JOURNAL READING

Psychiatry Geriatric

Depression in the elderly: Does family system play a role? A cross-sectional study
(BMC Psychiatry 2007, 7:57) Authors :

Ather M Taqui, Ahmed Itrat, Waris Qidwai and Zeeshan Qadri

Presented by Preceptor Reviewer Opponent Date Place

: : : : : :

Untung Sentosa Ike MP Siregar dr. SpKJ (K) MPH Teddy Hidayat dr. SpKJ (K) : Prof. Dr. Tuti Wahmurti AS, dr. SpKJ (K) May 19th 2011 Conference room, Departement of Psychiatry, Dr. Hasan Sadikin Hospital Bandung

DEPARTEMENT OF PSYCHIATRY PADJADJARAN UNIVERSITY, FACULTY OF MEDICINE Dr. HASAN SADIKIN HOSPITAL BAN D U N G 2011

7th JOURNAL READING

INTRODUCTION Health development, socio-economic program and education increase life expectancy and increase amount of elderly population. In 2010, The estimation of amount of Elderly population are 23.9 million (9.77%), and the life expectancy is 67.4 years, and in 2020 elderly people is estimated at 28.8 million (11.34%), with life expectancy 71.1 years. In the year 2010, the number of elderly residents who live in urban areas are 12,380,321 (9.58%) and who live in rural areas amounted are 15,612,232 (9.97%). The proportion will be changed, the elderly who live in larger urban areas are 15,714,952 (11.20%) compared to those living in rural areas are 13,107,927 (11.51%). (1) The other changes in society are the changing of the composition of the extended family to nuclear family, it clearly look at the Census of Population 1999. Families who previously not only consist of 4 or 5 children but also have uncles, aunts, Uwak, grandfather, grandmother, cousin, etc., that dominated the household during the 1970s, change to a small family with 2 children without relatives at this time. (2) The changing of composition of this society also done in Pakistan which became the focus of research by Taqui et al. They hypothesize that the changing would impact to elderly. the elderly residing in a nuclear family system would be at a higher risk of suffering from depression than those residing in a joint family system.

JOURNAL'S SUMMARY (3) Background The aim of this study was to determine the association between depression in the elderly and family systems. We also determined the prevalence of depression in the elderly, as well as correlation of depression with other important socio-demographic variables Method This is a cross-sectional study. Subject : Subjects participating in this study are elderly and attendants who visiting the Aga Khan University and Hospital

Inclusion critria o aged 65 years and above, and o who were permanent residents of Karachi (residing more than 2 years in the city) were included in the study.

Exclution Criteria : patients who : o subjects who could not understand Urdu o who were unable to complete the interview

Questionnaire The questionnaire was divided into two parts. Socio-demographic information : age, sex, marital status, education, living conditions, caregivers, employment status, financial support and the type of family system the subject was currently residing in. The 15-item Geriatric Depression Scale (GDS). The cut-off used for detecting depression was a score of 5 or above on the GDS. Translation and validation. After completion of the English version of the question naire, Three independent translations to Urdu and back-translations were done and the best worded script was selected. Pre-testing was carried out and No significant changes were made in the questionnaire. The results of the pre-test were discarded. The interviewers discussed the questionnaire thoroughly before data collection. Data collection 472 were approached 56 did not egree, 80,4 % were female 416 16 did not complete 400 were analyzied

Statistical Analyses The data was entered in Epi Data version 3.1 and analyzed in Statistical Package for Social

Sciences 13.0 (SPSS, Inc., Chicago, IL, USA). Univariate comparison of variables The Chi-square test and Fisher's exact test A stepwise multiple logistic regression analysis The Hosmer and Lemeshow goodness-of-fit test

Results. The mean age of the subjects was 69 years, 78% were male, 21.2% were unmarried and 63.3% were educated, 59.9% of males were unemployed or retired, 4 % were living alone and 11.8% had no caregivers present. 19.5% of the subjects screened positive for depression on the GDS. The subjects living in the joint family system (5 6.5%) outnumbered those in the nuclear family system (43.5%) by a small margin. There were significant differences in the distribution of marital status (p = 0.013) and education (p = 0.01) between the two family systems. In the univariate analysis, females were found to be 2.6 times more likely to suffer from depression compared to males (p < 0.001). Married people were less likely to suffer from depression compared to those who did not marry or who were separated or widowed (p < 0.001). The subjects living in a nuclear family system were more likely to suffer from depression than those living in a joint family system. Other factors that showed a significant association with depression in the subjects included being uneducated (p = 0.03), living alone (p < 0.001), being childless (p < 0.001), and being unemployed (p < 0.001). Multiple logistic regression analysis revealed the following factors to be independent predictors of depression in our sample: Nuclear family system, female gender, being unemployed or retired, being uneducated, being single and being divorced/widowed/separated. The subjects in a nuclear family system were 4.3 times more likely to suffer from depression than subjects in a joint family system (AOR = 4.3 [95% CI = 2.47.6]).

DISCUSSION 1. Although the level of nonresponnya 88.1% but 80.4% of 56 nonresponder were women (42 people), this means nonrespon levels in groups of women is 32.30%, it is higher than the assume of nonrespon rate. As a result of high of nonrespond rate,

the incidence of depression in women may be much higher than reported. The researchers need to reassess the causes of high levels of the nonrespon rate in the women's groups. There are no information, in this journal, about the training for senior students who become the interviewer. 2. Subjects were patients of a hospital who had any medical problem, but this study did not examine the relationship of general medical factors, such as chronic diseases and drugs, physical limitations, "bereavement, dementia, to depression (4,5,6). Actually, in the same subject, the relationship between these factors to depression has been analyzed but it was reported in a separate journal. (7). 3. The questionnaire of this study contained details of the types of caregiver, but the results and discussion caregiver only divided by 2 category (any and not any). There was no explanation of what the consideration of the decision. 4. In this study the definition of joint family and nuclear family is not consitent and its definition is not written detail on the questionnaire, as a consequence, the determining of the type of family system is highly dependent on the assessment of the interviewer. In addition, patients who live alone is included in the nuclear family, and in the nuclear family group there are patients who live with their children, even though there is no explanation as to whether their children are married. living alone and single status are the independent risk factor for depression among older. (8,9,10) Therefore, for this study, live alone and single patient were excluded and redifine of the family system, in my opinion, The definiton of the nuclear family is the patient who live with her/his spouse and joint familiy is the patient and her/his spouse who lives with another family.

CONCLUSION This study have the methodological bias, this study ignore the independent risk factor for depression among older and inconsitency in apply of the definition of family system. Further studies should be carry out with new definiton of family system and the other of independent risk factor for depression among older.

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