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BRIEF RESEARCH ARTICLE
Year : 2020  |  Volume : 64  |  Issue : 4  |  Page : 405-408  

Magnitude and gender-specific circumstances of depression among elderly population residing in an Urban slum area of a City in Maharashtra: A mixed-method study


1 Assistant Professor, Department of Community Medicine, Seth G.S. Medical College and K.E.M Hospital, Mumbai, Maharashtra, India
2 Associate Professor, Department of Community Medicine, Seth G.S. Medical College and K.E.M Hospital, Mumbai, Maharashtra, India

Date of Submission03-Oct-2019
Date of Decision02-Jun-2020
Date of Acceptance13-Oct-2020
Date of Web Publication11-Dec-2020

Correspondence Address:
Rukman M Manapurath
Department of Community Medicine, 3rd Floor Library Building, Seth G.S. Medical College and K.E.M Hospital, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.IJPH_501_19

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   Abstract 


The burden of geriatric mental health in India is showing a silent epidemic trend, but the knowledge on spectrum of their mental well-being dwelling in slums is very trivial. This mixed-method study aimed to estimate the proportion of depression among elderly and to find out the gender-specific circumstances, leading to depression. A total of 209 subjects selected through multistage sampling from an urban slum in a city of Maharashtra were interviewed for estimating depression, and six focus group discussions (FGDs) were conducted to explore the circumstances. Overall, 42.1% of elderly people had depression with 2.8% severe depression. Major themes highlighted after FGDs were self-esteem, social role, dependence, negative experience, and disgrace among males, and among females, main themes were justifiable reason, managing mood, suppression, undesirable events, and stigma. Depression is a significant public health problem, and a diverse approach is required to understand the perception of elderlies which will highlight the core issues related to depression.

Keywords: Female elderly, geriatric depression, mixed.method study, slum area


How to cite this article:
Pathak BG, Deshpande S, Manapurath RM. Magnitude and gender-specific circumstances of depression among elderly population residing in an Urban slum area of a City in Maharashtra: A mixed-method study. Indian J Public Health 2020;64:405-8

How to cite this URL:
Pathak BG, Deshpande S, Manapurath RM. Magnitude and gender-specific circumstances of depression among elderly population residing in an Urban slum area of a City in Maharashtra: A mixed-method study. Indian J Public Health [serial online] 2020 [cited 2021 Sep 26];64:405-8. Available from: https://www.ijph.in/text.asp?2020/64/4/405/303102



The aging process is sequence of a biological reality which has its own dynamic afar from human control.[1] The elderlies are losing their noteworthiness in their own house, due to societal transformation, intensifying feeling of loneliness, and economic insecurities impacting their psychological health. Depression, which is erroneously anticipated to be a normal part of aging, now shows a trend of silent epidemic in India.[2] Studies quotes geriatric depression prevalence to be 18.2%; still, this issue has not perceived a priority public health problem.[3] Again, rapid urbanization of Indian megacities has resulted a growing number of inhabitants living in slums. Knowledge on spectrum of mental well-being among old adults dwelling in slums is very trivial. Hence, an effort is being made through this study to assess the extent of geriatric depression in the slum area through quantitative methods and explore the gender-specific circumstances, leading to late-life depression via qualitative technique so that preventive and curative strategies can be prioritized.

A mixed-method study was conducted for a period of 24 months (2016–2018) in an urban slum area of a metropolitan city of Maharashtra having 1.80 lakh population and two urban health posts (UHPs). The study population consisted of elderly people aging 60 years and above inhabiting in the selected slum area for at least 1 year.

Quantitative data were collected via multistage sampling method where initially, lottery method was used to choose one UHP randomly. Then, among six blocks of this selected UHP, on block was randomly selected by using OpenEpi. Open Source Epidemiologic Statistics for Public Health (V/3.01). Considering 46% prevalence of depression with 95% confidence interval and with allowable error 15% of the expected prevalence, the estimated minimum sample size was 209.[4] Followed by this, systematic random sampling was used to interview 209 participants with a prevalidated questionnaire, and then, a short-form geriatric depression scale (GDS) was utilized to screen geriatric depression. The scale scores of 0–4 are considered normal; 5–10 indicate mild depression; and 11–15 indicate severe depression. More detailed information about GDS can be found elsewhere.[5] Later, focus group discussions (FGDs) were conducted among the depressed elderlies with the basic objective to find out the gender-specific circumstances of depressions of FGDs. Purposive sampling technique was utilized for selecting depressed elderlies, and each FGD session (duration: 40 min) was digitally recorded. Data saturation was achieved after six FGDs, i.e., three FGDs with females and three FGDs with males. Dynamic group interaction via FGDs helped investigating the complex behavior pertains to elderlies' residence and their perception on factors impacting their mental health. SPSS Statistics for Windows, version 16.0 (SPSS Inc., Chicago, Ill., USA) analyzed the quantitative data where Chi-square test determined the significant association between the risk determinants and depression. FGDs were digitally recorded; then, verbatims were back-translated into English and encoded via ATLAS-Ti 8.0 trial package computer program (ATLAS.ti Scientific Software Development GmbH, Berlin, Germany). Through inductive content analysis approach, we identified systematic recurrence of codes, and via content analysis, we generated open codes. Subsequently, axial coding was followed and similar-looking open codes were grouped under a subtheme. Ultimately, via constant comparison analysis among various subthemes, we generated the major themes.[6] These themes were the means of identifying gender-specific circumstances of geriatric depression.

Ethics approval was obtained from the institutional ethics committee of K.E.M. Hospital, Mumbai.

GDS scale screened depression among 88 (42.1%) participants; 82 (39.23%) were mildly depressed and 6 (2.8%) were severely depressed among which 5 (2.39%) were females. The mean GDS scoring and age of depression were 6.302 (± ±3.1) and 73.2 (±6.07), respectively. Common responses from the scale were “My situation is hopeless“ and “I have dropped many of my activities and interest.[5] [Table 1] shows the association of risk determinants with the occurrence of geriatric depression.
Table 1: Factors associated with occurrence of geriatric depression (n=209)

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[Figure 1] summarizes the themes and subthemes developed after FGDs. Few significant verbatims, subthemes, and themes evolved from FGDs are mentioned below:
Figure 1: Conceptual summarization of the themes and subthemes developed after focus group discussions.

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Male elderlies

Achievement: “Nobody remembers my past acclamations, so I feel low. I want to be young again.

Activity: “I am not able to do activities for me and my friends like before. I stay home most of time.

Financial: “Every time, I need some assistance for medicine, I have to ask my grandchildren or daughter. I feel low.

Health: “Since 1 year, I am not getting sleep at night, I feel so sad and un-well the next whole day.

Humiliation: “I have bared enough in my life till now, and if I say I am suffering from mental illness, I will be insulted and put down in our community.

Female elderlies

Long-term condition: “I am widow since 30 years. I am always treated badly by society, so I am bound to be sad always.

Negligence: “I had never got good things in life. I have suffered abuse from my childhood till this age…. And I have no one to care, that's why I never feel good.

Difficult emotions: “Most of the days, I get worried about daily activities at home, and then, I over-react and later I feel very sad of that event.

Decision-making: “Many things in my family went wrong but can't help because they don't allow me taking decisions. I feel suffocated and very sad.

Altered environment: “7 years back I came here, this house is in a dirty environment, and there is frequent illness at my house, it was not like this in my old village.

Shame: “No no! I don't want to go to doctor for my sadness, people will make fun of me.

Significant proportion of elderlies was found depressed, and proportion of depression was more among females. 55.1% of the elderly homemakers were depressed, indicating suppression and lack of empowerment among them. However, elderlies having some sort of financial securities were self-dependent and had a decent healthy life and less worries, ruling out socioeconomic status as a significant risk factor. Female gender, reduced physical activity, and addiction habits increase the likelihood of occurrence of depression. Tobacco usage was done by 22 females among 110, and most of the females hide this habit from their families. These findings were is in accordance with the existing research findings.[7],[8]

Gender-specific circumstances of depression among geriatric population can be explained with the various themes generated via FGDs. FGDs generated themes,highlighting financial insecurities as one of the major reason for elderly males' sadness. We have found factors, e.g., increasing age and less physical activity, significantly associated with depression in our quantitative analysis, and by using qualitative approach, we understand that the core issue is less activity resulting in reduced social interaction making elderly males isolated which instigates low mood. Risk factors, e.g., illness, unemployed status and financial burden, have ultimately increased male elderlies dependence on other family members and people, affecting their dignity and mental status.

The qualitative results highlighted that the female elderlies considered low mood as a natural segment of their lives. This is a worrisome scenario in public health aspect; as these elderly females considered sadness/low mood as a justifiable condition and never seek for medical advice. No decision-making role in family with the least value to their opinions in familial and societal matters has made females feel worthless and unhappy. Nevertheless, elderly females perceived the negative experiences differently when compared to males. The dependence on other people for basic needs made elderly males very sad. Major reason for this dependence was undesirable events affecting their economic and health status. However, in females, negative events are death of spouse/children, loss of support, etc., which increased their loneliness affecting their mental health. FGDs highlighted that stigma for mental health in this slum area is the biggest challenge, which averts the elderlies from preventive and curative measures. FGDs found that knowledge and awareness about medication for depression were comparatively less among elderly females. Other causes related to low mood in elderlies were: unhygienic living environment, temporary housing facility, frequent health-related issues and financial in-securities of their children and grandchildren. Similar findings have been brought to light by previous qualitative and mixed-method studies.[9],[10] Hence, qualitative analysis helped us in understanding that general risk determinants which are associated with depression can be perceived differently by males and females. Therefore, managing depression in males and females may need a diverse approach, and a standard management protocol for both genders may not be effective all the time. The strength of this research is the utilization of multiple methods and analysis strategies which enhanced the credibility of results. This study was conducted in one slum of a metropolitan area. Hence, the findings of this study cannot be generalized. Second, if subjective feelings were hidden by elderlies at the time of contact with the researchers, it may have led to variation in proportion of depression. Mental status of elderlies living in slum area is worrisome. Consequently, it is need of the hour to understand the perception of old adults and strategize management protocol.

Acknowledgment

I would like to thank the UHC and K.E.M. Hospital in helping in completing this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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