Depressive symptoms in late life in urban and semi-urban areas of South-West Greece: An undetected disorder?

Depressive and Anxiety Symptoms in Community-Dwelling Women in Rural Areas of Greece in the Post-COVID-19 Pandemic Era

Background/Objectives: Depressive and anxiety syndromes are associated with elevated disability and are more prevalent in women. Data on the prevalence of depressive and anxiety disorders in the rural context are limited and contradictory. It is relevant to study common mental disorders in rural areas in the most vulnerable population of women, particularly in the post-COVID-19 pandemic era. Methods: This is a cross-sectional study that was conducted in two primary healthcare sites in the rural region of Farsala, Central Greece after the obviation of all restrictive measures that had been posed due to the COVID-19 pandemic. All consecutive female patients that attended the study sites for any non-emergent reason were asked to participate in the study. For the recording of symptoms of depression and anxiety, the self-reported Depression, Anxiety, Stress Scale-21 (DASS-21) was used. Results: The study sample consisted of 129 women. The majority of participants were >50 years, with 27.9% being older adults. A small percentage (13.2%) suffered a chronic physical disease. A large proportion of the sample, slightly exceeding 40%, reported clinically relevant symptoms of anxiety, whereas a lower percentage of women with depressive symptoms was detected (17.1%). Symptoms of anxiety and depression were found to be interrelated, while a number of sociodemographic variables were associated with both, such as older age, education (primary), living status (alone, OR 123.5; 95% CI: 7.3-2098.8 for anxiety; OR 3.5; 95% CI: 1.3-9.8 for depression), employment (not working, (OR 0.157; 95% CI: 0.06-0.41 for anxiety; OR 0.08; 95% CI: 0.01-0.62 for depression) and the history of a chronic disease (OR 33.8; 95% CI: 4.3-264.7 for anxiety; OR 37.2; 95% CI: 10-138.1 for depression). Self-rated financial status was not related to symptoms of anxiety or depression. Conclusions: The study highlights the importance of inquiring for symptoms of depression and anxiety in women attending the rural primary care setting. The use of valid and reliable self-reported instruments that are easy to administrate may be helpful in this regard.

Depression is associated with worse health-related quality of life, lower physical activity levels, and inadequate sleep quality in a Greek elderly population

The present study is a cross-sectional study that aimed to investigate the potential associations between depression status, health-related quality of life, physical activity levels and sleep quality in a representative Greek elderly population. Three thousand four hundred five (3405) men and women over 65 years old from 14 different Greek regions were enrolled. Geriatric Depression Scale (GDS) was used to assess depression status, Health-Related Quality of Life (HRQOL) was evaluated using Short Form Health Survey, physical activity levels were assessed via the International Physical Activity Questionnaire (IPAQ) and sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). A high prevalence of depression and an increased incidence of poor quality of life, low physical activity levels and inadequate sleep quality among the elderly population were recorded. Depression status was independently associated with worse quality of life, poor physical activity, inadequate sleep quality, female gender, BMI and living alone after adjustment for potential confounding factors. Elderly age, low muscle mass, educational and financial status were also identified as indicators of depression; however, their impact on depression status was considerably attenuated after adjusting for confounding factors. In conclusion, depression was associated with worse health-related quality of life, poor physical activity and inadequate sleep quality in a Greek elderly population. Future randomized control trials should be performed to confirm the findings of this cross-sectional study.

Depression Levels Influence the Rate of Asthma Exacerbations in Females

Background: Anxiety and depression are common psychological disturbances among asthmatic patients. The aim of the present study is the assessment of anxiety and depression in asthmatic patients and their correlation with symptoms control level and number of exacerbations per year. Methods: One hundred patients with asthma diagnosis, according to the Global Initiative for Asthma (GINA), aged > 18 years old, having a stable disease, were included. Emotional status was evaluated using the Hospital Anxiety Depression Scale (HADS). Patients were followed up for a year to assess the number and severity of exacerbations. Results: Most of our patients were female (58%), middle-aged (mean = 54 ± 13), and married (81%), with low frequency of smoking habits (smokers, ex-smokers and non-smokers were 26%, 30% and 37%, respectively) and low levels of both anxiety and depression [median (interquartile range (IQR)) = 4(2) and median (IQR) = 4(2), respectively]. At the low and moderate level of the depression subscale, female patients experienced asthma exacerbations more frequently compared to male patients (adjusted Incidence Rate Ratio (aIRR) = 4.30; 95% Confidence Interval (CI): 1.94–9.53 and aIRR = 1.82; 95% CI: 1.07–3.13, respectively). Conclusions. Clinicians should evaluate asthma patients for depression, as gender differentially influences outcomes among those with low and moderate levels of depression, with female asthmatics presenting more frequent exacerbations.

Predictors of Depression and Insomnia in Community-Dwelling Elderly People: A Cross-Sectional Evidence of Their Bidirectional Relationship

Objective

The aim of this study was to examine associated factors of depression and insomnia in community-dwelling elderly people in order to identify independent predictors.

Materials and methods

A cross-sectional study was conducted among 250 older people aged 60 years and over living in an urban area. A stratified random sampling method was used for recruiting samples from five Open Care Centers for Elderly People of the Municipality of Larissa, Greece. Data were obtained through a questionnaire that included demographic, socioeconomic, and health-related characteristics, 15-item Geriatric Depression Scale (GDS-15), and Athens Insomnia Scale (AIS). Simple and multiple logistic regression analysis was performed.

Results

The prevalence of depression and insomnia was 28.4% (95% CI: 22.9-33.9) and 39.2% (95% CI: 33.0-45.4), respectively. Our findings showed that the overall GDS-15 score was positively related to the overall AIS score (r = 0.405; p < 0.001). The best-fit regression analysis demonstrated four significant predictors (marital status, monthly income, body weight status, and insomnia) explaining 31.6% of the variance in depression risk. Moreover, community-dwelling elderly Greek people with insomnia symptoms were females, had a lower monthly income, and more likely to suffer from chronic diseases and depression.

Conclusion

These findings point to the importance of recognizing risk factors for both depression and insomnia in attempting to apply preventive interventions in the elderly and optimize their quality of life.

The Relationship Between Self-Care Agency and Depression in Older Adults and Influencing Factors

Depression is a significant mental health problem in older adults. There is a decrease in self-care agency and an increase in the prevalence of depression with aging. The current study was conducted to determine the relationship between self-care agency and depression in Turkish older adults aged ≥65 years (N = 473) and the influencing factors. Data were collected using a demographics questionnaire, the Self-Care Agency Scale, and the Geriatric Depression Scale. Self-care agency was related to age, marital status, level of education, economic status, and persons lived with, and depression was related to gender, marital status, level of education, economic status, chronic disease, and persons lived with. A negative correlation was found between the scales. As the score of self-care agency increased, depression decreased. [Journal of Psychosocial Nursing and Mental Health Services, 58(10), 39-47.].

"We can't carry the weight of the whole world": illness experiences among Peruvian older adults with symptoms of depression and anxiety

BACKGROUND

Despite the high levels of depression and anxiety symptoms in old age, the use of mental health services in this population is low. Help-seeking behaviors are shaped by how an individual perceives and experiences their illness. The objective of this study was to characterize the illness experiences of Peruvian older adults with depression and anxiety symptoms in order to lay the foundation for tailored community-based mental health interventions.

METHODS

In this qualitative study, we conducted in-depth interviews with a purposively selected sample of older adults (≥ 60 years) from peri-urban areas of Lima, Peru. We included individuals with only depressive symptoms (Patient Health Questionnaire-9 ≥ 10), only anxiety symptoms (Beck Anxiety Inventory ≥ 16), with depressive and anxiety symptoms, and older adults who mentioned they had received mental health treatment/care. The interview guide included the following topics: perceptions and experiences about depression and anxiety; perceptions about the relationship between physical chronic diseases and mental health; experiences with mental health professionals and treatments, and coping mechanisms. Data collection was conducted between October 2018 and February 2019.

RESULTS

We interviewed 38 participants (23 women, 15 men) with a mean age of 67.9 years. Participants' ideas and perceptions of depression and anxiety showed considerable overlap. Participants attributed depression and anxiety mainly to familial and financial problems, loneliness, loss of independence and past traumatic experiences. Coping strategies used by older adults included 'self-reflection and adaptation' to circumstances, 'do your part', and seeking 'emotional support' mainly from non-professionals (relatives, friends, acquaintances, and religion).

CONCLUSIONS

Illness experiences of depression and anxiety set the pathway for tailored community-based mental health interventions for older adults. Overlapping narratives and perceptions of depression and anxiety suggest that these conditions should be addressed together. Mental health interventions should incorporate addressing areas related to depression and anxiety such as prevention of loss of independence, trauma, and loneliness. Good acceptability of receiving emotional support for non-professionals might offer an opportunity to incorporate them when delivering mental health care to older adults.

Relationship of the pre-operative comprehensive geriatric assessment to length of stay in Korean older adults undergoing spinal surgery

BACKGROUND

Although pre-operative, Comprehensive Geriatric Assessment has been used widely, its impact on the health status of older adults has not been fully examined.

AIMS

This study aimed to investigate the relationships between subcomponents of a Comprehensive Geriatric Assessment and length of hospital stay in older adults undergoing spinal surgery.

METHODS

Participants were 133 older adults in neurosurgical department. The Comprehensive Geriatric Assessment included nutrition, physical activity, functional status, cognition, depression, the Timed Up and Go test, self-rated health, and frailty. Length of stay was replaced by excessive number of days, because expected length of stay varied depending on the type of surgery.

RESULTS

Excessive lengths of stay were associated with pre-frailty (p = 0.02), frailty (p = 0.02), risk of depression (p < 0.01), and post-operative complications (p < 0.01). More specifically, frailty and risk of depression played as moderators as interacting post-operative complications. The effect of interaction was greatest in the older adults who were frail and depressed (p < 0.001).

DISCUSSION

Among the subcomponent of Comprehensive Geriatric Assessment, frailty and depression were significant predictors of excessive length of stay. The interrelationship between frailty and depression better explained excessive length of stay rather than considered as individual variable.

CONCLUSIONS

Clinicians are encouraged to pay attention to depression and frailty, and its interaction to improve the health status of surgical elderly patients.

Depression Among Elderly Users of Open and Closed Care Facilities in a Rural Region of Greece: an Important Public Health Issue

Introduction:

It is estimated that 5.7% of the total Greek population suffers from depressive disorders. Elderly may be particularly prone to depression compared to younger people. In Greece, there is a paucity of literature regarding the correlation between the existence of chronic diseases, sociodemographic features, participation in open/ closed structures, and the presence of depression or depressive symptoms, among seniors. The purpose of this study was to explore potential correlations between the above- mentioned variables, as a whole.

Methods:

This was a cross- sectional, questionnaire survey of 200 elderly aged 65 or above and were members of 12 Open Care Centers for the Elderly (OCCE) or residents in 2 nursing homes located in the rural region of Epirus, in Greece. Data collection took place in the form of structured individual interviews. For the identification of independent factors associated with the existence of depressive symptoms, stepwise logistic regression analysis was performed.

Results:

A total of 81 (40.5%) seniors experienced depressive symptoms, though only 39 of them (19.5%) had been diagnosed for depression. Depression rates were higher for those with more chronic diseases (p=0.01) and at divorced, widowed and single seniors compared to married ones (50.5% vs. 28.1% respectively, p=0.002). The prevalence of depression was higher among the elderly who lived in nursing homes compared to the participants who were registered members of the OCCE (50% vs. 35.6% respectively, p=0.049), while elderly who often participated in the social activities of OCCE, had significantly lower rates of depressive symptoms compared to those who scarcely were involved in these activities (23% vs. 46.2% respectively, p=0.019). Participants who suffered from osteoporosis were more likely of displaying depressive symptoms compared to those who didn’t; OR (95% Confidence Interval) = 2.61 (1.28-5.33), p=0.009.

Conclusions:

The existence of an action plan that includes education and training of health professionals on mental health of the elderly and the satisfactory operation of public facilities to promote the wellbeing of seniors and offer more incentives for activity participation, may reduce depression rates and the under-diagnosis of the disease.

Internal Consistency of Yesavage Geriatric Depression Scale (GDS 15-Item Version) in Ecuadorian Older Adults

The present study aimed to assess the validity of a Spanish version of the Geriatric Depression-15 Scale (GDS-15) in Ecuadorian adults. Cross-sectional study to validate GDS-15 in its short version (GDS-15). Internal consistency and factor structure were assessed through Kuder Richardson 20 and Confirmatory Factor Analysis. A total of 211 subjects 65 years of age and older participated in the validation process. Internal consistency was adequate, the Kuder Richardson 20 coefficient for the total scale was 0.73. Three factor structure was found for the scale. This study highlights the importance of having a validated scale for screening depression in the elderly. This study provides an evidence for the use of GDS-15 in Ecuadorian elderly population to screen for depression.

Mental Health Care Delivery for Older Adults in Rural Greece: Unmet Needs

Mental disorders may go unrecognized and undertreated in older adults. This is the rationale for the launch of specialized mental health services for the elderly in high resourced settings. Rural areas, however, do not receive adequate mental health care owing to socioeconomic and geographical reasons, and this is the case of rural Greece, where research on mental health of the elderly is scarce. This article discusses the challenges of providing mental health care for older adults in rural Greece and the available options. Care can be delivered through the existing rural mental health services that are the mobile mental health units and through the primary care physicians. Training in psychogeriatrics for the personnel of the former and in mental health for the latter is warranted.