Unrecognized geriatric depression in the emergency Department of a Teaching Hospital in Nepal: prevalence, contributing factors, and metric properties of 5 item geriatric depression scale in this population

Abstract

Background Depression is prevalent but poorly recognized in the Emergency Department (ED). We aimed to identify the frequency of unrecognized geriatric depression and its possible determinants in the ED using the 15-item geriatric depression scale (GDS). We also aimed to explore the performance of the shorter, five-item GDS as compared to the 15-item GDS. Methods This was a cross-sectional study of the ED patients ≥ 60 years. The previously validated Nepali version of GDS-15 screened the sample into “no”, “mild-moderate” and “severe” depression using cutoff values of 4/5, and 8/9 respectively. Demographic and socioeconomic factors, comorbidities and health seeking behaviors were studied and the relation was assessed with binary (Chi-square and Kruskal-Wallis test) and multinomial regression analysis. The performance of GDS-5 was compared with the GDS-15 as standard. Cronbach’s alpha was calculated to investigate reliability. Validity was assessed by calculating sensitivity, specificity, positive predictive value, negative predictive value, Spearman’s correlation, receiver operating characteristic curve, and kappa coefficient. Results Two hundred eighty patients were enrolled with an overall prevalence of unrecognized depression of 45.7% [104 (81.3%) mild-moderate depression, and 24 (18.8%) severe depression]. The mean age of the sample was 71.36 with female predominance (61%), and 82.5% were illiterate. In the binary analysis, those who had more pain, visited the ED more often, had musculoskeletal diseases and sleep problems, mobility problems, visited local healers previously, and who reported self-perceived “heart and mind” disease showed statistically significant differences among the three categories. In multinomial regression analysis, visits to local healers, sleep problems and frequency of pain were significantly related to depression. The sensitivity, specificity, area under curve and Spearman’s correlation of GDS-5 were 75.8%, 96%, 0.919, and 0.827 respectively. Cronbach’s alpha for GDS-5 was low (0.416), therefore a new version was proposed which improved the sensitivity to 90.6% and Cronbach’s alpha to 0.623. Conclusions Unrecognized geriatric depression was highly prevalent which urges the need for ED-based interventions for screening and referral. The proposed brief GDS-5 correlated well with the GDS-15 with better validity and internal reliability and offers a more expeditious form of screening for geriatric depression in emergency settings in Nepal.

Prevalence of Geriatric Depression and Associated Factors in Kalika Rural Municipality of Rasuwa District, Nepal

“…Contextual characteristics such as family support, good communication among family members, and family decision-making roles were also associated to depression. However, sex and individual factors such as cigarette use, alcohol consumption, and the presence of chronic disease were not associated to geriatric depression, which is consistent with earlier findings; a study conducted by Shrestha, Shrestha [6] found an association between the presence of chronic disease and depression and no association between age and depression, John and Nath [19] found type of family associated with depression but age was not associated, Bineetha, Vijayakumar [20] found sex, alcohol and tobacco consumption were not associated with depression, but that being unemployed was, Manandhar, Risal [1] found sex, alcohol consumption were not associated with depression, but that having a chronic health problem and physical capability were. Similarly, other studies have found that family support, living with children, stress, a lack of decision-making, and family income are all strongly associate to depression [1,2,21].…”

“…Jadav and Patel [11] found 34.1 % depression among senior population in rural area of Vadodara, Gujrat and Pilania, Yadav [12] found 34.4% depression among Indian elderly population. However, some studies contradict our findings: a study conducted among elderly people in a rural south Indian community found 12.7% [13], a study conducted in north India 9.5 % [14], a study conducted in Thailand 18.5% [15] ,and a study conducted in Nepal among older adults found 15.4% [16] which is lower than my study and some were higher than our study; a study conducted by Vol.12; Issue: 1; January 2022 Shrestha, Shrestha [6] in the emergency department of teaching hospital in Nepal found 45.7 % prevalence of geriatric depression, Jemal, Hailu [17] found 54.5 percent, and a study conducted by Simkhada, Wasti [18] among older adults in Kathmandu Nepal found 60.6%. This variation may be due to different in study setting and tool used to assess depression.…”

“…Depression is projected to affect 4.4 % of the world's population.. [5] In Nepal, depression affects 17.3 to 89.1% of elderly in nursing homes, 25.5 to 60.6 percent of elders living in the community, and 53.2 to 57.1 percent of elders in hospitals. [6] Geriatric depression is a serious public health concern that reduces quality of life and costs the family and society money. [1] Although the number of elderly people in Nepal is continually increasing, the government has given little importance to identifying their problems through research or even implementing the existing senior citizen act.…”

Effectiveness of emotional freedom techniques (EFT) vs sleep hygiene education group therapy (SHE) in management of sleep disorders among elderly

“…In agreement with this, a study in China in their study of sleep and depression in the elderly showed that sleep quality is a significant risk factor of depression 30 . Similarly, a study in Nepal revealed that depression was an underlying cause of unrecognized depression among elderly people 31 .…”

Physical and Mental Health Problems among Elderly in Selected Geriatric Homes of Makawanpur District

“…Most of the elderly felt they were neglected by the family and 36.2% felt they were burden to the family. 15 A structured interview schedule consisting of demographic, medical history and Geriatric depression scale (GDS-15) 16 , where 1-5 denotes no depression, 6-10 is mild and 11-15 denotes severe depression. Geriatric anxiety scale (GAS- Majority of the respondents i.e.…”