Depression Symptoms In Liuyang Rural Community-dwelling Elderly: Prevalence And Associated Factors

Objective: To assess the depressive symptoms of rural community-dwelling elderly in Liuyang County, Hunan Province, and find out associated factors. The results would provide scientific basis for the primaiy and secondary prevention of late-life depressive disorder.Methods: We selected the subjects through a multistage stratified cluster sampling procedure. First, all the thirty-six towns of Liuyang County were stratified into three levels according to economic status and one were selected as survey fields from each economic level. And then we randomly selected six villages from each town, so there were eighteen villages. At last, tow groups were chosen randomly from each village. So, all the 60 years old and older, namely bora before May 31,1947, from the thirty-six groups made up our sample in the abstract. Socio-demographic characteristics, Geriatric Depression Scale (GDS), Social Support Rating Scale (SSRS), Activities of Daily Living (ADL) and Life Events Scale for the Elderly (LESE) were administered.The elderly in this study included those local residents and those who had been living in the locality more than six months continuously. Those who met one of the criteria as follows were not included: first, living in institutions such as hospital and nursing homes during the survey time; second, those local residents who left for more than six months; third, and those local residents who left for no more than six months but would not come back in the survey period. Those who had impaired cognitive, disturbance conscious and serious illness were excluded.Results: There were 475 elderly people aged 60 years and older in the thirty-six groups, of which 446 were identified as our sample. 413 were investigated; the response rate was 92.6%. Except one person, all the 412 had completed information.The prevalence of the 30 depressive symptoms assessed by GDS ranged from 11.7% to 89.1% (weighted prevalence: 10.8%-85.1%). The five most prevalent depressive symptoms were "problem with memory" (85.1%), "hard to start new projects" (73.6%), "mind as clear as used to be"(67.0%), "others are better off" (62.4%)and "prefer to stay home"(54.2%).The scores of GDS ranged from 0 to 30 with a median of 12.0 (QR=12.0). Using the normative score ranges for the 30-item GDS of "normal" (0-10), "mild depression" (11-20), and "moderate to severe depression" (21-30), these results indicated that 35.2% of the total sample having mild depression while 17.3% having moderate to severe depression.Increasing age, female, rural residents, marriage instability, depending on others for living, self-rated lower economic status, lower health status, lower status in the family, getting few social support, impaired activities of daily living and bearing more stress from negative life events were associated with higher risk of depression in univariate ordinal regression models. But some associations disappeared after all the risk factors were considered together in the multi-regression model. The remaining risk factors included female(OR=2.565, 95%CI: 1.598-4.121), self-rated lower economic status(OR=2.138, 95%CI: 1.465-3.117), self-rated lower health status(OR=1.972, 95%CI: 1.480-2.627), self-rated lower status in the family(OR=1.682, 95%CI: 1.165-2.425), getting few social support(OR=2.835, 95%CI: 1.826-4.402), impaired activities of daily living(OR=2.983, 95%CI: 1.605-5.546) and bearing more stress from negative life events(OR=3.277, 95%CI: 2.042-5.259).Path analysis identified that social support could play a role as an intervening variable in the relationships between activities of daily living and depressive symptoms, negative life events and depressive symptoms.Conclusion: Prevalence of depressive symptoms in the Liuyang rural community-dwelling elderly was quite high, and prevalence in people with different socio-demographic characteristics was quite different. Depressive symptoms were affected by several factors as stated above. More attention should be paid on the issue of depression in rural community-dwelling elderly. Older people with more depressive symptoms should be transferred and diagnosed in time.