Participants
The current sample consisted of those who were aged 60 years and above, residing in two sectors of Chandigarh city which were randomly selected (sectors 61 and 37). Samples were randomly selected using a computer-generated random table. The inclusion criteria comprised those who were over 60 years and residing in Chandigarh for the past 1 year, who were willing to give consent, and whose Everyday Abilities Scale for India (EASI) score did not exceed “zero.” This was done to exclude any individuals with a cognitive impairment like dementia and EASI can be used on caregivers/family members as an alternative to the instruments like Hindi Mental State Examination (HMSE) [13]. Those found to be bedridden due to some severe physical illness, having difficulty in speaking and/or hearing, or receiving treatment for any psychiatric disorder in the past year were excluded from the study.
The sample size was calculated by taking prevalence of depression as 62.16% [11], precision as 5%, and 95% confidence interval. With a finite population size of 122 geriatric individuals residing in the study area, a sample of 92 individuals above the age of 60 years was calculated.
A total of 112 participants, in the range of 60 to 86 years, were telephonically contacted. Three of them did not give consent while three calls were not received (over three attempts made at the interval of 24 h). One record was excluded because the participant reported taking psychiatric consultation for depression over the past 1 year. Thirteen records were further excluded as their EASI score exceeded “zero.” Ninety-two participants were finally incorporated in the study. The data was collected over 45 days, spread over May and June 2020.
Procedure
The study was initiated after finalizing the list of individuals to be approached for the study, based on a computer-generated random table. Those aged 60 and above were then telephonically contacted and consent was sought. Participants were briefly explained the context and purpose of the present study and were informed that they would be free to decline or withdraw from the study at any point in time in the research. They were also assured regarding the confidentiality of their responses. Once verbal consent was obtained, they were asked if they had been seeking any sort of psychiatric consultation over the past year. Those who denied were further asked about the basic sociodemographic details and requested if speaking with their caregiver would be permitted. With their permission, their caregivers were approached and EASI was administered to know about the functional activity of the elderly resident as well as to screen for the presence of dementia-like illness. Those who scored “zero” on EASI were further included to administer the clinical datasheet and General Health Questionnaire-12 (GHQ-12) [14]. Those scoring > 2 on GHQ-12 were further administered the Geriatric Anxiety Inventory Hindi version (GAI) and Geriatric Depression Scale short version (GDS), and their responses were recorded. The average time taken for each call ranged between 15 and 20 min. Additionally, those scoring 1 or above on EASI or > 2 on GHQ were also guided to get in touch with the Department of Psychiatry for further evaluation.
The study was approved by the Institutional Ethics Committee and participants who had been found with psychiatric morbidity/illness were asked to undergo further evaluation.
Measurements
Sociodemographic details including age, gender, caregiver whereabouts, marital status, education, occupation, family income per month, religion, residence, family type, languages known, and presence of any chronic illness—its nature, duration, and ongoing medications—were recorded.
The 12-item Everyday Abilities Scale for India (EASI- Hindi version as Hindi was local vernacular language) was administered to assess the participants’ current day-to-day functional abilities and dementia-like illness [15]. Each question is answered as a Yes/No leading to a score of “one” where the subject is found to be facing difficulties in carrying out that particular function while a score of “zero” indicates adequate functioning. Higher EASI scores denote higher dysfunction.
The 12-item General Health Questionnaire (GHQ-12) was administered to screen for the presence of any of the common mental disorders besides assessing the overall psychological and psychiatric well-being of the participants. Each item is scored as either “zero” or one with the former indicating absence or usual amounts of the mental problem. A score of GHQ > 2 indicates the presence of psychological morbidity [14].
The Geriatric Anxiety Inventory Hindi version (GAI-Hindi) [16] consisting of 20 items and Geriatric Depression Scale short version (GDS) [17] comprising 15 items was administered to assess the presence and severity of anxiety and depressive symptoms respectively among the elderly participants. The items of either scale are answered as a “Yes” or “No” with the former suggesting the presence of the symptom. A score of more than 8 on GAI-Hindi and 5 or more on GDS indicates the presence of anxiety and depression and needs evaluation [16, 17].
Statistical analysis
The collected data were analyzed using the SYSTAT software for Windows (version 13.2). Quantitative data were presented in terms of mean and standard deviation while qualitative data were presented as frequency and proportions. Association between qualitative variables was analyzed using the chi-square test. The strength of association of sociodemographic factors with anxiety and depression was measured in terms of the odds ratio. The point of statistical significance was considered when the p value was found out to be less than 0.05 (p < 0.05).