Depression Among Community Dwelling Adults Health And Social Care Essay

Depression is a mental upset that reported often among aged cohort. With increasing aging population, depression becomes a great hazard to public wellness in the worldwide. WHO reported this mental upset will go a most of import wellness job among people by the 2030 ( Weil, 2009 ) . WHO ( 2003 ) is defined Depression is a “ common mental upset that presents with down temper, loss of involvement or pleasance, feelings of guilt or low dignity, disturbed slumber or appetency, low energy, and hapless concentration ” . The prevalence of depression among community -dwelling is different. Besides the prevalence of depression reported otherwise in western and Asiatic community. However a few surveies examined depression among aged community populating most surveies conducted on seniors who were disable ; ( Demura & A ; Sato, 2003 ; murata, koondo, hairai, ichida, ojima, 2003 ) or chronic diseases ( SIDIK, ZULKEFLI, & A ; MUSTAQIM, 2003 ) or go toing in primary wellness attention clinic ( SIDIK, ZULKEFLI, & A ; SHAH, 2003 ) . On the other manus comparing the prevalence of depression among aged in Western and Asiatic states is hard because of difference in design survey ( transverse -sectional, longitudinal, and correlativity ) , and instrument used ( CHONG, et al. , 2001 ) , besides different civilization population ( Jang, et al. , 2009 ) . However the prevalence of depression in Western society is higher than Asiatic society besides is different between states ( Wada et al, 2004 ) .

CHONG et Al ( 2001 ) conducted a cross-sectional survey of depression among Chinese aged life in community. In this survey, 1500 seniors that were age 65years old and above selected indiscriminately from three communities ( rural, semi-urban and urban ) . Using GMS -AGECAT questionnaire examine the prevalence of depression. The consequences of survey showed that 37.7 % of topics suffered psychiatric upsets, 15.3 % of topics were depressive neuroticism and 5.9 % of topics were major depression ( CHONG, et al. , 2001 ) .

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Wada et Al ( 2004 ) examine prevalence of depression among aged Nipponese life in rural community. Design of survey was cross-sectional ; the Numberss of respondents were 1798, age 65+ . Depression graduated table was GDS-15. The consequences showed that prevalence of depression utilizing cut-off 5.6 of GDS-15 ( Wada, et al. , 2004 ) .Also other survey on prevalence of depression in a rural community life of Malaysia conducted in 2004. The Numberss of respondents were 263 seniors that were age 60 old ages old, although the sample size was low. Design of survey was cross-sectional and interview did base on GDS ( Geriatric Depression Scale ) graduated table. The findings showed that prevalence of depression was 7.6 % ( SIDIK, Rampal, & A ; Afifi, 2004 ) .

In the 2004, the research workers conducted a survey on the prevalence of psychiatric upset among aged in France. In the survey was base on longitudinal survey, the sample size was 1873 seniors who were age 65 old ages old and older and life in community. Depression measured by DSM questionnaire. The consequences of survey illustrated that life clip and current prevalence of major depression among the respondents was 26.5 % and 3 % severally ( Ritchie, et al. , 2004 ) .

Other survey, Copeland et Al ( 2004 ) examine prevalence of depression among aged community life in 9 centres including of Iceland, Liverpool, Zaragoza, Dublin, Amsterdam, Berlin, London, Verona, and Munich in 2004. Infect these centres determined that together established a Centered Action, group their informations to compare prevalence of depression in seniors that were 65 and above. All the samples had applied GMS for mensurating depression. Samples size were different between 202 and 5222, age of respondents were 65+ , except Amsterdam ( 65-84 ) , Berlin ( 70+ ) , Munich ( 85+ ) and Iceland ( 88-89 ) , the all sitting surveies were urban except a sample that had been mix of urban and rural. Data aggregation was conducted between 1990 and 1996 except a sample in 1983. The consequences of survey showed that prevalence of depression among these centres was different. Degree of depression was: Iceland 8.8 % , Liverpool 10.0 % ; Zaragoza 10.7 % ; Dublin 11.9 % ; Amsterdam 12.0 % ; Berlin 16.5 % ; London 17.3 % ; Verona 18.3 % and Munich 23.6 % ( Copeland, et al. , 2004 ) .

1b- hazard factors of depression

Based on old surveies, it is understood that the factors associated with depression in late life are multi-factorial and scope between persons and population. Besides the hazard factors of depression in late life categorize into three subgroup of biological, psychological and sociological ( George, 1994 ; Kurlowicz 1993 ) . Murata et Al ( 2008 ) investigated the hazard factors of depression in the aged community life. The information of this survey pull on undertaking of AGES ( Aichi Gerontological Evaluation Study ) that was a go oning survey on forecaster factors of loss healthy in aged is get downing from 1999 in Japan. Using mail study selected indiscriminately 32,891 topics ( adult females and work forces ) that were age 60 old ages old and above from 6 urban, 2 semi-urban, and 7 rural ) . Depression variable examined by Geriatric Depression Scale ( GDS-15 ) every bit good as other variables including of socio- -economic position ( degree of instruction, income and household size ) and aged country of abode were examined. The findings showed that work forces with less socio- -economic position are more down than adult females every bit good as rural abode. Additionally increasing old ages of instruction and income decreased the prevalence of depression among aged ( Murata, et al. , 2008 ) .

Other similar survey confirmed that aged socio- -economic position affected on depression. This survey was a longitudinal design, 2593 seniors age 65 and older were respondents. The information come up LASA that was a go oning survey of forecasters of alterations in aged wellbeing in the Netherlands. Depression examined by CES-D graduated table and socio-economic position investigated by the old ages of instruction and household income. The consequences show that aged with low income and instruction are more down ( Koster, et al. , 2006 ) .

Other hazard factors could do depression among aged are ADL and societal support. BOZO et Al ( 2009 ) examined the consequence of ADL and societal support on depression. The design of survey was cross-sectional ; the sample size was 102 elderly aged 60+ life in 3 metropolis of Turkey. ADL investigated by 17-item, 5-point Likert-type questionnaire, societal support examined Multidimensional Scale of Perceived Social Support ( MSPSS ) and depression measured by The BDI comprised 21 multiple-choice inquiries. The consequences showed that seniors who was high activity daily life and societal support at the consequence was low down ( BOZO, TOKSABAY, & A ; KURUM, 2009 ) .

Other survey investigated the consequence of lifestyle factors. In this instance survey design was cross-sectional, the Numberss of respondents were 1302 adult females and work forces in community life and the consequence of lifestyle factors examine by smoke, imbibing and nutrient behaviour every bit good as depression graduated table was GDS. The determination demonstrated that depression was associated with aged life style specially old -old age ( Demura & A ; Sato, 2003 ) . In extra, functional restriction and chronic diseases could do high depression in the aged.

Matthew Niti et Al ( 2007 ) examined relationship between chronic diseases and functional position among aged community life. This study was longitudinal survey, sample size was 2,611 seniors who were age 55 + . Depression measurement was GDS, chronic diseases measured by self-report questionnaire that included 20 chronic unwellnesss. The consequence showed that elderly without chronic diseases were low depressed ( 7.5 % ) . While seniors who with chronic diseases were high depressed ( 13.2-24.2 % ) ( Niti, Ng, Kua, Ho, & A ; Tan, 2007 ) .

Other hazard factor that could take depression among aged is personality trait such as self-esteem. Although there is few surveies related to this hazard factor among aged ( Deeg Kerkhof,2010 ) . However, in life-time seniors face with function backdown and societal isolation and theses elements hurt aged ego regard ( Kim & A ; Park, 2000 ) . In this instance, Westawa ( 1992 ) conducted a cross-sectional survey, the figure of answering 100 ( 15- and 60+ ) with TB. Depression variable investigated by BDI graduated table and self-esteem variable determine by Rosenberg Self-Esteem Scale. The consequences of survey showed that there is a negative relation between depression and self-pride ( WESTAWA & A ; WOLMARANS, 1992 ) .

1c- Correlational versus longitudinal surveies on depression

In the instance of depression among community populating aged, some surveies are correlate and the research worker wanted to find the relationship between depression and some psycho societal and physical variables.sometimes the correlational survey is transverse sectional and the research worker attempt to find the correlativity between depression and other variables in definit and short period of time.In the other manus sometimes may be two variables be correlate to each other for short period of clip non for long time.Therefore the best consequence will be gain with crsos-sectional studies.But sometimes the research workers want to find the alteration in depression symptom over clip by carry oning longitudinal staudies.Here are some illustration of correlational and longitudinal surveies about depression among aged who populating in the community.

1-Correlational studies- The Survey Method on depression among community livng aged

In a survey that was conducted by You, Lee, Fitzpatrick, Kim, et Al ( 2009 ) , the research worker wanted to place the relationship between depression with spiritualty, populating entirely, and perceived wellness in Korean older grownups that live in the community.the consequence of the survey showed a positive correlativity between populating entirely and depression. It means that Korean older grownups who populating entirely were significantly more down than older grownups who stay with household ( P & lt ; .01 ) .but between the variables of attending and importance of faith with general wellness and depression was no relationship.

Simillarly In other correlational survey, that was conducted by Azar, Murrell, Mast ( 2005 ) the research worker attempt to place the relationship between race and depression and besides between race and cerebrovascular hazard factors in 362 community-dwelling older grownups both black and white.The consequence showed a positive relationship between race and depression in which Black topics were more likely than Whites to be depress, but there were no relationship between race and cerebrovascular hazard factors.

Both of these surveies were transverse -sectional and the aged people studied for short period of clip or at a defined time.Although, the correlational surveies can be longitudinal and the topics unders study detect for long period of clip.

Longitudinal surveies on depression among community populating aged:

In an longitudinal survey that was conducted by Henderson, Korten, Jacomb, Mackinnon, et Al ( 1997 ) A sample of 1045 individuals aged 70+ old ages in 1990-1 in Australia was re-interviewed after 3.6 old ages. The intent of survey was to see the alteration in depression with clip and to find the best forecasters of the depressive symptoms at follow-up and the result of depression over clip. The consequences indicated that mortality and refusal were more in those who had symptoms of depression in the beginning of the survey. There was no relationship between depression and age or Apolipoprotein E genotype. The best forecasters of depressive symptoms after 3.6 old ages was the figure of depression symptom at the first stage of the survey and accordingly some factors such as diminution in wellness and in activities of day-to-day life, terrible neurosis, wellness jobs, deficient societal support, diminution in current activity s and high service usage.

another longitudinal surveies conducted by Dufouil, Fuhrer, Dartigues, Alperovitch ( 1996 ) The purpose of this survey was to place whether terrible depressive symptomatology is prognostic of cognitive diminution between aged after 3 old ages. Data collected from a community-based prospective cohort survey. In this survey 1,600 instances were interviewed at the beginning of the survey at 1989 and 3-year subsequently. The determination of survey showed that a terrible depressive symptom is non prognostic of cognitive diminution after 3 old ages of followup.

Besides there is another longitudinal survey as mentioned by Roshanaei-Moghaddam, Katon, Russo ( 2009 ) that includes:

Katon et Al ( 2008 ) carried a survey to see the alterations in depressive symptoms and grade of physical activity in 2759 diabetic patients. The research workers measured the sum of exercising and depression symptom in the beginning of the survey and 5 old ages subsequently. the aged people with no or less depressive symptoms in the baseline and 5-year later had significantly more yearss of exerting per hebdomad than the other groups with less depression in the baseline and important depression 5 old ages subsequently or groups with changeless depression.

Besides In a 1-year prospective survey that was carried by Juarbe et Al. ( 2006 ) , they attempted to look into the relationship between depression, physical activity and weight addition in 232 premenopausal Latina and White adult females. There was no correlativity between depression in the beginning of survey and the subsequent sum of physical activity at 1-year later.

Similarly In a 5-year followup survey, Panagiotakos et Al ( 2008 ) attempted to place the determiners of physical inaction in 1955 community inhabitants during 5 old ages. The consequence showed that depression and anxiousness were strong forecasters for inaction among aged ( Roshanaei-Moghaddam, Katon, Russo, 2009 )

2- Justify why biopsychosocial theoretical account of depression used as your major theoretical model is most appropriate and relevant to your survey.

The influencing factors on depression are multi-factorial.The old surveies showed that depressive syndrome in aged could be at the consequence of many different factors such as biological, physiological and sociological elements ( George, 1994 ; ( Kurlowicz, 1993 ) . Harmonizing to these classs, the Biopsychosocial theoretical account of depression could accommodate my survey. On the other manus Biopsychosocial theoretical account comes up from system theory and explicate that a upset non merely emerge at the consequence of biological system but besides it could be at the consequences of interaction between multi-systems ( external and internal factors ) ( Williams, Wilkinson, Stott, & A ; Menkes, 2008 ) . Harmonizing this theoretical account, an person as a life system can be influenced by environmental stressors. Therefore this theoretical account provides to analyze non merely relationship between depression and biological factors but besides it make possible to look into relation between psychosocial factors. Besides with utilizing this theoretical account is possible to happen a rational relationship between the survey variables ( cohen, magia, yaffee, & A ; walcott-brown, 2005 ) . The Biopsychosocial theoretical account is a phase theoretical account that includes six degrees ( George, 1994 ) . In each degree, it is need to set stressors based on their happening clip therefore this theoretical account show that there is a graded ( hierarchal ) rational between dependent variable and mugwumps variables ( magia, Kerns, consedine, & A ; fyffe, 2003 ) .However utilizing this theoretical account provide to analyze comprehensive and different set of variables for identify precise hazard factors relevant to depression.

There is a sum-up of the theoretical account base on my research variables.

Level one: Demographic variables: Age, gender, ethnicity, faith.

Flat two: Early event & A ; accomplishments: instruction.

Level three: subsequently events & A ; accomplishment: matrimonial position, income, occupation, urban/ rural abode.

Level four: Social integrating Variable: Social web ( frequence of contact ) .

Level five: exposure and protective factors: Functional restriction, Disability, Health job, life manner ( smoke, intoxicant consumption, exercising ) , Self-rated wellness, societal support.

Level six: provoking agents and get bying scheme: retirement, Perceived of life satisfaction of societal support, Self-esteem.

3- Discuss the issues of measurings in depression research

Diagnosing, handling, and pull offing geriatric depression is really complex and disputing. Because of Depression in older people is frequently accompanied with assorted medical conditions. Literatures review showed there are many different instruments for mensurating depression. Santor ( 2006 ) states that more than 280 instrument for mensurating depression have been made from 1918 ( Santor, Gregus, & A ; Welch, 2006 ) and some instrument often use for measuring depression in aged such as GDS, BDI, GMS, HRSD, MADRS and so on ( Burns and Lawlor et al,2002 ) . The research workers based on their purpose of survey select an instrument. However utilizing different instrument in surveies make hard comparing consequences of the surveies. The most of import issue related to content of measurings. For illustration Beck Depression Inventory graduated table more focal point on cognitive damage besides this graduated table have some inquiries about bodily ailments by contrast of GDS graduated table. Although both graduated tables could be answered by the aged but that could consequence on concluding tonss while to finish GMS and HRSD need to develop interviewer and observation and replies are more accurate. Sometime two graduated tables are non correlated. At this instance, Koehler and et Al ( 2005 ) examined mensurating depressive symptoms in nursing place occupants with two different graduated tables ( MDS and GDS ) . After comparing the consequences of survey, they find out that the consequences of happening are non related ( Koehler, et al. , 2005 ) .

There are brief descriptions of some mensurating depression instrument and the issues.


Yesavage and et Al ( 1983 ) designed GDS that self-report questionnaire and usage often in researches for measurement of depression in non-institutionalized or institutionalised elderly. The respondent could finish this signifier by ego. Because the questionnaire has a merely construction and reply is yes or no. The GDS is in three versions including of GDS-30, GDS-15 and GDS-4. This instrument does non hold application among aged cognitive damage because of invalid. The diagnosing standards are non including of anorexia, weight loss, insomnia and cardiac symptoms. For illustration GDS is superior to HRSD in aged with moderate dementedness. Because GDS elicits present-state replies elders no demand to utilize their memory.


The Beck Depression Inventory graduated table draws up cognitive theories by Back In 1961. Three versions of BDI are accessible besides it is self-reported and utilizing in all age groups. The depressive symptoms elements of BDI are dwelling of hopelessness and crossness, cognitive symptoms and bodily ailments. Although, the most scale points are associated with cognitive symptoms ( Beck, 2006 ) . The BDI was originally developed to observe, buttocks, and proctor alterations in depressive Symptoms among people in a mental wellness attention puting. It is besides used to observe depressive symptoms in a primary attention scene.

Hamilton Rating Scale for Depression ( HRSD )

HRSD graduated table is a 17 point questionnaire that make by Hamilton in 1960 ; the content graduated table is including down temper, guilt feelings, Suicide, sleep perturbations, anxiousness degrees and weight loss ( Hamilton, 1960 ) . Besides to finish this graduated table demand to develop interviewer and observation. This graduated table has more focal point on bodily upsets, anxiousness and general psychiatric upsets and is good valid in grownup. The HDRS was originally developed for infirmary inmates.

Montgomery and Asberg depression Rating Scale

The MADRS original come back to British and Swedish research workers in 1979. The graduated table is brief, observer-related graduated table, including 10 inquiries and the content is dwelling of symptoms of Mood, Anxiety, Sexual Function, Appetite, Sleep, Functional Status, Ability to Think, Physical Symptoms, Hypochondriasis, Diurnal fluctuation and general Psychiatric Distress ( United States Department of Health and Human Services ) . It does n’t measure bodily symptoms that may be of import in the aged. This graduated table is good proof in younger population.

MADRS Designed to be used in patients with major depressive upset, both to mensurate the grade of badness of depressive symptoms, and peculiarly as a sensitive step of alteration in symptom badness during the intervention of depression.


In 1986, Copeland et al created Geriatric Mental State that applies really often in community study for diagnose mental upsets among aged age group. Besides it is appreciate graduated table in community surveies. There are two versions ; the version 1 has focused on dying symptoms and version 2 able to divide depression and dying symptoms ( Santor and et al 2006 ) . DSM is able to do comprehensive and different factors from the findings. Using AGECAT system information put into some relational degree and established the upsets groups such as Organic Schizophrenia and related paranoid provinces, Mania, Depression, Obsessional Neuroses, Hypochondriasis, Phobic Neuroses and Anxiety Neuroses. Respondents obtain a degree of assurance of diagnosing on each of the diagnostic groups and acquire a mark 0-4 or 0-5. After comparing phases with each other, the system obtains concluding diagnosing. ‘Well ‘ is awarded to respondent who do non hold any symptoms whereas ‘sub instance ‘ is gotten to respondent who with degree of assurance 1 and 2, eventually ‘case ‘ are respondent who with degree of assurance 3 and 4 ( Chong, Chan, 2001 ) .However utilizing the graduated table could do job when survey population are low educated because of high increasing of bodily diagnose ( Copeland JR, Prince M, 2002 ) .

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