Preliminary communicationQuality of life and physical activity associated to lower prevalence of depression in community-dwelling elderly subjects from Sao Paulo
Introduction
Depression is a heterogeneous mental illness with diverse phenotypes. Patients present with different clinical pictures based on the number of symptoms, their severity, the clinical setting and etiology. Although at the moment, there is no one clear definition of subsyndromal depression, many studies have shown the close relationship between clinically significant depressive symptoms (CSDS) and the risk of developing major depressive disorder (MDD) in the future (Steffens and Benjamin, 2012, Blazer and Hybels, 2004, Blazer, 2003).
According to Albanese et al. (2012), among elderly people worldwide, ICD-10 depression prevalence ranged from 0.5% in China to 13.8% in Dominican Republic, and EURO-D depression prevalence was consistently higher ranging from 2.8% in China to 41.5% in India. A recent meta-analysis of prevalence of depression among Brazilian elderly developed by our group found rates of MDD between 3,0% and 15,0%, with a combined prevalence of 7,0% (Barcelos-Ferreira et al., 2010).
In spite of these evidences about great frequencies of depression among older people, studies that calculate the prevalence of MDD, assessing the relationship with CSDS and similar associated factors in the same population, have never been carried out in Brazilian.
The objective of this study was to calculate the prevalence of MDD in a community sample of older people (>60 years), living in the city of Sao Paulo, in the Southeast region of Brazil, and to investigate possible associated factors such as cognitive and functional impairment (CFI), life style, history of clinical diseases and sociodemographic variables.
Section snippets
Study design
A two-phase design was applied to estimate the prevalence of MDD. In the first phase, subjects were screened for depression, and all the screen positives and a random sample of screen negatives were invited to the second phase, or clinical evaluation.
Sample selection
Sao Paulo is the biggest city in Brazil and according to the “Fundação Instituto Brasileiro de Geografia e Estatistica” in 2000 (IBGE, 2000) the city's population was 10,426,384, of whom 969,654 (9.3%) were 60 years old or older.
A cluster random
First phase
A sample of 2233 older people (≥60 years) was invited to participate in this study. Of these, 1563 subjects agreed to be interviewed at home (response rate=70%).
The mean age of the sample was 71 years (SD=8.0), ranging from 60 to 102, and the sample was predominantly female. The variable occupation was simplified for analysis, as shown in Table 1, which also describes the sociodemographic characteristics of the sample assessed at home. In addition, we added in the data analysis the variable
Discussion
Our data originated from a population-based cross-sectional epidemiologic study performed with older subjects (≥60 years), who lived in the city of Sao Paulo, in the Southeast region of Brazil. The MDD prevalence was 3.8% (95% CI=2.8% a 4.7%) and the frequency of CSDS was 13% (95% CI: 11–15). The effect of socio-demographic, clinical characteristics and lifestyle on depression is in accordance with previous studies, which showed higher odds ratio for female gender, CFI, PDE, clinical disease,
Limitations
There are several limitations of the study that deserve comment. As reported earlier, the large time period between phases of the study certainly influenced the rate of depression prevalence. Another limitation is that our sample was restricted only to community residents, deliberately excluding persons in hospitals or nursing homes, where the prevalence of CSDS or major depression and the associated factors are likely to be higher and have worse consequences. Moreover, the widely differing
Conclusion
In conclusion, we believe that the greater contribution of our study is the relationship between CSDS as reported earlier in the first phase and MDD in the diagnosis phase, with similar associated factors. The low rate of using antidepressant medications found among depressed subjects in our data signalizes how harmful could be under diagnosed depression to quality of life on aging. As mentioned in the literature at the moment, our study confirms the association between depression and
Role of funding source
This study was supported by Fundacao de Apoio a Pesquisa do Estado de Sao Paulo (FAPESP), grant no. 01/05959-7.
Conflict of interest
All authors declare that they have no conflicts of interest.
Acknowledgements
This study was supported by Fundacao de Apoio a Pesquisa do Estado de Sao Paulo (FAPESP), grant no. 01/05959-7.
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