Geriatric Mental State Schedule Research Articles

Prevalence of Psychiatric Disorders among Elderly In-Patients in Non-Psychiatric Wards of a Teaching Hospital in Northern Nigeria

The population of the elderly is increasing globally with enormous challenges particularly in developing countries. Aging increases the risk for both physical and psychiatric disorders with psychiatric disorders often unrecognized in non-psychiatric settings. This presents huge costs to both patient and society. The study aimed at estimating the rate of psychiatric morbidity in non-psychiatric wards of a tertiary hospital in Northern Nigeria. One hundred and forty (140) subjects were recruited into this cross-sectional descriptive study. Participants were initially screened using the Self Reporting Questionnaire (SRQ) and the Modified Mini-Mental State Examination (MMSE) after administering the Socio-demographic questionnaire. Subjects scoring >5 in the SRQ and or ≤13 in the Modified MMSE were then further interviewed using the Geriatric Mental State Schedule (GMS). Clinical Psychiatric diagnosis was also made based on ICD-10 diagnostic criteria from all information available and later compared with GMS diagnoses. Mean age of participants was 67.5, SD ±6.4. The rate of psychiatric morbidity using ICD-10 diagnosis was 47.9% with depression being the commonest disorder (18.6%) followed by delirium (17.1%) and dementia (10.7%). Depression and anxiety disorders were particularly under-recognized by non-psychiatric doctors. Identified risk factors for psychiatric morbidity included female gender, low socioeconomic status, low educational level and presence of multiple medical diagnoses. The rate of psychiatric morbidity among elderly in-patients in non-psychiatric settings has remained high in comparison to previous studies with huge gaps in recognition and treatment reflecting the need for more collaboration between medical teams.

Changes in pro-inflammatory cytokine levels and late-life depression: A two year population based longitudinal study

Longitudinal associations of cytokine levels with depression are unclear. This study aimed to investigate cross-sectional and prospective associations between five serum pro-inflammatory cytokine levels and late-life depression. 732 Korean people aged 65+ were evaluated at baseline. Of 631 without depression (Geriatric Mental State schedule) at baseline, 521 (83%) were followed over a 2 year period and incident depression was ascertained. Serum tumor necrosis factor-α, interleukin (IL)-1α, IL-1β, IL-6, and IL-8 levels were assayed at both baseline and follow-up. Associations between cytokine levels and depressive status were evaluated using linear regression models, considering potential covariates (demographics, cognitive function, disability, lifestyle factors, and vascular risk factors) and applying Bonferroni corrections. Prevalent depression at baseline was significantly associated with higher contemporaneous levels of IL-1β and IL-8, independent of relevant covariates and after applying Bonferroni corrections. In the analyses of the five cytokine levels in combination, independent associations were found between prevalent depression and increased numbers of cytokines at higher levels at baseline. Incident depression was significantly associated with increases in IL-1β, IL-6, and IL-8 levels during the follow-up independent of relevant covariates and after applying Bonferroni corrections. In combination analyses, incident depression was independently associated with higher numbers of cytokines showing increasing levels over the same follow-up period. However, incident depression was not predicted by higher baseline pro-inflammatory cytokine levels in any analysis. Our findings suggest that depression might affect serum cytokines alterations and lead to inflammatory processes in late-life.

Longitudinal associations between glucocorticoid receptor methylation and late-life depression

It has been suggested that hypothalamus–pituitary–adrenal (HPA) axis dysregulation plays a role in the etiology of depression. HPA axis function is mediated by glucocorticoid receptors (GRs), which are influenced by epigenetic mechanisms (DNA methylation). The association between the DNA methylation of the GR gene (nuclear receptor subfamily 3, group C, member 1; NR3C1) and late-life depression as well as the role of NR3C1 methylation in the prediction of the incidence of depression have not yet been investigated. Therefore, we examined the independent and longitudinal effects of the methylation of three CpG sites in exon 1F of NR3C1 on late-life depression using peripheral blood. In total, 732 Korean community residents aged ≥65 years were assessed; 521 individuals in this group without depression at baseline were followed 2 years later. The Geriatric Mental State Schedule was used to identify depression, and demographic and clinical covariates were evaluated. The effects of NR3C1 methylation (the individual methylation status of three CpG sites and their average values) on current and follow-up depression were calculated using a multivariate logistic regression model. Higher NR3C1 methylation levels at CpG 2 and 3 and the average methylation value were independently associated with the prevalence of depression at baseline. Additionally, a higher NR3C1 methylation level at CpG 2 was associated with depression incidence 2 years later in this population. These findings suggest an association between the methylation of NR3C1 exon 1F, especially at CpG 2, and depression later in life.

Gender differences in the association of cognitive impairment with the risk of hip fracture in the older population

ObjectivesTo test the hypothesis that differences by gender will be observed in the association of hip fracture risk with stages of cognitive impairment; and to explore the association between Petersen’s “mild cognitive impairment” (MCI) and DSM-5 “mild neurocognitive disorder” (MND). Study designA community sample of 4803 individuals aged 55+ years was assessed in a two-phase case-finding enquiry in Zaragoza, Spain, and was followed up for 16 years. Medical and psychiatric history was collected with standardized instruments, including the Mini-Mental Status Examination (MMSE), Geriatric Mental State (GMS), History and Aetiology Schedule, and a Risk Factors Questionnaire.The statistical analysis included calculations of Hazard Ratios (HR) in multivariate Cox proportional hazards regression models. Main outcome measuresIdentified cases of hip fracture, validated by blind researchers. ResultsIn men, hip fracture risk was increased at the “mild” (HR=4.99 (1.39–17.91)) and at the “severe” (HR=9.31 (1.35–64.06)) stages of cognitive impairment, indicated by MMSE performance. In contrast, in women no association could be documented at the “mild stage” (power=89%), and the association disappeared altogether at the “severe stage” in the final multivariate statistical model (power 100%). No association observed between hip fracture and mild cognitive impairment in both men (power=28% for P-MCI) and women (power=44% and 19% for Petersen’s MCI and DSM-5 MND, respectively). ConclusionsIncreased hip fracture risk was associated with “mild” stages of cognitive impairment in men, but not in women. To explore the potential association with the construct MCI or MND, studies with greater statistical power would be required.

The association between subjective memory complaint and objective cognitive function in older people with previous major depression.

The goal of this study is to investigate associations between subjective memory complaint and objective cognitive performance in older people with previous major depression–a high-risk sample for cognitive impairment and later dementia. A cross-sectional study was carried out in people aged 60 or over with previous major depression but not fulfilling current major depression criteria according to DSM-IV-TR. People with dementia or Mini-Mental State Examination score less than 17 were excluded. Subjective memory complaint was defined on the basis of a score ≧4 on the subscale of Geriatric Mental State schedule, a maximum score of 8. Older people aged equal or over 60 without any psychiatric diagnosis were enrolled as healthy controls. Cognitive function was evaluated using a series of cognitive tests assessing verbal memory, attention/speed, visuospatial function, verbal fluency, and cognitive flexibility in all participants. One hundred and thirteen older people with previous major depression and forty-six healthy controls were enrolled. Subjective memory complaint was present in more than half of the participants with depression history (55.8%). Among those with major depression history, subjective memory complaint was associated with lower total immediate recall and delayed verbal recall scores after adjustment. The associations between subjective memory complaint and worse memory performance were stronger in participants with lower depressive symptoms (Hamilton Depression Rating Scale score<7). The results suggest subjective memory complaint may be a valid appraisal of memory performance in older people with previous major depression and consideration should be given to more proactive assessment and follow-up in these clinical samples.

Associations of Upper Arm and Thigh Circumferences with Dementia and Depression in Korean Elders.

ObjectivePrevious studies have reported an association between weight loss and cognitive impairment. Changes in anthropometric measurements, such as arm and thigh circumferences, are associated with body mass changes and physical activity. Our aim was to investigate the association of upper arm and thigh circumferences with dementia and depression in the community-dwelling elderly population.MethodsIn total, 2,498 community residents aged 65 years or over were clinically assessed for dementia using the Korean version of the Community Screening Interview for Dementia. Depression was also assessed using the Korean version of the Geriatric Mental State Schedule B3. Arm and thigh circumferences were measured. Complex sample logistic regression was performed to evaluate associations of changes in anthropometric measurements with dementia/depression after controlling for other covariates.ResultsIn the adjusted analyses, there was an independent association between dementia and arm circumference (OR=1.12; 95% CI=1.06–1.19). This association was significant in the females (OR=1.12; 95% CI=1.05–1.19) but not in males (OR=1.07; 95% CI=0.93–1.28). The association between dementia and thigh circumference was not significant in the adjusted analysis (OR=1.03; 95% CI=0.99–1.07). No significant association was found between either upper arm or thigh circumference and depression.ConclusionIn the older female Korean population, decreased upper arm circumference was associated with dementia and may represent a biological marker for this condition. This association may be explained by nutritional deficits or decreased physical activity.

Anxiety symptoms in Korean elderly individuals: a two-year longitudinal community study.

Although late-life anxiety occurs frequently and is associated with higher morbidity, few longitudinal studies have been concerned with the evaluation thereof. We investigated the prevalence, incidence, and persistence of anxiety and related factors over a two-year period in community-dwelling Korean elderly individuals. A total of 1,204 Korean elderly individuals were evaluated at baseline, and 909 were followed up two years later. The community version of the Geriatric Mental State Schedule was used to estimate anxiety at both baseline and follow-up interviews. We defined "prevalence" as the rate of anxiety symptoms (for both anxiety cases and sub-threshold anxiety) at baseline; "incidence" as the rate of anxiety symptoms at follow-up in those without baseline anxiety symptoms; and "persistence" as the rate of anxiety symptoms at follow-up in those with baseline anxiety symptoms. Associations between various covariates and anxiety status were examined using multivariate logistic regression models. The prevalence, incidence, and persistence of anxiety symptoms were 38.1%, 29.3%, and 41.1%, respectively. Prevalent anxiety symptoms were associated independently with female, rented housing, more stressful life event and medical illness, physical inactivity, depression, insomnia, and lower cognitive function. Incident anxiety symptoms were predicted by older age, female gender, depression, and insomnia; persistent anxiety symptoms were predicted by older age, more medical illness, and baseline depression. Since depression was associated with prevalent, incident, and persistent anxiety symptoms, effective detection and management thereof is important in older adults to reduce anxiety. Furthermore, preventive collaborative care should be considered, particularly for older, female, insomniac patients.

Depression in elderly people living in rural Nigeria and its association with perceived health, poverty, and social network.

The relationship between late-life depression, poverty, social network, and perceived health is little studied in Africa; the magnitude of the problem remains largely unknown and there is an urgent need to research into this area. We interviewed community dwelling elderly persons of two rural areas in Nigeria using Mini-Mental State Examination (MMSE) and Geriatric Depression Scale (GDS-30). Those who scored 11 and above on the GDS-30 were further interviewed using Geriatric Mental State Schedule (GMSS). Diagnosis of depression was based on the International Classification of Diseases 10th edition (ICD-10) and GMSS-Automated Geriatric Examination for Computer Assisted Taxonomy (GMMS-AGECAT). A total of 458 community dwelling elderly persons participated in the study of which 57% were females. Mean age of the participants was 73.65(±7.8) years (95% CI 72.93-74.37). The mean GDS-30 and MMSE scores were 4.15(±4.80) and 21.73(±4.67), respectively. A total of 59 and 58 participants had depression based on ICD-10 criteria and GMSS-AGECAT, respectively. Agreement between ICD-10 and AGECAT diagnoses was κ = 0.931. By multiple logistic regression analysis, late-life depression was significantly associated with financial difficulties (Odds ratio 4.52 and bereavement Odds ratio 2.70). Late-life depression in this cohort is associated with health and socio-economic factors that are worth paying attention to, in a region of economic deprivation and inadequate healthcare.

Longitudinal associations between BDNF promoter methylation and late-life depression

Reduced brain-derived neurotrophic factor (BDNF) function has been suggested as a risk factor for late-life depression. BDNF secretion is influenced by epigenetic (DNA promoter methylation) and genetic (val66met polymorphism) profiles. We investigated the independent and interactive effects of BDNF methylation and val66met polymorphism on late-life depression. In total, 732 Korean community residents aged ≥65 years were evaluated, and 521 of them without depression at baseline were followed up 2 years later. Depression was determined using the Geriatric Mental State Schedule, and depression severity was evaluated with the Geriatric Depression Scale. Demographic and clinical covariates were obtained. The effects of BDNF methylation and polymorphism on the diagnosis of depression were investigated using a multivariate logistic regression model, and the relationships between BDNF methylation and depression severity were evaluated using partial correlation tests. Higher BDNF methylation was independently associated with the prevalence and incidence of depression and severe depressive symptoms. No significant methylation-genotype interactions were found. BDNF promoter methylation could be a proxy biomarker for depression late in life.

Associations of Pulmonary Function with Dementia and Depression in an Older Korean Population.

ObjectivePrevious studies reported an association between pulmonary function and cognitive function. However, not much has been investigated in this regard concerning dementia in a community population, taking depression into account. We aimed to examine the associations of pulmonary function with dementia and depression in a community-dwelling elderly population.MethodsA total of 1,038 participants were evaluated for dementia and depression using the Korean version of the Geriatric Mental State Schedule B3 (GMS B3-K), the Community Screening Interview for Dementia-Korean version (CSID-K) and a modified 10-item Word List Learning from the Consortium to Establish a Registry of Alzheimer's Disease (CERAD). Pulmonary function was measured as forced expiratory volume in 1 s (FEV1) from a forced expiratory maneuver.ResultsPrevalence rates of dementia and depression were 11.0% and 10.4%, respectively. Individuals who were diagnosed with dementia manifested a lower mean FEV1, as compared to those without dementia after adjusting for potential confounders, including disability and depression [OR=1.34 (1.05-1.72)]. Following gender-stratified analysis, the association was only statistically significant in women [OR=1.40 (1.04-1.89)]. The association between depression and mean FEV1 was less significant compared to dementia [OR=1.32 (1.10-1.58)]. However, the association was no longer significant after adjusting for age and years of education. No association was significant in the gender-stratified analysis.ConclusionDecreased pulmonary function was associated with dementia status only in an older female Korean population. Pulmonary function and depression were not significantly associated in either gender.

Burden and correlates of geriatric depression in the Uyghur elderly population, observation from Xinjiang, China.

BackgroundWith the gradual aging of the population, geriatric depression has become a major public health issue in China owing to its overall upward trend and associated negative socio-economic impact. Dearth of information regarding the burden and correlates of geriatric depression among Uyghur minority population in Xinjiang Autonomous Region, called for a comprehensive survey involving representative sample for designing efficient targeted intervention to control this disabling disease.MethodsA cross-sectional study was conducted among 1329 consenting Uyghur elderly in 2011 in six randomly selected communities/villages in Xinjiang. Information about socio-demographics, behavior, negative life-events, satisfaction regarding income/quality of life and other chronic diseases were collected while assessment of geriatric depression was done using Geriatric Mental State Schedule (GMS).ResultsAmong these participants, majority were currently married, had attended elementary school or less, had an average annual family income of less than 3000 Yuan/person, had strong religious beliefs while 10.61% (2.77% in urban and 23.60% in rural area) had geriatric depression (5.91% among male and 14.58% among females). 61.83% were suffering from other chronic diseases, 96.16% could take care of themselves and 39.28% had experienced negative events during last two years. Religious belief (AOR = 3.92, 95% CI 1.18–13.03), satisfaction regarding quality of life (AOR = 0.53, 95% CI 0.37–0.84) and income (AOR = 0.75, 95% CI 0.35–1.60), suffering from more chronic diseases (AOR = 1.70, 95% CI 1.42–2.04), experiencing three or more negative events (AOR = 1.72, 95% CI 0.92–3.22) and lack of ability to take self-care (AOR = 2.20, 95% CI 1.09–4.48) were all associated with having geriatric depression with or without adjustment for gender, education and occupation.ConclusionHigh prevalence of geriatric depression among Uyghur elderly in Xinjiang seemed to call for urgent interventions, specifically targeting rural residents, who experienced more negative life-events, were suffering from chronic diseases and were dissatisfied with their income and quality of life.

Associations of cytokine genes with Alzheimer's disease and depression in an elderly Korean population

BackgroundInflammatory processes regulated by cytokines are important in the aetiology of Alzheimer's disease (AD) and depression. Differences in transcriptional activities associated with several genetic polymorphisms affect cytokine production. We investigated...

P.2.b.004 Longitudinal associations between BDNF promoter methylation and late-life depression

Introduction: Late-life depression is associated with an elevated risk of suicide as well as functional and cognitive impairments, which confer a risk of dementia [1]. Considering these negative consequences of geriatric depression, understanding the etiology of depression is an important step toward early detection and effective treatment of depression in the elderly population. Reduced brain-derived neurotrophic factor (BDNF) function has been suggested as a risk factor for late-life depression. BDNF secretion is influenced by epigenetic (DNA promoter methylation) [2] and genetic (val66met polymorphism) profiles [3]. We investigated the independent and interactive effects of BDNF methylation and val66met polymorphism on late-life depression. Methods: In total, 732 Korean community residents aged 65 years were evaluated, and 521 of them without depression at baseline were followed up 2 years later. The prevalence and incidence of depression were determined using the Geriatric Mental State Schedule, and depression severity was evaluated with the Geriatric Depression Scale. Covariates included age, sex, education, chronic physical disorders, cognitive function, and disability. The effects of BDNF methylation and polymorphism on the diagnosis of depression were investigated using a multivariate logistic regression model, and the relationships between BDNF methylation and depression severity were evaluated using partial correlation tests. Results: Of the 631 participants without depression at baseline, 521 (82.6%) were followed up. Depression was identified 2 years later in 86 (16.5%) of the 521 participants who were followed up. After applying Bonferroni correction, the prevalence of depression at baseline was significantly associated with higher BDNF promoter methylation at CpG site 9 and a higher average methylation percentage. Furthermore, the incidence of depression at the 2-year follow up was significantly associated with higher BDNF promoter methylation at CpG site 9 and a higher average methylation percentage. The results of multivariate logistic regression analysis after adjustment for covariates were that the prevalence and incidence of depression were independently associated with a higher methylation percentage at CpG site 9 and a higher average methylation percentage after applying Bonferroni correction. Partial correlations of BDNF methylation percentages with the GDS scores were summarized as follows. After applying Bonferroni correction, higher baseline GDS scores were significantly correlated with a higher methylation percentage at CpG site 9 and higher average methylation percentage after adjustment for sex, number of chronic medical illnesses, cognitive function, and disability. Additionally, higher GDS scores at follow-up were significantly correlated with a higher average methylation percentage in the same adjusted model. However, there were no significant associations between BDNF promoter methylation percentages and genotype. Furthermore, there were no significant interactive effects of BDNF methylation percentages and genotype on the prevalence or incidence of depression in the multivariate logistic regression model. Conclusions: Higher BDNF methylation was independently associated with prevalence and incidence of depression as well as severe depressive symptoms. No significant methylation-genotype interactions were found. BDNF promoter methylation could be a proxy biomarker for depression late in life.

The descriptive epidemiology of delirium symptoms in a large population-based cohort study: results from the Medical Research Council Cognitive Function and Ageing Study (MRC CFAS).

BackgroundIn the general population, the epidemiological relationships between delirium and adverse outcomes are not well defined. The aims of this study were to: (1) construct an algorithm for the diagnosis of delirium using the Geriatric Mental State (GMS) examination; (2) test the criterion validity of this algorithm against mortality and dementia risk; (3) report the age-specific prevalence of delirium as determined by this algorithm.MethodsParticipant and informant data in a randomly weighted subsample of the Cognitive Function and Ageing Study were taken from a standardized assessment battery. The algorithmic definition of delirium was based on the DSM-IV classification. Outcomes were: proportional hazard ratios for death; odds ratios of dementia at 2-year follow-up.ResultsData from 2197 persons (representative of 13,004) were used, median age 77 years, 64% women. Study-defined delirium was associated with a new dementia diagnosis at two years (OR 8.82, 95% CI 2.76 to 28.2) and death (HR 1.28, 95% CI 1.03 to 1.60), even after adjustment for acute illness severity. Similar associations were seen for study-defined subsyndromal delirium. Age-specific prevalence as determined by the algorithm increased with age from 1.8% in the 65-69 year age group to 10.1% in the ≥85 age group (p < 0.01 for trend). For study-defined subsyndromal delirium, age-specific period prevalence ranged from 8.2% (65-69 years) to 36.1% (≥85 years).ConclusionsThese results demonstrate the possibility of constructing an algorithmic diagnosis for study-defined delirium using data from the GMS schedule, with predictive criterion validity for mortality and dementia risk. These are the first population-based analyses able to account prospectively for both illness severity and an earlier study diagnosis of dementia.

Association of BDNF promoter methylation and genotype with suicidal ideation in elderly Koreans.

Brain-derived neurotrophic factor (BDNF) has been considered a risk factor for suicidal behavior in adult populations. BDNF secretion is influenced by epigenetic (DNA promoter methylation) and genetic (val66met polymorphism) profiles. We investigated the independent and interactive effects of BDNF methylation status and val66met polymorphisms on late-life suicidal ideation. In total, 732 Korean community residents aged 65+ years were evaluated; of 639 without suicidal ideation, 579 (90.6%) were followed up 2 years later. The prevalence and incidence of suicidal ideation were ascertained using the Geriatric Mental State Schedule. Sociodemographic and clinical covariates included age, sex, education, depressive symptoms, cognitive function, and disability. The independent effects of BDNF methylation status on the prevalence and incidence of suicidal ideation were investigated using multivariate logistic regression models. The two-way interactions of BDNF methylation status and val66met polymorphism on suicidal ideation were assessed using the same models. Higher BDNF methylation status was significantly associated with both prevalence and incidence of suicidal ideation, independent of potential covariates. No significant methylation-genotype interaction was found. The BDNF hypothesis and the epigenetic origin of the suicidal behavior were supported, even in old age. BDNF promoter methylation status may be useful as a biological marker for suicidality in late life.

Late life depression among elderly hypertensive patients

To determine the correlates of late life depression among elderly hypertensive patients as seen in Zaria Northern Nigeria. Elderly hypertensive patients attending the cardiac clinic of Ahmadu Bello University Teaching Hospital Zaria were recruited for the study. They were interviewed using socio-demographic Questionnaire, Consortium to Establish Registry for Alzheimer's Disease (CERAD), Geriatric Depression Scale-30 and Stick Design Test. Patients that had a score of 11 and above in the GDS-30 were further interviewed using the Geriatric Mental State Schedule (GMSS) AGECAT. Data obtained from the study was analyzed using Statistical Package for Social Sciences windows version 15. All tests of significance were carried out at 5% level of probability. A total of 179 patients participated in the study out of which 110 (65.1%) were females. The mean age of the subject was 68.23±5.72 years. The rate of late life depression based on International Classification of Diseases (ICD), 10th edition and Geriatric Mental State Schedule AGECAT (GMSS-AGECAT) diagnoses were 17. 88% (32) and 20.11 % (36) respectively. There was very good agreement between diagnoses based on ICD-10 criteria and GMSS-AGECAT (kappa=0.82, p<.001). Late life depression was significantly associated with recent bereavement (OR=11.04, p=.001), poverty (OR=4.39, p=.036) and lower diastolic blood pressure (7.04, p=.008). The rate of late life depression in this study is comparable to that of other studies reported in the literature. Poverty and bereavement but not high blood pressure, are important factors associated with depression in the elderly.

Study on the prevalence and risk factors of depressive symptoms among 'empty-nest' and 'non-empty-nest' elderly in four provinces and cities in China

To investigate the prevalence and determinants of depressive symptoms among 'empty-nest' and 'non-empty-nest' elderly in four cities/provinces. 4265 elderly aged 60 and over, were recruited with cluster sampling method in Shanghai, Heilongjiang, Guangdong and Shanxi province and interviewed, using the Geriatric Mental State Schedule and self-developed related questionnaire. (1) The prevalence of depressive symptoms for 'empty-nest' elderly was (8.18%), significantly higher than that for 'non-empty-nest' elderly (P=0.019); (2) the 'empty-nest' elderly had a significantly higher proportion of the following factors: being male, married, with higher income (≥15,000 Yuan/year), living in city, with high education background, under employment etc. than the 'non-empty-nest' elderly (P<0.0001); (3) the 'empty-nest' elderly had significantly higher proportions on good self-rated health status and life (P=0.0001, P<0.0001) as well as heavier health problems and economic difficulties (P=0.001, P=0.002); (4) there were significantly negative associations between depressive symptoms and the following 10 factors: being female, single, having bad self-rated health and life status, having somatic disease≥3, with big health problems in the last two years and loss of dearest persons, community engagement and involvement of religious activities. The 'empty-nest' elderly showed higher prevalence of having depressive symptoms than the 'non-empty-nest' elderly. The 'empty-nest' elderly had characteristics as being single, female, having adverse event etc. and should be under greater attention for care.

Prevalence of depressive disorders in the elderly

Community-based mental health studies have revealed that the point prevalence of depressive disorders in the elderly population of the world varies between 10% and 20%, depending on cultural situations. A retrospective study based on analysis of various study reports was conducted, to determine the median prevalence rates of depressive disorders in the elderly population of India and various other countries in the world. All the studies that constituted the sample were conducted between 1955 and 2005. Included are only community-based, cross-sectional surveys and some prospective studies that had not excluded depression at baseline. These studies were conducted on a homogenous community of the elderly population in the world, who were selected by a simple random sampling technique. After applying the inclusion and exclusion criteria on published and indexed articles, 74 original research studies that surveyed a total of 487 275 elderly individuals, in the age group of 60 years and above, residing in various parts of the world, were included for the final analysis. The median prevalence rate and its corresponding interquartile range were calculated. The chi-square test and chi-square for linear trend were applied. A P value of <.05 was considered as statistically significant. The median prevalence rate of depressive disorders in the world for the elderly population was determined to be 10.3% (interquartile range [IQR], 4.7%-16.0%). The median prevalence rate of depression among the elderly Indian population was determined to be 21.9% (IQR, 11.6%–31.1%). Although there was a significant decrease in the trend of world prevalence of geriatric depression, it was significantly higher among Indians, in recent years, than the rest of the world.

Synergistic associations of depression and apolipoprotein E genotype with incidence of dementia

A cohort study of Japanese-American men suggested interactive effects of depression and apolipoprotein E (APOE) e4 allele on risk of incident dementia. In another sample of East Asian origin, we sought to replicate the findings and to explore individual depressive symptoms where this interaction was most evident. Of 625 Korean community elders without dementia at baseline, 518 (83%) were followed over a 2.4-year period and were clinically assessed for incident dementia. Depression was identified by the Geriatric Mental State Schedule (GMS), and nine individual depressive symptoms relevant to DSM-IV major depressive episode criteria were extracted. APOE genotype was ascertained. Covariates included age, gender, education, and disability. There were synergistic interactions between depression and APOE e4 on incident dementia independent of covariates. This interaction was particularly strong for four depressive symptoms: depressed mood, worthlessness, concentration difficulty, and suicidal ideation. We were able to replicate the previous study, finding that, at least in East Asian origin populations, the APOE e4 allele is a stronger predictor of incident dementia in the presence of depressive syndrome, and particular depressive symptoms.

Religion, health beliefs and the use of mental health services by the elderly

Background: Few studies have investigated whether elderly people of particular religious affiliations were more or less likely to seek treatment for mental illness, and whether it was related to their health beliefs. Method: In the National Mental Survey of Elderly Singaporeans in 2004, data were collected on reported religious affiliations, and 1-year prevalence of mental disorders (DSM-IV diagnoses of psychiatric disorders) from diagnostic interviews using the Geriatric Mental State schedule, self-report of treatment for mental health problems, and health beliefs about the curability of mental illness, embarrassment and stigma, ease in discussing mental problems, effectiveness and safety of treatment, and trust in professionals. Results: Compared to those with no religious affiliation, elderly people of all religious affiliations showed higher prevalence of mental health problems, yet reported less frequent treatment by healthcare professionals. In multivariate analyses, the adjusted odds ratio (95% confidence interval) of association with seeking treatment were for Christianity, 0.12 (0.02–0.57); Islam, 0.12 (0.01–1.31); Buddhism/Taoism, 0.59 (0.18–1.88); and Hinduism, 0.21 (0.02–2.56) versus no affiliation. Various religious affiliations differ from each other and from non-religious affiliation on some negative health beliefs, but they did not adequately explain why religious affiliates were less likely to seek treatment. Conclusion: Further studies should evaluate the lower tendency of elderly people with religious affiliations to seek treatment for mental health problems.