Research On Risk Factors And Investigation On Geriatric Depression In Uygur Elderly Of Communities

BackgroundThe manifestations of geriatric depression mainly include depression, anxiety, retardation and physical discomfort, which cannot be simply classified into physical illness and brain organic disease. The incidence rate of geriatric depression is rising in recent years. Geriatric depression can lead to mental disability and suicidal behavior of the elderly, which will bring huge burden to society, families and individuals. There has been a lot of research on geriatric depression at home and abroad. However there are few researches aiming at the geriatric depression in Uygur elderly in Xinjiang. In Xinjiang, the proportion of the elderly over the age of 60 is 10.93%, which symbolizes that Xinjiang has stepped into an aging society. The aging in Xinjiang has the following features:the aging degree in rural area is higher than urban area; the aging population of minorities is larger than that of the Han nationality; health status of the elderly population is poor. Khotan, habitant of Uygur elderly, was one of the longevity districts in the world. The physical and mental health status of Uygur elderly should be viewed with some concern. The elderly are less likely to take the initiative to consult a psychologist to solve psychosomatic problems that appear to be physical illness, which leads to severe missed diagnoses in geriatric depression. The physical and mental health of the Uygur elderly can be preliminarily guaranteed by community screening. At present, there is no mental health assessment scale in Uygur language for Uygur elderly to use. Hence, the development of scale in Uygur language for Uygur elderly to use by learning from the experience at home and abroad is of great significance to development of healthy aging. The etiological factors of geriatric depression are very complex, including social, psychological, immune factors, etc. Case control study on first-episode geriatric depression in Uygur elderly of communities can avoid the influences of hospital medicines and human disturbance factors, and thus objectively explore the influences of various social factors, biochemical and immunological parameters on the disease, and lay the foundations for etiology study of geriatric depression.Purpose:(1) To verify the application performance of GMS in Uygur language and assess the feasibility, reliability and validity of the GMS.(2) To find out the morbidity rate of geriatric depression in Uygur elderly and social influencing factors by screening the Uygur geriatric depression patients of communities.(3) To lay the foundations for etiology study of geriatric depression by carrying out case control study and compare the differences between the Uygur geriatric depression patients and the control group in terms of physical function indexes, blood-lipid and cytokines.Methods:This research contains three main parts:评定1. First part:selection and application of research tools:translating the GMS into Uygur language version with skills of scale translation, retroversion and culture debugging; Examining the reliability and validity of Uygur language version of GMS in communities and hospital clinics.2. Second part:inventory survey on geriatric depression in Uygur elderly: randomly selecting a city and a country in southern, northern and eastern Xinjiang, where Uygur population is more concentrated, with the two-stage stratified random sampling and randomly selecting a community or a village in the corresponding region again; carrying out questionnaire survey on geriatric depression among Uygur elderly with GMS in Uygur language, pursuant to the inclusion/exclusion criteria; the survey includes various social factors such as self-assessment of satisfaction degree of life and health status, social support, type and number of physical disease described by the informants and self-care ability of daily living; analysis on relevant social influencing factors of geriatric depression in Uygur elderly with logistic regression model.3. Third part:case control study on geriatric depression in Uygur elderly:randomly selecting 54 Uygur geriatric depression patients who are diagnosed as geriatric depression by psychiatrists pursuant to CCMD-3 on the basis of previous inventory survey and pairing 48 health cases in the same region; measuring body weight, height and other physical function indexes; detecting the differences between the case group and control group in terms of blood-lipid series, blood serum cytokine IL-1β、IL-2、 IL-6、TNF-a; clarifying the relations between these indexes and geriatric depression in Uygur elderly.Results:(1) The feasibility of Uygur language version of GMS is good among Xinjiang Uygur elderly, and its reliability and validity are also well:the total Cronbach’a coefficient of Uygur language version of GMS is 0.963; the coefficient of agreement of inter-observers is 0.930; the test-retest reliability of GMS is 0.870. Expert content validity index (CVI) is 0.856; the criterion-related validation is determined by diagnostic criteria of CCMD3, the diagnostic accordance rate of geriatric depression is 84.00%, the sensitivity is 85.42%(41/48), the specificity is 82.69%(43/52), the positive predictive value is 82.00%(41/50), and the negative predictive value is 86.00%(43/50). Kappa=0.68 (P=0.00).(2) In this survey, the prevalence rate of Uygur elderly who have geriatric depression in town and country communities is 10.60%, the morbidity rate in town communities is 2.80% and the morbidity rate in country communities is 23.60%; the morbidity rate of male is 5.91% and the morbidity rate of female is 14.58%, which is 2.717 times as many as the rate of male. (χ2=24.572,95% confidential intervals: 1.830-4.035);(3) In this survey, the single factor analysis of geriatric depression of Uygur elderly shows that:the differences of the occurrence of geriatric depression in Uygur elderly in the aspects of marital status (χ2=1.853, P=0.603) and age (x2=0.304, P=0.959) is not statistically significant; the differences in the aspects of educational level (x2=17.548, P=0.002) and occupation (x2=31.366, P=0.000) have statistical significance; the differences in the aspects of smoking (x2=0.700, P=0.403) and drinking (x2=0.082, P=0.775) have no statistical significance; there is correlation between the occurrence of geriatric depression in Uygur elderly and factors like joining collective tourism or not (χ2=10.137, P=0.001), joining community activities or not (χ2=11.087, P=0.001), playing cards or not (χ2=18.071, P=0.000), playing Mahjong or not (x2=5.021, P=0.025), playing Chinese chess or not (x2=6.349, P=0.011), and usually walking or not (x2=5.021, P=0.025), and their differences have statistical significance; The differences of self-evaluated health status of Uygur geriatric depression patients of communities have statistical significance (χ2=37.604, P=0.000); the proportion of Uygur elderly who have more than one disease is 61.93% of the total population, the proportion of Uygur elderly who have more than three diseases is 28.37%, and the proportion of depression patients is as high as 22.02%; the impairment rate of self-care ability of daily living of Uygur elderly is 3.83%; the geriatric depression patients who do not get al.ong well with their family are 2.184 times as many as the geriatric depression patients who get al.ong well with their family (x2=4.840,95% confidential intervals:1.089-4.382); if the number of negative life events in life of Uygur elderly is more than 3, the incidence rate of depression is 20.43%, and the differences of negative life events like financial difficulties (χ2=13.559,95% confidential intervals:1.449-3.518) and death of kinsfolk (χ2= 10.695,95% confidential intervals:1.289-2.828) have statistical significance; the occurrence rate of geriatric depression caused by financial difficulties is 2.258 times as many as the occurrence rate of old people who have no financial difficulties. The normal ability of daily living is a protective factor of geriatric depression, it’s OR is 0.217 (x2=14.709,95% confidential intervals:0.099-0.474), and the differences have statistical significance.(4) In this survey, the multiple logistic regression analysis of geriatric depression Uygur elderly shows that:there is correlation between the occurrence of geriatric depression and factors including female, poor self-evaluated health status, Alzheimer Disease history, stroke or partial paralysis, the number of physical diseases, and different regions; rural and urban hierarchical multiple logistic regression analysis shows that:for the old urban Uygur people, there is correlation between geriatric depression in Uygur elderly and factors including poor self-evaluated health status, stroke or partial paralysis, migraine, attendance of religious activities, and negative life events; for the rural Uygur elderly, there is correlation between geriatric depression in Uygur elderly and factors including poor self-evaluated health status, female, depression history, dementia history, and the number of physical diseases. There is correlation between Uygur geriatric depression and factors including self-evaluated health status and physical diseases.(5) Case control study shows that:the differences of case group’s and control groups’systolic pressure (t=2.697, P=0.008) and weight (t=2.153, P=0.034) have statistical significance, but the systolic pressure measured per hour of the two groups is all in the normal range (control groupl30.611±14.215, and depression group 137±8.693); The triglyceride of case group is higher than control group, whose differences have statistical significance t=2.084,.P=0.04, and other serum lipid parameters’differences have no statistical significance; the TNF-a index of case group is significantly higher than control group, whose differences have statistical significance (t=3.675,P=0.001), but the differences of IL-1β, IL-6, IL-2 index have no statistical significance.Conclusions:(1) The Uygur language version of GMS has good reliability, validity, and diagnostic efficacy, thus it can be used to screen geriatric depression in Uygur elderly of communities in Xinjiang.(2) The morbidity rate of geriatric depression in Uygur elderly is relatively high, which is closely related to the poor health status and the number of physical illness described by the patients. The society should attach importance to this phenomenon. The morbidity rate of geriatric depression in urban area is nearly same with other provinces; however the morbidity rate of geriatric depression in urban area is remarkably higher than other provinces, which is related to more physical illnesses, poor self-evaluated health status, low social status of women and history of stroke or paralysis of Uygur elderly in rural area. the protection factors physical and mental health of Uygur elderly include tobacco-free and alcohol-free, large family inhabitant, harmonious relationship with the neighbors. However, but less traditional puzzle game activities, self-evaluated economic difficulties, poor self-evaluated health status, increasing physical diseases and increasing negative life events have a negative impact on physical and mental health of the Uygur elderly.(3) The rise of blood pressure,weight and triglyceride further increased the risk of occurrence of depression in Uygur elderly. The blood serum cytokine TNF-a has influence on geriatric depression in Uygur elderly. Since the research group aims at Uygur people, the samples are from communities, and the interference factors are less, it is necessary to further increase the sample size of case control study to demonstrate the role of blood serum cytokines in geriatric depression and the relevance between the two.