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Middle East Current Psychiatry
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Prevalence of psychiatric disorders in the aging population in the northeastern of Iran

Middle East Current Psychiatry volume 30, Article number: 25 (2023) Cite this article

Abstract

Background

The prevalence of psychiatric disorders by demographic characteristics in elderly people is poorly understood, at least in the northwest of Iran. We aimed to estimate the prevalence of various psychiatric disorders in the elderly population in East Azerbaijan Province, Tabriz. A total of 1000 aging people were randomly selected from the general population. Data were collected using valid structured instruments and face-to-face interviews by trained psychologists. The Structured Clinical Interview for DSM-IV-TR (SCID-IV) and Abbreviated Mental Test Questionnaire were used. Chi-square (χ2) test was used for categorized variables, and an independent T-test was carried out for quantitative variables.

Results

Overall, 38.5% of the elderly had at least one mental disorder (47.2% women, 27.3% men). The prevalence of major depressive disorder (MDD) and any anxiety disorders was 16.6% (22.4% female and 9.3% male) and 16.7% (23.1% female and 8.6% male), respectively. Likewise, the overall prevalence of any depressive symptoms, post-traumatic stress disorder (PTSD), general anxiety disorder (GAD), obsessive-compulsive disorder (OCD), and panic disorders were 21.6%, 7%, 5.3%, and 5.9%, respectively. The prevalence of any mental disorder in the first, second, and third quartiles of the socio-economic level was 54.3%, 37%, and 17.8%, respectively. The prevalence of any mental disorders among the marginalized and the non-marginalized population is 55.3 and 31.5%, respectively.

Conclusions

We found 38.5% (47.2% women, 27.3% men) of the elderly people had any mental disorders, and 21.6% of them had any depressive disorders. The prevalence of mental disorders in elders was almost like adults and middle-aged people in this study. However, the prevalence of mental disorders was higher than in marginalized population and low socio-economic status.

Background

In recent years, old age is one of the main challenges for mental health systems around the world [1, 2]. Annually, the aging population of the world increased by 1.7%, and this is 4.2% for people with an age of at least 65 [3]. It is estimated that the elderly population will reach 1.5 billion by 2025, and two billion by 2050 [4]. In fact, Iran has had its own share of this population change, such that it is predicted that the elderly population will increase from its present share, 7.8%, to 28% in the year 2050 [5].

The World Health Organization (WHO) predicts that the world's elderly population will increase from 800 million to 2 billion by 2050. Of them, 29% are in developed countries and 9% in developing countries. In Iran, according to the latest national census, 9.69% and 11.74% of the population are elderly people in the Country and East Azerbaijan province, respectively [5].

Depression is the second most common mental disorder among aging people [6]. In 2018, a meta-analysis study indicated that the pooled prevalence of depression is 43% among Iranian elderly people [7]. Currently, a meta-analysis in 2022 found that the overall prevalence of depression among Iranian elderly people was 53.7% [8]. Several physical and social factors contribute to the morbidity of depression. Isolation resulting from retirement and disablement, lack of a proper caring approach towards the elderly in society, economic problems, and physical diseases, can all pave the way for a reduction in social status and the emergence of depression [9]. According to a report from the World Health Organization (WHO), 20% of people over 60 years suffer from psychological or neurological problems, except pain, and this group is responsible for 6.6% of the disability among people older than 60. The most prevalent mental or neurological disorders are dementia and depression, which are estimated to constitute respectively 5% and 7% of these groups of disorders. One fourth of the deaths caused by suicide happens in people older than 60 [10]. Indeed, many factors play a role in the incidence and prevalence of mental disorders in the elderly. The role of social and demographic factors is bolder and more effective. Several studies count depression as one of the reasons for disability in older ages, loss of loved ones, the solitary and long life in the house, being cared for in special institutes, and retirement, as the effective factors causing depression in the elderly [11, 12].

In the aging process, different systems of the body lose strength, and the abilities of a person decrease. The elderly are exposed to increased disability, reduced independence, and increased dependence on others [13].

Considering low studies conducted on psychiatric disorders among elderly people, at least in East Azerbaijan Province, conducting a population-based survey is necessary to estimate the actual measures of psychiatric disorders so that a precise and valid rate is provided for planners and researchers in the field. Regarding the mentioned notes above, the increasing aging elderly population in Iran, and the importance of their mental health in enhancing their quality of life and health status, the current survey was aimed to investigate the prevalence of psychiatric disorders in aging people based on demographic characteristics.

Methods

Study design and setting

A population-based cross-sectional study was conducted to estimate the prevalence of psychiatric disorders in the aging population in Tabriz, 2019. Target population was people 60 years or above in Tabriz. The sample size was determined based on the prevalence of elderly depression and mental disorders in Iran in previous meta-analysis studies [8, 14, 15] for p=0.53, α= 0.05, and d = 0.1p, and considering the effect of the design effect (DE) and dropouts, 1000 samples were selected.

A random cluster sampling was carried out to select the participants in the study where each community health center is considered as a cluster based on protocols for cross-sectional studies of surveillance of risk factors of non-communicable diseases in Iran [16]. In the current study, there were 150 clusters, each with 20 families inside them, have been selected randomly, based on the results of the population census. The households were surveyed from the right of clusters in the presence of elderly people, and if agreed and cooperated, the questionnaires were completed by trained interviewers. In the absence of an older person in the household or lack of cooperation, the next household was surveyed.

Measurements

Socio-economic status

In this questionnaire, questions regarding age, sex, marital status, education, and economic status have been asked. To check the socio-economic status of the elderly, the brief Iranian questionnaire “The Iranian Questionnaire for Measuring the Socio-Economic Status” has been used. The validity and reliability of this questionnaire have been checked and verified in previous studies [17]. This questionnaire has six questions and addresses the variables of job, education, property, income, and costs related to family health. Career status codes have been assigned to different jobs based on the presented table, and then, for lining up with the other variables, the results are inversed. Finally, the results of the six variables are summed together. The results for the three questions have been multiplied by 0.33. Quartiles are used for classifying socio-economic status.

Structured clinical interview for DSM-IV-TR (SCID-IV)

This is a structured clinical interview based on the DSM-IV-TR criteria, which is used to diagnose axis I and axis II disorders. This scale has been frequently used in psychiatric studies. Previous studies have confirmed the validity of the Persian version of SCID-IV for clinical and researching usages [18]. In the present research, the clinical version of SCID-IV has been used to confirm the diagnosis of psychiatric disorders.

Abbreviated Mental Test Questionnaire

Cognitive disorders were assessed using the Persian version of the Abbreviated Mental Test Questionnaire. The psychometric properties of this instrument were confirmed in the Iranian population. Sensitivity of 92.15% and specificity of 81.5% of the tool were reported by Bakhtiyari et al. [19] in Iran. The internal consistency and the external reliability (intra-rater) of this instrument were 0.76 and ICC = 0.89, respectively.

Statistical analysis

Data were analyzed using SPSS software (version 19.0, Chicago, IL, USA). Descriptive statistics were used to describe and present frequency and prestige. Chi-square (χ2) test was used to test categorical variables. Independent T-test was used for the comparison of normal quantitative variables [20, 21] (Mann-Whitney for non-parametric variables). P-value <0.05 was considered significant in all of the tests.

Results

A total of 1000 older people (60 years or above) participated in this study. Sex distribution was 454 (43.9%) men and 581 (56.1%) women. The average of men’s age was 70.36 (95% CI: 69.64–71.08). The elderly participants’ age-sex pyramid has been shown in Fig. 1.

Fig. 1
figure 1

The age pyramid of the elderly participants. Age groups: 0–2 : 60–70 years; 2–4 : 71–80 years; 4–6 : over 80 years

Full size image

Table 1 showed that the prevalence of mental disorders among aging people by sex. Overall, 38.5% of the participants had one or more mental disorders (47.2% women and 27.3% men). Concerning the number of mental disorders, 23.6% of the elderly had one, 9.8% had two, and 5.2% had more than two mental disorders. There were statistically significant differences in the number of disorders by sex (P-value = 0.001).

Table 1 The prevalence of mental disorders among aging people by sex in Tabriz, 2017
Full size table

Regarding mental disorder type, the overall prevalence of major depressive disorder (MDD) and any anxiety disorder was 16.6% (22.4% female and 9.3% male) and 16.7% (23.1% female and 8.6% male), respectively. There was a significant difference in the prevalence of depression and anxiety between females and males (P=0.001). However, the prevalence of any depressive disorders (symptoms) were 21.6% (29.3% female and 11.9% male). The prevalence of panic disorder was 3% (4.3% female and 1.3% male). We found 5.9% of the depressed subjects had Obsessive Compulsive Disorder (OCD), and 5.3% of them had General Anxiety Disorder (GAD). In both disorders, there was a significant statistical difference between men and women (P=0.001). Moreover, the overall prevalence of phobia, agoraphobia, and PTSD was 4.4%, 7, and 7%, respectively (Table 1).

The prevalence of any mental disorders in the first, second, and third quartiles of the socio-economic level was 54.3, 37, and 17.8%, respectively. Likewise, the prevalence of any anxiety disorder was 27.9, 20.7, and 9.3%, respectively (Table 2).

Table 2 The prevalence of mental disorders in elderly people by quartile in Tabriz, 2017
Full size table

The prevalence of panic disorder among the marginalized and the non-marginalized populations was 7.2 and 1.2%, respectively (p-value = 0.001). The prevalence of MDD among the marginalized and the non-marginalized populations was 23.4 and 12.6%, respectively (p-value = 0.001). The prevalence of OCD among the marginalized and the non-marginalized populations was 9.3 and 4.4%, respectively. The difference between these two regions is statistically significant (p-value = 0.003).

The prevalence of GAD among the marginalized and the non-marginalized populations was 7.2% and 5%, respectively. 26.5% of the marginalized population and 13.2% of the non-marginalized population had any anxiety disorder (p-value = 0.001). The prevalence of any mental disorders among the marginalized and the non-marginalized population is 55.3 and 31.5%, respectively. The difference between these two regions is statistically significant (p-value = 0.0001). The prevalence of MDD in 60–74 years old, 75–84 years, and 85 years and more were 15.3, 20.9, and 27.8%, respectively (Table 3).

Table 3 The prevalence of mental disorders in elderly people by age groups in Tabriz, 2017
Full size table

Discussion

The increase in the elderly population is creating new challenges, and the health system should make the necessary strategies to manage this situation. Psychological problems are among the most important problems in elderly people, and they can adversely affect the quality of their life.

Our study is one of the rare surveys in East Azerbaijan Province, Tabriz assessing common psychiatric disorders among elderly people. Depression is common mental disorder among the aging population [7, 22] and also young adults in Iran [9]. Evidence confirmed that the prevalence of depression increased from 43 to 53.7% among Iranian elderly people [8, 14]. Besides, a review study in Iran revealed that female gender, marring status, living in a nursing home, education level, age, and socio-economic status were the most important factors associated with depression [23].

In our study, 38.5% of the elderly had at least one mental disorder, and this measure was 47.2 and 27.3% among women and men, respectively. 23.6% of the subjects had one mental disorder. In a study about people older than 55, which was conducted in Europe, 19.1% of the subjects had mental disorders. Seventeen percent of them had depression disorder, and 11.3% of them had anxiety disorders [24].

Findings of a study conducted among the elderly people in Khoy, Iran demonstrated that 1.3% of the elderly people suffer from very severe stress, 1.3% from severe depression, and 3.1% from severe anxiety. Moreover, this study showed that there is a significant association between anxiety, stress, and depression disorders and demographic characteristics such as sex, education, marital status, medical condition, as well as their housing conditions [25]. The results of a study conducted by Ghafari et al. on the elderly in Tehran also have shown that 4.8% of elderly patients have severe stress, 4.8% severe depression, and 11.5% severe anxiety [26].

In a study conducted in Australia, 13% of the subjects reported psychiatric disorder symptoms in the previous month, and 16% reported these symptoms in the previous year. Majority of women had mood disorders and GAD than men, and fewer women had substance use disorders than men. Except for cognitive disorders, the increase in age did not coincide with an increase in the probability of mental disorders [27]. Kessler showed that the prevalence of depression and its symptoms in developing countries (42%) is more than in developed countries (33%) [28]. In a study that investigated the prevalence of mental disorders in the elderly people of Europe, one in every two persons had experienced a mental disorder in the course of life, one in every three persons had been mentally sick in the previous year, and one in every four persons was mentally sick at the time of the study. Anxiety disorders, mood diseases, and drug-related diseases had the most prevalence [29].

In a study that assessed the prevalence of depression and related issues in elderly people, 13.7% of men and 18.2% of women had depression. In both of the sexes, there was a specific relation between depression and age, education, income, life quality, and marital status.

Our results showed that the prevalence of any mental disorder in the first, second, and third quartiles of socio-economic status was 54.3, 37, and 17.8%, respectively. The prevalence of depressive disorder in this quartile was 27.9, 20.7, and 9.3%, respectively. In another study which had analyzed the effects of socioeconomic differences on depression in old people, it was shown that depression was evidently more prevalent among people with less income and education [30]. In the present study, the prevalence of major depression is estimated to be 16.6% in total, 29.3% in women, and 11.9% in men. The results were similar to a study conducted in the United States, which had estimated it to be 14.4% [31]. In another study which had analyzed the prevalence of depression among elderly patients hospitalized in wards other than the psychiatric ward, the prevalence of major depression was varying between 10% and 21% [32]. Shah et al reported the prevalence of depression disorder at 35.9% in elderly care centers [33]. In the conducted study, the prevalence of anxiety disorder is estimated to be 16.7. This measure was 23.1 among women and 8.6 among men. This result was similar to the result of Reynold et al which was reported to be 11.71 [34]. It was also similar to the results of Skoogl and Bryant’s studies [35, 36].

In the conducted study, the prevalence of Mood and anxiety disorders among women (22.4 and 23.1%, respectively) is reported more than those of men (9.3 and 8.6%, respectively), and this result was similar to the results of Volkert et al. [37].

Strengthens and limitations

The current study is the first population-based study investigating the prevalence of common psychiatric disorders among the elderly population in Tabriz, Iran. Our study had some limitations. The first concern for prevalence studies is needed a sufficient sample size and a well-defined sampling process to estimate parameters. To solve this issue, we chose a large sample size and clustering sampling based on protocols for cross-sectional studies of surveillance of risk factors of non-communicable diseases in Iran [16].

The second concern was information bias to collect and interview the participants. We used trained interviewers by referring to households and using face-to-face interviews.

Conclusions

Findings indicated that 38.5% (47.2% women and 27.3% men) of elderly people had any mental disorder. The prevalence of MDD and any depressive symptoms were 16.6% and 21.6%, respectively. The prevalence of mental disorders in elders was almost like adults and middle-aged people. We found the prevalence of mental disorders was more in marginalized populations and low socioeconomic status.

Availability of data and materials

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Abbreviations

MDD:

Major depressive disorder

OCD:

Obsessive-compulsive disorder

GAD:

Generalized anxiety disorder

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Acknowledgements

The authors thank all the participants, the Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, and Clinical Research Development Unit, Razi Educational for their cooperation during this study.

Funding

The present study was financially supported, reviewed, and supervised by Tabriz University of Medical Sciences.

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Authors and Affiliations

  1. Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran

    Ali Fakhari, Sepideh Herizchi, Shahrokh Amiri, Seyed Gholamreza Noorazar, Maryam Mirzajanzade, Habibeh Barzegar & Hosein Azizi

  2. Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

    Homayoun Sadeghi-Bazargani & Mostafa Farahbakhsh

  3. Department of Psychiatry, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

    Mostafa Farahbakhsh

  4. Department of Epidemiology and Biostatistics, School of Health, Tehran University of Medical Sciences, Tehran, Iran

    Hosein Azizi

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Contributions

AF designed the original idea and developed the protocol; SH, MF, HS, SA, SGN, HA, HB, and MM contributed to the protocol development and developed the manuscript and analyses, data extraction, content analysis, interpretation, and edition. All authors approved the final submitted version.

Corresponding author

Correspondence to Mostafa Farahbakhsh.

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The study protocol was approved by the Ethics Committee, Tabriz University of Medical Sciences. Written informed consent was obtained before the study. We confirm that all methods were performed in accordance with the relevant guidelines and regulations.

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The authors declare no competing interests regarding this study and its publication.

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Fakhari, A., Herizchi, S., Sadeghi-Bazargani, H. et al. Prevalence of psychiatric disorders in the aging population in the northeastern of Iran. Middle East Curr Psychiatry 30, 25 (2023). https://doi.org/10.1186/s43045-023-00287-4

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