published_or_final_version / Nursing Studies / Master / Master of Nursing

published_or_final_version / Gerontology / Master / Master of Social Sciences

Background: Depression is the leading cause of premature death and disability worldwide. The globally aging population with increasing burdens of chronic diseases is certain to face increasing problems. Elderly people in whom physical and mental co-morbidities are common represent a group that is highly susceptible to the harm of depression. Worse still, the reduced accessibility of elderly to healthcare implies that the public health burden of depression seen in the healthcare sector is only tip of the clinical iceberg. Objectives: This review aims to synthesize the current evidence of public health burden of geriatric depression, and the public health challenges in tackling this growing threat in the context of under-detection, social disparities and population ageing, and to summarize its current situation in Hong Kong and compare with other Methods: A literature search was conducted in databases PubMed, Medline and Cochrane (January 2002-June 2012) using the keywords “depression, depressive episode, epidemiology, prevalence, incidence, elderly”. A total of 1285full-text articles were obtained, out of which 52 articles were potentially relevant. Critical appraisal was performed on articles after a priori specified inclusion and exclusion criteria were applied. After removing the duplicates and examining the contents, 15 articles were adopted for review. Results: Depression brings along heavy disease burden which highly associated with mortality and morbidity. Late-life depression accounts for 17-37% in primary care settings, while around 3% in the community. The ongoing problems of under-detection, under-treatment and the progressive population ageing increase the challenges and complexity of matter. Gender difference is identified, while social support, social relationships and socioeconomic status were shown to be highly correlated with elderly depression in both the East and the West. Conclusions: Elderly depression is a global threat causing increasing public health burden to healthcare systems and societies worldwide. Over the decades, public health sector is facing numerous challenges intackling it, including the practice-related challenges complicated by characteristics of elderly, policy-related challenges explained by the clinical iceberg concept, and societal related challenges. By understanding the older population and challenges in the community control of depression, it is the time to action and turn public health over a new leaf. / published_or_final_version / Public Health / Master / Master of Public Health

Introduction Geriatric depression is one of the major public health issues around the world. Geriatric depression is often being misinterpreted as a normal aspect of aging process, but it is indeed a complex psychological problem that would result in significant increases in DALYs. With effective treatments, depressive symptoms and signs can be reduced. Nevertheless, pharmacological intervention is often used as the first-line treatment for geriatric depression. In recent years, different types of non-pharmacological intervention have been getting more attention in terms of theirs effectiveness in treating geriatric depression. Objectives Primary objective is to determine whether two categories of non-pharmacological intervention (physical activity and reminiscence therapy) are effective in relieving depression in elderly that are 60 years old or older. The other objectives are to examine enduring effects of physical activity and reminiscence therapy, and compare the effectiveness of reminiscence therapy and physical activity in alleviating depressive symptoms in elderly compared with no intervention and/or other intervention. Methods Relevant studies published between the year of 2000 and 2013 were searched and identified through several electronic databases, including the Cochrane Library, PubMed, Medline, PsycINFO and Google Scholar, with a combination of keywords. All randomized controlled trials that examine physical activity and reminiscence therapy on elderly that are 60 years old or older, being diagnosed or indicated as suffering from depression were included. The methodological quality of each study was assessed. The outcome measure of this review is the depression symptom level. Main Result A total of 12 randomized controlled trials met the inclusion criteria, in which seven were about physical activity and five of them were about reminiscence therapy. Significant immediate reduction in depressive symptoms was found in five out of seven physical activity studies and in four out of five reminiscence studies. Three and two studies respectively on physical activity and reminiscence therapy had assessed the effect at follow-up and looked at the lasting effect. In two physical activity studies that have assessed the short-term effect beyond the completion of intervention, incongruent findings were found. Only one physical activity study has examined the long-term effect and it reported significant positive result. On the other hand, there were two reminiscence therapy studies assessing the short-term effect on depressive symptoms. These two studies reported significant improvement in depressive symptoms. Since there were few studies reporting the medium and long-term effect of physical activity and reminiscence therapy, no conclusion can be made on their enduring effect of reducing depressive symptoms. Conclusions Physical activity and reminiscence therapy appear to be effective non-pharmacological interventions for relieving depressive symptoms in elderly. They may complement pharmacological intervention and/or may offer alternative treatment option for elderly with depression. However, the mode, intensity, duration, type, format of physical activity and reminiscence therapy on depressive symptoms in elderly remain unclear. Further testing is need before these interventions can be routinely used to alleviate depressive symptoms in elderly with depression. / published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / abstract / toc / Clinical Psychology / Master / Master of Social Sciences

Thesis (M.Nurs.)--University of Hong Kong, 2008. / Includes bibliographical references (p. 90-97)

Thesis (M. Med. Sc.)--University of Hong Kong, 2010. / Includes bibliographical references.

Thesis (M.A.)--Eastern Illinois University, 2010. / Includes bibliographical references (leaves 56-63).

Severity and pattern of depressive symptomatology were examined among four groups of elderly individuals, i.e., patients with DSM-III diagnoses of major depression (n = 54), patients with presumed dementia of the Alzheimer's type (DAT) (n = 27), patients with idiopathic Parkinson's disease (PD) (n = 30), and normal controls (n = 29). The depressed elderly group obtained significantly (p < .001) higher means, and the control group obtained significantly (p < .01) lower means, than the neurologically impaired groups on clinician ratings (Hamilton Rating Scale for Depression, HRS-D) and self-report (Beck Depression Inventory, BDI) of depression. However, HRS-D means of the PD and DAT groups did not differ significantly (p < .125). The depressed elderly group also obtained significantly (p < .001) higher means than the contrast groups on HRS-D vegetative and cognitive depression primary factors (adapted from Rhoades & Overall, 1983), while the control group obtained significantly (p < .001 to 0.01) lower means. At the intermediate level, the PD mean on the vegetative factor was significantly (p < .05) higher than the DAT mean, while the groups did not differ significantly (p < .79) on the cognitive factor. The depressed elderly group obtained a substantially lower interfactor correlation coefficient than the neurologically impaired groups, suggesting greater heterogeneity in manifestation of depression at moderate than at mild levels of severity. However, the finding of zero variance on some HRS-D items for the neurologically impaired groups suggested that factor structures may differ for PD, DAT, and depressed groups. For PD patients, the prediction that PD symptom severity ratings would correlate more highly with clinician ratings (HRS-D) than self-report (BDI) of depression, due to PD symptoms that resemble depression, was not supported. Speculation that the DAT group might report less depression due to loss of insight was not supported in this group of mildly to moderately demented patients. Only 22% demonstrated loss of insight, while 93% exhibited some degree of depressed mood on the HRS-D. Over 50% of the control group of PD spouses and community volunteers endorsed some degree of fatigue, work inhibition, and decreased libido, illustrating the need for considering base-rates in assessment.

Thesis (M.Soc.Sc.)--University of Hong Kong, 2006. / Title from title page (viewed Apr. 23, 2007) Includes bibliographical references (p. 39-51).