Prevalence of Depression in Older Nursing Home Residents in High and Low Altitude Regions: A Comparative Study

Yu-Tao Xiang,Fei Wang,Qinge Zhang,Shou Liu,Dexing Zhang,Xiling Cui,Chee H Ng

doi:10.3389/fpsyt.2021.669234

Abstract

Objective: Depressive symptoms (depression hereafter) is common in older adults, and closely associated with environmental factors. This study compared the prevalence of depression in older adults living in high-altitude and low-altitude regions, and their association with quality of life (QOL).Method: A total of 632 older nursing home residents were included, with 425 participants living in low-altitude and 207 participants living in high-altitude regions. Depression and QOL were assessed using standardized instruments.Results: The prevalence of depression was 26.9% (95% CI: 23.43–30.37%) in the whole sample of older nursing home residents, with 11.1% (95% CI: 8.01–14.05%) in those living in low-altitude and 59.4% (95% CI: 52.68–66.17%) in those living in high-altitude regions. Multiple logistic regression analysis revealed that living in low-altitude region (P < 0.001, OR = 0.07, 95% CI: 0.04–0.12) was associated with lower risk of depression, while perception of poor health status (P < 0.001, OR = 3.86, 95% CI: 1.98–7.54) and having insomnia (P < 0.001, OR = 4.76, 95% CI: 2.99–7.56) were associated with higher risk of depression. QOL was significantly lower in physical (F(1,632) = 35.421, P < 0.001), psychological (F(1,632) = 20.777, P < 0.001), social (F(1,632) = 8.169, P < 0.001) and environmental domains (F(1,632) = 11.861, P < 0.001) in those with depression.Conclusion: Depression was common in older nursing home residents especially those living in the high-altitude region. Considering the negative impact of depression on QOL and functional outcomes, routine screening and timely treatment of depression should be implemented in this population.

Highlights

Due to biological and psychosocial risk factors such as physical disorders, retirement, bereavement and social isolation, depressive symptoms are common in older adults [1, 2], which could lead to a range of negative health outcomes including poor daily functioning, cognitive decline and high risk of suicidality [3,4,5]
The discrepancy in depression prevalence between studies could be partly due to the use of different measures of depression; for example, the Center for Epidemiologic Studies Depression Scale (CES-D) [9], Montgomery–Åsberg Depression Rating Scale (MADRS) [10], Hamilton Rating Scale for Depression (HAMD) [11], and Patients’ Health Questionnaire (PHQ-9) [12] were used in different studies
Living in high-altitude areas is associated with hypoxia [16], lower atmospheric pressure and altered pharmacokinetics of certain psychotropic medications [17], all of which could increase the risk of depression [18]

Summary

Introduction

Due to biological and psychosocial risk factors such as physical disorders, retirement, bereavement and social isolation, depressive symptoms (depression hereafter) are common in older adults [1, 2], which could lead to a range of negative health outcomes including poor daily functioning, cognitive decline and high risk of suicidality [3,4,5]. The discrepancy in depression prevalence between studies could be partly due to the use of different measures of depression; for example, the Center for Epidemiologic Studies Depression Scale (CES-D) [9], Montgomery–Åsberg Depression Rating Scale (MADRS) [10], Hamilton Rating Scale for Depression (HAMD) [11], and Patients’ Health Questionnaire (PHQ-9) [12] were used in different studies. Environmental factors such as altitude are strongly linked with psychiatric problems [13]. A common limitation of previous studies of depression in high altitude has been the lack of comparison with those living in low-altitude areas

Methods

Results

Conclusion