Effect Of Structured Group Reminiscence On Depressive Symptoms And Life Satisfaction In Urban Community-dwelling Elders

Objective:to investigate the prevalence of depressive symptoms among urban community-dwelling elderly in part administrative regions of Changsha City; to explore socio-demographic factors of depressive symptoms in urban community-dwelling elderly of Changsha City; to develop a well-defined protocol of structured group reminiscence based on cultural background of elderly in Changsha City being implemented in community environment; to determine the effect of structured group reminiscence on depression symptoms and life satisfaction among mild to moderate depressed,community-based elderly.Methods:We conducted a two-stage study with a multi-center cross-sectional community-based survey and a community intervention trial. In the first stage by multistage cluster random sampling procedure, we first selected Yuelu Region, Kaifu Region and Tianxin Region which ranked relatively behind in GDP indicator from five administrative regions in Changsha City, then randomly selected four communities from each sampled region, a total of 700 participants was randomly sampled from residents aged 60 years or older of twelve communities, eleven socio-demographic characteristic were assessed by self-designed scale, the Geriatric Depression Scale(30 Items) was used to screen depressive symptoms with a threshold of≥10.Subjects of the second-stage study were from elders who was identified as mild to moderate depressive (GDS scored 11-25)in the first-stage cross-sectional investigation. Forty-nine participants from three control communities received regular community nursing care consisting of community mental health education lecture, pamphlets about elderly health, telephone counseling or family visit if necessary; based on that, Forty-seven participants from three intervention community settings received structured group reminiscence sessions called "Reminiscence Club" about reminiscence topic discussion weekly for 6 weeks in three fixed community intervention sites. The Geriatric Depression Scale and Life Satisfaction Index A were administered pre-and post-intervention.Results:①658 elders completed the scales effectively, the average GDS score of sampled participants is 8.7±6.3,lower than the scores of rural community-dwelling elderly in another study (t=-15.84, P< 0.01).The prevalence of depressive symptoms assessed by GDS is 33.5% (95% CI:29.9%-37.1%)in 658 elders,30.0%(95% CI:26.5%-33.5%) and 35.7%(95% CI:26.5%-33.5%)for men and women, respectively. For male elders,26.2% have mild depressive symptoms, while 3.8% have moderate to severe depressive symptoms; for female elders,29.1% have mild depressive symptoms,6.6% have moderate to severe depressive symptoms. There was no statistical significance between different gender on prevalence and grading of depressive symptoms(P> 0.05).②Compared with screening negative group, positive rate of the thirty depressive symptoms was statistically higher in screening positive group (all P<0.01).Sorting by prevalence rate,"hard to get started on new projects" (80.0%), "feeling have more problems with memory than most"(74.1%),"not in good spirits most of the time" ranks first, second and third.③Marital Status, education background, profession before retirement, monthly incomes, self rating health and living status were influencing factors of screening positive depressive symptoms by univariate analysis.Logistic regression model showed that geriatric depressive symptoms was significantly associated with profession before retirement(OR= 1.642), self rating health(OR=2.446),living alone(OR= 1.829), education background is a protective factor(OR=0.765).④Repeated measures analysis of variance showed that the main effects of intervention on depressive symptoms and life satisfaction were significant (P<0.01), the main effects of time indicator on depressive symptoms and life satisfaction were also significant (P＜0.01),there were significant interactions between time and intervention (P＜0.01).Interaction diagram indicated that the interevntion group had signifcantly lower self-reported depression scores and higher self-reported life satisfaction scores than the regular care group as the intervention prolonged.⑤By paired-samples T test, findings indicated the difference between pretest and posttest on GDS scores were statistically significant both in intervention group(t=13.82, P=0.000) and regular care group(t=5.93, P=0.000)., there was no significant difference as measured by two independent-samples T test between the intervention group and control group in GDS scores at pre-intervention, but after the six group sessions, GDS scores showed a significant decline in the intervention group (t=5.55,P=0.000).⑥By Wilcoxon signed-rank test, findings indicated the difference between pretest and posttest on LISA scores were statistically significant in intervention group(Z=14.72, P＝0.000),while not in regular care group(Z=1.80, P=0.078). there was no significant difference as measured by two Mann-Whiney U test between the intervention group and control group in LISA scores at pre-intervention, but after the six group sessions, LISA scores showed a significant improvement in the intervention group (Z=-7.61,P＝0.000).Conclusions:①As a common late-life psychological problem, the prevalence rate of depressive symptoms is relatively high in part communities with relatively poor economics status. Community nurses should identify depressive symptoms timely with valid screening instruments in order to avoid poor outcome of major late-life depression.②Past occupation with physical labour, lower education level, living alone and lower self rating health are associated with screening positive of depressive symptoms in urban community-dwelling elders.③Along with mental health education strategy, structured group reminiscence has a positive effect on decreasing depressive symptoms and improving self-reported life satisfaction in urban community-dwelling elders in Changsha City.④Combining strength both of group counseling and reminiscence therapy, structured group reminiscence is feasible to implement in Changsha urban community-dwelling elders. A well-designed protocol with operation manual for group guider has been developed, which could be applied by community nurses in primary prevention and secondary prevention of late-life depression. Further research about this intervention is needed in community nursing home environment.