Soziale Kontakte und Depression bei geriatrischen Patienten: Gibt es einen Einfluss von Geschlecht?

Zusammenfassung

Depression gehört zu den häufigsten affektiven Erkrankungen. Die Ermittlung von beeinflussbaren Faktoren, die mit Depression assoziiert sind, stellt eine wichtige Voraussetzung für Präventionsmaßnahmen dar. Bei 580 geriatrischen Patienten des Klinikums Neuperlach wurden in einer Querschnittstudie Daten zu sozialen Faktoren erhoben. In der vorliegenden Arbeit ist mit Hilfe ordinaler logistischer Regression ihre Assoziation mit Depression (klinische Diagnose mittels ICD-10) und depressiven Symptomen (GDS) untersucht worden. Die Ergebnisse zeigen, dass das Auftreten von depressiven Symptomen und von Depression mit geringeren sozialen Kontakten und weniger Unterstützung assoziiert war, auch nach Adjustierung für andere Risikofaktoren (zum Beispiel körperliche Beeinträchtigung und Demenz). Dieser Zusammenhang war bei Frauen (zum Beispiel depressive Symptome: mäßig versus viel Kontakte: OR=2,7; 95% KI: 1,8-4,1) deutlicher ausgeprägt als bei Männern (OR=1,3; 95% KI: 0,7-2,4). Ob Frauen jedoch stärker von Programmen zur Förderung von sozialer Unterstützung profitieren könnten als Männer, ist ein wichtiger Aspekt, der zukünftig noch in prospektiven Studien zu klären ist.

Abstract

Depression is one of the most common affective illnesses. The investigation of changeable factors that are associated with depression is an important condition for the establishment of preventive measures. In a cross-sectional study, data on social factors were recorded from 580 geriatric patients of the municipal hospital in Munich. Ordinal logistic regression was used to analyse their association with depression (clinical diagnoses by ICD-10) and depressive symptoms (GDS). The results indicate that the occurrence of depressive symptoms and of depression was associated with less social contacts and less support, even after adjustment for other risk factors (for example, physical and cognitive impairment). This association was more distinct for women (for example, depressive symptoms: moderate versus much contact: OR=2.7; 95% CI: 1.8-4.1) than for men (OR=1.3; 95% CI: 0.7-2.4). Further research is needed to investigate whether women could benefit more than men from programmes promoting social support.

Depression - GDS - soziale Kontakte - Gender - Geriatrie

Depression - GDS - social contact - gender - geriatrics

Literatur

• 1 Angst F, Stassen HH, Clayton PJ, Angst J. Mortality of patients with mood disorders: follow-up over 34-38 years.  J Affect Disord. 2002;  68 167-181
• 2 Himelhoch S, Weller WE, Wu AW, Anderson GF, Cooper LA. Chronic medical illness, depression, and use of acute medical services among Medicare beneficiaries.  Med Care. 2004;  42 512-521
• 3 Katz IR, Streim J, Parmelee P. Prevention of depression, recurrence and complications in late life.  Prev Med. 1994;  23 743-750
• 4 Kelly B, Burnett P, Pelusi D, Badger S, Varghese F, Robertson M. Factors associated with the wish to hasten death: a study of patients with terminal illness.  Psychol Med. 2003;  33 75-81
• 5 Mueller TI, Kohn R, Leventhal N. et al . The course of depression in elderly patients.  Am J Geriatr Psychiatry. 2004;  12 22-29
• 6 Sartorius N. Physical symptoms of depression as a public health concern.  J Clin Psychiatry. 2003;  64 ((Suppl. 7)) 3-4
• 7 Gostynski M, Ajdacic-Gross V, Gutzwiller F, Michel JP, Herrmann F. Depression bei Betagten in der Schweiz.  Nervenarzt. 2002;  73 851-860
• 8 Linden M, Kurtz G, Baltes MM, Geiselmann B, Lang FR, Reischies FM, Helmchen H. Depression bei Hochbetagten. Ergebnisse der Berliner Altersstudie.  Nervenarzt. 1998;  69 27-37
• 9 Fava M. The role of the serotonergic and noradrenergic neurotransmitter systems in the treatment of psychological and physical symptoms of depression.  J Clin Psychiatry. 2003;  64 ((Suppl. 13)) 26-29
• 10 Akechi T, Okuyama T, Sugawara Y, Nakano T, Shima Y, Uchitomi . Major depression, adjustment disorders, and post-traumatic stress disorder in terminally ill cancer patients: associated and predictive factors.  J Clin Oncol. 2004;  22 1957-1965
• 11 Frasure-Smith N, Lespérance F, Gravel G. et al . Social support, depression, and mortality during the first year after myocardial infarction.  Circulation. 2000;  101 1919-1924
• 12 Henderson AS, Korten AE, Jacomb PA. et al . The course of depression in the elderly: a longitudinal community-based study in Australia.  Psychol Med. 1997;  27 119-129
• 13 O'Sullivan C. The psychosocial determinants of depression: a lifespan perspective.  J Nerv Ment Dis. 2004;  192 585-594
• 14 Schroevers MJ, Ranchor AV, Sanderman R. The role of social support and self-esteem in the presence and course of depressive symptoms: a comparison of cancer patients and individuals from the general population.  Social Science & Medicine. 2003;  57 375-385
• 15 Travis LA, Lyness JM, Shields CG, King DA, Cox C. Social support, depression, and functional disability in older adult primary-care patients.  Am J Geriatr Psychiatry. 2004;  12 265-271
• 16 De Leeuw JR, De Graeff A, Ros WJG, Hordijk GJ, Blijham GH, Winnubst JAM. Negative and positive influences of social support on depression in patients with head and neck cancer: A prospective study.  Psycho-Oncology. 2000;  9 20-28
• 17 Schreurs KM, Ridder DT de. Integration of coping and social support perspectives: implications for the study of adaptation to chronic diseases.  Clinical Psychology Review. 1997;  17 98-112
• 18 Penninx B, Tilburg T van, Boeke AJ, Deeg DL, Kriegsman DM, Eijk JT van. Effects of social support and personal coping resources on depressive symptoms: Different for various chronic diseases?.  Health Psychology. 1998;  17 551-558
• 19 Bildt C, Michelsen H. Gender differences in the effects from working conditions on mental health: a 4-year follow-up.  Int Arch Occup Environ Health. 2002;  75 252-258
• 20 Edwards AC, Nazroo JY, Brown GW. Gender differences in marital support following a shared life event.  Soc Sci Med. 1998;  46 1077-1085
• 21 Elliott M. Gender differences in causes of depression.  Women Health. 2001;  33 163-177
• 22 Olstad R, Sexton H, Sogaard AJ. The Finnmark Study: a prospective population study of the social support buffer hypothesis, specific stressors and mental distress.  Soc Psychiatry Psychiatr Epidemiol. 2001;  36 582-589
• 23 Schraedley PK, Gotlib IH, Hayward C. Gender differences in correlates of depressive symptoms in adolescents.  J Adolesc Health. 1999;  25 98-108
• 24 Kendler KS, Myers J, Prescott CA. Sex differences in the relationship between social support and risk for major depression: a longitudinal study of opposite-sex twin pairs.  Am J Psychiatry. 2005;  162 250-256
• 25 Landman-Peeters KM, Hartman CA, Pompe G der van, Boer JA den, Minderaa RB, Ormel J. Gender differences in the relation between social support, problems in parent-offspring communication, and depression and anxiety.  Soc Sci Med. 2005;  60 2549-2559
• 26 Dalgard OS, Dowrick C, Lehtinen V, Vazquez-Barquero JL, Casey P, Wilkinson G, Ayuso-Mateos JL, Page H, Dunn G. Negative life events, social support and gender difference in depression: A multinational community survey with data from the ODIN study.  Soc Psychiatry Psychiatr Epidemiol. 2006;  41 444-451
• 27 Penning MJ, Strain LA. Gender differences in disability, assistance, and subjective well-being in later life.  Journal Gerontology: Social Science. 1994;  49 202-208
• 28 Nagurney AJ, Reich JW, Newsom JT. Gender moderates the effects of independence and dependence desires during the social support process.  Psychology & Aging. 2004;  19 215-218
• 29 World Health Organization .The ICD-10 classification of mental and behavioural disorders. Clinical descriptions and diagnostic guidelines. Geneva: World Health Organization 1992
• 30 Sheikh JI, Yesavage JA. Geriatric Depression Scale (GDS): Recent evidence and development of a shorter version. In: Brink TL, ed. Clinical Gerontology: A guide to assessment and intervention. New York: The Haworth Press 1986: 165-173
• 31 Almeida OP, Almeida SA. Short versions of the geriatric depression scale: a study of their validity for the diagnosis of a major depressive episode according to ID-10 and DSM-IV.  Int J Geriat Psychiatry. 1999;  14 858-865
• 32 D'Arth P, Katona P, Mullan E, Evans S, Katona C. Screening detection and management of depression in elderly primary care attenders. I. The acceptability and performance of the 15 item Geriatric Depression Scale (GDS15) and the development of short versions.  Fam Pract. 1994;  11 260-266
• 33 Gauggel S, Birkner B. Validität und Reliabilität einer deutschen Version der Geriatrischen Depressionsskala (GDS).  Zeitschrift für Klinische Psychologie. 1999;  28 18-27
• 34 Mahoney FI, Barthel DW. Functional evaluation: the Barthel index.  Md State Med J. 1965;  14 61-65
• 35 Folstein MF, Folstein SE, MacHugh PR. ‚Mini-Mental State‘: a practical method for grading cognitive state of patients for the clinician.  J Psychiatr Res. 1975;  12 189-196
• 36 Druley JA, Townsend AL. Self-esteem as a mediator between spousal support and depressive symptoms: A comparison of healthy individuals and individuals coping with arthritis.  Health Psychology. 1998;  17 255-261
• 37 Zietemann V, Zietemann P, Weitkunat R, Kwetkat A. Depressionshäufigkeit in Abhängigkeit von verschiedenen Erkrankungen.  Nervenarzt. 2006;  , DOI 10.1007/s00115-006-2106-y
• 38 Nikolaus T, Specht-Leible N, Bach M, Oster P, Schlierf G. Soziale Aspekte bei Diagnostik und Therapie hochbetagter Patienten. Erste Erfahrungen mit einem neu entwickelten Fragebogen im Rahmen des geriatrischen Assessment.  Z Gerontol. 1994;  27 240-245
• 39 Greenland S. Alternative models for ordinal logistic regression.  Stat Med. 1994;  13 1665-1677
• 40 Greenland S. Introduction to Regression Models. In: Rothman KJ, Greenland S (Hrsg). Modern epidemiology. Second Edition Lippincott Williams & Wilkins 1998: 359-399
• 41 http://www.ats.ucla.edu/stat/sas/seminars/sas_logistic/logistic1.htm
• 42 Glaesmer H, Künstler J, Reuter W. Verbesserung von grundlegenden Alltagsfunktionen, Mobilität und kognitiver Leistungsfähigkeit durch Behandlung in einer geriatrischen Tagesklinik.  Z Gerontol Geriat. 2003;  36 475-483
• 43 Littlefield CH, Rodin GM, Murray MA, Craven JL. Influence of functional impairment and social support on depressive symtoms in persons with diabetes.  Health Psychol. 1990;  9 737-349
• 44 Coyne JC. Toward an interactional description of depression.  Psychiatry. 1976;  39 28-40
• 45 Henderson S, Byrne DG, Duncan-Jones P, Scott R, Adcock S. Social relationships, adversity and neurosis: a study of associations in a general population sample.  Br J Psychiatry. 1980;  136 574-583
• 46 Brown GW, Andrews B, Harris T, Adler Z, Bridge L. Social support, self-esteem and depression.  Psychol Med. 1986;  16 813-831
• 47 Bolger N, Foster M, Vinokur AD, Ng R. Close relationships and adjustment to a life crisis: The case of breast cancer.  J Personality Social Psychol. 1996;  70 283-294
• 48 Moyer A, Salovey P. Predictors of social support and psychological distress in women with breast cancer.  J Health Psychology. 1999;  4 177-191
• 49 Brummett BH, Babyak MA, Barefoot JC. et al . Social support and hostility as predictors of depressive symptoms in cardiac patients one month after hospitalization: a prospective study.  Psychosom Med. 1998;  60 707-713
• 50 Leentjens AF, Akker M den van, Metsemakers JF, Lousberg R, Verhey FR. Higher incidence of depression preceding the onset of Parkinson's disease: a register study.  Mov Disord.. 2003;  18 414-418
• 51 Lesch KP. Gene-environment interaction and the genetics of depression.  Rev Psychiatr Neurosci. 2004;  29 174-184
• 52 Pohjasvaara T, Leppavuori A, Siira I, Vataja R, Kaste M, Erkinjuntti T. Frequency and clinical determinants of poststroke depression.  Stroke. 1998;  29 2311-2317

Korrespondenzadresse