Screening for depressive symptoms in older adults in
					the Family Health Strategy, Porto Alegre, Brazil

Nogueira, Eduardo Lopes; Rubin, Leonardo Librelotto; Giacobbo, Sara de Souza; Gomes, Irenio; Cataldo Neto, Alfredo

doi:10.1590/S0034-8910.2014048004660

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Original Articles • Rev. Saúde Pública 48 (3) • June 2014 • https://doi.org/10.1590/S0034-8910.2014048004660 copy

Screening for depressive symptoms in older adults in the Family Health Strategy, Porto Alegre, Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE

To analyze the prevalence of depression in older adults and associated factors.

METHODS

Cross-sectional study using a stratified random sample of 621 individuals aged ≥ 60 from 27 family health teams in Porto Alegre, RS, Southern Brazil, between 2010 and 2012. Community health agents measured depression using the 15-item Geriatric Depression Scale. Scores of ≥ 6 were considered as depression and between 11 and 15 as severe depression. Poisson regression was used to search for independent associations of sociodemographic and self-perceived health with both depression and its severity.

RESULTS

The prevalence of depression was 30.6% and was significantly higher in women (35.9% women versus 20.9% men, p < 0.001). The variables independently associated with depression were: female gender (PR = 1.4, 95%CI 1.1;1.8); low education, especially illiteracy (PR = 1.8, 95%CI 1.2;2 6); regular self-rated health (OR = 2.2, 95%CI 1.6;3.0); and poor/very poor self-rated health (PR = 4.0, 95%CI 2.9;5.5). Except for education, the strength of association of these factors increases significantly in severe depression.

CONCLUSIONS

A high prevalence of depression was observed in the evaluations conducted by community health agents, professionals who are not highly specialized. The findings identified using the 15-item Geriatric Depression Scale in this way are similar to those in the literature, with depression more associated with low education, female gender and worse self-rated health. From a primary health care strategic point of view, the findings become still more relevant, indicating that community health agents could play an important role in identifying depression in older adults.

Aged; Depression, epidemiology; Family Health Strategy; Mental Health Services, Manpower; Cross-Sectional Studies

Variable	n^a	Geriatric Depression Scale ≥ 6		p^b

		n	%
Sex				< 0.001^c
Female	379	136	35.9
Male	206	43	20.9
Age (years)				0.798
60 to 69	332	98	29.5
70 to 79	192	62	32.3
≥ 80	61	19	31.3
Schooling (years)				0.004
< 1	127	46	36.2
1 to 3	231	68	29.4
4 to 7	130	49	37.7
≥ 8	94		17.0^b
Income (Brazilian minimum wage)				0.115
< 2	514	165	32.1
≥ 2	38	7	18.4
Household income (Brazilian minimum wage)				0.220
≤ 3	451	144	31.9
> 3	53	12	22.6
Retired				0.217
Yes	363	102	28.1
No	197	66	33.5
Race/Ethnicity				0.636
White	378	113	29.9
Non-white	202	65	32.2
Religion				0.287
Catholic	382	108	28.3
Evangelic	109	39	38.5
Other	86	28	32.6
Marital status				0.939
Single	104	32	30.8
Married	207	60	29.0
Widowed	182	58	31.9
Separated/Divorced	90	28	31.1
Living alone				0.079
Yes	104	40	38.5
No	471	137	29.1
Practicing religion				0.312
Yes	381	111	29.1
No	187	63	33.7
Self-perceived health				< 0.001^c
Very good/Good	194	26	13.4^d
Regular	323	109	33.7
Poor/Very poor	59	41	69.5^e
Total	585	179	30.6

	n^a	%	Geriatric Depression Scale
Variable			6-10		11		p^b

			n	%	n	%
Sex							< 0.001^c
Female	136	35.9	103	27.2	33	8.7
Male	43	20.9	35	17.0	8	3.9
Age (years)							0.967
60 to 69	98	29.5	76	22.9	22	6.6
70 to 79	62	32.3	47	24.5	15	7.8
≥ 80	19	31.3	15	24.6	4	6.6
Schooling (years)							0.021
< 1	46	36.2	33	26.0	13	10.2
1 to 3	68	29.4	53	22.9	15	6.5
4 to 7	49	37.7	40	30.8	9	6.9
≥ 8	16^b	17.0	12	12.8	4	4.3
Income (Brazilian minimum wage)							0.115
< 2	165	32.1	124	24.1	41	8.0
≥ 2	7	18.4	7	18.4	0	0.0
Household income (Brazilian minimum wage)							0,107
≤ 3	144	31.9	109	24.2	35	7.8
> 3	12	22.6	11	20.8	1	1.9
Retired							0.211
Yes	102	28.1	77	21.2	25	6.9
No	66	33.5	52	26.4	14	7.1
Race/Ethnicity							0.851
White	113	29.9	87	23.0	26	6.9
Non-white	65	32.2	50	24.8	15	7.4
Religion							0.006
Catholic	108	28.3	75^b	16.9	33^a	8.6
Evangelic	39	38.5	36^a	33.0	3	2.8
Other	28	32.6	25	29.1	3	3.5
Marital status							0.982
Single	32	30.8	25	24.0	7	6.7
Married	60	29.0	49	23.7	11	5.3
Widowed	58	31.9	43	23.6	15	8.2
Separated/Divorced	28	31.1	20	22.2	8	8.9
Living alone							0.153
Yes	40	38.5	32	30.8	8	7.7
No	137	29.1	105	22.3	32	6.8
Practicing religion							0.198
Yes	111	29.1	91	23.9	20	5.2
No	63	33.7	46	24.6	17	9.1
Self-perceived health							< 0.001^c
Very good/Good	26^d	13.4	21	10.8	5	2.6
Regular	109	33.7	88	27.2	21	6.5
Poor/Very poor	41^e	69.5	27	45.8	14	23.7

Total	179	30.6

Variable	No depression versus GDS ≥ 6					No depression versus GDS 6-10					No depression versus GDS ≥ 11

	PR_raw	95%CI	PR_ajusted	95%CI	p	PR_raw	95%CI	PR_ajusted	95%CI	p	PR_raw	95%CI	PR_ajusted	95%CI	p
Sex
Male	1		1			1		1			1		1
Female	1.4	1.1;1.8	1.4	1.1;1.8	0.002	1.7	1.2;2.4	1.6	1.2;2.3	0.004	2.6	1.2;5.4	2.9	1.2;6.8	0.016
Age (age)
> 80	1		1			1		1			1		1
70 to 79	1.2	0.8;1.8	1.2	0.8;1.8	0.393	1.0	0.6;1.7	1.0	0.6;1.6	0.95	1.2	0.4;3.4	0.9	0.3;3.2	0.921
60 to 69	1.3	0.9;1.9	1.3	0.9;1.9	0.221	0.9	0.6;1.5	0.9	0.6;1.5	0.697	1.0	0.4;2.7	0.8	0.2;2.7	0.719
Schooling (years)
≥ 8	1		1			1		1			1		1
4 to 7	2.1	2.4;3.2	1.5	1.0;2.2	0.041	2.5	1.4;4.4	2.0	1.1;3.5	0.02	2.1	0.7;6.4	1.4	0.4;4.7	0.548
1 to 3	1.7	1.1;1.5	1.3	0.9;1.9	0.115	1.8	1.0;3.3	1.3	0.7;2.3	0.334	1.7	0.6;5.0	1.2	0.4;3.2	0.761
< 1	2.1	1.4;3.1	1.8	1.2;2.6	0.003	2.2	1.2;4.0	1.4	0.8;2.6	0.259	2.8	1.0;8.4	1.2	0.4;3.5	0.693
Income (Brazilian minimum wage)
≥ 2	1					1
< 2	1.8	1.0;3.2				1.4	0.7;2.8
Living alone
No	1		1			1		1			1		1
Yes	1.1	0.9;1.4	1.0	0.8;1.3	0.764	1.4	1.0;1.9	1.3	1.0;1.8	0.101	1.3	0.6;2.6	0.9	0.4;2.0	0.852
Practicing religion
No	1		1			1		1			1		1
Yes	0.9	0.7;1.1	0.9	0.8;1.1	0.514	0.9	0.7;1.3	1.0	0.7;1.3	0.919	0.6	0.3;1.1	0.7	0.4;1.3	0.276
Self-perceived health
Very good/Good	1		1			1		1			1		1
Regular	2.3	1.7;3.1	2.2	1.6;3.0	< 0.001^a	2.6	1.7;4.1	2.5	1.6;3.9	< 0.001^a	3.1	1.2;8.0	4.5	1.4;15.1	0.014
Bad/Very bad	4.1	3.1;5.6	4.0	2.9;5.5	< 0.001^a	5.4	3.4;8.6	5.3	3.3;8.5	< 0.001^a	15.1	5.9;39.1	23.6	7.2;77.4	< 0.001^a

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E-mail: revsp@usp.br

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[1] Correspondence: Eduardo Lopes Nogueira Hospital São Lucas Ambulatório de Psiquiatria - PUCRS Av. Ipiranga, 6690 Prédio 60 3^o andar Sala 309 90610-000 Porto Alegre, RS, Brasil E-mail: mdcedln@gmail.com