Printer Friendly

Evaluation of the relationship between major depressive disorder and bereavement symptoms in elderly patients who present either to psychiatry or family medicine.

INTRODUCTION

Major depressive disorder (MDD) is a very common disorder worldwide; large-scale studies report a prevalence of 13% (1). Because the occurrence of MDD in the elderly differs to some extent compared to that seen in adulthood, studies investigating the prevalence of MDD in the elderly population report different results, and it is seen at a prevalence of approximately 5% within any given period of time (2). The number of studies investigating MDD in the elderly population in Turkey is limited; an extensive study reported that the prevalence of MDD is approximately 18% and that most patients did not receive psychiatric treatment (3). Biological, psychological, and social problems seen in the elderly lead to increased development of MDD (4).

One of the most common of these problems is the loss of a loved one, which is an important risk factor for the development of MDD (5). In widowed patients who lost their spouses at an advanced age, psychiatric symptoms and deterioration in the general health status in the forthcoming period were observed more frequently than in patients who did not experience this loss (6). Bereavement and adaptive and non-adaptive symptoms due to bereavement are considered to be an important risk factor for MDD (5); however increased severity or decreased functionality has not been observed when bereavement is seen concurrently with MDD (7). Because this condition has a significant effect on mortality and morbidity early diagnosis and treatment has an important role (8).

It was reported that the experience of loss is higher than 50% in individuals older than 65 years of age, particularly in women, and that the prevalence of the experience of loss increases significantly with advanced age (9). Our information on the co-existence of symptoms of bereavement and MDD in the elderly is limited. Most of our information on the co-existence of bereavement and depressive disorder is from studies including non-elderly patients. When studies conducted in this field were reviewed, in a community sample, the prevalence of complicated grief (CG) was 9% among individuals who lost a loved one (10). However, comorbidity of CG was found to be 18% in patients with MDD (7). Studies with patients presenting to outpatient psychiatric clinics reported a prevalence of CG as high as 33%-34% (11,12). In our study we analyzed the prevalence of depressive disorder and symptoms of bereavement among individuals who presented to two separate units (psychiatric and family medicine outpatient units).

Because social withdrawal, grief, and increased depressed mood are symptoms shared by both bereavement and MDD, it is difficult for most clinicians to make a diagnosis of MDD in individuals experiencing bereavement, to differentiate the symptoms, and to make a connection between them (13). This confusion regarding the diagnosis of MDD and bereavement was included in the DSM-IV diagnosis classification under exclusion criteria. In criterion E, loss of a loved one within the last 2 months is considered to be an exclusion criterion for MDD (14). As a result of the studies and assessments in this field, the DSM-V removed bereavement from the exclusion criteria for the diagnosis of MDD This suggests that the boundaries between bereavement and depressive disorder are not clear Some authors reported that MDD should be distinguished regardless of time (15), and bereavement should be classified as a separate diagnosis (16).

Complicated grief is defined as the presence of lasting severe and resistant acute symptoms related to experience of loss, although a period of 6-12 months have passed after the experience of loss, and the presence of extreme and discomforting thoughts, feelings, and behaviors as a result of the loss (17). In the literature, the Inventory of Complicated Grief (ICG), which determines CG based on non-adaptive symptoms and uses a cutoff score to make a diagnosis of CG, is used (18). We used the Core Bereavement Items (CBI), which measures bereavement at a non-adaptive level and is used to determine the level of bereavement (19). The purpose of using this scale was to measure adaptive and non-adaptive bereavement symptoms, rather than making a diagnosis of CG dicotomically (CB is present or not). On the other hand, because there are uncertainties regarding the diagnosis of CG, we believed that measuring more common symptoms of bereavement would be more appropriate to avoid this uncertainty

When studies and interpretations in this field were reviewed, it was found that there are no clear boundaries between symptoms of bereavement and MDD, that symptoms of bereavement are not noticed unless probed, and that co-existence of depression and bereavement has an important place in the follow-up and treatment of MDD Our purpose in this study was to determine the prevalence and severity of MDD and the severity of bereavement symptoms in patients older than 65 years of age who lost a loved one and presented to either psychiatric or family medicine units and to evaluate the relationship between MDD and bereavement.

METHODS

Subjects

Patients older than 65 years of age who presented to either the family medicine or psychiatric out-patient units of Haskoy District Polyclinic, which is a part of the Ministry of Health Dickapi Yildirim Beyazit Training and Research Hospital, between January 2012 and April 2012 were recruited consecutively.

At baseline, the Mini Mental Test was conducted for individuals recruited for the study to determine their mental state. Those with MMT scores lower than 23 were not included in the study. A total of 43 patients who presented to the family medicine unit and 67 patients who presented to the psychiatric unit participated in the study.

Among the individuals who participated in the study those who lost a loved one at least 6 months ago or longer were included in the study. The reason why the time period of at least 6 months was specified for the study is that this is the required time for the level of bereavement to become adaptive (17,18). Overall, 22 (32.9%) of the patients who presented to the psychiatric unit lost their child, 26 (38.7%) lost their spouse, 14 (20.9%) lost their sibling, and 5 (7.5%) lost a loved one other than these.

In total, 11 (25.5%) of the patients who presented to the family medicine unit lost their child, 14 (32.6%) lost their spouse, and 18 (41.9%) lost their sibling. Five (7.5%) of the patients who presented to the psychiatric unit described experiences of loss lasting between 6 and 12 months, 16 (23.9%) between 1 and 5 years, and 46 (68.6%) longer than 5 years. Six (14.0%) of the patients who presented to the family medicine unit described experiences of loss lasting between 6 and 12 months, 6 (14.0%) between 1 and 5 years, and 31 (72.0%) longer than 5 years.

Psychiatric examination was performed, and the Structural Clinical Interview For DSM-IV Axis I Disorders (SCID-I) was administered to all of the individuals who participated in the study After psychiatric examination, a data form including socio-demographic characteristics was administered. Individuals who participated in the study were requested to fill out the Depression Scale for the Elderly (DSE) and the Core Bereavement Items (CBI) scale. The tests were read to illiterate subjects by a physician associate at the family medicine unit. Psychiatric examinations of the individuals who participated in the study were performed by a psychiatrist. Other data collection tools were applied by 1 family physician, 1 psychiatrist, and 2 family physician associates. For each patient who participated in the study approximately 45-60 min were spared. Participation in the study was on a volunteer basis, and the Helsinki declaration was complied with. All patients provided informed consent for the study

Data Collection Tools

Sociodemographic Data Form: This form contained questions relating to gender education, marital status, previous employment, whether there is someone providing care at home, presence of a chronic disease, and monthly income. Additionally, questions were asked relating to topics such as the presence of a short-term stress factor (presence of a negative life event within the last 3 months), presence of a long-term stress factor (presence of a negative life event for longer than 3 months and continuing), first-degree family history of psychiatric disorder history of presentation to a psychiatric ward, duration of the experience of loss, degree of relativity to the lost loved one(s), and whether the experience of loss was of a sudden or expected nature.

Geriatric Depression Scale (GDS): This screening questionnaire, which was developed by Yesavage et al. (20), consists of 30 questions evaluating the past week. The questions in the scale are yes or no questions, and the score ranges between 0 and 30. The Turkish validity and reliability study of this scale was conducted by Sagduyu (21) (test-retest consistency, r=0.87; internal consistency Cronbach a=0.72). In this form of the scale, which has been adapted for Turkey the cutoff is 13/14, and from this cutoff, the sensitivity is reportedly 0.90 and the specificity is 0.97.

Core Bereavement Items (CBI): CBI is a scale that is filled out by the participant and is commonly used in the time period after the loss of a loved one. The scale, developed by Burnet et al. (19) in 1997, assesses the severity of bereavement in individuals who have lost a loved one. The scale consists of three categories that analyze images and thoughts about the lost loved one and the status of acute separation and grief. The scale includes 17 questions using a 4-point Likert scale. The total score of the scale varies from 0 to 51. The original of the scale was administered to 158 adults with experience of loss, and the Cronbach a coefficient was found to be 0.91. A Turkish validity and reliability study was conducted by Selvi et al. (22), and the internal consistency Cronbach a value was found to be 0.94.

Standardized Mini-Mental State Test for the Educated and the Uneducated (SMMT/SMMT-E): The scale, developed by Folstein et al. (23), is used in the assessment of cognitive disorders. Orientation, registration, attention-calculation, recall (memory), and language tests are evaluated. The cutoff score of the test was accepted as 23. The SMMT and SMMT-E used in the study were edited by Gungen et al. (24).

Structural Clinical Interview for DSM-IV Axis I Disorders (SCID-I): This is a structured clinical interview form developed by Spitzer et al. (25) to diagnose DSM-IV Axis-I disorders. A Turkish validity and reliability study was conducted by Ozkurkcugil et al. (26)

Statistical Analysis

Data obtained from the study were analyzed using the Statistical Package for the Social Sciences (SPSS Inc; Chicago, IL, USA) 16.0 program, which is used to perform statistical analyses in the social sciences. The sociodemographic characteristics of the elderly patients who presented to either the psychiatric or family medicine ward were analyzed as independent variables, and the Standardized Mini Mental Test for the Educated and the Non-Educated (SMMT/SMMT-E) scores were analyzed as dependent variables. In the study percentage, standard deviation, mean, and t analyses were conducted depending on the nature of the variables, and the minimum level of significance was accepted as 0.05.

RESULTS

The individuals who participated in the study were assessed in two groups: those who presented to the family medicine unit and those who presented to the psychiatric unit. The mean age of the 43 people who presented to the family medicine unit was 70.6 [+ or -] 5.2 years. Twenty-two (51.2%) of the participants were female and 21 (48.8%) were male. Thirty-three (76.7%) were married and 10 (23.3%) were widowed. Thirty-two (74.4%) were literate and 11 (25.6%) were illiterate. The mean age of the 67 people who presented to the psychiatric unit was 71.9 [+ or -] 5.2 years. Fifty-four (80.6%) of them were female and 13 were male (19.4%). Thirty-five (52.2%) were married and 32 (47.7%) were widowed. Thirty-three (49.2%) were literate and 34 were illiterate (50.8%). Table 1 shows the other answers to the questions on the sociodemographic data form. When the two groups were compared by sociodemographic data, being female, low level of education, being widowed, exposure to longterm stress, and previous history of psychiatric presentation were significantly higher in patients who presented to the psychiatric unit than those who presented to the family medicine unit (p=0.00l, p=0.009, p=0.0l0, p=0.032, and p<0.00l, respectively).

As seen in Table 2, both groups were internally assessed according to sociodemographic data in terms of CBI scale and GDS. In the group of elderly patients who presented to the psychiatric unit, mean CBI scale scores were statistically significantly higher in the presence of short-term and long-term stress (p=0.047 and p=0.007, respectively). Mean GDS scores were statistically significantly higher in women (p=0.006), the illiterate (p=0.050), non-pensioners (p=0.004), in the presence of short-term stress (p=0.029), in the presence of long-term stress (p=0.003), and in those with a sudden experience of loss (p=0.042). In the group of elderly patients who presented to the family medicine unit, mean CBI scale scores and mean GDS scores were statistically significantly higher in the presence of long-term stress (p=0.00l and p=0.022).

The scores of the CBI scale, GDS, and mini mental test used in the study for both groups are compared in Table 3. Mean CBI scale scores were 16.5 [+ or -] 12.3 in those who presented to the psychiatric unit and 10.1 [+ or -] 11.4 in those who presented to the family medicine unit, and a statistically significant difference was not found (p=0.009). Mean GDS scores were 18.1 [+ or -] 5.3 in those who presented to the psychiatric unit and 10.8 [+ or -] 6.7 in those who presented to the family medicine unit, and a statistically significant difference was not found (p=0.001). Mean mini mental test scores were 25.2 [+ or -] 2.5 in those who presented to the psychiatric unit and 26.7 [+ or -] 3.l in those who presented to the family unit. Mini mental test scores were statistically significantly higher in those who presented to the psychiatric unit (p=0.0ll).

A correlation analysis of GDS and CBI scale scores was made for patients who presented to either unit. The Pearson correlation value for patients who presented to the psychiatric unit was found to be 0.380 (p=0.003). The Pearson correlation value for patients who presented to the family medicine unit was found to be 0.365 (p=0.016).

Geriatric Depression Scale scores of patients who presented to either ward were accepted as a dependent variable, and regression analysis was performed to evaluate their relationship to CBI scale scores. In patients who presented to the psychiatric unit, CBI scale and geriatric depression scale scores were found to be significantly definitive (F=6.59, df=1, p=0.013, adjusted [R.sup.2]=0.078). In patients who presented to the family medicine unit, CBI scale and GDS scores were found to be significantly definitive (F=5.78, df=1, p=0.021, adjusted R2=0.102).

DISCUSSION

Although the co-existence of bereavement and MDD is seen very frequently, uncertainties remain about the boundaries of the two psychopathologies (15,16). Particularly our information on the co-existence of these two psychopathologies in the elderly is limited. In this study, we aimed to evaluate the relationship between the diagnosis of MDD and the severity of depressive and bereavement symptoms in people older than 65 years of age who lost a loved one within the last 6 months and who presented to either a family medicine or psychiatric outpatient unit.

When the sociodemographic data of the patients who presented to either unit were assessed, being female, being illiterate, loss of spouse, and exposure to long-term stress were significantly higher in those who presented to the psychiatric unit than those who presented to the family medicine unit. Similarly a large-scale study reported a high rate of females and a low level of education in patients who presented to the psychiatric unit (27). In a study of widowed patients, it was reported that psychiatric presentation and psychotropic medication use were significantly higher in widowed patients than in non-widowed subjects (28) and, similarly that natural life events (losses and health problems) and challenges were an important risk factor in the occurrence and recurrence of MDD in the elderly (29).

The most important restrictive factors for the studies investigating MDD in the elderly appear to be the high prevalence of cognitive disorders in these patients and the small number of instruments to measure depressive disorder (30). With regard to cognitive disorder we did not include patients with a mini mental test score of 23 or higher in our study The GDS and CBI scales were used as supportive tools to measure the symptoms of MDD and bereavement. In our study we found that MMT scores of patients who presented to the psychiatric unit were significantly lower than those who presented to the family medicine unit. Although the co-existence of depressive disorder and cognitive disorder in the elderly is clearly demonstrated in studies conducted in this field, how these two 112 conditions affect each other has not been clarified (31,32).

The GDS scores of patients who presented to the psychiatric unit were significantly higher than those of patients who presented to the family medicine unit. It was found that being female, being illiterate, being a non-pensioner the presence of short-term stress, the presence of longterm stress, and the sudden nature of the experience of loss in those who presented to the psychiatric unit increased the GDS scores and diagnosis of MDD significantly In those who presented to the family medicine unit, only the presence of long-term stress and GDS scores and MDD diagnosis were significantly higher When studies in this field in the literature were reviewed, it was seen that among risk factors of MDD observed in the elderly being a female (30), low level of education (33,34), and negative life events and life challenges (29,35,36) are effective, and the sudden and unexpected nature of the experience of loss is closely related to the severity of depressive symptoms and general health status (37). In the group that participated in the study being a pensioner appears to be associated with good socioeconomic status and being educated. Our study is consistent with the results of the studies conducted in this field.

When we evaluated the relationship between CBI scale scores and socio-demographic data in both groups that participated in our study the CBI scale scores were significantly higher only in patients who described an acute and chronic stress factor Patients who describe symptoms of bereavement may have higher susceptibility to stress or may have difficulty coping with stress. Comorbidity of disorders related to anxiety is observed frequently particularly in individuals with complicated grief (38,39). However separation anxiety and avoidant personality traits, which are closely associated with stress, were found to be higher in these individuals (40). The type of loss experience and reaction to loss may appear as a post-traumatic stress disorder; this reaction to stress is called traumatic grief (41,42). However, it was reported that patients with a co-existence of MDD and complicated grief are exposed to long-term life events more frequently and social support is lower in these individuals (43).

In our study 33 (49.2%) of the patients who presented to the psychiatric unit and 7 (16.3%) of those who presented to the family medicine unit were diagnosed with MDD. CBI scale scores were statistically significantly higher in patients with a diagnosis of MDD than in those without a diagnosis of MDD in both groups of patients. In the elderly the prevalence of MDD is reportedly 25% 2-7 months after the experience of loss, whereas the prevalence of MDD is reportedly 15% 13 months after the experience of loss (44). However the fact that the prevalence of complicated grief after the experience of loss in the general population is reportedly 2.4%-24.6% shows that it is closely associated with cultural difference (45,46). On the other hand, there is a significant relationship between the degree of relativity to the lost loved one and the occurrence of bereavement (47). Because of these complicating factors in the assessment of bereavement, we evaluated the severity of the bereavement rather than making a diagnosis of complicated grief. In epidemiologic studies, the prevalence of complicated grief ranges between 9% and 20% (43,48,49). In the literature, one study investigating complicated grief where psychiatric patients were monitored on an outpatient basis reported that more than half of the patients lost one or more of their relatives, and one-third of them had moderate or severe complicated grief (7,12,50). The findings in our study support the fact that a high rate of co-existence of MDD and bereavement may apply to the elderly as well.

The GDS and CBI scale scores of patients who presented to the psychiatric unit were significantly higher than those of patients who presented to the family medicine unit. This finding shows that depressive and bereavement symptoms are severe in patients who present to a psychiatric unit. This result may be associated with the fact that patients present to a psychiatric unit present primarily for depressive complaints, In studies with patients with complicated grief, it was found that these individuals had many psychopathologies, such as deterioration in autobiographical memory (51), decrease in problem solving skills (52), increased neuroticism, and insecure attachment (53). Similarly, individuals with MDD have been shown to have impaired cognitive functions, increased neuroticism, insecure attachment, and impaired social problem solving (54,55,56,57). These characteristics may give rise to the thought that diagnoses of MDD and complicated grief have similar psychopathologies. The DSM-V has recently been finalized with endophenotypical characteristics. The fact that these two psychiatric conditions have common endophenotypical characteristics may support the omission of bereavement from the exclusion criteria of MDD diagnosis. However, in regression analysis of patients presenting to either family medicine or psychiatric units, CBI scores significantly predict GDS scores. This result suggests that bereavement and depressive symptoms are closely associated.

Because our study investigates symptoms of MDD and bereavement in the elderly and was conducted at two different outpatient units, we believe that it represents a contribution to the literature. The limitations of our study include the fact that the sample size is small, that there is no homogeneity in terms of the lost loved one (only spouse or only child), that the sample group is located in one region only (district polyclinic), that the experience of loss is limited to at least 6 months or longer, and that there is no observational study.

In conclusion, our study found that symptoms of bereavement were significantly higher in patients with a diagnosis of MDD who presented to either psychiatric or family medicine wards than in those without a diagnosis of MDD, Additionally, the level of bereavement in patients who presented to either unit was significantly higher in the presence of stress. Probing experiences of loss and assessing reactions to the experience of loss have an important place in the diagnosis and follow-up of MDDs in the elderly. Moreover, identifying symptoms of bereavement may be useful in the management of stress. We believe that developing programs specific to the elderly and increasing social support factors may be preventive in improving community mental health.

DOI: 10.5152/npa.2015.10095

Conflict of Interest: No conflict of interest was declared by the authors.

Financial Disclosure: The authors declared that this study has received no financial support.

REFERENCES

(1.) Hasin DS, Goodwin RD, Stinson FS, Grant BF, Epidemiology of Major Depressive Disorder Results from the National Epidemiologic Survey on Alcoholism and Related Conditions. Arch Gen Psychiatry 2005; 62:1097-1106. [CrossRef]

(2.) Steffens DC, Skoog I, Norton MC, Hart AD, Tschanz JT, Plassman BL, Wyse BW, Welsh-Bohmer KA, Breitner JC. Prevalence of depression and its treatment in an elderly population: the Cache County study. Arch Gen Psychiatry 2000; 57:601-607. [CrossRef]

(3.) Kulaksizoglu IB, Gurvit H, Polat A. Unrecognized depression in community-dwelling elderly persons in Istanbul. Int Psychogeriatr 2005; 17:303-312. [CrossRef]

(4.) Fiske A, Wetherell JL, Gatz M. Depression in older adults. Annu Rev Clin Psychol 2009; 5:363-389. [CrossRef]

(5.) Li J, Laursen TM, Precht DH, Olsen J, Mortensen PB. Hospitalization for mental illness among parents after the death of a child. N Engl J Med 2005; 352:1190-1196. [CrossRef]

(6.) Chen JH, Bierhals AJ, Prigerson HG, Kasl SV, Mazure CM, Jacobs S. Gender differences in the effects of bereavement-related psychological distress in health outcomes. Psychol Med 1999; 29:367-380. [CrossRef]

(7.) Kersting A, Kroker K, Horstmann J, Ohrmann P, Baune BT, Arolt V Suslow T Complicated grief in patients with unipolar depression. J Affect Disord 2009; 118:201-204. [CrossRef]

(8.) Shear MK, Simon N, Wall M, Zisook S, Neimeyer R, Duan N, Reynolds C, Lebowitz B, Sung S, Ghesquiere A, Gorscak B, Clayton P Ito M, Nakajima S, Konishi T Melhem N, Meert K, Schiff M, O'Connor MF First M, Sareen J, Bolton J, Skritskaya N, Mancini AD, Keshaviah A. Complicated grief and related bereavement issues for DSM-5. Depress Anxiety 2011; 28:103-117. [CrossRef]

(9.) Zisook S, Shuchter SR, Sledge P. Diagnostic and treatment considerations in depression associated with late-life bereavement. In Diagnosis and Treatment of Depression in Late Life, ed. LS Schneider, CF Reynolds, BD Lebowitz, et al. Washington, DC: Am. Psychiatr Press 1994; 419-436.

(10.) Middleton W, Burnett P, Raphael B, Martinek N. The bereavement response: A cluster analysis. Br J Psychiatry 1996; 169:167-171. [CrossRef]

(11.) Piper WE, Ogrodniczuk JS, Weideman R. Screening for complicated grief: when less may provide more. Can J Psychiatry 2005; 50:680-683.

(12.) Prigerson H, Ahmed I, Silverman GK, Saxena AK, Maciejewski PK, Jacobs SC, Kasl SV, Aqeel N, Hamirani M. Rates and risks of complicated grief among psychiatric clinic patients in karachi, pakistan. Death Stud 2002; 26:781-792. [CrossRef]

(13.) Zisook S, Reynolds CF Pies R, Simon N, Lebowitz B, Madowitz J, Tal-Young I, Shear MK. Bereavement, complicated grief, and DSM, part 1: depression. J Clin Psychiatry 2010; 71:955-956. [CrossRef]

(14.) American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington (DC) 7 American Psychiatric Association,1994.

(15.) Karam EG, Tabet CC, Alam D, Shamseddeen W, Chatila Y, Mneimneh Z, Salamoun MM, Hamalian M. Bereavement related and non-bereavement related depressions: a comparative field study. J Affect Disord 2009; 112:102-110. [CrossRef]

(16.) Simon NM, Shear KM, Thompson EH, Zalta AK, Perlman C, Reynolds CF, Frank E, Melhem NM, Silowash R.The prevalence and correlates of psychiatric comorbidity in individuals with complicated grief. Compr Psychiatry 2007; 48:395-399. [CrossRef]

(17.) Miller MD Complicated grief in late life. Dialogues Clin Neurosci 2012; 14:195-202.

(18.) Prigerson HG, Maciejewski PK, Reynolds CF, 3rd, Bierhals AJ, Newsom JT, Fasiczka A, Frank E, Doman J, Miller M. Inventory of Complicated Grief: a scale to measure maladaptive symptoms of loss. Psychiatry Res 1995; 59:65-79. [CrossRef]

(19.) Burnet P, Middleton W, Raphael B. Measuring core bereavement phenomena. Psychol Med 1997; 27:49-57. [CrossRef]

(20.) Yesavage JA, Brink TL, Rose TL. Development and validation of geriatric depression screening scale: a preliminary report. J Psychiatr Res 1983; 17:37-49. [CrossRef]

(21.) Sagduyu A."Yaslilar icin Depresyon Olcegi":Hamilton Depresyon Olcegi ile karsilastirmali guvenirlilik ve gecerlilik calismasi. Turk Psikiyatri Dergisi 1997; 8:3-8.

(22.) Selvi Y, Ozturk RI, Agargun MY, Besiroglu L, Cilli AS. Temel yas unsurlari olcegi Turkce formunun gecerlik ve guvenirlik calismasi. Arch Neuropsychiatr 2011; 48:129-134. [CrossRef]

(23.) 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; 12:189-198. [CrossRef]

(24.) Gungen C, Ertan T Eker E, Yasar R, Engin F Standardize mini mental test'in Turk toplumunda hafif demans tanisinda gecerlik ve guvenilirligi. Turk Psikiyatri Dergisi 2002; 13:273-281.

(25.) Spitzer RL, Micheal B, Miriam G, Janet BW. Stuctured clinical interview for DSM-IV Axis 1 Disorders (SCID-I), Clinical version, Washington DC., American Psychiatric Pres. 1997.

(26.) Ozturkcukigil A, Aydemir O, Yildiz M, Danaca AE, Koroglu E. DSM-IV Eksen I bozukluklari icin yapilandirilmis klinik gorusmenin Turkce'ye uyarlanmasi ve guvenirlik calismasi. ilac Tedavi Dergisi 1999; 12:233-236.

(27.) Oyekcin DG. Bir devlet hastanesi psikiyatri poliklinigine bir yil icinde bacvuran olgularin sosyo-demografik ozellikleri ve psikiyatrik tani dagilimi. Anadolu Psikiyatri Dergisi 2008; 9:39-43.

(28.) Moller J, Bjorkenstam E, Ljung R, Yngwe MA. Widowhood and the risk of psychiatric care, psychotropic medication and all-cause mortality: a cohort study of 658,022 elderly people in Sweden. Aging Ment Health 2011; 5:259-266. [CrossRef]

(29.) Brilman EI, Ormel J. Life events, difficulties and onset of depressive episodes in later life. Psychol Med 2001; 31:859-869.

(30.) Forsell Y, Winblad B. Incidence of major depression in a very elderly population. Int J Geriatr Psychiatry 1999; 14:368-372. [CrossRef]

(31.) Spira AP, Rebok GW, Stone KL, Kramer JH, Yaffe K. Depressive symptoms in oldest-old women: risk of mild cognitive impairment and dementia. Am J Geriatr Psychiatry 2012; 20:1006-1015. [CrossRef]

(32.) Heun R, Hein S. Risk factors of major depression in the elderly. Eur Psychiatry 2005; 20:199-204. [CrossRef]

(33.) Shin JH, Do YK, Maselko J, Brouwer RJ, Song SW, Ostbye T Predictors of and health services utilization related to depressive symptoms among elderly Koreans. Soc Sci Med 2012; 75:179-185. [CrossRef]

(34.) Henderson AS, Jorm AF Mackinnon A, Christensen H, Scott LR, Korten AE, et al. The prevalence of depressive disorders and the distribution of depressive symptoms in later life: a survey using Draft ICD-10 and DSM-III-R. Psychol Med 1993; 23:719-729. [CrossRef]

(35.) Prigerson HG, Reynolds 3rd CF, Frank E, Kupfer DJ, George CJ, Houck PR. Stressful life events, social rhythms, and depressive symptoms among the elderly: an examination of hypothesized causal linkages. Psychiatry Res 1994; 51:33-49. [CrossRef]

(36.) Prince MJ, Harwood RH, Blizard RA, Thomas A, Mann AH. Social support deficits, loneliness and life events as risk factors for depression in old age. The Gospel Oak Project VI. Psychol Med 1997; 27:323-332. [CrossRef]

(37.) Miyabayashi S, Yasuda J. Effects of loss from suicide, accidents, acute illness and chronic illness on bereaved spouses and parents in Japan: their general health, depressive mood, and grief reaction. Psychiatry Clin Neurosci 2007; 61:502-508. [CrossRef]

(38.) Marques L, Bui E, LeBlanc N, Porter E, Robinaugh D, Dryman MT, Nadal-Vicens M, Worthington J, Simon N. Complicated grief symptoms in anxiety disorders: prevalence and associated impairment. Depress Anxiety 2013; 30:1211-1216. [CrossRef]

(39.) Bui E, Leblanc NJ, Morris LK, Marques L, Shear MK, Simon NM. Panic-agoraphobic spectrum symptoms in complicated grief. Psychiatry Res 2013; 30:118-120. [CrossRef]

(40.) Simon NM, Wall MM, Keshaviah A, Dryman MT LeBlanc NJ, Shear MK. Informing the symptom profile of complicated grief. Depress Anxiety 2011; 28:118-126. [CrossRef]

(41.) Dell'Osso L, Carmassi C, Musetti L, Socci C, Shear MK, Conversano C, Maremmani I, Perugi G.Lifetime mood symptoms and adult separation anxiety in patients with complicated grief and/or post-traumatic stress disorder: a preliminary report. Psychiatry Res 2012; 15:436-440. [CrossRef]

(42.) Simon NM. Is complicated grief a post-loss stress disorder? Depress Anxiety 2012; 29:541-554.

(43.) Sung SC, Dryman MT, Marks E, Shear MK, Ghesquiere A, Fava M, Simon NM. Complicated grief among individuals with major depression: prevalence, comorbidity, and associated features. J Affect Disord 2011; 134:453-458. [CrossRef]

(44.) Zisook S, Shuchter SR. Depression through the first year after the death of a spouse. Am J Psychiatry 1991; 148:1346-1352. [CrossRef]

(45.) Fujisawa D, Miyashita M, Nakajima S, Ito M, Kato M, Kim Y. Prevalence and determinants of complicated grief in general population. J Affect Disord 2010; 127:352-358. [CrossRef]

(46.) Chiu YW, Huang CT, Yin SM, Huang YC, Chien CH, Chuang HY. Determinants of complicated grief in caregivers who cared for terminal cancer patients. Support Care Cancer 2010; 18:1321-1327. [CrossRef]

(47.) Malkinson R, Bar-Tur L. The aging of grief in Israel: a perspective of bereaved parents. Death Stud 1999; 23:413-431. [CrossRef]

(48.) Prigerson H, Jacobs S. Traumatic grief as a distinct disorder: a rationale, consensus criteria, and a preliminary empirical test. In: Stroebe MS, Hansson RO, Stroebe W, Schut H. (Eds.), Handbook of bereavement research: consequences, coping and care. American Psychological Association, Washington, 2001.

(49.) Raphael B, Minkov C, Dobson M. Psychotherapeutic and pharmacological intervention for bereaved peersons. In: MS S, Hansson RO, Stroebe W, Schit H. (Eds.), Handbook of bereavement research: Consequences, coping and care. American Psychological Association, Washington DC, 2001.

(50.) Piper WE, Ogrodniczuk JS, Azim HF Weideman R. Prevalence of loss and complicated grief among psychiatric outpatients. Psychiatr Serv 2001; 52:1069-1074. [CrossRef]

(51.) Maccallum F, Bryant RA. Impaired autobiographical memory in complicated grief. Behav Res Ther 2010; 48:328-334. [CrossRef]

(52.) Maccallum F, Bryant RA. Social problem solving in complicated grief. Br J Clin Psychol 2010; 49:577-590. [CrossRef]

(53.) Boelen PA, Klugkist I. Cognitive behavioral variables mediate the associations of neuroticism and attachment insecurity with Prolonged Grief Disorder severity. Anxiety Stress Coping 2011; 24:291-307. [CrossRef]

(54.) Baune BT, Fuhr M, Air T, Hering C.Neuropsychological functioning in adolescents and young adults with major depressive disorder- A review. Psychiatry Res 2014; 30:261-271. [CrossRef]

(55.) Klein DN, Kotov R, Bufferd SJ. Personality and depression: explanatory models and review of the evidence. Annu Rev Clin Psychol 2011; 7:269-295. [CrossRef]

(56.) Ponizovsky AM, Drannikov A. Contribution of attachment insecurity to health-related quality of life in depressed patients. World J Psychiatry 2013; 22:41-49.

(57.) Watkins E, Baracaia S. Rumination and social problem-solving in depression. Behav Res Ther 2002; 40:1179-1189. [CrossRef]

Ibrahim TAYMUR [1], Kadir OZDEL [2], Cenk AYPAK [3], Veil DUYAN [4], Ozlem TUREDI [3], Buket Belkiz GUNGOR [1], Yavuz SELVI [5]

[1] Clinic of Psychiatry, sevket Yilmaz Training and Research Hospital, Bursa, Turkey

[2] Clinic of Psychiatry, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey

[3] Clinic of Family Practice, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey

[4] Ankara University Scholl of Health Sciences, Social Service Specialist, Ankara, Turkey

[5] Department of Psychiatry, Selcuk University School of Medicine, Konya, Turkey

Correspondence Address: Ibrahim Taymur, Sevket Yilmaz Egitim Arastirma Hastanesi, Psikiyatri Klinigi, Bursa, Turkiye

E-mail: dritay@yahoo.com

Received: 09.12.2014 Accepted: 21.03.2015
Table 1. Comparison of the demographic data of patients admitted
to the psychiatry and family medicine outpatient departments

                  Psychiatry        Family medicine      p

Age (years)    71.9 [+ or -] 5.2   70.6 [+ or -] 5.2   0.083

Sex

Female            54 (80.6%)          22 (5l.2%)       0.001
Male              13 (19.4%)          21 (48.8%)

Literate

Yes               33 (49.2%)          32 (74.4%)       0.009
No                34 (50.8%)          11 (25.6%)

Marital status

Married           35 (52.2%)          33 (76.7%)       0.010
Widowed           32 (47.8%)          10 (23.3%)

Retirement

Yes               33 (49.2%)          27 (62.8%)       0.167
No                34 (50.8%)          16 (37.2%)

Have a home care person

Yes               11 (16.4%)           6 (13.9%)       0.730
No                56 (83.6%)          37 (86.1%)

Chronic disease

Yes               57 (85.1%)          37 (86.1%)      0.899
No                10 (14.9%)           6 (13.9%)

Short-term stress

Yes               22 (32.8%)          10 (23.3%)       0.285
No                45 (67.2%)          33 (76.7%)

Long-term stress

Yes               45 (67.2%)          20 (46.5%)       0.032
No                22 (32.8%)          23 (53.5%)

Psychiatric disorders in family

Yes               18 (26.9%)           9 (20.9%)       0.485
No                49 (73.1%)          34 (79.1%)

Previous psychiatric history

Yes               51 (76.1%)          10 (23.3%)       <0.001
No                16 (23.9%)          33 (76.7%)

Sudden experience of loss

Yes               23 (34.3%)           9 (20.9%)       0.297
No                44 (65.7%)          34 (79.1%)

Table 2. Internal assessment of both groups by sociodemographic
data in terms of CBI scale and GDS

                                  Psychiatry

                   CBI                           GDS

             Mean [+ or -] SD       p     Mean [+ or -] SD      p

Sex

Female      17.5 [+ or -] 12.5    0.188   19.0 [+ or -] 5.2   0.006
Male        11.5 [+ or -] 10.6            14.5 [+ or -] 4.5

Literate (education)

Yes         15.5 [+ or -] 12.8    0.516   16.8 [+ or -] 4.8   0.050
No          17.6 [+ or -] 12.0            19.4 [+ or -] 5.6

Marital status

Married     13.8 [+ or -] 12.8    0.118   18.7 [+ or -] 4.8   0.373
Widowed     18.9 [+ or -] 11.6            17.5 [+ or -] 5.9

Retirement

Yes         13.3 [+ or -] 11.3    0.055   16.2 [+ or -] 5.5   0.004
No          19.6 [+ or -] 12.8            20.0 [+ or -] 4.5

Have a home care person

Yes         18.1 [+ or -] 13.1    0.709   19.1 [+ or -] 4.6   0.530
No          16.3 [+ or -] 12.4            17.9 [+ or -] 5.5

Chronic disease

Yes         17.6 [+ or -] 12.8    0.148   18.4 [+ or -] 5.2   0.268
No          11.4 [+ or -] 9.1             16.4 [+ or -] 6.0

Short term stress

Yes         21.6 [+ or -] 13.9    0.047   20.1 [+ or -] 5.2   0.029
No          14.5 [+ or -] 11.2            17.1 [+ or -] 5.2

Long term stress

Yes         19.6 [+ or -] 12.6    0.007   19.4 [+ or -] 5.3   0.003
No          10.3 [+ or -] 9.5             15.4 [+ or -] 4.4

Psychiatric disorders in family

Yes         21.1 [+ or -] 15.4    0.121   20.2 [+ or -] 5.2   0.055
No          15.1 [+ or -] 11.1            17.4 [+ or -] 5.3

Previous psychiatric history

Yes         16.1 [+ or -] 12.3    0.553   18.3 [+ or -] 5.6   0.697
No          18.5 [+ or -] 13.2            17.7 [+ or -] 4.7

Sudden experience of loss

Yes         19.0 [+ or -] 11.8    0.472   20.1 [+ or -] 5.0   0.042
No          16.5 [+ or -] 12.3            17.0 [+ or -] 5.7

MDD

Yes        18.40 [+ or -] 14.78   0.012   19.3 [+ or -] 4.2   0.003
No          8.81 [+ or -] 6.52            13.0 [+ or -] 6.7

                                 Family medicine

                   CBI                           GDS

             Mean [+ or -] SD       p      Mean [+ or -] SD      p

Sex

Female      11.7 [+ or -] 13.9    0.367   12.2 [+ or -] 7.0    0.132
Male         8.5 [+ or -] 9.6              9.3 [+ or -] 5.6

Literate (education)

Yes         10.2 [+ or -] 11.4    0.933   10.6 [+ or -] 6.9    0.708
No          9.9 [+ or -] 12.0             1 1.4 [+ or -] 4.8

Marital status

Married     9.6 [+ or -] 10.6     0.570    9.7 [+ or -] 5.7    0.051
Widowed     12.0 [+ or -] 14.6            14.3 [+ or -] 7.8

Retirement

Yes         9.8 [+ or -] 11.6     0.821   10.8 [+ or -] 7.1    0.999
No          10.6 [+ or -] 11.5            10.8 [+ or -] 5.5

Have a home care person

Yes         11.6 [+ or -] 8.6     0.734   14.5 [+ or -] 8.4    0.134
No          9.9 [+ or -] 11.9             10.2 [+ or -] 6.0

Chronic disease

Yes         10.1 [+ or -] 10.9    0.909   11.0 [+ or -] 6.5    0.552
No          10.7 [+ or -] 15.9             9.3 [+ or -] 6.0

Short term stress

Yes         13.7 [+ or -] 12.7    0.271   11.7 [+ or -] 5.9    0.627
No          9.1 [+ or -] 11.0             10.5 [+ or -] 6.7

Long term stress

Yes         16.2 [+ or -] 13.7    0.001   13.2 [+ or -] 7.3    0.022
No           4.9 [+ or -] 5.3              8.7 [+ or -] 4.9

Psychiatric disorders in family

Yes         12.0 [+ or -] 13.0    0.595   12.8 [+ or -] 7.7    0.312
No          9.6 [+ or -] 1 1.7            10.3 [+ or -] 6.1

Previous psychiatric history

Yes         9.3 [+ or -] 10.2     0.790   12.6 [+ or -] 5.0    0.325
No          10.4 [+ or -] 12.0            10.2 [+ or -] 6.8

Sudden experience of loss

Yes         18.2 [+ or -] 13.3    0.191   12.5 [+ or -] 7.0    0.660
No          12.3 [+ or -] 10.3            1 1.2 [+ or -] 7.4

MDD

Yes        18.39 [+ or -] 15.28   0.001   16.2 [+ or -] 6.8    0.002
No          7.43 [+ or -] 8.55             8.9 [+ or -] 5.2

CBI: core bereavement items; GDS: geriatric depression scale;
SD: standard deviation; MDD: major depressive disorder

Table 3. Comparison of CBI scale, GDS, and mini mental
test scores used in the study for both groups

                             Psychiatry

Core Bereavement Items   16.5 [+ or -] 12.3
(Mean [+ or -] SD)

Geriatric                18.1 [+ or -] 5.3
Depression Scale
(Mean [+ or -] SD)

Mini Mental Test         25.2 [+ or -] 2.5
(Mean [+ or -] SD)

Major Depressive             33 (%49.2)
Disorder (n, %)

                          Family medicine       p

Core Bereavement Items   10.1 [+ or -] 11.4   0.009
(Mean [+ or -] SD)

Geriatric                10.8 [+ or -] 6.7    <0.001
Depression Scale
(Mean [+ or -] SD)

Mini Mental Test         26.7 [+ or -] 3.1    0.011
(Mean [+ or -] SD)

Major Depressive             7 (%16.3)        <0.001
Disorder (n, %)

SD: standard deviation
COPYRIGHT 2016 Galenos Yayinevi Tic. Ltd.
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2016 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Title Annotation:Research Article
Author:Taymur, Ibrahim; Ozdel, Kadir; Aypak, Cenk; Duyan, Veil; Turedi, Ozlem; Gungor, Buket Belkiz; Selvi,
Publication:Archives of Neuropsychiatry
Article Type:Report
Date:Jun 1, 2016
Words:6831
Previous Article:Effect of sleep quality on psychiatric symptoms and life quality in newspaper couriers.
Next Article:Determination of genotypic and phenotypic characteristics of Friedreich's ataxia and autosomal dominant spinocerebellar ataxia types 1,2, 3, and 6.
Topics:

Terms of use | Privacy policy | Copyright © 2020 Farlex, Inc. | Feedback | For webmasters