Academic journal article South African Journal of Psychiatry

Factors Associated with and Prevalence of Depressive Features Amongst Older Adults in an Urban City in Eastern China

Academic journal article South African Journal of Psychiatry

Factors Associated with and Prevalence of Depressive Features Amongst Older Adults in an Urban City in Eastern China

Article excerpt


Depression is an important public health concern affecting the health and quality of life amongst the elderly. (1) Depression may increase the risk of physical and mental diseases (such as cardiovascular and cerebrovascular disease) and the risk of death and other serious consequences. In developed countries, prevalence rates amongst non-institutionalised older people range from 0.4% to 10.2% for depression disorders and from 7.2% to 36.0% for depressive symptoms. (2,3,4) Depression will become the second highest cause of disease burden by the year 2020. (5)

Risk factors of depression have been widely explored, including socio-demographic factors (gender, age, education level, marital status, economic status, living style), (6,7,8) health status (sleep disorders, cardiovascular and cerebrovascular diseases, diabetes), (3,9,10) impaired daily living activities, (6,7,10,11) cognitive impairment, (7) living through stressful events, (12) social support (4,9,11,13) and health behaviour. (14)

The process of urbanisation in China has been accelerating in recent years, and the living environment of the elderly has changed dramatically along with this process. Therefore, the mental health of the elderly has been affected in many instances. In meta-analyses, it was found that over time the proportion of older people with depressive symptoms has increased in China. (15) However, current prevalence estimates are scarce. Studies conducted in mainland China have shown the prevalence of depression symptoms to be 13.01%, (11) 27.0%, (12) and 59.8% (16) amongst older people. Taking into account the complexity and consequences of the problem, it is important to study depressive features of the urban elderly and the associated factors that may have been affected by the process of urbanisation. Suzhou is located in the eastern part of China. Based on a large sample of older people (age 60 +) living in a community in Suzhou, the objectives of this study are as follows:

1. To report the prevalence of depressive features in the elderly.

2. To investigate associated factors with depressive features.


This was a community-based study conducted in Suzhou in 2012. A stratified cluster random sampling method was performed, and six districts of Suzhou were divided by socioeconomic status into three layers. Three communities in each layer were extracted using a random sampling strategy. People aged 60 or older and living in local areas for more than 5 years were invited to complete a standardised questionnaire. People with cognitive impairments, dementia or disable to communicate with interviewers (such as deaf and mute) were excluded. After investigators explained the goal and the method of the investigation, participants filled out the questionnaires by themselves. The investigators provided detailed explanations to those who had difficulty in understanding the content of the questionnaires. The questionnaires were completed by the investigators for any participants who were illiterate. A total of 4325 questionnaires were issued, and 4077 valid questionnaires were recovered. The response rate was 94.27%.

The Chinese version of Zung's self-rating depression scale (SDS) was intended to assess depressive features in older people. SDS is a short-range self-rating scale that is easy to operate and which can reflect effectively the severity of depression. It has been widely used, not only amongst the general population, but also specifically for studies involving older populations. In a study of older Brazilians (average age 61.03 years), SDS was validated amongst a group of patients with Parkinson's diseases. The sensitivity was 88.9%, specificity was 83.3%, the Cronbach coefficient was 0.73 and the SDS and GDS-15 scale scores were highly correlated (r = 0.652,p < 0.0001).17 SDS is composed of 20 items, and total scores range from 20 (best) to 80 (worst). …

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