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Relationship of Family Function and Depression in the Elderly at the Out-patient Department of Veterans Memorial Medical Center Carmina Leoncio, MD, DPAFP 1 st World Congress on Healthy Ageing

Introduction “Projections suggest that by 2020, depression will become the second leading cause of disease worldwide, as measured by disability-adjusted life years .” - Chapman DP, Perry GS. Depression as a Major Component of Public Health for Older Adults. Preventing Chronic Disease: public health research practice and policy 2008; 5:1-9.

Introduction According to practice guidelines, formal diagnosis should be made upon fulfillment of the DSM IV criteria or ICD 10 and should be made by a Psychiatrist. - American Psychiatric Association. Practice guidelines for the treatment of patients with bipolar disorder. (Revision) 2002 May. Am J Psychiatry 2002; 159 (Suppl 4): 1-50.

Introduction “The Geriatric Depression Scale (GDS) is a reliable and valid measure of geriatric depression.” - Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, Leirer VO. Development and validation of a geriatric depression screening scale: a preliminary report. Journal of Psychiatric Research 1982-83;17(1):37-49.

Introduction Risk factors for geriatric depression: 1. bereavement due to loss of spouse 2. sleep disturbance 3. disability prior depression 4. female gender 5. social isolation 6. lack of social support system

Introduction The Family APGAR assesses the family’s functionality in 5 aspects namely: A - Adaptation P - Partnership G - Growth A - Affection R - Resolve

Introduction Objectives: 1. to determine the relationship of family function and geriatric depression in an out-patient setting 2. to determine the prevalence of depression among the elderly patients of the Out-patient Department of our institution 3. to determine the relationship between the sociodemographic data and family characteristics of the respondents with geriatric depression

Purposive Method of Sampling N =213 Inclusion and Exclusion Criteria are met N = 200 Accomplish the 3-part questionnaire Determine Geriatric Depression Scale (GDS) Score and Family APGAR Score Without probable depression With probable depression (GDS Score = 0-9) (GDS Score = 10-30) Functional Family Dysfunctional Family Functional Family Dysfunctional Family (Family APGAR (Family APGAR (Family APGAR (Family APGAR Score = 0-7) Score = 8-10) Score = 8-10) Score = 0-7) Schematic Diagram of Methodology

Results Table1. Sociodemographic Data and Family Characteristics of Respondents Variables N (%) Age 65-74 105 (52.5) 75-84 75 (37.5) >85 20 (10.0) Gender Male 83 (41.5) Female 117 (58.5) Civil Status Single 0 (0) Married 108 (54.0) Widow/Widower/Separated 92 (46.0) Employment Status Employed 11 (5.5) Retired/Unemployed 189 (94.5)

Results Table1. Sociodemographic Data and Family Characteristics of Respondents (cont’d) Living Condition Living Alone 9 (4.5) Living with non-family members 4 (2.0) Living with other family members 14 (7.0) Living with spouse only 33 (16.5) Living with spouse & children 140 (70.0) Financial Support Self Only 154 (77.0) Non-family members 1 (0.5) Other family members 2 (1.0) Children 43 (21.5) Primary Caregiver None 20 (10.0) Non-family Members 5 (2.5) Family Members 175 (87.5)

Results Figure 1. Results of Geriatric Depression Scale among the Respondents 136 (68%) 140 120 64 100 (32%) 80 60 40 20 0 with without probable probable depression depression

Results Figure 2. Status of Family Function among Respondents 117 (58.5%) 120 66 100 (33%) 80 17 60 (8.5%) 40 20 0 highly moderately severely functional dysfunctional dysfunctional

Results Table 2. Comparison of sociodemographic data and family characteristics among respondents with probable depression and those without probable depression Variables With probable Without probable p value depression depression N (%) N (%) Age 0.49 65-74 30 (46.9) 75 (55.2) 75-84 26 (40.6) 49 (36.0) >85 8 (12.5) 12 (8.8) Gender 0.09 Male 21 (32.8) 62 (45.6) Female 43 (67.2) 74 (54.4) Civil Status 0.06 Single 0 (0.0) 0 (0.0) Married 28 (43.8) 80 (58.8) Widow/Widower/Separated 36 (56.2) 56 (41.2)

Results Table 2. Comparison of sociodemographic data and family characteristics among respondents with probable depression and those without probable depression (cont’d) Employment Status 1.00 Employed 3 (4.7) 8 (5.9) Retired/Unemployed 61 (95.3) 128 (94.1) Living Condition 0.96 Living Alone 1 (1.6) 8 (5.9) Living with non-family members 1 (1.6) 3 (2.2) Living with other family members 8 (12.5) 6 (4.4) Living with spouse only 9 (14.1) 24 (17.6) Living with spouse & children 45 (70.3) 95 (69.9) Financial Support 0.53 Self Only 51 (79.7) 103 (75.7) Non-family members 0 (0.0) 1 (0.7) Other family members 1 (1.6) 1 (0.7) Children 12 (18.8) 31 (22.8) Primary Caregiver 0.94 None 5 (7.8) 15 (11.0) Non-family Members 3 (4.7) 2 (1.5) Family Members 56 (87.5) 119 (87.5)

Results Figure 3. Comparison of Family Functionality among those with probable depression and those without probable depression 94 (69.1%) 100 90 80 70 with functional 41 42 60 families (64.1%) (30.1%) with dysfunctional 50 families 23 40 (35.9%) 30 20 10 0 those with those without probable probable depression depression

Results Table 3. Univariate analysis of the association between family functionality and depression in the elderly Odds Ratio (95% CI) Estimate Lower Upper Dysfunctional Family 3.990 2.131 7.468 Functional Family 0.251 0.134 0.469

Discussion  The study showed a high prevalence rate of geriatric depression of 32%.  The prevalence rate in this study is higher than that noted in other Asian countries.

Discussion A community study done in Taiwan by Chong et al showed a prevalence rate of only 21.3%. - Chong M, Chen C, Tsang H, Yeh T, Chen C, Lee Y, Tang T and Lo H. Community Study of Depression In Old Age in Taiwan: prevalence, life events and socio- demographic correlates. British Journal of Psychiatry 2001; 178, 29-35. Another community study done by Mohd Sidik et al in Malaysia showed a prevalence rate of only 7.6%. - Mohd Sidik S, Mohd Zulkefli NA and Mustaqim A. Prevalence of Depression with Chronic Illness among the Elderly in a Rural Community in Malaysia. Asia Pacific Family Medicine 2003; 2: 196-199.

Discussion  The prevalence rate in our study estimates that seen in a rural study done in China showing a prevalence rate of 30.8%. - Gao S, Jin Y, Unverzagt F, Liang C, Hall K, Ma F, Murrell J, Cheng Y, Matesan J, Li P, Bian J and Handrie H. Correlates of Depressive Symptoms in Rural Elderly Chinese.International Journal of Geriatric Psychiatry 2009; 24 (12): 1358-1366.  Our study also approximates the results of another local study done by Cruz which showed a prevalence rate of 34% in a rural community setting. - Cruz C. The Prevalence of Depression in the Elderly at Area C, San Martin II, Sapang Palay, Del Monte Bulacan. The Filipino Family Physician 2008; 36 (2): 73-77.

Discussion This study did prove one risk factor which may have contributed to the high prevalence of geriatric depression among our respondents; that is poor social support.

Discussion In a study done in China prevalence of depression in a rural area with high social support went down to as low as 6%. Social support was considered protective against depression. - Chen J, Wei L, Hu Z, Qin X, Copeland J and Hemingway H. Depression in Older People in Rural China. Archives of Internal Medicine 2005; 165: 2019-2026.

Discussion According to Blazer, impaired social support is associated with depression and this does not only include network size and composition, but also satisfaction to the quality of social support given. - Blazer D. Depression in Late Life: Review and Commentary. Journal of Gerontology 2003; 58A (3): 249-265.

Discussion  It is important for us primary care physicians to determine how our patients view their respective families.  One way of doing this is by using the Family APGAR, which reflects how satisfied patients are with their relationship among other family members.

Discussion  In this study, the Family APGAR is seen as a good tool in determining if our elderly patients have a possible risk of developing depression.

Conclusions and Recommendations  Prevalence of geriatric depression the Out – patient Department of our institution is 32%.  Family functionality was noted to have a negative correlation with geriatric depression.  Respondents from dysfunctional families (APGAR Score = 0-7) had a 3-fold risk of having depression than those from functional families (APGAR Score = 8-10).

Conclusions and Recommendations  Since the Family APGAR is a widely used tool in family assessment among family physicians, it is recommended that elderly patients with low APGAR Scores be screened for Geriatric Depression.  These patients may benefit from family counseling and referral to a Psychiatrist for proper diagnosis and management.