Prevalence of mental illness and their association with sociodemographic factors in the rural geriatric population in Chittoor, Andhra Pradesh, India: A community-based study
Khadervali Nagoor, Surendra Babu Darivemula, N Bayapa Reddy, Shakeer Kahn Patan, C Sravana Deepthi, Chandra Sekhar Chittooru
Department of Community Medicine, Apollo Institute of Medical Sciences and Research, Chittoor, Andhra Pradesh, India
|Date of Submission||26-Jun-2018|
|Date of Acceptance||13-Aug-2018|
|Date of Web Publication||28-Dec-2018|
Dr. Surendra Babu Darivemula
Department of Community Medicine, Apollo Institute of Medical Sciences and Research, Flat 704-NT, Murukambattu, Chittoor - 517 127, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
BACKGROUND: Mental health problems such as cognitive impairment, depression, anxiety, and sleep disorders arising out of senility, neurosis, and living conditions are common in the geriatric population.
OBJECTIVE: The objective of this study was to estimate the prevalence of mental illness and to describe their sociodemographic factors in the rural geriatric population and see their association with other factors.
METHODOLOGY: A community-based cross-sectional study was done on individuals aged more than 60 years. The study instruments were predesigned semi-structured questionnaire, Folstein's Mini–Mental Status Examination Scale for assessing dementia in cognitive functioning and Yesavages Geriatric Depression Scale to estimate the prevalence of depression and to assess the activities of the daily living by Barthel index and the anxiety were assessed based on the perception of the participants while conducting the interview.
RESULTS: A total of 415 individuals participated, out of them 199 (47.9%) were males and 216 (52.1%) were females. Prevalence of mental illness was 217 (52.2%) with one or the other type of mental illness. The prevalence of cognitive impairment was 47.7% and depression according to Geriatric Depression Scale >5 was 27.7%. The remaining 62 (14.9%) had dementia and 30 (7.2%) had anxiety disorder as the mental illness. The socio-demographic factors such as age more than 70 years, female gender, illiterates, living in joint family, middle and lower socio-economic class, financially totally dependent and had poor and unfair relationship with the family members were strongly associated with the mental illness and it was statistically significant with P < 0.05.
CONCLUSION: Measures should be taken to support the elders, establish community elderly societies, advisory offices, and services to help the elderly. The sequence of social interventions required for the management of the elderly psychological problems.
Keywords: Depression, geriatric, mental health, prevalence, rural
|How to cite this article:|
Nagoor K, Darivemula SB, Reddy N B, Patan SK, Deepthi C S, Chittooru CS. Prevalence of mental illness and their association with sociodemographic factors in the rural geriatric population in Chittoor, Andhra Pradesh, India: A community-based study. J Edu Health Promot 2018;7:165
|How to cite this URL:|
Nagoor K, Darivemula SB, Reddy N B, Patan SK, Deepthi C S, Chittooru CS. Prevalence of mental illness and their association with sociodemographic factors in the rural geriatric population in Chittoor, Andhra Pradesh, India: A community-based study. J Edu Health Promot [serial online] 2018 [cited 2019 Jul 23];7:165. Available from: http://www.jehp.net/text.asp?2018/7/1/165/248920
| Introduction|| |
Psychiatric morbidity, which increases with age, is more prevalent in the geriatric (43.32%) than in the non-geriatric group (4.66%). Prevalence of depression, the most common problem, ranges between 13% and 22%. Aging declines the cognitive functioning due to senile changes. If the goal of “Health for All” is to be achieved, policymakers and administrators must pay more attention to various issues of this group.
The proportion of older adults in less developed countries is rising much faster than in developed countries. The life expectancy of an average Indian has increased from 36.7 in 1951 to over 67.14 in 2012. In addition, the population of older adults (≥60 years) in India increased to 102 million in 2011. The proportion of elderly persons in India rose from 5.3% in 1961 to 7.5% in 2001, and was currently 8.4% in 2011. The geriatric population is not a homogeneous category; it consists of different ages, belonging to different socioeconomic groups, having different health status. The mental disorders that are frequently encountered include dementia and mood disorders. Other disorders include neurotic and personality disorders, drug and alcohol abuse, delirium, and mental psychosis.
Psychosocial medicine teaches us that every disease is conditioned by unfavorable social factors. There is limited data about the epidemiology concerning the settings where elderly persons die due to a variety of social, cultural, and economic factors. We therefore conducted this study to find out social and psychological problems of the elderly.
| Methodology|| |
A community-based cross-sectional study.
February 2017 to July 2017.
People aged more than 60 years.
The objectives of this study were to estimate the prevalence of mental illness and to describe sociodemographic factors in the rural geriatric population and see their association with other factors.
A pre-designed semi-structured questionnaire was used to collect data pertaining to sociodemographic profile and psychological status among geriatric population after getting informed consent. The other instruments used were Folstein's Mini–Mental Status Examination Scale was used to assess the dementia for cognitive functioning, in terms of orientation (time and place), attention, memory power, and literary ability. Based on the score (maximum: 30), the participants were graded as normal (≥24), mild (20–23), moderate (10–19), and severely impaired (<10).
Yesavage's Geriatric Depression Scale – shorter version, a 15-question instrument, was used to assess whether the individual was having depression. The participants were categorized as depression absent (≤5) or present (>5). Sleep pattern among the participants was categorized as “normal” or “disturbed” (difficulty in falling asleep, reduced duration, and poor quality of sleep). To assess the activities of the daily living, we used Barthel index, and based on the perception of the participant while conducting the interview, the anxiety was assessed.
Sample size and data collection
For sample size calculation, we used the formula 4pq/d,2 where prevalence (P) of psychiatric morbidity among elderly was 20% and allowable error taken as 20% then calculated minimum sample size was 400. A total of 64 villages were present under the primary health center, Thavanampalli, and our rural health training center was also the part of that mandal. Out of the 64 villages, 20 villages were selected by lottery method. A total of twenty individuals were selected from each of selected village and approached house-to-house visit. Finally, a total of 415 samples were studied. The study was conducted after getting the permission from the institutional ethical committee. Before collecting the data participation information sheet and consent form was obtained.
Data were entered into Microsoft Excel sheet and analyzed by using IBM SPSS Statistics 21.0 version by United States and an appropriate statistical test was applied. The data were expressed in frequency, proportions, and to see the association with other sociodemographic variables, the statistical methods used was simple logistic regression, Chi-square test was applied and shown with P < 0.05.
| Results|| |
A total of 415 elderly persons participated in the study [Table 1], out of them, 199 (47.9%) were males and 216 (52.1%) were females. Out of them, less than 70 years were 248 (59.8%) and more than 70 years were 167 (40.2%) and the mean age for the study population was 67.2 years with a standard deviation of 7.8 years. According to their educational status, 290 (69.9%) were illiterate, 97 (23.3%) were literate, and 28 (6.8%) were educated up to primary level. With respect to type of the family, majority 294 (70.9%) belonged to the nuclear family and the remaining 121 (29.1%) belonged to the joint family. Almost three-fourth of the participants were married 286 (68.9%), more than one-fourth 118 (28.4%) of the participants were widowed, and very few 11 (2.7%) were divorced. More than half 238 (57.3%) of the participants belonged to the Hindu religion, one-fourth 104 (25.1%) of them were Muslims, and 73 (17.6%) belonged to Christians. According to the Modified B.G. Prasad socio-economical classification, majority of them belong to lower middle class 120 (28.9%) and middle class 96 (23.1%).
|Table 1: Distribution of participants according to Socio-demographic and economic profile|
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With respect to sleep pattern, 226 (55.5%) of the participants were had normal/good sleep and 189 (45.5%) of them had disturbed sleep. As per the relationship with the family members, 143 (34.5%) males and 122 (29.4%) females responded that they had good relationship, while 88 (21.2%) and 62 (14.9%) reported to be having unfair and poor relationship, respectively. Out of those who had unfair and poor relationship, higher number of females reported that they had unfair 52 (26%) and poor 37 (18.5%) relationship. Majority of the elderly 206 (49.6%) and 104 (25.1%) dependent financially either totally and partially on their children respectively. Only 101 (24.3%) people were financially independent. Majority of elderly females 166 (40%) was financially totally dependent on their children compared to elderly males 46 (10.8%). The addiction pattern of the elderly, more than three quarters of the elderly 399 were current addicts for different types of tobacco, out of them chewing was 216 (54.1%), smoking was 138 (34.6%) and ganja or bhang were 38 (9.5%) and only 76 persons were past addicts. Higher proportion of males 278 (69.7%) was current addicts compared to females 121 (30.3%).
The leisure time activities [Table 2] among the study population, the major leisure time activities was gossiping 70 (16.9%), religious activities 66 (15.9%) and play with their grand children walking 65 (15.7%) followed by walking 54 (13.0%), take care of domestic animals 40 (9.6%) and the remaining do nothing 71 (17.1%), listening to radio 33 (8.0%) and very few do reading news papers and books 16 (3.9%). The severity of the disability was assessed by using Barthel Index scoring, majority 363 (87.4%) of the participants were able to do their activities independently, 32 (7.8%) were moderately disabled and 20 (4.8%) were severely disabled. Regarding disability with respect to specific activities, of the 415 elderly persons 48 (11.6%) needed help for climbing the stairs, 47 (11.3%) were occasional accident bladder control and 36 (8.6%) needed help for transfer from bed to chair and back 36 (8.6%) elderly persons needed help for going to the toilet, 31 (7.4%) for dressing and 19 (4.5%) for bathing. 14 (3.4%) walked with help from other person.
|Table 2: Distribution of Elderly Persons according to Leisure Time Activities and Barthel index grading of activities|
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The prevalence of mental illness [Table 3] suffering with one or the other type was 217 (52.2%), of which males were 81 (19.5%) and females were 136 (32.7%) respectively. Out of 217, majority 115 (27.7%) had depression according to Geriatric Depression Scale >5, most of them were females 74 (17.8%) compared to males 41 (9.8%). The remaining 30 (7.2%) had anxiety disorder and 62 (14.9%) had dementia as the mental illness. Out of all the three mental illness majority of the females were affected. According to the cognitive impairment 217 (52.3%) of the participants were had normal, 113 (27.2%) of them had mild impairment (20–23), 52 (12.6%) of them had moderate impairment (10–19) and 33 (7.9%) of them were severely impaired (<10) as per Mini–Mental scale.
|Table 3: Distribution of Mental illness and Cognitive impairment among Elderly Population (n=415)|
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To see the association [Table 4], we had grouped different mental illness (depression, anxiety, and dementia). According to the age and gender those who are more than 70 years (P < 0.002) and in females (P < 0.006) the mental illness was more when compare to males and less than 70 years and it was statistically significant. Those with illiterates and primary school had more mental illness than the literates with the P < 0.001and according to the socioeconomic status those who belong to middle and lower class were had more mental illness than the upper class with the P < 0.001 and it was statistically significant. According to the financial dependence, those who are financially totally dependent on family members were had more mental illness than those who are partially and independent leading their life with P < 0.001. Those who had unfair and poor relationship with the family members were had more mental illness than those who were had good relationship and it was statistically significant with P = 0.001.
|Table 4: Distribution of the participants with mental illness and their association with sociodemographic factors|
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| Discussion|| |
Out of the 415 elderly persons, 216 (52.0%) were females and 199 (48.0%) were males in a studies done by Tiwari and Dube also showed similar age group. In the present chewing tobacco was 216 (54.1%), smoking was 138 (34.6%) and ganja or bhang were 38 (9.5%) and only 76 persons were past addicts. Higher proportion of males 278 (69.7%) was current addicts compared to females 121 (30.3%). In a study done by Pandvel et al. conducted among 100 elderly people above 60 years in the rural areas of Pune, India, showed that, 38% were addicted to asher a kind of chewing tobacco. 25% of the males were addicted to alcohol and 34% addicted to smoking bidi. Our study had 47% of dependency in finance because of Low prevalence of economic dependency was the reason for a lesser number of totally neglected subjects (13.75%) than in the studies by Elango (38.0%) and Kishore (55.8%). Thus, economic dependency and living arrangements were the main factors deciding the status of the subject in the family. Prevalence of a disturbed sleep pattern of the study subjects (36.0%) differs from the studies of Singh et al. (3.5%), Jain and Aras (43.9%), and Goswami et al. (58.36%) because of difference in the prevalence of factors responsible for depression. Poor status of the family might be responsible for the disturbed sleep pattern among those living with family members.
The present study had the prevalence of mental illness among the elderly was 23.6%, Dube and Premarajan et al. found psychiatric morbidity 22.3% and 17.3%, respectively, comparable to the present study. A higher prevalence was reported in other studies, and in Mehta et al. and Shaji et al. in their respective community-based studies on elderly. In a study conducted by Tiwari et al. showed, the overall prevalence of psychiatric morbidity in rural older adults was found to be 23.7% mood (affective) disorders was the commonest (7.6%, 95%), followed by mild cognitive impairment (4.6%), mental and behavioral disorders due to substance use (4.0%) and dementia (2.8%). The present study had the depression of 19.1% which was also shown similar results by Singh et al. and Similar to studies by (45.9%), Jain et al. Nair et al. (21.9%) and Rao et al. (43.0%) high prevalence of depression was observed among the subjects (47.0%) because of different settings and study tool used.
The present study showing that the elderly people are moderately dependent on their children was 7.8% and total dependency was 4.8% for their activities. In a study by Puteh et al., a total of 175 elderly subjects enrolled, prevalence of mild dependency was 14.9%; moderate dependency was 9.1%; severe and total dependency was at 1.1% each which was little bit higher in moderate and low in severe total because of the variation in the sample size and the methodology they adopted to verify. The present study showing most of the leisure time activity was gossiping, religious activities, walking, and playing with children. Similar study done by Badami et al..so reported the leisure time activities like Going out for walk, involving in religious activities, watching TV, caring for grand children and Participating in community organization. Since this study was conducted among the elderly population residing in the rural most villages of Chittoor district, the findings of the study cannot be generalized to the other elders, especially those living in the urban areas. There was significant strong association was shown statistically with different sociodemographic variables such as age, gender, education, literacy, socioeconomic status and dependency financially. Similar studies,,, from different Indian settings were shown the same association with the sociodemographic factors.
Strengths and weakness
Since it was a community-based study we can strongly attribute the results to the general rural south Indian population. We had used two different validated tools to assess the psychiatric illness we can compare the results with the other Indian studies at different settings. The study weakness was some of the people with psychiatric illness were excluded because of their uncooperation.
Accredited social health activists, village level health workers, and volunteers must be trained to identify the psychological problems of elderly persons and to provide advice and treat accordingly. It is well known that psychiatric morbidities adversely impact the quality of life of the older person and outcome of comorbid medical illnesses. A community yoga and meditation program for the elderly has to be implemented. Vocational rehabilitation to the elderly to live financial independent life by giving less physical work jobs like storytellers, entertainers, instructor's etc. There is a strong case to upgrade the knowledge and skill of primary care doctors to diagnose and treat depression in patients seeking their help. Better awareness among primary care clinicians can result in better detection of cases and their management.
| Conclusions|| |
The study revealed a strong relation between sociodemographic factors such as female sex, age (>70 years), illiteracy, lower and middle socioeconomic status, in terms of relationship with the family members, financial dependency, and the psychiatric morbidity of the individuals. The 12th Plan proposal for National Mental Health Programme aims at focusing on the functional and service delivery on integration with mental health along with general health, availability of mental health professionals, promotion of community participation in service delivery etc., Measures should be taken to support the elders, establish community elderly societies, advisory offices and services to help the elderly. The sequence of social interventions required for the management of the elderly psychological problems.
We sincerely appreciate and our heartfelt thanks to all those who were participants in the study.
Financial support and sponsorship
Conflicts of interest.
There are no conflicts of interest.
| References|| |
Prakash IJ. Aging, disability, and disabled older people in India. J Aging Soc Policy 2003; 15:85-108.
Tiwari SC. Geriatric psychiatric morbidity in rural Northern India: Implications for the future. Age Ageing 1999;28:161-8.
Joshi PC, Sengupta SN. Health issues of the elderly. Seminar 2000;488:40-3.
Rajan SI, Chatterjee CB. Population Ageing and Health in India. Mumbai, India: Centre for Enquiry into Health and Allied Themes; 2006.
Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12:189-98.
Yesavage JA. Geriatric depression scale. Psychopharmacol Bull 1988;24:709-11.
Tiwari SC, Srivastava G, Tripathi RK, Pandey NM, Agarwal GG, Pandey S, et al.
Prevalence of psychiatric morbidity amongst the community dwelling rural older adults in Northern India. Indian J Med Res 2013;138:504-14.
] [Full text]
Dube KC. A study of prevalence and biosocial variables in mental illness in a rural and an urban community in Uttar Pradesh – India. Acta Psychiatr Scand 1970;46:327-59.
Pandvel HT, Chavan VM, Giri PA. Study of health problems and addiction pattern among elderly population in rural areas of Pune, India Pandve et al.
Epidemiology (Sunnyvale) 2017;7:2.
Elango S. A study of health and health related social problems in the geriatric population in a rural area of Tamil Nadu. Indian J Public Health 1998;42:7-8.
] [Full text]
Kishore S, Garg BS. Sociomedical problems of aged population in a rural area of Wardha district. Indian J Public Health 1997;41:43-8.
Singh VB, Nayak KC, Kataria DK, Verma SK, Jain P, Sidhu D, et al
. Psychiatric co-morbidities in patients attending geriatric clinic at a tertiary care hospital. J Indian Acad Geriatr 2005; 2:65-9.
Sreejith S. Nair, Pooja Raghunath, and Sreekanth S. Nair Prevalence of Psychiatric Disorders among the Rural Geriatric Population: A Pilot Study in Karnataka, India, Cent Asian J Glob Health. 2015; 4 (1): 138.
Goswami A, Reddiah VP, Kapoor SK, Singh B, Dey AB, Dwivedi SN, et al
. Prevalence and determinants of cognitive impairment in rural elderly population in India. Help Age India Res Dev J 2006; 12:8-15.
Premarajan KC, Danabalan M, Chandrasekar R, Srinivasa DK. Prevalence of psychiatry morbidity in an urban community of Pondicherry. Indian J Psychiatry 1993; 35:99-102.
] [Full text]
Nandi PS, Banerjee G, Mukherjee SP, Nandi S, Nandi DN. A study of psychiatric morbidity of the elderly population of a rural community in West Bengal. Indian J Psychiatry 1997;39:122-9.
] [Full text]
Mehta P, Joseph A, Verghese A. An epidemiologic study of psychiatric disorders in a rural area in Tamilnadu. Indian J Psychiatry 1985; 27:153-8.
] [Full text]
Shaji S, Verghese A, Promodu K, George B, Shibu VP. Prevalence of priority psychiatric disorders in a rural area in Kerala. Indian J Psychiatry 1995;37:91-6.
] [Full text]
Jain RK, Aras RY. Depression in geriatric population in urban slums of Mumbai. Indian J Public Health 2007; 51:112-3.
] [Full text]
Rao AV. National Task Force Study on Problems of the aged seeking psychiatric help. ICMR 1987. Mental health status of the elderly. ICMR Bull 1996;26:28-34.
Sharifa EBW. Puteh, Intan MA. Bakar, Boekhtiar Borhanuddin, Khalib Latiff, Rahmah M. Amin and Rosnah Sutan, A prevalence study of the activities of daily living (ADL) dependency among the elderly in four districts in Selangor, Malaysia. Epidemiol Prev Med 2015; 1:110.
Badami S, Yenagi GV. Leisure time activities: A boost for elderly health. Adv Res J Soc Sci 2015;6:191-7.
Reddy NB, Pallavi M, Reddy NN, Reddy CS, Singh RK, Pirabu RA, et al.
Psychological morbidity status among the rural geriatric population of Tamil Nadu, India: A Cross-sectional study. Indian J Psychol Med 2012;34:227-31.
] [Full text]
Sengupta P, Benjamin AI. Prevalence of depression and associated risk factors among the elderly in urban and rural field practice areas of a tertiary care institution in Ludhiana. Indian J Public Health 2015;59:3-8.
] [Full text]
Nakulan A, Sumesh TP, Kumar S, Rejani PP, Shaji KS. Prevalence and risk factors for depression among community resident older people in Kerala. Indian J Psychiatry 2015; 57:262-6.
] [Full text]
Buvneshkumar M, John KR, Logaraj M. A study on prevalence of depression and associated risk factors among elderly in a rural block of Tamil Nadu. Indian J Public Health 2018;62:89-94.
] [Full text]
Press Information Bureau, National Mental Health Programme. Government of India, Ministry of Health and Family Welfare; 13 December, 2013.
[Table 1], [Table 2], [Table 3], [Table 4]