Depression in older adults: Prevalence and risk factors in a primary health care sample

Abstract

Background: Depression in the geriatric population has been identified as a significant problem in view of the associated negative outcomes regarding poor functioning, increased perception of poor health and increased utilisation of medical services. Significantly associated with increased morbidity and mortality,  depression has been found to be an independent cause of disability as well as adding to disability due to primary physical illnesses. Early identification and treatment of depression reduces medical costs and lessens caregiver burden. Epidemiological data and prevalence rates of geriatric depression in Africa are limited, although such data are vital to mobilise and plan government mental health initiatives aimed at screening and early intervention.

Objective: To determine the prevalence of depression and associated clinical and socio-demographic factors amongst older adult patients attending a primary health care clinic in the Ethekwini District in Kwa-Zulu Natal, South Africa.

Methods: The 15-item Geriatric Depression Scale and a socio-demographic  questionnaire were administered in English to 255 geriatric outpatients, randomly selected, at a local community clinic in Durban.

Data analysis: Data were analysed using SPSS version 23®. Descriptive statistics were used to summarise the sample demographics and response rate and non-parametric statistics were used to test for associations and differences.

Results: A Cronbach’s alpha for the GDS was calculated (p = 0.793). Some 40% of participants screened positive for depression. Female gender, widowhood and a negative subjective health status rating were significantly associated with depression and marriage appeared to be protective (p < 0.001). Participants with a poor subjective health rating were 21 times more likely to be depressed and widowhood conferred an almost fourfold increased risk of being depressed, with widows at greater risk than widowers. No association between depression and specific medical conditions was identified.

Conclusion: There is a high rate of undetected depression among the elderly attending a local primary health care clinic with widowhood and poor subjective health being strong predictors of mood disorders. The findings warrant replication in bigger samples.

Keywords: depression, elderly, prevalence, self-rated health, widowhood