Depressive symptoms in older Estonians: prevalence and models.

Abstract

To the Editor: Most psychiatric literature on old age is from North America and Western Europe. In different cultures, the prevalence of and factors promoting depressive symptoms might vary.1,2 The present study was undertaken to examine the prevalence of and find factors associated with depressive symptoms in older persons in Estonia, which is a country passing through a period of economic and social transition. In this study, we screened for depressive symptoms using the brief version of the Geriatric Depression Scale (GDS15) with a cutoff score of 5/6. The study was a cross-sectional population-based study. A random sample of persons aged 65 and older consisted of 1,000 subjects (0.5% of the older population of Estonia). A questionnaire was filled in and family doctors performed tests (GDS15 and Mini-Mental State Examination (MMSE)) after obtaining agreement from patients in older persons homes in April/May 2000. Response rate was 81.1%. Overall prevalence of depressed mood was 40.3% (95% confidence interval = 36.9%–43.7%). The prevalence of depressed mood increased with age (65–84, 39.2%; ≥85, 52.9%; P < .001) and was higher in women (men, 35.2%; women, 42.8%; P = .02). There were no significant differences in the prevalence of depressive symptoms in rural and urban populations. For creating models of depressed mood, variables from each section of the questionnaire (personal data, family, housing, coping with everyday life, financial coping, social engagement, interpersonal relations, need for help, health, use of medicines) were used (38 potential arguments). Influence of personal data (age, gender, nationality, education) was nonsignificant (P = .70, .16, .60, and .11, respectively). The linear model of GDS15 score consisted of the eight variables (see Table 1). The descriptive power (in the sense of determination coefficient R2) of the model was 42.7%; the model and all its arguments were significant (at the level .05). In conclusion, our survey revealed higher levels of depressive symptoms in older Estonians (40%) than described by different researchers in other regions (11–36%).3–5 Similar to other reports,4 depressive symptoms were more prominent in older age groups and in women, but when adjusted for other factors, small effects of age, gender, and marital status were observed. In contrary to some other studies,1,6 factors of subjective health perception were more strongly associated with depressed mood than medical diagnoses. The only objective medical factor that correlated to depressive mood in our study was MMSE score. More than half of the variables in our model (five of eight) belonged to the category of social factors.