Academic journal article Hong Kong Journal of Psychiatry

Prevalence of Depression in Chinese People with Parkinson's Disease

Academic journal article Hong Kong Journal of Psychiatry

Prevalence of Depression in Chinese People with Parkinson's Disease

Article excerpt

Abstract

Objectives: To examine the point prevalence of depressive disorders and their clinical correlates in Chinese patients with Parkinson's disease.

Patients and Methods: Chinese people with Parkinson's disease attending 2 general neurology outpatient clinics were recruited consecutively and a convenience sample was taken from among those attending a Parkinson's disease clinic. The Chinese-Bilingual Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (4th Edition) was used to identify patients who suffered from different kinds of depressive disorder. The demographic and clinical variables of those with depression were compared with those participants who did not have depression.

Results: The point prevalence of any type of depressive disorder was 26.3%. Major depressive episodes were diagnosed in 19 (14.3%) patients, 7 of whom had concurrent dysthymia. Three percent had minor depression and 9% had dysthymia. A history of depression, the age of onset of Parkinson's disease, and global disability were found to be the clinical correlates of depression in Parkinson's disease.

Conclusion: This study indicates that depression is frequent among Chinese people with Parkinson's disease attending neurology clinics in Hong Kong. The clinical correlates of Parkinson's disease found in this study concurred with those found in other studies.

Key words: Parkinson disease; Depression; Prevalence

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Introduction

Parkinson's disease (PD) is a neurodegenerative disorder that involves disturbances in motor control. It is a disabling and long-term disease that causes considerable difficulties in the lives of sufferers and their families. The societal burden of PD treatment is expected to escalate, as the population in Hong Kong is ageing, whilst the mean age of onset of PD is relatively early, at around 60 years. (1) In a cross-sectional survey of the residential homes for the elderly in Hong Kong, 3.4% of the subjects were found to have PD. (2)

It has been shown that a PD patient is most susceptible to depression during the first half year of diagnosis. (3) This phenomenon is likely to be a psychological reaction to being labelled as having PD, which is a chronic disease with deterioration in various functional aspects that is not, at present, curable. Younger patients find it more difficult to accept a diagnosis of PD and are more likely to have disruptions in their career, family, and financial aspects. (4) Therefore, they are more susceptible to depression. Stress is a known precipitating factor for depression, especially for those who have a history of depression.

Nonetheless, as PD disease progresses, the 'psychological' theory alone cannot explain the high prevalence of depression in those with advanced disease. Depression is not only found to precede the onset of PD, but is a risk factor for PD. (5) The 'biological' theory proposes that depression shares a common neurodegenerative pathway with PD, which makes depression more frequent in PD than expected. Some authors proposed several candidate pathological mechanisms besides dopamine depletion that can cause behavioural symptom, including dysfunction within noradrenergic, (6) serotonergic, (7) and cholinergic (8) systems and neural loss from Lewy bodies and plaques and tangles. (9) However, it seems that both 'psychological' and 'biological' theories interact in complex ways in different PD patients.

Preliminary studies have suggested that depression in PD (dPD) is highly prevalent in the Chinese community. Clinical correlates of dPD are still to be determined. As measurement of the prevalence of dPD is important for resource allocation, comprehensive and methodologically sound studies on this subject are clearly warranted. This study focuses on the frequency of dPD, and its socio-demographic and clinical correlates. …

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