Depression among Elderly Attending Primary Health Care Centers in Bahrain: Towards a Policy for Detection and Intervention

Abstract

Abstract : Objectives: To estimate the prevalence of depression and the sociodemographic characteristics and disease status associated with it among Bahraini elderly attending the local health centers. Methods: A cross-sectional study of Bahraini persons aged 60 years and older attending the local health centers was conducted during the period from July to August 2006.One health center was randomly selected from each of the four geographical regions of Bahrain. The study was conducted in the four selected primary health centers. A structured questionnaire was developed and completed during an interview with the elderly subjects. The questionnaire assessed the elderly sociodemographic characteristics and disease status. The shorter version of the Geriatric Depression Scale GDS-15 was used to screen for depression among the study participants. Results: The study population comprised of 270 Bahraini elderly subjects. Men constituted 46% of the study sample while women constituted 54%. The mean age for male participants was 68.65 ± 6.3 and the mean age for females was 68.36 ± 7.More than half of women (52%) compared to 8.9% of men were widowed; this difference was significant (P = 0.000).Many subjects (53%) were Illiterate (can't read or write). Illiteracy was found to be higher among women (68.5%) than among men (34.7%) and the difference in the educational achievement between men and women was highly significant (P = 0.000).The majority of the elderly (83%) were living with their spouses or children. Only 7.5% of them were living alone. Very few of the participants (1.5%) didn't have a stable source of income .Furthermore, most of the elderly participants (65.2%) were dependent economically on others and only 9.6% of them were still working. Most of the elderly (84%) were socially active mainly by attending religious places and social gatherings. Many elderly (79.6%) were providing support to their family. There was a high prevalence of chronic diseases among the participants (91.5%).Half of the participants reported having hypertension or diabetes. Most elderly (82%) were taking at least one type of regular medication. The prevalence of depression among the participants was estimated to be 41.5%.The mean depressive score for men was 3.67 ± 3.07 and for women it was 5.86 ± 3.62.Severe depressive symptoms were reported by 3.2% of men and by 7.5% of women. The risk of depression was significantly more among women than among men with an odds ratio (OR) of 4.3 (95% CI = 2.54-7.32).Depressive symptoms were significantly related to widowhood and divorced status (P = 0.000).Subjects who were illiterate or had low level of education reported more depressive symptoms (P=0.041).Socially isolated elderly were more prone to have depression (P = 0.006).Elderly subjects who were providing support to their family reported significantly less depressive symptoms (P = 0.002).Past history of psychiatric problems was found to be significantly associated with depression (P = 0.017).The presence of chronic disease was also significantly associated with depression (P= 0.014).The following chronic diseases were significantly associated with more depressive symptoms: hypertension (P = 0.012), heart disease (P = 0.017), chronic joints problem(P = 0.000), chronic ear disease (P = 0.048),and chronic eye disease (P = 0.000). These risk factors remained highly significant even after adjusting for other variables in the multiple logistic regression model: female sex (P=0.007), widowed or divorced states (P = 0.042), social isolation (P=0.007), and the presence of eye disease (P = 0.000) or joint problem (P = 0.000). Conclusion: Depressive symptoms are highly prevalent among Bahraini elderly attending the local health centers. Family physicians should be trained to screen for and to manage depression in highly susceptible groups