Study On The Prevalence Of Late Life Depression And The Construction Of Risk Factor Models In Primary Community Health Service Institutions

Objective:1.At present,the aging of the population is one of the globally major social issues of general concern.As an important connotation of healthy aging strategy,mental health has always been a hot research topic in the field of mental and mental health at home and abroad.Late life depression(LLD),second only to Alzheimer's,has become the most common mental disorder that seriously endangers the mental health of the elderly,and it has become more prominent with the aggravation of the aging problem.However,due to the different screening tools for diagnosis,the large differences in sample source,sample size,economic development,and social and cultural background,the survey results of the prevalence of LLD in various countries and regions are quite different.Moreover,considering that the clinical symptoms of mostly elderly patients with depressive disorder demonstrate atypical,somatization symptoms such as digestion and circulation often mislead doctors to conduct a large number of medical examinations,resulting in70% to 90% of patients being missed or even being misdiagnosed.In addition,homebased care is still the first choice for the elderly and their families in China.However,due to the "4-2-1" family model,the accelerated pace of children's work,the farther lengthening of living distances,and the increase of empty-nest families,and other existed factors.The function of family care for the elderly is weakening day by day,and the integrated medical care and elderly care service system based on home care,supported by community care and supplemented by institutional care has become the mainstream model.The primary community health service institutions(PCHSI)have become the first window to provide medical care and psychological care services for the elderly.Therefore,this second part of the study is to use the method of epidemiological questionnaire to analyze the prevalence and characteristics of depression in the elderly who have contracted services with PCHSI at this stage.2.Depressive disorder has become the most common mental disorder that seriously endangers the mental health of the elderly.The prevalence rate in the elderly is as high as10%-20%,leading to social impairment,reduced physical activity and quality of life in the elderly.At present,there are many experiments and investigations on the risk factors of depressive disorder in the elderly,mainly focusing on the study of the correlation between clinical disease characteristics,psychological factors and social factors on the occurrence and development of the disease and the process of action.Previous studies were limited to investigate related risk factors of derpressive disorder,but lacked any discussion of the internal relations among the various factors.Therefore,the third part of this study utilizes the psychological stress system model as the theoretical framework,and uses the method of literature review and discussion by the research group to screen predictor variables and determine research tools.Finally,based on the theory of decision tree model,combined with the influence of biological,psychological and sociological factors on the depression level of the tested elderly,a risk factor model of LLD was then constructed.3.Major depressive disorder(MDD),as one of the most common clinical mental disorders,affects more than 3 million people worldwide with an incidence rate of 4.4%.In the past ten years,the prevalence of MDD has been increase by 18%,and it has become the second main cause of death for people ranged from 15 to 29 years old.Evidence have demonstrated that successful antidepressant treatment is one of the most effective ways of reducing disability,preventing morbidity,and improving quality of life for patients with MDD.In addition,given that a significant number of patients fail to respond to the existing antidepressant agents,the development and application of atypical antidepressants,phytochemicals,and new drug therapeutic targets,as well as the combination of medication and other psychotherapy have become one of the important research directions in the treatment of depressive disorder.Moreover,based on the utilization of antidepressant drugs,scholars also compared the clinical treatment effectiveness by employing outcome indicators,such as acceptability,efficacy,tolerance,adverse reactions,and changes in brain structure and function.Thus,scholars utilized MDD and drug therapy as a research subject to carry out large numbers of clinical and basic studies,which provided significant results.At the same time,the quality of papers published in influential journals increased,and the publications showed an increasing trend year by year.This part of the study,methods of bibliometric analysis were used to analyze the hot topics in the research field of drug therapy studies on MDD,explore the development of theme trends and changes of knowledge structures,so as to provide theoretical guidance for the formulation of intervention measures of LLD.Methods:1.In the first part,the prevalence and clinical characteristics of LLD in PCHSI were analyzed by using the method of large sample epidemiological questionnaire survey.A total of 826 questionnaires were sent out to the elderly subjects from 6 PCHSI in Liaoning Province,and 656 of them were effectively recovered(effective recovery rate was 79.42%).Among them,there were 204 males(31.1%)and 452 females(68.9%).2.Participants of the second part comes from the above six PCHSIs and psychological outpatient of the first hospital of China Medical University.Additionally,the risk factor model of LLD was established based on the statistical method of decision tree model.Overall,a total of 936 questionnaires were distributed and 737 were effectively recovered(effective recovery rate of 78.74%),including 213 male cases(28.9%)and 524 female cases(71.1%)?3.The study subject of the third part aims to analyze the theme trends and knowledge structure of drug therapy studies on MDD,literature published in Pub Med and related to drug therapy studies on MDD were retrieved by using retrieval method,which took[ "Major depressive disorder" / " depressive disorder,Major " ] AND [ " Drug therapy " / "Antidepressive Agents " ] as search term between 2001 and 2018 in 6-year increments(2001-2006,2007-2012 and 2013-2018).After extracting major Medical Subject Headings(Me SH)terms/Me SH subheadings,bi-clustering analysis,social network analysis,and strategic diagrams were employed to complete bibliometric analysis.Results:1.The first part of the epidemiological survey showed that screening analysis was conducted on 656 elderly community residents with MINI,GDS and HAMD,and the results of the prevalence of LLD corresponding to different tools were 20.7%,22.4% and20.6%.Further chi-square analysis found that type of registered permanent residence,marital status,children,living ways,history of mental illness,chronic disease,occupational type,work,income,satisfaction of economic income,physical exercise,eating habits,a total of 12 variables have significant influence on the prevalence of LLD(P < 0.05).2.In the second part,the risk factors model for depression showed that according to research by 737 elderly subjects' investigation of depression the regression analysis found that type of registered permanent residence,children condition,personal and family history of mental illness,the elderly life events,sleep quality,neurotic personality,somatization symptoms,family and social dysfunction,use of social support,psychological elastic resilience,strength and optimism dimension are significant factors of LLD.Based on further confirmation of decision tree model and theory of risk factors for elderly depression,including social dysfunction,the mild and above level of somatization symptom,the elderly life events scores?65,scores of strength(subscale of CD-RISC)< 25,neurotic personality trait,sleep disorder,and scores of optimism(subscale of IBS)<26,and scores of low frustration tolerance(subscale of IBS)?22can be used as predicted risk factors of late-life depression.The correct classification judgment rate of the model was 89.45%.Sensitivity,specificity,positive predictive value and negative predictive value were 83.10%,92.17%,81.94% and 92.73%.The area under the ROC curve were 0.951(0.934-0.968).3.According to the bibliometric analysis of the first part,1,577,2,680,2,848 relevant research articles were retrieved for the periods during 2001–2006,2007–2012,and 2013–2018,respectively.In line with strategic diagrams,the main undeveloped and peripheral theme clusters during 2001–2006 were functional mechanisms of antidepressants in pathophysiology,neuroendocrinology and neural biochemistry.These themes were replaced during 2007–2012 by clinical efficacy and influencing factors of antidepressants with or without psychotherapy,mechanisms of adverse reactions of antidepressants,and predictive studies of clinical therapeutic effects of antidepressants based on brain imaging.During 2013–2018 application and evaluation of new antidepressant agents,early identification and prevention of suicide of patients with MDD,as well as geneticor bio-markers affecting the response and efficacy of antidepressants were the primary themes.Based on social network analyses,emerging hotspots,such as antidepressive agents,second-generation/adverse effects,depressive disorder,major/metabolism,psychotherapy/methods,and brain/drug effects could be identified during 2007–2012 and2013–2018.Conclusions:1.The prevalence of depression in elderly residents who have contracted services with genral practitioners in PCHSI is high.The prevalence of LLD screened by MINI,GDS and HAMD are 20.7%,22.4% and 20.6%,respectively.The mental health problems in this elderly group should be paid close attention by government functional departments and(mental)medical and health institutions.2.Somatization symptoms being mild and above,have positive personal history of mental illness,more stressful life events,poor quality of sleep,neurotic personality,low IBS score and frustration tolerance,social and family dysfunction are risk factors for increasing the elderly suffering from depression.High degree of social support,better psychological elasticity are protective factors that can reduce the risk of depression.3.Based on decision tree model theory,the risk factors of LLD included social dysfunction,significant somatization symptoms,high stress life events,low level of mental resilience,high level of irrational beliefs,poor sleep quality,neurotic personality.Statistical analysis shows that the model has good performance and can be used for screening LLD patients in clinical and community health institutions.4.These undeveloped theme clusters and emerging hotspots can be helpful for researchers to clarify the current status of their respective fields and future trends,and to generate novel ideas that may launch new research directions.Additionally,findings of this part can provide a scientific basis for constructing intervention measures for LLD in the follow-up research.