Citation:
Reyna-Avila L, Peña-Marcial E, Pérez-Cabañas R, Lorenzo-Angel LA, Molina-Machuca D, Aparicio-Tejeda
JM. Depresión en adultos mayores del municipio de Mochitlán, Guerrero. Univ Salud [Internet].
2023;25(3):56-62. DOI:
https://doi.org/10.22267/rus.232503.319.
Introduction: Depression in older adults in an important aspect since it affects
significantly their health and quality of life. As people age, they may experience physical,
emotional, and social changes that make them more susceptible to depression. Based on estimations
from the World Health Organization, the global population over 60 years of age with some depressive
symptoms will increase from 12% to 22% between 2015 and 2050.
Objective: To identify the prevalence and factors associated with depression in
older adults from the municipality of Mochitlan, Guerrero.
Materials and methods: Mixt quantitative research with an analytical
cross-sectional design and a simple random sampling of 26 older adults. Information was collected
through a multiple choice survey administered by the researchers using an instrument with four
sections. The ethnographic method was used for the qualitative approach, through a semi-structured
interview to a focus group of seven older adults, with 3 open questions.
Results: Mild (38.46%), moderate (7.69%), and serious (3.85) was found. The
associated factors were: female gender; type of work; and monthly income. The qualitative analysis
showed positive and negative emotions.
Conclusions: 50% of the population had some type of depression.
Introducción: La depresión en adultos mayores es un tema importante debido a que
afecta de manera significativa la salud y calidad de vida. A medida que las personas envejecen,
pueden experimentar cambios físicos, emocionales y sociales que los hacen más susceptibles a tener
depresión. La Organización Mundial de la Salud (OMS) estima que entre 2015 y 2050 la población
mundial mayor de 60 años pasará del 12% al 22% de padecer algún síntoma depresivo.
Objetivo: Identificar la prevalencia y factores asociados a la depresión en adultos
mayores del Municipio de Mochitlán, Guerrero.
Materiales y métodos: Investigación mixta, cuantitativa con diseño transversal
analítico, muestreo aleatorio simple en una población de 26 adultos mayores, se recao información
mediante una encuesta aplicada por los investigadores con opción múltiple utilizando un instrumento
de cuatro apartados. Para el enfoque cualitativo se utilizó el método etnográfico, mediante una
entrevista semiestructurada con 3 preguntas abiertas a un grupo focal de siete adultos mayores.
Resultados: Se encontró depresión leve (38,46%), moderada (7,69%) y grave (3,85%).
Los factores asociados fueron género femenino, tipo de trabajo; ingreso mensual. El análisis
cualitativo mostro emociones positivas y negativas.
Conclusiones: 50% de la población presento algún tipo de depresión.
Introdução: A depressão em idosos é um tema importante porque afeta
significativamente a saúde e a qualidade de vida. À medida que as pessoas envelhecem, elas podem
passar por mudanças físicas, emocionais e sociais que as tornam mais suscetíveis à depressão. A
Organização Mundial da Saúde (OMS) estima que entre 2015 e 2050, a população mundial com mais de 60
anos passará de 12% a 22% sofrendo de alguns sintomas depressivos.
Objetivo: Identificar a prevalência e os fatores associados à depressão em idosos
do município de Mochitlán, Guerrero.
Materiais e métodos: Pesquisa mista, quantitativa, com desenho analítico
transversal, amostragem aleatória simples em população de 26 idosos, as informações foram coletadas
por meio de questionário aplicado pelos pesquisadores com múltipla escolha por meio de instrumento
de quatro seções. Para a abordagem qualitativa utilizou-se o método etnográfico, por meio de
entrevista semiestruturada com 3 questões abertas a um grupo focal de sete idosos.
Resultados: Foi encontrada depressão leve (38,46%), moderada (7,69%) e grave
(3,85%). Os fatores associados foram sexo feminino, tipo de trabalho; ingresso mensal. A análise
qualitativa evidenciou emoções positivas e negativas.
Conclusões: 50% da população apresentou algum tipo de depressão.
In older adults, the emotional situation is affected by various factors such as physical health,
social relationships, traumatic events and/or significant losses, among others. Therefore, they
usually experience feelings of loneliness, isolation, and, consequently, depression1.
Depression is one of the main mental disorders with the highest prevalence in older adults and
its development is affected by different factors. The WHO estimates that by 2030 the main cause
of death worldwide will be mental disorders. These estimations indicate that between 2015 and
2050 the world population over 60 years of age with some type of depressive symptoms will grow
from 12% to 22%. Currently, the worldwide prevalence of depression in older adults is 13.5 %2. In Mexico, mental disorders rank fourth between all
medical cases, being depression one of the most frequent illnesses (7.8%)3.
Depression in older adults is a disorder that affects significantly the quality of life of this
population. This emotional illness is characterized by persistent feelings of sadness, loss of
interest in activities that they used to enjoy, sleeping difficulties, changes in appetite, and
reduced energy. It can also trigger memory and concentration problems as well as thoughts of
death or suicide4,5.
There are several factors associated with depression in older adults, including presence of
chronic diseases (diabetes or cardiovascular diseases), the loss of loved ones and friends,
loneliness, social isolation, financial problems, changes in their social roles, and lack of
family support. All these factors can have a negative impact on their emotional well-being4,5.
It is important to highlight that depression is not a normal event during the aging process and
that it can be effectively treated. Early diagnosis and access to appropriate treatment (e.g.
cognitive behavioral therapy and antidepressant medications) can improve their symptoms and
quality of life6.
Therefore, the objective of this study was to identify the prevalence and factors associated
with depression in older adults from the municipality of Mochitlan, Guerrero. In addition, this
research was aimed at describing their emotional state, since, to the best of our knowledge,
there are no current studies focused on assessing this problem in this particular population.
The research followed a mixed approach. Whereas the qualitative approach applied an
ethnographic method, the quantitative cross-sectional analytical component used a simple
random sampling method, through the formula:. A sample of 26 out of 51 older adults was obtained, with a limit for the
estimation error equals to 0.00403846154.
Information collection was conducted directly at two time points. In the first one,
qualitative data was obtained through an instrument that has four sections:
sociodemographic data, health status, substance use, and geriatric depression. For the
last item, the Yesavage (GDS-15) geriatric depression scale was applied, which was
designed by Jerome A. Yesavage and collaborators in 1983. In 1986 the scale was modified
to a shorter version containing 15 positive and negative questions, which can be
answered as "yes" or "no"7. Its internal
consistency is 0.78. The Kaiser-Meyer-Olkin test to measure sampling adequacy produced a
coefficient of 0.70 and a construct reliability of 0.87. This instrument is recommended
by the National Institute of Geriatrics for its application in geriatric populations8. The Cronbach's Alpha coefficient was used
for the reliability or internal consistency of this research, with a result of 0.867.
Qualitative data was collected during the second time point through a semi-structured
interview that contained three open questions and was applied to the focus group made up
of seven older adults who agreed to participate. The COVID-19 pandemic was a factor that
limited a greater participation. The questions were taken and adapted from Yesavage
(GDS-15) geriatric depression scale. The oral responses were recorded to guarantee a
complete register.
The dependent variable was Depression, which was measured through the Yesavage (GDS-15)
geriatric depression scale that included 15 items. The score contained four ranges:
normal (0-4); mild (5-8); moderate (9-10); and serious (12-15). The independent
variables were sociodemographic data, characteristics of the home, basic services,
tenure, and number of people living in the home, accompaniment (living alone or
accompanied), epidemiological data (diseases diagnosed in older adults) and substance
consumption.
The analysis of quantitative data was carried out through the SPSS version 21
statistical package. The descriptive analysis was conducted using graphs and tables with
frequencies and percentages. Chi2, Tau-b, and Tau-c were applied to the
bivariate analyses of the relationship between dependent and independent variables. The
qualitative assessment involved the initial transcription of the interviews and the data
were interpreted through codes, subthemes, and themes, which facilitated the
interpretation of the findings. Subsequently, the themes were described based on
theoretical aspects and validated with the content of the interviews.
The participants were male and female adults aged 60 years and older, form the
municipality of Mochitlan, Guerrero, who agreed to participate voluntarily by signing
the informed consent that explained clearly the objectives of the study, procedures to
be carried out, possible risks and benefits associated with their participation, as well
as the guarantee of privacy and confidentiality. The study was conducted from October
2021 to July 2022.
They study way reviewed and approved by researchers and professors of the University and
followed the ethical principles established in article 100 of the Health General Law and
the official Mexican Standard NOM-012-SSA3-20129,10.
65.38% of the participants were women (17). The mean age was 71.81 years (standard deviation of
8.025), while the age range was 60 to 99 years. 80.77% (21) were married, 50% (13) had a job, 8
of them being farmers (61.54%) and 7 participants working more than 7 hours a day (53.85%).
96.15% of the participants had a monthly income that was lower than $500 MXN (25).
Based on the Geriatric Depression Scale (GDS-15), 65.4% of participants prefer to stay at home,
53.8% think that the majority of people are in a better situation, 46.2% have stopped doing the
activities or tasks that they used to do, 42.3% feel useless, and 38.5% mention that they feel
helpless and unprotected (Table 1).
# Table 1.
Items of the Geriatric Depression Scale (GDS-15) applied to the study population
Item
Yes
No
Ƒ
%
ƒ
%
1- Generally speaking, are you satisfied with your life?
23
88.5
3
11.5
2- Have you dropped many of your usual tasks and hobbies?
12
46.2
14
53.8
3- Do you feel that your life is empty?
10
38.5
16
61.5
4- Do you often get bored?
5
19.2
21
80.8
5- Are you in good spirits most of the time?
19
73.1
7
26.9
6- Are you afraid that something bad is going to happen to you?
8
30.8
18
69.2
7- Do you feel happy most of the time?
25
96.2
1
3.8
8- Do you often fell helpless or unprotected?
10
38.5
16
61.5
9- Do you prefer stay at home, rather than going out and doing new
things?
17
65.4
9
34.6
10- Do you feel that have more problems with memory than most
people?
6
23.1
20
76.9
11- Right now, do you that is wonderful to be alive?
26
100
0
0
12- Do you feel pretty worthless the way you are now?
11
42.3
15
57.7
13- Do you feel full of energy?
24
92.3
2
7.7
14- Do you feel that your situation is hopeless?
7
26.9
19
73.1
15- Do you think that most people are better off than you are?
14
53.8
12
46.2
Depression survey in older adults from the
Municipality
of Mochitlan, Guerrero. May 2022
50% (13) of participants had depression, of which 38.46% (10), 7.69% (2), and 3.85% (1) had
mild, moderate, and serious depression, respectively (Figure 1). It was found
a relationship with bone fractures (chi2 0.000) and associations with the following
variables: gender (Tau-C 0.268); importance of religion in their lives (Tau-C 0.846); being born
in the municipality (Tau-C 0.580); knowing how to read (Tau-C 0.733); type of job (Tau-C 0.332);
working hours (Tau-C 0.329); monthly income (Tau-C 0.298); being affiliated to a health
institution (Tau-C 0.249); type of material being used to build most of the house (Tau-C 0.27);
and whether the participants like to live with the people they are with now (Tau-C 0.685) (Table 2).
# Figure 1.
Depression in interviewed older adults
# Table 2.
Distribution of depression according to its relationship or association with the
independent
variables
Variable
Depression
Normal
Mild
Moderate
Serious
Total
ƒ
%
ƒ
%
ƒ
%
ƒ
%
ƒ
%
X2
Tau-c
Gender
0.485
0.268
Female
7
26.92
8
30.77
1
3.85
1
3.85
17
65.39
Male
6
23.08
2
7.69
1
3.85
0
0
9
34.62
How important is religion in your life?
0.305
0.846
Important
10
38.46
9
34.62
2
7.69
0
0
21
80.68
Regular
2
7.69
1
3.85
0
0
1
3.85
4
15.39
Does not know
1
3.85
0
0
0
0
0
0
1
3.85
Are you originally from this municipality?
0.783
0.580
Yes
7
26.92
5
19.23
1
3.85
0
0
13
50
No
6
23.08
5
19.23
1
3.85
1
3.85
13
50.01
Do you know how to read?
0.569
0.733
Si
5
19.23
3
11.54
1
85
1
3.85
10
38.47
No
8
30.77
7
26.92
1
3.85
0
0
16
61.54
Type of job
0.174
0.332
Farmer
6
46.15
1
7.69
1
7.69
0
0
8
61.53
Other
2
15.38
3
23.08
0
0
0
0
5
38.46
Daily working hours
0.489
0.329
5 to 6 hrs.
3
23.08
2
15.38
1
7.69
0
0
6
46.15
7 to 8 hrs.
5
38.46
2
15.38
0
0
0
0
7
53.84
Monthly income
0.792
0.298
Less than $ 500
12
46.15
10
38.46
2
7.69
0
0
24
92.3
$ 500 to $ 1000
1
3.85
0
0
1
3.85
0
0
2
7.7
Are you affiliated to a healthcare institution?
0.252
0.249
Yes
8
30.77
4
15.38
0
0
1
3.85
13
50
No
5
19.23
6
23.08
2
7.68
0
0
13
49.99
What is the healthcare institution to which you
belong?
0.713
0.290
INSABI
7
53.85
4
30.77
0
0
1
7.69
12
92.31
ISSSTE
1
7.69
0
0
0
0
0
0
1
7.69
What material is most of the floor in your home
made
of?
0.308
0.27
Soil
5
19.23
1
3.85
0
0
0
0
6
23.08
Cement or brick
8
30.77
9
34.62
2
7.69
1
3.85
20
76.93
Do you have any bone fracture?
0
0.109
Yes
0
0
0
0
1
3.85
0
0
1
3.85
No
13
50
10
38.46
1
3.85
1
3.85
25
96.16
Do you like to live with the people you are living
now?
0.036
0.685
Yes
12
46.15
10
38.46
1
3.85
1
3.85
24
92.31
No
1
3.85
0
0
0
0
0
0
1
3.85
Does not know/ Does not answer
0
0
0
0
1
3.85
0
0
1
3.85
The qualitative analysis focused on interviews of seven older adults and covered three aspects:
feelings-emotions; health issues; and protection.
In the Feelings-emotions found, some were positive, in which peace, tranquility and well-being
were expressed, that is, a state of calm and satisfaction where the older adult enjoys his or
her time of rest and carries out activities normally, feeling strong and with vitality to
continue living (OA1, OA3). "I feel a little calm" (OA1, OA3). They also express excitement,
they report feeling strength, energy and courage to endure and face difficulties that they
experience in this stage, such as the changes and situations or difficulties that arise. (OA1,
OA4). "I don't feel helpless, for me it is a weakness" (OA1, OA4).
A feeling of safety is also a positive emotion, understood as a state where danger and other
conditions that may cause physical, psychological or material damage can be controlled in order
to preserve health and well-being. Consequently, older adults need a greater care to avoid
accidents and this is the reason why sometimes they prefer to stay at home since it is the only
place where they feel safe. "When I am at home I am fine, I am not going out anymore (OA7).
"Better being at home rather than being somewhere else" (OA6).
Negative feelings in older adults were expressed by a change in mood, there are changes in the
emotional aspect, different negative emotions are presented, which can sometimes be controlled
(OA5). That is to say, memories make people feel emotions. When thinking about the past, the
older adult longs for the times when he could work and support his home. Unfortunately, the
years have passed and he has lost his capacity with the passage of time (OA7). "I was a working
man and now I can't do it anymore. When I go to the field and I want to cut firewood, the
ricochets of the ax hurt me. […] (OA1, OA7).
Hopelessness is the feeling of not finding alternative solutions to a certain situation or not
having expectations for the future. Older adults feel this way because they cannot improve their
lives, they feel they are useless, and the only thing that is coming is death. "I cannot do
things as I used to do it and that bothers me. How I will be able to survive now that I am not
able to do anything, that is the problem" (OA7).
Different emotions were manifested, including externalized boredom due to feeling uninterested
in what surrounds them, having nothing to do or feeling that life is boring. However, fun or
recreational activity was manifested, understood as an activity that takes place in free time,
being a moment of distraction and rest from usual activities.
"Sometimes I go out with my children to have fun but it is not fun if the situation is not
convenient for me" (OA5). "When I am at home I get bored. I must go out even if it is to the
town or where I work and when I come back I am relieved how I am not used to being without doing
something, I was a working man" (OA7).
In health problems, physical deterioration caused by a series of changes and complications was
evident, affecting physical capacity, mainly walking, which may be due to the wear and tear that
occurs around the age of 60, reducing bone mass and tissues, they atrophy, this results in older
adults losing the ability to move and perform activities. "I can't work anymore" (OA1); "I
cannot walk"; "[…] at home what else can I do, I work with my pickaxe, I sit for a while when I
get tired, my shoulders are torn" (OA7).
Protection is expressed by feeling security and family support, caring for a person so that they
do not suffer harm and protecting them; in addition to care between members who have family ties
or ties and live in the same home. "[...] when children have obligations, there is little they
can help you now because they have their children, before they did it because they did not have
a family, I feel that with a lot of work I am getting ahead with my family and I will help with
what I can, it is no longer the same as before [...]" (AM7).
Boredom can cause depression. It is an emotional state of where the interest and motivation to
carry out diverse activities are lost. Older adults experience these feelings due to changes
that they experience at this stage and/or difficulties caused by diseases that prevent them from
performing normal activities such as farm work. Therefore, they feel bored being at home and
they like to go out to do the activities they used to do before in order to feel lightened, but
sometimes their health situation becomes a limitation (OA2, OA7). "I feel bored because I cannot
walk or go out" (OA2). "[…] yes, I get bored, I must go out even if it is to the town or where I
work and when I come back I fell relieved. I am not used to this feeling as I was a working man
and now I feel like this, I need to walk through the fields, but I cannot do it anymore" (OA7).
Helplessness is expressed by feeling vulnerable, alone, sad and afraid; when there is no one to
take care of them, it produces a feeling of inner unrest. In older adults this is closely
related to the presence of diseases or mobility problems that limit the ability to work,
generating economic instability; they report receiving very little or no help from their
children (OA2, OA6, and OA7). "I can't work anymore" (AM2) "Sometimes I get desperate because of
illnesses" (AM6) "[…] I can't work like before, that's what saddens me, what to do to support
myself, is the problem [...] I feel that with a lot of work we are coping with things with my
family and I will help with what I can, it is no longer the same, for that reason I feel sad,
helpless or useless for no longer being able to do things like before [...]" (AM7).
Depression is one of the main reasons why older adults decide not to leave the house since it is
a condition that affects their thoughts and feelings, which causes them to stay at home and lose
the desire to go out. Some of the reasons to avoid going out are: older adults may not be in the
mood or feel without energy; joint problems; or body pain (e.g. hips, shoulders, elbows, wrists,
fingers, knees, and ankles, among others). "[…] yes because I cannot walk" (OA2), "Sometimes
when my children go out I go with them to have fun, but if the situation is not convenient for
me then I do not go" (OA5) (Figure 2).
Research on depression in older adults is a topic of great relevance because of the increase in
their life expectancy and the fast growing rate of this population worldwide. Depression in this
age group is a serious public health problem as it can have significant consequences for the
quality of life and well-being of older adults. The prevalence of depression varies
considerably, according to estimations from different studies. The prevalence registered in this
study (50%) is similar to the one obtained by Peña et al.11 in Guerrero (50.7%) and Salvador et al.12 in Ecuador (54.9%), but it is lower than the
figures reported by Miranda et al.13 (89%)
in Ecuador, Cárdenas et al.14 (81%) and De
los Santos et al.15 in México (74,3%). In
contrast, our prevalence value is higher than the one reported by Borrayo et al.16, in Guatemala.
This study found mild (38.46%), moderate (7.69%), and serious (3.85%) depression in the study
population. These results differ from those reported by Peña-Marcial et al.11, who registered 81% and 16% for moderate and
serious depression, respectively. Similarly, Miranda et al.13 observed a 60% of mild depression and a 29% of established
depression; as well as the study by Lliguisupa et al.17, who report 35.3% mild depression and 11% established
depression.
The results show that depression affects both genders differently (0.268). This observation
coincides with the study of Cardenas et al.14, who reported that depression was more common in women,
suggesting a relationship between gender and depression (χ2=823 and p=0.007). Also,
Miranda et al.13, and Salvador et
al.12, have shown that women are at a higher
risk for depression. Likewise, Peña-Marcia et al.11, reported that 50.7% of the study population were women
experiencing some degree of depression.
The data from this research carried out show that the type of job (0.332) and monthly income
(0.298) were related to the presence of depression. These results coincide with the study by
Cárdenas et al.14, in which a relationship
was found with domestic activities and not doing any activity, presenting a higher frequency of
moderate depression in 79.8% and 77.8% respectively (χ2=13.27 and p=0.004).
Socioeconomic status also showed a relationship with depression, as did the study conducted by
Miranda et al.13, in which low socioeconomic
status was a potential risk factor for depression (55%).The data of this investigation also show
that type of job (0.332) and monthly income (0.298) are related to the presence of depression.
Likewise, this study found a relationship of other factors such as the importance of religion in
their lives (0.846), being native (0.580), knowing how to read (0.733), number of daily working
hours (0.329), belonging to a healthcare institution (0.249), type of institution (0.290),
construction material of the home floor (0.325), the person feels comfortable living alone or
with other people (0.044). A relationship with the presence of bone fractures was identified χ2
(p=0.000). However, these findings differ from the results of other studies.
The feelings-emotions present in this stage were positive such as tranquility, well-being,
strength, encouragement, security and fun and/or negative which included mood swings, longing,
hopelessness and boredom. It is mentioned that there are physical problems due to wear and tear,
which makes walking difficult, and for this reason older adults prefer to stay at home where
they feel comfort, security and protection, some have the support that their family provides
them.
These findings coincide with the study by Estupiñán-Palacios et al.18, who found that health problems lead to a feeling of
hopelessness and emptiness in your life. The data is based on what is reported by the Ministry
of Health of Colombia, about the aging process, which brings with it the loss of the ability to
develop habits, causing significant changes in the environment19. Also coinciding with the study by Martínez-Mendoza et
al.20, which showed the presence of
diseases, as well as alterations in their emotional state due to loneliness and distance from
their loved ones, which is reflected in sadness, irritability and melancholy.
Samaniego-Zhunio et al.21 showed that
emotions are a reaction that includes experiential, behavioral and physiological elements,
through which the person tries to deal with a significant situation or event.
Our results show that depression is a multifactorial health problem that affects older adults,
as it is the last stage of their lives when they face: losses, crisis, as well as physical,
psychological, family, social, and economic decay, which manifest as mood changes, longing, and
hopelessness that sometimes they cannot handle, triggering a great risk for the appearance of
diseases. Nevertheless, there are also positive feelings such as tranquility, strength,
encouragement, and security, which function as protective factors and may improve the quality of
live of older adults.
Recommendations: Health care professionals should conduct continuous screening
strategies to identify properly and quickly depression in the elderly population and implement
proper interventions coordinated with a multidisciplinary and interdisciplinary team, involving
the family, in order to follow up on diagnosed adults according to the Mexican Official Standard
NOM-025-SSA2-2014.
To encourage the personnel who work at first level assistance institutions to conduct home
visits in order to know, prevent, and follow up on problems and/or needs of older adults.
It is suggested that professional from education institutions should conduct research on elderly
populations that live at their own homes in order to identify problems they may experience and
search for strategies to improve their quality of life.
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