Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-26T15:02:56.781Z Has data issue: false hasContentIssue false
  • English
  • Français

Co-occurrence of anxiety and depression amongst older adults in low- and middle-income countries: findings from the 10/66 study

Published online by Cambridge University Press:  05 April 2011

A. M. Prina ,
C. P. Ferri ,
M. Guerra ,
C. Brayne  and
M. Prince
A. M. Prina*
Affiliation:
Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK
C. P. Ferri
Affiliation:
King's College London, Institute of Psychiatry, Health Service and Population Research Department, Centre for Public Mental Health, London, UK
M. Guerra
Affiliation:
King's College London, Institute of Psychiatry, Health Service and Population Research Department, Centre for Public Mental Health, London, UK Universidad Peruana Cayetano Heredia, Lima, Peru Institute de la Memoria y Desordenes Relacionadas, Lima, Peru
C. Brayne
Affiliation:
Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK
M. Prince
Affiliation:
King's College London, Institute of Psychiatry, Health Service and Population Research Department, Centre for Public Mental Health, London, UK
*
*Address for correspondence: A. M. Prina, M.Phil., Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

There is relative little information about the prevalence and risk factors of co-morbid anxiety and depression in later life. These disorders are often associated with worse response to treatment than either condition alone, and researching their epidemiology in diverse settings is vital to policy makers. We therefore investigated the co-occurrence of anxiety and depressive syndromes amongst older adults living in developing countries and measured the separate and joint effect of these two disorders on levels of associated disability.

Method

The 10/66 study carried out cross-cultural surveys of all residents aged 65 years or over (n=15021) in 11 sites in seven countries (People's Republic of China, India, Cuba, Dominican Republic, Venezuela, Mexico and Peru). Anxiety was measured by using the Geriatric Mental State Examination and the Automated Geriatric Examination for Computer Assisted Taxonomy diagnostic system. Depression was assessed according to International Classification of Diseases 10th revision (ICD-10) and EURO-D criteria. Disability was measured by using the World Health Organization's Disablement Assessment Scale Version II. Zero-inflated negative binomial regression models were used to investigate the association of common mental disorders and disability.

Results

The prevalence of co-occurring anxiety and depression (with the exclusion of subthreshold disorders) ranged between 0.9% and 4.2% across sites. Gender, socio-economic status, urbanicity and physical co-morbidities were associated with the different co-morbid states. Having both disorders was linked to higher disability scores than having anxiety or depression alone.

Conclusions

Given the close association of co-morbid anxiety and depression with disability, new policies to improve prevention, recognition and treatment will be needed to adapt to ageing populations and their mental health needs.

Keywords

Anxietyco-morbiditydepressionepidemiologyold age
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 10 , October 2011 , pp. 2047 - 2056
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Beekman, AT, de Beurs, E, van Balkom, AJ, Deeg, DJ, van Dyck, R, van Tilburg, W (2000). Anxiety and depression in later life: co-occurrence and communality of risk factors. American Journal of Psychiatry 157, 89–95.CrossRefGoogle ScholarPubMed
Bijl, RV, Ravelli, A (2000). Current and residual functional disability associated with psychopathology: findings from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Psychological Medicine 30, 657–668.CrossRefGoogle ScholarPubMed
Blazer, DG (2000). Psychiatry and the oldest old. American Journal of Psychiatry 157, 1915–1924.CrossRefGoogle ScholarPubMed
Byers, AL, Yaffe, K, Covinsky, KE, Friedman, MB, Bruce, ML (2010). High occurrence of mood and anxiety disorders among older adults. Archives of General Psychiatry 67, 489–496.CrossRefGoogle ScholarPubMed
Castro-Costa, E, Dewey, M, Stewart, R, Banerjee, S, Huppert, F, Mendonca-Lima, C, Bula, C, Reisches, F, Wancata, J, Ritchie, K, Tsolaki, M, Mateos, R, Prince, M (2008). Ascertaining late-life depressive symptoms in Europe: an evaluation of the survey version of the EURO-D scale in 10 nations. The SHARE project. International Journal of Methods in Psychiatric Research 17, 12–29.CrossRefGoogle ScholarPubMed
Copeland, JR, Prince, M, Wilson, KCM, Dewey, ME, Payne, J, Gurland, B (2002). The Geriatric Mental State Examination in the 21st century. International Journal of Geriatric Psychiatry 17, 729–732.CrossRefGoogle Scholar
Das-Munshi, J, Goldberg, D, Bebbington, PE, Bughra, DK, Brugha, TS, Dewey, ME, Jenkins, R, Stewart, R, Prince, M (2002). Public health significance of mixed anxiety and depression: beyond current classification. British Journal of Psychiatry 192, 171–177.CrossRefGoogle Scholar
Greene, WH (1994). Accounting for Excess Zeros and Sample Selection in Poisson and Negative Binomial Regression Models. Working paper no. 94–10. Stern School of Business, New York University: New York.Google Scholar
Kendell, R, Jablensky, A (2003). Distinguishing between the validity and utility of psychiatric diagnoses. American Journal of Psychiatry 160, 4–12.CrossRefGoogle ScholarPubMed
Kendler, KS (1996). Major depression and generalised anxiety disorder. Same genes, (partly) different environments – revisited. British Journal of Psychiatry 30, 68–75.CrossRefGoogle Scholar
Kessler, RC, McGonagle, KA, Zhao, S, Nelson, CB, Hughes, M, Eshleman, S, Wittchen, HU, Kendler, KS (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Archives of General Psychiatry 51, 8–19.CrossRefGoogle ScholarPubMed
Kvaal, K, McDougall, FA, Brayne, C, Matthews, FE, Dewey, ME (2008). Co-occurrence of anxiety and depressive disorders in a community sample of older people: results from the MRC CFAS (Medical Research Council Cognitive Function and Ageing Study). International Journal of Geriatric Psychiatry 23, 229–237.CrossRefGoogle Scholar
Lee, S (1999). Diagnosis postponed: shenjing shuairuo and the transformation of psychiatry in post-Mao China. Culture, Medicine and Psychiatry 23, 349–380.CrossRefGoogle ScholarPubMed
Lenze, EJ, Mulsant, BH, Shear, MK, Alexopoulos, GS, Frank, E, Reynolds, CF III (2001). Comorbidity of depression and anxiety disorders in later life. Depression and Anxiety 14, 86–93.CrossRefGoogle ScholarPubMed
Lenze, EJ, Mulsant, BH, Shear, MK, Schulberg, HC, Dew, MA, Begley, AE, Pollock, BG, Reynolds, CF III (2000). Comorbid anxiety disorders in depressed elderly patients. American Journal of Psychiatry 157, 722–728.CrossRefGoogle ScholarPubMed
Long, JS (1997). Regression Models for Categorical and Limited Dependent Variables. Sage Publications: Thousand Oaks.Google Scholar
Ormel, J, Kempen, GI, Deeg, DJ, Brilman, EI, van Sonderen, E, Relyveld, J (1998). Functioning, well-being, and health perception in late middle-aged and older people: comparing the effects of depressive symptoms and chronic medical conditions. Journal of the American Geriatrics Society 46, 39–48.CrossRefGoogle ScholarPubMed
Prince, M, Acosta, D, Chiu, H, Copeland, J, Dewey, M, Scazufca, M, Varghese, M; the 10/66 Dementia Research Group (2004). Effects of education and culture on the validity of the Geriatric Mental State and its AGECAT algorithm. British Journal of Psychiatry 185, 429–436.CrossRefGoogle ScholarPubMed
Prince, M, Acosta, D, Chiu, H, Scazufca, M, Varghese, M (2003). Dementia diagnosis in developing countries: a cross-cultural validation study. Lancet 361, 909–917.CrossRefGoogle ScholarPubMed
Prince, M, Ferri, CP, Acosta, D, Albanese, E, Arizaga, R, Dewey, M, Gavrilova, SI, Guerra, M, Huang, Y, Jacob, KS, Krishnamoorthy, ES, McKeigue, P, Rodriguez, JL, Salas, A, Sosa, AL, Sousa, RMM, Stewart, R, Uwakwe, R (2007). The protocols for the 10/66 Dementia Research Group population-based research programme. BMC Public Health 7, 165–178.CrossRefGoogle Scholar
Prince, MJ, Beekman, AT, Deeg, DJ, Fuhrer, R, Kivela, SL, Lawlor, BA, Lobo, A, Magnusson, H, Meller, I, van Oyen, H, Reischies, F, Roelands, M, Skoog, I, Turrina, C, Copeland, JR (1999 a). Depression symptoms in late life assessed using the EURO-D scale. Effect of age, gender and marital status in 14 European centres. British Journal of Psychiatry 174, 339–345.CrossRefGoogle ScholarPubMed
Prince, MJ, Reischies, F, Beekman, AT, Furher, R, Jonker, C, Kivela, SL, Lawlor, BA, Lobo, A, Magnusson, H, Fichter, M, van Oyen, H, Roelands, M, Skoog, I, Turrina, C, Copeland, JR (1999 b). Development of the EURO-D scale – a European Union initiative to compare symptoms of depression in 14 European centres. British Journal of Psychiatry 174, 330–338.CrossRefGoogle Scholar
Rehm, J, Ustun, TB, Sexena, S, Nelson, CB, Chatterji, S, Ivis, F, Adlaf, ED (1999). On the development and psychometric testing of the WHO screening instrument to assess disablement in the general population. International Journal of Methods for Psychiatric Research 8, 110–122.CrossRefGoogle Scholar
Schoevers, RA, Beekman, AT, Deeg, DJ, Jonker, C, van Tilburg, W (2003). Comorbidity and risk-patterns of depression, generalised anxiety disorder and mixed anxiety-depression in later life: results from the AMSTEL study. International Journal of Geriatric Psychiatry 18, 994–1001.CrossRefGoogle ScholarPubMed
Sousa, RM, Dewey, ME, Acosta, D, Jotheeswaran, AT, Castro-Costa, E, Ferri, CP, Guerra, M, Huang, Y, Jacob, KS, Rodriguez Pichardo, JG, Garcia Ramirez, N, Llibre Rodriguez, J, Calvo Rodriguez, M, Salas, A, Sosa, AL, Williams, J, Prince, MJ (2010). Measuring disability across cultures – the psychometric properties of the WHODAS II in older people from seven low- and middle-income countries. The 10/66 Dementia Research Group population-based survey. International Journal of Methods in Psychiatric Research 19, 1–17.CrossRefGoogle Scholar
Sullivan, MD, LaCroix, AZ, Baum, C, Grothaus, LC, Katon, WJ (1997). Functional status in coronary artery disease: a one-year prospective study of the role of anxiety and depression. American Journal of Medicine 103, 348–356.CrossRefGoogle ScholarPubMed
Vuong, Q (1989). Likelihood ratio tests for model selection and non-nested hypotheses. Econometrica 57, 307–334.CrossRefGoogle Scholar
Weich, S (2005). Absence of spatial variation in rates of the common mental disorders. Journal of Epidemiology and Community Health 59, 254–257.CrossRefGoogle ScholarPubMed
World Health Organization (1992). International Statistical Classification of Diseases, 10th Revision (ICD-10). World Health Organization: Geneva, Switzerland.Google Scholar
World Health Organization (2004). The Global Burden of Disease. 2004 Update. World Health Organization: Geneva, Switzerland.Google Scholar
Supplementary material: File

Prina et al. Supplementary Material

Prina et al. Supplementary Table

Download Prina et al. Supplementary Material(File)
File 94.7 KB