Kar, & Basilio, 2010). Socioeconomic and cultural differences may play role in these numbers. Although gender differences in the oldest population are minimal, elderly women are more at risk of depression. Other risk factors of depression among the elderly are lack of close social contacts and activities, functional impairment, stressful life events, low income, low educational level, social isolation, and chronic diseases such as diabetes mellitus, hypertension, cardiac disease, prior history of depression (Chang-Quan et al., 2010; Djernes, 2006; Nahcivan, 2005; Shin, Jung, Jo, & Kng, 2009; Weyerer, Eifflaender-Gorfer, & Ko¨hler, 2008). The aim of the present study is to determine the prevalence and risk factors of depression among community-dwelling older population in an urban area in Turkey. 2. Materials and methods This cross-sectional study was conducted among elderly individuals 65 years and over in the town of Narlıdere (an urban area) in the province of Izmir in Turkey by a door-to-door survey. Population of the elderly was 4012 subjects, and cluster sampling method was used for sample size. Using the Epi-Info 2000 package, the minimum sample size was calculated as 471 elderly subjects based on depression prevalence of 15%, with 3% precision and 95% confidence interval (CI). The sample size was received from Turkish Statistical Institute (TUIK), and 512 older subjects in 2601 houses was determined. The research team visited a total of 490 (95.7%) subjects in their houses. Eight subjects were excluded from the investigation since their screening tests were not completed due to their physical disabilities or their communication problems. A total of 482 subjects were included in the study. Depression in the elderly has been diagnosed by a clinical interview and a short version of Geriatric Depression Scale (GDS-15 items) is used as screening test (Ertan, Bugay, & Eker, 2004). 2.1. The variables of the study, description of the variables The dependent variable in the present study was depression. A short form GDS-15 items was used as screening test. A score of 8 or higher was accepted as presence of depression. The independent variables were classified as (a) the socioeconomic variables; age, gender, status of education, social insurance, working before and during aging, personal and house hold income. (b) The variables of health status; chronic disease and loss of capacity diagnosed by Barthel Index (Available at: http:// www.strokecenter.org/trials/scales/barthel.pdf.) (40 scores: severely dependent, 41–60 scores: dependent, 61 scores: independent). 2.2. Data collection Data collection was completed between September 2006 and July 2008. All of the target subjects in the selected sample houses of 2601 were reached. To conduct home visits, permission was taken from local authority. After oral informed consents taken from elderly subjects and relatives living in the same house, subjects were interviewed face to face, and screening test was applicated. The study was approved by the ethics committee of the Faculty of Medicine of Dokuz Eylul University.
151
Table 1 Sociodemographic characteristics of the elderly residents. Characteristics Gender Male Female Age groups (y) 65–69 70–74 75–79 80–84 85 Marital status Married Widowed Divorced–single Education Illiterate Literate Primary school Secondary school High school University Social insurance (no) Working at the present Personal income (yes) Monthly personal income ( 0.30 is significant. If w value is significant, variables were analysed by using logistic regression model. 3. Results The mean age of the 482 elderly subjects was 71.7 years (range 65–114 years; SD: 6.5). Socio-demographic characteristics of the elderly are shown in Table 1. Of the elderly population, 58.9% were females, 71.4% were between the ages of 65–74, 63.3% were married, 34.2% were illiterate, and 50.4% did not graduate from primary school. While 12% of the elderly had been lived alone, 45.6% had been lived with marital partner, 24.5% with children and 15% with marital partner and children, 2.1% with relatives, 0.8% with marital partner and relatives. In our study population 9.8% of the subjects were socially uninsured, 27.2% did not have any personal income and 5.7% were working during the study. Mean monthly personal income was 446.5 385 Turkish Lira (TL) (range; 0–3.000 TL). Of the older persons, 25.5% lived in squatter’s house, 29.6% perceived their economic status as bad or very bad. Of the older subjects, 31.4% had a job, 18.2% were active smokers, 24.9% were former smoker. Alcohol consumption rate was 8%. The health status of the elderly is shown in Table 2. Of the total 482 subjects, 18.5% had depression. Nearly 80% of older subjects had minimum one chronic disease. Most commonly seen diseases were hypertension (53.7%), cardiovascular disease (23.7%), hypercholesterolism (21%), diabetes mellitus (18.3%) and musculosceletal disease (15.7%). Association between depression and sociodemographic-economic characteristics is shown in Table 3.
E. Yaka et al. / Archives of Gerontology and Geriatrics 59 (2014) 150–154
152 Table 2 Health status of elderly residents.
Table 4 Presence of depression according to health status. N (n = 482)
Characteristics Chronic disease (yes) Cardio-vascular disease Hypertension Diabetes mellitus Cerebrovascular disease Hypercholesterolism Musculosceletal disease Chronic obstructive pulmonary d. Neurodegenerative disease Gastrointestinal disease Cancer Psychiatric disease Hypertrophy of prostate Daily life activity (dependent)
%
404 114 259 88 28 101 77 44 14 40 15 13 27 23
83.8 23.7 53.7 18.3 5.8 21.0 15.7 9.1 2.9 8.3 3.1 2.7 5.6 4.8
Table 3 Association between depression and sociodemographic-economic characteristics. Characteristics
n (482) Depression (+) N
Gender Male Female Marital status Married Divorced/widowed/ single Education Illiter./liter./primary sch. Middle s./high s./ university Living Alone Spouse/children Perceived economical status Bad-very bad Fair-good-very good Social insurance No Yes Working No Yes
%
x
2
Phi (w)
px2
Pphi
198 284
19 9.6 17.555
Contents lists available at ScienceDirect
Archives of Gerontology and Geriatrics journal homepage: www.elsevier.com/locate/archger
Prevalence and risk factors of depression among community dwelling elderly Erdem Yaka a,*, Pembe Keskinoglu b, Reyhan Ucku c, Go¨rsev Gu¨lmen Yener a,d, Zeliha Tunca e Dokuz Eylu¨l University, Faculty of Medicine, Department of Neurology, I˙zmir, Turkey Dokuz Eylu¨l University, Faculty of Medicine, Department of Biostatistics and Medical Informatics, I˙zmir, Turkey c Dokuz Eylu¨l University, Faculty of Medicine, Department of Public Health, I˙zmir, Turkey d ˙ Istanbul Kultur University, Beyinmer, I˙stanbul, Turkey e Dokuz Eylu¨l University, Faculty of Medicine, Department of Psychiatry, I˙zmir, Turkey a
b
A R T I C L E I N F O
A B S T R A C T
Article history: Received 5 August 2013 Received in revised form 26 March 2014 Accepted 28 March 2014 Available online 5 April 2014
Depression in the elderly is associated with increased morbidity and mortality. The purpose of this study was to determine the prevalence and risk factors of depression among community-dwelling older population in an urban setting in Turkey. This cross-sectional study was conducted among 482 elderly individuals 65 years and over in an urban area. Cluster sampling method was used for sample size. Depression in the elderly had been diagnosed by a clinical interview and Geriatric Depression Scale. Data were collected by door-to-door survey. Chi square test was used for statistical analysis. P value, which was calculated by the results of chi square test and coefficient of phi (w), below 0.05 was included in the analysis of logistic regression. Depression was significantly associated with female gender, being single or divorced, lower educational status, low income, unemployment, and lack of health insurance. However, logistic regression analysis revealed higher depression rates in the elderly with chronic obstructive pulmonary disease, psychiatric disease, cerebrovascular disease, low income and being dependent. Depression is common among community-dwelling older people in an urban area of Izmir, Turkey. Older adults living in community should be cautiously screened to prevent or manage depression. ß 2014 Elsevier Ireland Ltd. All rights reserved.
Keywords: Depression Prevalence Risk factor Older adult Turkey
1. Introduction Although some studies demonstrate that healthy, normally functioning older adults may be at no greater risk of depression than younger adults, depression in late life remains as an important public health problem. Depression in the elderly is associated with increased medical morbidity and mortality, increased risk of deteriorating physical health, social and cognitive decline, suicide and self-neglect (Buys, Roberto, Miller, & Blieszner, 2008; Djernes, 2006; McDougall et al., 2007; Roberts, Kaplan, Shema, & Strawbridge, 1997; Stevens et al., 1999; Valvanne, Juva, Erkinjuntti, & Tilvis, 1996). In addition, depression increases the
* Corresponding author. Tel.: +90 232 4124050/533 3481733; fax: +90 232 2777721. E-mail addresses: [email protected], [email protected] (E. Yaka). http://dx.doi.org/10.1016/j.archger.2014.03.014 0167-4943/ß 2014 Elsevier Ireland Ltd. All rights reserved.
utilization of health care services. It is also projected to be the second leading cause of disease burden in older populations by the year 2020 (Chapman & Perry, 2008). Estimates of the prevalence of depression among older population depends on many factors including community, nursing home and hospital, as well as on methodological factors such as utilized depression screening tools, clinical diagnosis, and concomitant diseases. The prevalences of depressive disorders vary widely from one elderly population to another. The total prevalence of major depression and dysthymia among persons aged >65 years old in developed communities ranges widely from 2.3% to 25%. The prevalence of depression among older population in Europe is reported as 0.4–35%, with weighted average for major depression of 1.8% and for minor depression of 9.8% (Evers et al., 2002; Lobo, Saz, Marcos, Dı´a, & De-la-Ca´mara, 1995; McCall, Parks, Smith, Pope, & Griggs, 2002; Newman, Sheldon, & Bland, 1998; Ohayon, Priest, Guilleminault, & Caulet, 1999; Snowdon & Lane,
E. Yaka et al. / Archives of Gerontology and Geriatrics 59 (2014) 150–154
1995). Data from 74 studies showed us that the median prevalence rate (MPR) of depressive disorders in the world for the elderly population was 10.3% with inter-quartile range (IQR) varying between 4.7% and 16.0%. The ratio of depression among elderly individuals was lower in Asia (4.2%) than Europe (10.9%) and America (8.4%). Some studies from the developing countries had reported a very high prevalence rate of 21.9% with IQR ranging from 11.6% to 31.1% (Barua, Ghosh, Kar, & Basilio, 2010). Socioeconomic and cultural differences may play role in these numbers. Although gender differences in the oldest population are minimal, elderly women are more at risk of depression. Other risk factors of depression among the elderly are lack of close social contacts and activities, functional impairment, stressful life events, low income, low educational level, social isolation, and chronic diseases such as diabetes mellitus, hypertension, cardiac disease, prior history of depression (Chang-Quan et al., 2010; Djernes, 2006; Nahcivan, 2005; Shin, Jung, Jo, & Kng, 2009; Weyerer, Eifflaender-Gorfer, & Ko¨hler, 2008). The aim of the present study is to determine the prevalence and risk factors of depression among community-dwelling older population in an urban area in Turkey. 2. Materials and methods This cross-sectional study was conducted among elderly individuals 65 years and over in the town of Narlıdere (an urban area) in the province of Izmir in Turkey by a door-to-door survey. Population of the elderly was 4012 subjects, and cluster sampling method was used for sample size. Using the Epi-Info 2000 package, the minimum sample size was calculated as 471 elderly subjects based on depression prevalence of 15%, with 3% precision and 95% confidence interval (CI). The sample size was received from Turkish Statistical Institute (TUIK), and 512 older subjects in 2601 houses was determined. The research team visited a total of 490 (95.7%) subjects in their houses. Eight subjects were excluded from the investigation since their screening tests were not completed due to their physical disabilities or their communication problems. A total of 482 subjects were included in the study. Depression in the elderly has been diagnosed by a clinical interview and a short version of Geriatric Depression Scale (GDS-15 items) is used as screening test (Ertan, Bugay, & Eker, 2004). 2.1. The variables of the study, description of the variables The dependent variable in the present study was depression. A short form GDS-15 items was used as screening test. A score of 8 or higher was accepted as presence of depression. The independent variables were classified as (a) the socioeconomic variables; age, gender, status of education, social insurance, working before and during aging, personal and house hold income. (b) The variables of health status; chronic disease and loss of capacity diagnosed by Barthel Index (Available at: http:// www.strokecenter.org/trials/scales/barthel.pdf.) (40 scores: severely dependent, 41–60 scores: dependent, 61 scores: independent). 2.2. Data collection Data collection was completed between September 2006 and July 2008. All of the target subjects in the selected sample houses of 2601 were reached. To conduct home visits, permission was taken from local authority. After oral informed consents taken from elderly subjects and relatives living in the same house, subjects were interviewed face to face, and screening test was applicated. The study was approved by the ethics committee of the Faculty of Medicine of Dokuz Eylul University.
151
Table 1 Sociodemographic characteristics of the elderly residents. Characteristics Gender Male Female Age groups (y) 65–69 70–74 75–79 80–84 85 Marital status Married Widowed Divorced–single Education Illiterate Literate Primary school Secondary school High school University Social insurance (no) Working at the present Personal income (yes) Monthly personal income ( 0.30 is significant. If w value is significant, variables were analysed by using logistic regression model. 3. Results The mean age of the 482 elderly subjects was 71.7 years (range 65–114 years; SD: 6.5). Socio-demographic characteristics of the elderly are shown in Table 1. Of the elderly population, 58.9% were females, 71.4% were between the ages of 65–74, 63.3% were married, 34.2% were illiterate, and 50.4% did not graduate from primary school. While 12% of the elderly had been lived alone, 45.6% had been lived with marital partner, 24.5% with children and 15% with marital partner and children, 2.1% with relatives, 0.8% with marital partner and relatives. In our study population 9.8% of the subjects were socially uninsured, 27.2% did not have any personal income and 5.7% were working during the study. Mean monthly personal income was 446.5 385 Turkish Lira (TL) (range; 0–3.000 TL). Of the older persons, 25.5% lived in squatter’s house, 29.6% perceived their economic status as bad or very bad. Of the older subjects, 31.4% had a job, 18.2% were active smokers, 24.9% were former smoker. Alcohol consumption rate was 8%. The health status of the elderly is shown in Table 2. Of the total 482 subjects, 18.5% had depression. Nearly 80% of older subjects had minimum one chronic disease. Most commonly seen diseases were hypertension (53.7%), cardiovascular disease (23.7%), hypercholesterolism (21%), diabetes mellitus (18.3%) and musculosceletal disease (15.7%). Association between depression and sociodemographic-economic characteristics is shown in Table 3.
E. Yaka et al. / Archives of Gerontology and Geriatrics 59 (2014) 150–154
152 Table 2 Health status of elderly residents.
Table 4 Presence of depression according to health status. N (n = 482)
Characteristics Chronic disease (yes) Cardio-vascular disease Hypertension Diabetes mellitus Cerebrovascular disease Hypercholesterolism Musculosceletal disease Chronic obstructive pulmonary d. Neurodegenerative disease Gastrointestinal disease Cancer Psychiatric disease Hypertrophy of prostate Daily life activity (dependent)
%
404 114 259 88 28 101 77 44 14 40 15 13 27 23
83.8 23.7 53.7 18.3 5.8 21.0 15.7 9.1 2.9 8.3 3.1 2.7 5.6 4.8
Table 3 Association between depression and sociodemographic-economic characteristics. Characteristics
n (482) Depression (+) N
Gender Male Female Marital status Married Divorced/widowed/ single Education Illiter./liter./primary sch. Middle s./high s./ university Living Alone Spouse/children Perceived economical status Bad-very bad Fair-good-very good Social insurance No Yes Working No Yes
%
x
2
Phi (w)
px2
Pphi
198 284
19 9.6 17.555
