Estudo de rastreamento e diagn?stico da depress?o nos idosos cadastrados na estrat?gia sa?de da fam?lia de Porto Alegre, RS, Brasil

• Ano de defesa: 2014
• Autor(a) principal: Nogueira, Eduardo Lopes
• Orientador(a): Cataldo Neto, Alfredo
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Pontif?cia Universidade Cat?lica do Rio Grande do Sul
• Programa de Pós-Graduação: Programa de P?s-Gradua??o em Gerontologia Biom?dica
• Departamento: Instituto de Geriatria e Gerontologia
• País: Brasil
• Palavras-chave em Português: GERONTOLOGIA; GERONTOLOGIA BIOM?DICA; IDOSOS; ENVELHECIMENTO; DEPRESS?O - IDOSOS; DIAGN?STICO; EPIDEMIOLOGIA; SA?DE P?BLICA - PORTO ALEGRE (RS)
• Área do conhecimento CNPq: CIENCIAS DA SAUDE::MEDICINA
• Link de acesso: http://tede2.pucrs.br/tede2/handle/tede/6412

Population aging is particularly evident in developing countries. This fact modifies the health/disease profile in the population, with chronic diseases becoming more prevalent than the acute and infectious. Geriatric depression stands out among those diseases of a chronic nature, being highly prevalent in the world. The impact of the consequences of increased depression is still difficult to measure, although projections by the World Health Organization (WHO) place it, by 2030, as being the main disorder contributing to the global burden of disease. The WHO alert also indicates that the impact will be more intense in low- and middle-income countries, which is related to the underdiagnosis and undertreatment of this disorder at a primary care level. Furthermore, other factors increases the complexity of depression in the elderly, especially the comorbidity with anxiety disorders, contributing to the severity of the disease, which suggests a greater relevance for investigating both disorders. This cross-sectional study with prospective data collection aimed to examine factors related to depression in a random sample of the elderly, registered with the Family Health Strategy (FHS) program in the city of Porto Alegre. Data collection was conducted in two phases: 1) screening phase: measurement of sociodemographic and multidimensional health data and measurement of clinical significant depressive symptoms, using the 15-item Geriatric Depression Scale (GDS-15) accomplished in a home visit by Community Health Agents (CHA); and 2) specialist interview for the diagnostic assessment of psychiatric disorders, using the validated Brazilian version of the Mini International Neuropsychiatric Interview, 5.0.0 plus (M.I.N.I. 5.0.0 plus BR) - adopting the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR) as the gold standard. This study aimed to: examine the prevalence of clinical significant depressive symptoms and their associated characteristics, detected through data collection conducted by CHA; 2) identify associations between the diagnoses of depressive and anxiety disorders with the use of psychotropic medications. Two scientific articles were produced based on this research, with each investigating an objective outlined above. In the first, the sample consisted of 621 individuals aged 60+ years, who had completed the data screening phase performed by the CHA. The results showed that a high prevalence of depression (30.6%) was estimated via the screening assessment conducted by professionals without a high level of specialization. Depression was shown to be significantly more common in women than men (35.9% versus 20.9%; P<0.001). Independent associations were measured through robust analysis with Poisson regression to estimate the prevalence ratios (PR) of depression with the variables: female gender (PR: 1.4, CI: 1.1-1.8); low educational level, especially illiteracy (PR: 1.8, CI: 1.2-2.6); regular self-perceived health (PR: 2.2, CI: 1.6-3) and poor/very poor self-perceived health (PR: 4, CI: 2.9-5.5). These findings are consistent with the existing scientific literature. However, it should be emphasized that this replication of findings was carried out exclusively by CHA in the close to real-life situation of the Family Health Strategy program. In the second work, the sample consisted of 501 elderly people enrolled in the FHS, who had completed both screening and specialist evaluations. The paper examined associations between diagnosis of depressive and anxiety disorders with the use of psychotropic drugs. Clinical variables were analyzed in a dichotomous manner by grouping the diagnoses of unipolar depression and anxiety with consistent psychopharmacotherapeutic indications: 1) unipolar depression: current major depressive episode, recurrent major depressive disorder or dysthymia; 2) anxiety: generalized anxiety disorder, obsessive compulsive disorder, posttraumatic stress disorder, panic disorder, social phobia or agoraphobia. The psychotropic drugs were grouped into antidepressants, benzodiazepines, mood stabilizers, antipsychotics, anticonvulsants, and other psychotropic drugs. The results showed high frequencies of unipolar depression (11.4%), anxiety (9.0%), and depression and anxiety comorbidity (8.6%), observed in the total sample. Female gender was more associated with both the unipolar depression group (26.4% versus 9.5%, P <0.001) and the anxiety group (21.9% versus 10.5%, P<0.001). Antidepressants are considered the pharmacological treatment of choice for the disease groups analyzed and were the most frequently used (13.2%), followed by benzodiazepines (6.8%), and antipsychotics (2.2%). In depression, the elderly received antidepressants (40.4%) more frequently than benzodiazepines (19.3%), antipsychotics (7.0%), mood stabilizers (1.8%), and other psychotropic drugs (24.6%). However, the chance of receiving benzodiazepines rather than antidepressants was considerably higher (PR: 6.6 vs 4.2); a tendency towards antipsychotic drug use was also observed (PR: 6.8). As such, the findings of this study indicate that elderly individuals with unipolar depressive disorders have a greater risk of receiving psychosedative drugs like benzodiazepines and antipsychotics, than antidepressants. The frequency of antidepressant use in anxiety disorders is considered low (11.1%), with the risk of benzodiazepine use in this diagnostic group being approximately 3.5 times greater than the use of antidepressants (PR 4.3 versus 1.2). The findings in the elderly group with a comorbidity diagnosis of at least one depressive and one anxiety disorder are of even greater concern. Although these are particularly severe cases with a tendency of chronification, the chances of their using an antidepressant is reduced by almost half, in comparison to the group diagnosed with depression alone (PR: 4.2 versus 2.2). An aging population and the growth of depressive disorders in the world increasingly indicate the importance of expanding our knowledge regarding this disease in older age groups. While results such as those shown by the outlined studies are worrying, they shed light on the significant problems of public health. Findings generated by a strategic model that include the local family health teams provide hope for the implementation of action plans in elderly mental health, by indicating that lay professionals can play a fundamental role in the early detection and prevention of depression at a community and primary care level. In summary, the research has allowed important health issues to be examined and produced data showing a high prevalence of geriatric depression, as well as indicators that appropriate pharmacological therapy for this disease is not being achieved. Therefore, the implementation of an active strategic model of action is necessary for a preventive approach to elderly mental health care. This would allow the use of low-cost tools (screening scales) that make it possible to detect cases of depression at an early stage and more severe cases, as well as helping in the identification of those elderly individuals at risk or receiving inadequate treatment.