Physical Comorbidity and Its Impact on Symptom Profile of Depression among Elderly Patients Attending Psychiatry Services of a Tertiary Care Hospital

By Grover, Sandeep; Dalla, Eish et al. | Indian Journal of Psychological Medicine, July-August 2017 | Go to article overview

Physical Comorbidity and Its Impact on Symptom Profile of Depression among Elderly Patients Attending Psychiatry Services of a Tertiary Care Hospital


Grover, Sandeep, Dalla, Eish, Mehra, Aseem, Chakrabarti, Subho, Avasthi, Ajit, Indian Journal of Psychological Medicine


Byline: Sandeep. Grover, Eish. Dalla, Aseem. Mehra, Subho. Chakrabarti, Ajit. Avasthi

Aim: This study aimed to evaluate the prevalence of physical comorbidities among elderly patients with depression attending psychiatric services and the secondary aim of the study was to evaluate the influence of physical comorbidities on symptom profile of depression. Methodology: 140 patients with a diagnosis of depression as per the International Classification of Diseases-10 criteria were evaluated on Geriatric Depression Scale (GDS) and a physical comorbidity checklist. Results: More than two-third (72.1%) of the patients had at least one physical illness. Out of those with physical comorbidity, more than half (57 out of 101) had at least 2 physical illnesses. The most commonly involved systems were cardiovascular system (n = 68; 48.6%), followed by endocrinological system (27.1%) and ophthalmological system (26.4%). Most common physical comorbidity was hypertension (47.14%), followed by cataract (25.7%) and diabetes mellitus (25%). The presence of any physical comorbidity, presence of hypertension or presence of diabetes mellitus did not influence the manifestations of depression as assessed by GDS-30. Conclusion: Elderly patients with depression have high rates of physical comorbidities. Clinicians managing elderly patients with depression must get their patient thoroughly evaluated for the presence of various physical comorbidities.

Introduction

Depression is a common mental disorder among elderly. The prevalence rate of depression in elderly in community samples from India has varied from 8.9% to 62.16 per 1000 population.[sup][1] The prevalence rates which have been reported in clinic population have varied from 42.4% to 72%.[sup][1]

The concern of medical illnesses among psychiatric patients has been reflected for decades. With regard to elderly persons, physical comorbidity is particularly important in patients with depression.[sup][2] The association of depression with medical comorbidities has been understood in many ways. Depression may predate the onset of medical illnesses and can present as an early symptom of medical illnesses, such as being an early sign of Parkinson's disease.[sup][3] Alternatively, it may act as a risk factor for the development of medical disorders, such as in coronary heart disease,[sup][4],[5] Parkinson's disease,[sup][3],[6] myocardial infarction,[sup][5] diabetes mellitus,[sup][7] and malignancies.[sup][8] The converse is also true, i.e., medical disorders may contribute to the pathogenesis of depression, for example, it is now well known that late-life depression may be caused or exacerbated by cerebrovascular disease.[sup][9],[10] Data also suggest that risk of depression increases in the presence of physical illnesses such as Parkinson's disease,[sup][11] myocardial infarction,[sup][12] diabetes mellitus,[sup][13] malignancy,[sup][14] and epilepsy [sup][15]. Overall the comorbidity model emphasizes a bidirectional association, conceptualizing the coexistence of depression and medical illnesses and elucidating a definable relationship between these conditions, with each condition having a negative impact on the onset, course, prognosis, and treatment of the other.[sup][16] Accordingly, it is important to understand the comorbidity.

In the Indian context, although there is reasonable amount of data on the prevalence of depression in people with different age groups in various physical illnesses,[sup][1],[17] data on physical comorbidity among elderly patients with depression is limited to a handful studies. Sagar et al .[sup][18] compared elderly patients with and without depression and reported that undiagnosed physical illnesses were significantly higher in those with depression. Further, it was seen that higher proportion of elderly patients with depression had multiple physical illnesses. Hypertension, osteoarthritis, and cataract were significantly more common among patients with depression. …

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