Use of WhatsApp by older adults screened for depression in socioeconomically deprived areas of Guarulhos, São Paulo State, Brazil: challenges and possibilities for telehealth

Moretti, Felipe Azevedo; Scazufca, Márcia; Nakamura, Carina Akemi; Souza, Caio Hudson Queiroz de; Seward, Nadine; Araya, Ricardo; Moreno-Agostino, Darío

doi:10.1590/0102-311XEN093422

person Felipe Azevedo Moretti

contributed to the study conception, data analysis and interpretation, writing and review, and approved the final version of the manuscript

school Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil.school Instituto D’Or de Pesquisa e Ensino, São Paulo, Brasil.

0000-0002-9747-7790

person Márcia Scazufca

contributed to the study conception, writing and review, and approved the final version of the manuscript

school Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil.school Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil.

0000-0002-4545-006X

person Carina Akemi Nakamura

contributed to the study conception, data analysis, and review, and approved the final version of the manuscript

school Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil.

0000-0002-4761-4486

person Caio Hudson Queiroz de Souza

contributed with the writing and review and approved the final version of the manuscript

school Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil.

0000-0002-8768-4817

person Nadine Seward

contributed with the writing and review, statistical analysis, and approved the final version of the manuscript

school Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, U.K..

0000-0002-4821-9437

person Ricardo Araya

contributed to the study conception, review, and approved the final version of the manuscript

school Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, U.K..

0000-0002-0420-5148

person Darío Moreno-Agostino

contributed to the study conception, statistical analyses, data analyses, writing and review, and approved the final version of the manuscript

school Centre for Longitudinal Studies, University College London, London, U.K.school Centre for Society and Mental Health, King’s College London, London, U.K.

0000-0003-0459-657X

personCorrespondence F. A. Moretti Faculdade de Medicina, Universidade de São Paulo. Rua Dr. Ovídio Pires de Campos 785, São Paulo, SP 05403-903, Brasil.
emailfelipe.moretti@unifesp.br

groupsContributors

F. A. Moretti contributed to the study conception, data analysis and interpretation, writing and review, and approved the final version of the manuscript. M. Scazufca contributed to the study conception, writing and review, and approved the final version of the manuscript. C. A. Nakamura contributed to the study conception, data analysis, and review, and approved the final version of the manuscript. C. H. Q. Souza contributed with the writing and review and approved the final version of the manuscript. N. Seward contributed with the writing and review, statistical analysis, and approved the final version of the manuscript. R. Araya contributed to the study conception, review, and approved the final version of the manuscript. D. Moreno-Agostino contributed to the study conception, statistical analyses, data analyses, writing and review, and approved the final version of the manuscript.

Additional information

ORCID: Felipe Azevedo Moretti (0000-0002-9747-7790); Márcia Scazufca (0000-0002-4545-006X); Carina Akemi Nakamura (0000-0002-4761-4486); Caio Hudson Queiroz de Souza (0000-0002-8768-4817); Nadine Seward (0000-0002-4821-9437); Ricardo Araya (0000-0002-0420-5148); Darío Moreno-Agostino (0000-0003-0459-657X).

Characteristics	Overall sample (n = 3,356)	Depressive symptomatology subsample * (n = 1,020)
Characteristics	n (%)	n (%)
Age [mean (SD)]	68.3 (6.7)	68.6 (7.0)
Gender
Men	1,231 (36.7)	270 (26.5)
Women	2,125 (63.3)	750 (73.5)
Schooling level (years)
None	535 (15.9)	181 (17.7)
1-4	1,556 (46.4)	504 (49.4)
5-8	754 (22.5)	209 (20.5)
≥ 8	491 (14.6)	120 (11.8)
Missing	20 (0.6)	6 (0.6)
Personal income (minimum wages **)
≤ 1	2,100 (62.6)	731 (71.7)
1-2	648 (19.3)	161 (15.8)
2-3	233 (6.9)	39 (3.8)
> 3	165 (4.9)	32 (3.1)
Missing	210 (6.3)	57 (5.6)
Has a mobile phone
No	1,087 (32.4)	373 (36.6)
Yes	2,251 (67.1)	641 (62.8)
Missing	18 (0.5)	6 (0.6)
Sends/Receives WhatsApp messages
No	1,801 (53.7)	587 (57.5)
Yes	1,535 (45.7)	427 (41.9)
Missing	20 (0.6)	6 (0.6)
Watches WhatsApp videos
No	1,945 (58.0)	629 (61.7)
Yes	1,370 (40.8)	378 (37.1)
Missing	41 (1.2)	13 (1.3)

	Outcome: has mobile phone
	OR (95%CI)	p-value
Overall sample (including PHQ-9 screening)
PHQ-9 screening
≥ 10	0.84 (0.71; 1.00)	0.044
Gender (reference: men)
Women	1.15 (0.97; 1.37)	0.113
Age in years (reference: 60-69)
70-79	0.52 (0.44; 0.62)	< 0.001
≥ 80	0.26 (0.19; 0.35)	< 0.001
Personal income in minimum wages * (reference: ≤ 1)
1-2	1.31 (1.06; 1.61)	0.012
2-3	2.02 (1.40; 2.92)	< 0.001
> 3	2.24 (1.44; 3.48)	< 0.001
Schooling level in years (reference: none)
1-4	1.84 (1.49; 2.28)	< 0.001
5-8	2.27 (1.76; 2.94)	< 0.001
≥ 8	3.63 (2.62; 5.04)	< 0.001
Model fit: pseudo-R²	0.081
Depressive symptomatology subsample (PHQ-9 ≥ 10)
Gender (reference: men)
Women	1.59 (1.15; 2.20)	0.006
Age in years (reference: 60-69)
70-79	0.52 (0.38; 0.71)	< 0.001
≥ 80	0.22 (0.13; 0.38)	< 0.001
Personal income in minimum wages * (reference: ≤ 1)
1-2	0.95 (0.65; 1.40)	0.800
2-3	2.31 (0.97; 5.49)	0.058
> 3	4.40 (1.57; 12.31)	0.005
Schooling level in years (reference: none)
1-4	1.78 (1.23; 2.58)	0.002
5-8	2.52 (1.57; 4.03)	< 0.001
≥ 8	2.96 (1.65; 5.31)	< 0.001
Model fit: pseudo-R²	0.086

	Outcome: uses WhatsApp for messaging		Outcome: watches videos received via WhatsApp
	OR (95%CI)	p-value	OR (95%CI)	p-value
Overall sample (including PHQ-9 screening)
PHQ-9 screening
≥ 10	0.84 (0.71; 1.00)	0.045	0.84 (0.70; 0.99)	0.040
Gender (reference: men)
Women	1.88 (1.58; 2.25)	< 0.001	1.78 (1.49; 2.13)	< 0.001
Age in years (reference: 60-69)
70-79	0.43 (0.36; 0.52)	< 0.001	0.47 (0.39; 0.57)	< 0.001
≥ 80	0.17 (0.11; 0.25)	< 0.001	0.16 (0.10; 0.26)	< 0.001
Personal income in minimum wages * (reference: ≤ 1)
1-2	1.19 (0.97; 1.45)	0.092	1.13 (0.92; 1.38)	0.253
2-3	1.82 (1.33; 2.51)	< 0.001	1.66 (1.21; 2.26)	0.002
> 3	2.37 (1.62; 3.46)	< 0.001	1.96 (1.36; 2.83)	< 0.001
Schooling level in years (reference: none)
1-4	2.53 (1.96; 3.27)	< 0.001	2.40 (1.85; 3.13)	< 0.001
5-8	4.52 (3.41; 5.99)	< 0.001	3.72 (2.79; 4.97)	< 0.001
≥ 8	8.39 (6.05; 11.62)	< 0.001	7.47 (5.40; 10.33)	< 0.001
Model fit: pseudo-R²	0.142		0.122
Depressive symptomatology subsample (PHQ-9 ≥ 10)
Gender (reference: men)
Women	2.65 (1.85; 3.80)	< 0.001	2.36 (1.64; 3.41)	< 0.001
Age in years (reference: 60-69)
70-79	0.40 (0.29; 0.57)	< 0.001	0.43 (0.31; 0.61)	< 0.001
≥ 80	0.17 (0.08; 0.35)	< 0.001	0.12 (0.05; 0.28)	< 0.001
Personal income in minimum wages * (reference: ≤ 1)
1-2	0.95 (0.63; 1.42)	0.798	0.84 (0.55; 1.26)	0.393
2-3	1.88 (0.91; 3.91)	0.090	1.60 (0.78; 3.28)	0.198
> 3	4.96 (2.08; 11.84)	< 0.001	4.99 (2.12; 11.72)	< 0.001
Schooling level in years (reference: none)
1-4	2.89 (1.81; 4.63)	< 0.001	2.27 (1.42; 3.65)	0.001
5-8	5.74 (3.38; 9.77)	< 0.001	4.27 (2.51; 7.25)	< 0.001
≥ 8	8.30 (4.48; 15.38)	< 0.001	6.21 (3.39; 11.38)	< 0.001
Model fit: pseudo-R²	0.156		0.139

[TFN1] SD: standard deviation.

[TFN2] * Depressive symptomatology subsample included participants in the overall sample with PHQ-9 scores ≥ 10;

[TFN3] ** Minimum wage: BRL 998 (~ USD 197).

Use of WhatsApp by older adults screened for depression in socioeconomically deprived areas of Guarulhos, São Paulo State, Brazil: challenges and possibilities for telehealth

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Abstracts