|Year : 2015 | Volume
| Issue : 1 | Page : 38-41
Depression in nonpsychiatric geriatric outpatients
Anamica Lall, Sandeep Kumar Goyal
Department of Psychiatry, Christian Medical College, Ludhiana, Punjab, India
|Date of Web Publication||23-Jul-2015|
Dr. Sandeep Kumar Goyal
Department of Psychiatry, Christian Medical College, Ludhiana, Punjab
Source of Support: None, Conflict of Interest: None
Background: Depression in elderly is under diagnosed. This study was planned to find the prevalence of depression in the nonpsychiatric geriatric population, which often goes undiagnosed and untreated.
Aims: The primary aim of the study was to find the sociodemographic profile and prevalence of depression among nonpsychiatric geriatric outpatients and the secondary aim was to find factors associated with depression.
Settings and Design: By using purposive sampling, 100 patients aged more than 60 years attending various Out Patient Departments (OPDs) other than the Psychiatry OPD were recruited.
Materials and Methods: Geriatric depression scale was used to diagnose depression.
Results: 21% patients had mild depression and another 21% patients were severely depressed. 64% of the patients had one medical illness and 36% of the patients have more than 1 medical illness. Widow/widower patients had significantly more depressive symptom as compared to patients having a living spouse. Patients with two or more medical illnesses had significantly more depressive symptoms as compared to the patients with one medical illness.
Conclusions: 42% of the nonpsychiatric geriatric patients were found to have depression. Depression was more common in geriatric patients who were widow/widower or had more than 1 medical illness.
Keywords: Co-morbid, depression, geriatric
|How to cite this article:|
Lall A, Goyal SK. Depression in nonpsychiatric geriatric outpatients. J Geriatr Ment Health 2015;2:38-41
| Introduction|| |
The elderly constitute a rapidly growing proportion of our population. From the year 1950 to 2000, the proportion of people above 60 years in the developing countries went up slightly from 6% to 8%, however, by 2050, the proportion of people above 60 years is estimated to reach 19%. 
Depression in the elderly is a common problem. There are many reasons for depression in older adults is so often overlooked. Elderly adults are often isolated, with few around to notice their distress. Physicians are more likely to ignore depression in older patients, concentrating instead on physical complaints. Finally, many depressed seniors are reluctant to talk about their feelings or ask for help. 
Several large studies have now demonstrated a relationship between depression and ischemic heart disease. Depression is a risk factor for development of chronic illnesses such as diabetes and coronary heart disease (CHD) and adversely affects the course, complications, and management of chronic medical illness.  According to a World Health Organization (WHO) report, patients above the age of 55 with depression had a death rate four times higher than those without depression. Most of these deaths occurred from heart disease or stroke. 
de Groot et al.  found that elderly patients with one or more of the medical illnesses are more prone to develop depression and moreover depression may worsen the medical illness or may be a risk factor for development and/or outcome of medical illness.
Few studies from India and neighboring countries have evaluated the prevalence of depression in elderly patients in various settings. Khattri and Nepal  studied 100 elderly patients aged 65 and above selected from the psychiatry, medicine, and general practice outpatient departments of Tribhuvan University Teaching Hospital, Nepal. More than half (53.2%) of the participants were found to experience depressive illness according to geriatric depression scale (GDS). In terms of severity, 34.2% of patients had mild and 19% severe depression.
Sood et al.  studied 528 patients (age 65 years and above) admitted to various departments of the teaching hospital attached to the Government Medical College, Amritsar. Psychiatric assessment of patients was made on the basis of psycho-geriatric assessment scales and present state examination. Of the 528 patients, 260 (49%) had psychiatric co-morbidity. The most common psychiatric disorder was depression 25.94%.
Nandi et al.  did a study in two villages of West Bengal with the aim of assessing mental morbidity of the elderly population aged 60 years and above. It was found that 61% of these elderly people needed psychiatric treatment. The overwhelming majority of affected persons were suffering from depression.
Tiwari and Srivastava  conducted a study in Lucknow to assess the prevalence of psychiatric illness in persons 60 years and above in a defined rural community, and compared it with that of nongeriatric population to know the difference between the geriatric and nongeriatric segments. It was observed that psychiatric morbidity was much higher in the geriatric population (42.21%) as compared to the nongeriatric population (3.97%). The total prevalence of psychiatric disorders in the geriatric group was 42.21% and neurotic depression, manic-depressive psychosis depressed, and anxiety states were the most prevalent.
Singh and Kedare  examined 100 medically ill elderly patients attending the psychiatric outpatient department (OPD) and geriatric OPD of a Tertiary Care Hospital and found that 72% of medically ill elderly patients have depression.
Most of the studies, which found depression in geriatric population included patients from psychiatry OPD in sample population or were done in geriatric patients with medical illness attending psychiatric OPD. , There are studies assessing psychiatric morbidity in admitted elderly patients  and studies finding psychiatric morbidity in persons 60 years and above in community. , Depression in elderly is under-diagnosed as elderly people are reluctant in seeking mental health services. Conner et al.  concluded that the stigma associated with having a mental illness has a negative influence on attitudes and intentions toward seeking mental health services among older adults with depression. Hence, we planned a study to find depression in geriatric patients attending various medical-surgical outpatient services other than the psychiatry outpatient services.
The primary aim of the study was to find the sociodemographic profile and prevalence of depression among nonpsychiatric geriatric outpatients and the secondary aim was to find factors associated with depression.
| Materials and Methods|| |
This was a cross-sectional study done at a tertiary care hospital. Institutional Ethics Committee approval was obtained.
For the purpose of study, 100 patients aged more than 60 years attending various OPDs, excluding Psychiatry OPD were selected by using purposive sampling. Patients who refused consent, who were unconscious, in delirium, and had diagnosed psychiatric illness (current/past) were excluded. They were interviewed after taking informed written consent. The study was carried out in the months of July and August 2010.
Specially constructed sociodemographic performa was used.
Geriatric depression scale
The GDS, developed by Yesavage et al.  is a 30-item self-rated scale used to evaluate depression in the elderly. The GDS has been reported to be a useful screen for depression in elderly populations. Because depression in the elderly may manifest somewhat differently than depression in younger populations, use of the GDS may be a better choice for assessment of mood disorder in later life than some of the commonly utilized scales in younger populations.
All statistical analysis was performed using SPSS, version 21.0. IBM corp. Armonk, NY, USA.
| Results|| |
Prevalence of depression
Among the 100 patients, 21% patients were found to have mild depression and another 21% were found to have severe depression. Overall, 42% of the patients were suffering from depression.
Among 100 patients, 62 were males and 38 were females. The majority of the geriatric patients belonged to the age group 60-65 years (37%). Majority of the patients were literate. Only 22% of the patients were illiterate.
Majority (84%) of the patient's belonged to an urban area. Two-fifth (44%) of the patients were retired and one-fourth (27%) were housewives. Three-fifth (61%) of the patients had monthly income <10,000 Rs. and belonged to the nuclear families. Slightly less than one-third (30%) of the participants were widow/widower [Table 1].
When those with and without depression were compared, depression was found to be significantly more prevalent among housewives and those who were widow/widowers [Table 1]. No significant differences were noted between those with and without depression in terms of various sociodemographic variables such as age, gender, place of living (rural/urban), education, family type, and income.
Depression and co-morbid illness
Among 100 patients attending medical and surgical outpatient services, 64% of the patients had one medical illness and 36% of the patients had more than one medical illness. Hypertension was the most common medical illness, 18% patients had only hypertension, and another 34% patients had hypertension along with other co-morbid medical illness. 17% patients had diabetes mellitus, 17% had diabetes mellitus and hypertension both. Other diagnoses were hypertension and post myocardial infarction (8%), arthritis (6%), liver disease (5%), chronic obstructive pulmonary disease/asthma (5%), hypertension, post myocardial infarction and post coronary artery bypass graft (4%), diabetes mellitus, hypertension and cerebrovascular accident (3%), diabetes mellitus, hypertension and post myocardial infarction (2%), and diabetes mellitus and asthma(2%). Among surgical patients 3% had a fracture, 2% had abdominal pain, and another 2% patients came in OPD for postsurgical follow-up. 6% patients had other medical illnesses.
Higher percentage of patients with two or more medical illnesses had depression as compared to patients with one medical illness, and this difference was statistically significant.
| Discussion|| |
Our study shows that 21% patients had mild depression and 21% patients were severely depressed. Widow/widower and housewives had more depressive symptom as compared to married, and the association between the marital status and occupation of patient and GDS score was statistically significant.
Statistical correlation between depression and various sociodemographic variables such as age, gender, place of living (rural/urban), education, family type, and income were not significant.
A meta-analysis of 74 studies, including 487,275 elderly individuals found the worldwide prevalence rate of depressive disorders to be between 4.7% and 16%. This study indicates a comparatively higher prevalence of geriatric depression in India (21.9%). 
Higher prevalence of depression in our study can be due to the fact that it is a hospital based study. Khattri and Nepal  found that 53.2% of the patients aged 65 or more had depression, but in their study geriatric patients from psychiatry OPD were also included. In a study by Akhtar et al.  61.4% of the elderly patients attending OPDs registration area of a tertiary care teaching hospital in Delhi were screened positive for depression.
Higher percentage of patients with two or more medical illnesses had depression as compared to patients with one medical illness, and this difference was statistically significant. Singh and Kedare  also had a similar result.
Old age is associated with various physical disabilities, which leads to dependency on others for daily activities, which may be a reason for depression in elderly.  Higher age, low educational status, financial dependence, and having any chronic health problems were significantly independent predictors of depression in a study by Akhtar et al.  Disability, new medical illness, poor health status, prior depression, poor self-perceived health, and bereavement were identified as risk factors in a meta-analysis.  Schoevers et al.  reported that the highest risk for major depressive risk is spousal death, becoming even higher if the subjects also had a chronic illness, and in subjects who did not recently lose their partner, being disabled was the most important risk indicator. Further risk indicators were the presence of a chronic medical illness and female gender.
To conclude, the present study suggests that 42% of the nonpsychiatric geriatric patients have depression, which goes undiagnosed and untreated. For early diagnosis and treatment of depression in patients aged 60 years and more, physicians should be sensitized and trained in using scales like GDS which take very less time and are easy to administer and patients who are diagnosed to be having depression should be evaluated in detail and treated at the earliest.
Present study was limited by small sample size, assessment of depression as per GDS only, and these patients were not assessed by a psychiatrist by using a structured clinical interview.
Financial support and sponsorship
This project was done as short term studentship project of ICMR.
Conflicts of interest
There are no conflicts of interest.
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