RESUMEN
BACKGROUND: Risk factors for late-life depression have been studied in high-income countries, but there have been no longitudinal studies from middle-income countries. This study reports risk factors for late-life depression and correlates of antidepressant using the Costa Rican Longevity and Healthy Aging Study (CRELES), a nationally representative cohort of adults age 60 and over. METHODS: CRELES contains baseline interviews in 2005 (n=2827) with follow-up interviews in 2007 and 2009. CRELES used the Geriatric Depression Scale Short Form to identify depression using cut-offs for mild and severe depression and contained a 14-question assessment to determine physical disability. Participants self-reported antidepressant use and chronic health conditions. We examined correlates of newly screened depression and new antidepressant use among participants not depressed or not using antidepressants in the previous study wave. We used generalized estimating equations to estimate the association among variables. RESULTS: Increases in disability were associated with newly screening for mild and severe depression. New medical conditions and recent widowhood were associated with newly screening for severe depression. Recent widowhood was also associated with new use of antidepressant medication. LIMITATIONS: Limitations of this study include absence of persons living in institutions, inconsistency of screening tools with clinical diagnoses, and possible effects of stigma and recall bias on screening. CONCLUSIONS: Risk factors for late-life depression in Costa Rica are similar to risk factors in high-income countries. Patterns of antidepressant use suggest providers may recognize the role of bereavement as a risk factor for late-life depression but not of disability or chronic conditions.
Asunto(s)
Depresión/epidemiología , Anciano , Anciano de 80 o más Años , Antidepresivos/uso terapéutico , Costa Rica/epidemiología , Depresión/tratamiento farmacológico , Evaluación de la Discapacidad , Femenino , Estado de Salud , Humanos , Enfermedades de Inicio Tardío/tratamiento farmacológico , Enfermedades de Inicio Tardío/epidemiología , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Factores de RiesgoRESUMEN
OBJECTIVE: The relationship of education, psychiatric diagnoses, and use of psychotropic medication has been explored in the United States, but little is known about this relationship in poorer countries, despite the high burden of mental illness in these countries. This study estimated educational gradients in diagnosis and psychotropic drug use in the United States and Costa Rica, a middle-income country with universal health insurance. METHODS: Analyses were conducted by using data of older adults (≥60) from the 2005 U.S. Medical Expenditure Panel Survey (N=4,788) and the 2005 Costa Rican Longevity and Healthy Aging Study (N=2,827). Logistic regressions examined the effect of education level (low, medium, or high) and urban residence on the rates of self-reported mental health diagnoses, screening diagnosis, and psychotropic medication use with and without an associated psychiatric diagnosis. RESULTS: Rates of self-reported diagnoses were lower in the United States (12%) than in Costa Rica (20%), possibly reflecting differences in survey wording. In both countries, the odds of having depression were significantly lower among persons with high education. In Costa Rica, use of psychotropic medication among persons with self-reported diagnoses increased by education level. CONCLUSIONS: The educational gradients in medication use were different in the United States and Costa Rica, and stigma and access to care in these countries may play an important role in these differences, although type of insurance did not affect educational gradients in the United States. These analyses increase the evidence of the role of education in use of the health care system.
Asunto(s)
Evaluación Geriátrica/estadística & datos numéricos , Trastornos Mentales/tratamiento farmacológico , Psicotrópicos/uso terapéutico , Anciano , Costa Rica , Escolaridad , Femenino , Humanos , Masculino , Factores Socioeconómicos , Estados UnidosRESUMEN
Os autores apresentam uma discussåo sobre pontos críticos relativos ao Transtorno da Personalidade Anti-Social tanto em seus aspectos clínicos como de sua epidemiologia, enfatizando os problemas envolvidos no desenvolvimento de critérios estáveis de diagnóstico. Do ponto de vista da prevalência e incidência deste transtorno, såo apresentados os estudos mais atuais, com discussåo da metodologia utilizada, enfatizando-se os aspectos mais controversos. Alguns pontos referentes aos aspectos etiológicos såo também apresentados, principalmente a falta de uma teoria comum, bem como nossas críticas e questionamentos referentes ao desenvolvimento da pesquisa neste campo no futuro
Asunto(s)
Trastorno de Personalidad Antisocial/diagnóstico , Trastorno de Personalidad Antisocial/epidemiología , Trastorno de Personalidad Antisocial/etiología , Incidencia , PrevalenciaRESUMEN
Os autores apresentam uma discussao sobre pontos criticos relativos ao Transtorno de Personalidade Anti-Social tanto em seus aspectos clinicos como de sua epidemiologia, enfatizando os problemas envolvidos no desenvolvimento de criterios estaveis de diagnostico. Do ponto de vista da prevalencia e incidencia deste transtorno, sao apresentados os estudos mais atuais, com discussao da metodologia utilizada, enfatizando-se os aspectos mais controversos. Alguns pontos referentes aos aspectos etiologicos sao tambem apresentados, principalmente a falta de uma teoria comum, bem como nossas criticas e questionamentos referentes ao desenvolvimento da pesquisa neste campo no futuro.