Abstract
ObjectiveThis study aimed to develop a culturally acceptable and valid scale to assess depressive symptoms in older Indigenous Australians, to determine the prevalence of depressive disorders in the older Kimberley community, and to investigate the sociodemographic, lifestyle and clinical factors associated with depression in this population.MethodsCross-sectional survey of adults aged 45 years or over from six remote Indigenous communities in the Kimberley and 30% of those living in Derby, Western Australia. The 11 linguistic and culturally sensitive items of the Kimberley Indigenous Cognitive Assessment of Depression (KICA-dep) scale were derived from the signs and symptoms required to establish the diagnosis of a depressive episode according to the DSM-IV-TR and ICD-10 criteria, and their frequency was rated on a 4-point scale ranging from ‘never’ to ‘all the time’ (range of scores: 0 to 33). The diagnosis of depressive disorder was established after a face-to-face assessment with a consultant psychiatrist. Other measures included sociodemographic and lifestyle factors, and clinical history.ResultsThe study included 250 participants aged 46 to 89 years (mean±SD = 60.9±10.7), of whom 143 (57.2%) were women. The internal reliability of the KICA-dep was 0.88 and the cut-point 7/8 (non-case/case) was associated with 78% sensitivity and 82% specificity for the diagnosis of a depressive disorder. The point-prevalence of a depressive disorder in this population was 7.7%; 4.0% for men and 10.4% for women. Heart problems were associated with increased odds of depression (odds ratio = 3.3, 95% confidence interval = 1.2,8.8).ConclusionsThe KICA-dep has robust psychometric properties and can be used with confidence as a screening tool for depression among older Indigenous Australians. Depressive disorders are common in this population, possibly because of increased stressors and health morbidities.
Highlights
Depression is a leading cause of years lived with disability [1], affecting about 5% of the population at any point in time [2], including older adults [3]
There are concerns, for example, that depression may be common among Indigenous Australians living in remote areas [7], but surveys of these populations have been opportunistic and have used strategies of uncertain validity to ascertain the presence of depression [8,9]
One hundred and forty-four of the 250 participants completed an additional face-toface assessment with a consultant psychiatrist who was blind to the results of the KICA-dep
Summary
Depression is a leading cause of years lived with disability [1], affecting about 5% of the population at any point in time [2], including older adults [3]. An early attempt to validate a modified version of the Patient Health Questionnaire (PHQ-9) for use in this population recruited 34 Indigenous people with ischaemic heart disease in contact with a specific health service of the Northern Territory of Australia [10]. They reported that the PHQ-9 cut-point 8/9 (non-case/case) was associated with 70% sensitivity, 78% specificity, 58% positivity predictive value and 86% negative predictive value for the diagnosis of either minor or major depression. They found that clinically significant depressive symptoms affected nine of the KICA-Dep Items: In the last week have you: Response
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