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Vol. 34, N° 2, 2018
ISSN 0120-5552
eISSN 2011-7531
409
Salud Uninorte. Barranquilla (Col.) 2018; 34 (2): 409-419
artículo original/original article
http://dx.doi.org/10.14482/sun.34.1.9720
Fecha de recepción: 18 de julio de 2017
Fecha de aceptación: 26 de febrero de 2018
Depression in the elderly: A study
in three cities of Colombia
Depresión en el adulto mayor: Un estudio
en tres ciudades de Colombia
Alejandra Segura-Cardona1, Jonathan Hernández-Calle2,
Doris Cardona-Arango3, Angela Segura-Cardona4, Diana Muñoz-Rodríguez5,
Daniel Jaramillo-Arroyave6
Abstract
Objective: To explore the demographic, health and functional factors associated with depression
in the elderly in three cities from Colombia: Medellin, Barranquilla and Pasto.
Materials and methods: An analytical cross-sectional study. The study population correspon-
ded to a probabilistic sample of 1514 adult whose age is 60 years or over. A sample was selected
by a probabilistic sampling, in two-stage, and conglomerate, according to the geographical and
administrative distribution of each city.
Results: The results support that the city of Pasto presents the highest number of elderly
people with depression; conditions such as low educational level (PR = 4.11), hyperthyroidism
/ hypothyroidism (PR = 3.43), and dependence on activities of daily living such as using the
telephone (PR = 3.80) increase the prevalence of the disease.
Conclusion: Depression is present in an important part of the population of older adults and
is associated with conditions not only of health but also demographic and functional capacity.
It is necessary to address these components from the public health that promotes the prevention
of this condition if you want to contribute to the goals of active, satisfactory and healthy aging
in Colombia and a better quality of life for this population.
Keywords: Depression, elderly, health, functional capacity.
1 Professor Universidad CES .alejasegura10@gmail.com https://orcid.org/0000-0002-1624-0952
2 Professor Institución Universitaria de Envigado nathancalle@yahoo.es https://orcid.org/0000-0001-7749-1547
3 Professor Universidad CES dcardona@ces.edu.co https://orcid.org/0000-0003-4338-588X
4 Professor Universidad CES asegura@ces.edu.co https://orcid.org/0000-0002-0010-1413
5 Professor Universidad CES dmunoz@ces.edu.co
6 Professor Universidad CES dajaramillo@ces.edu.co https://orcid.org/0000-0001-8735-7050
Correspondence: Alejandra Segura Cardona. Dirección postal: Calle 10A # 22-04.Universidad CES. Tel: (57)
(4) 444 05 55 Ext. 1445. Fax: (57) (4) 268 28 76. e-mail:alejasegura10@gmail.com
410 Salud Uninorte. Barranquilla (Col.) 2018; 34 (2): 409-419
Alejandra Segura-Cardona, Jonathan Hernández-Calle, Doris Cardona-Arango,
Angela Segura-Cardona, Diana Muñoz-Rodríguez, Daniel Jaramillo-Arroyave
Resumen
Objetivo: Explorar los factores demográcos, de salud y de funcionalidad asociados con la
depresión en los adultos mayores en tres ciudades de Colombia: Medellín, Barranquilla y Pasto.
Material y métodos: Estudio analítico transversal. La población del estudio correspondió
a una muestra probabilística de 1514 adultos de 60 años y más. La muestra fue seleccionada
mediante un muestreo probabilístico, por conglomerado, bietápico, según la distribución
geográca y administrativa de cada ciudad.
Resultados: Los resultados muestran que la ciudad de Pasto presenta el mayor número
de adultos mayores con depresión; condiciones como el bajo nivel educativo (RP=4,11), el
hipertiroidismo/hipotiroidismo (RP=3,43), y la dependencia en actividades básicas de la vida
diaria como usar el teléfono (RP=3,80) incrementan la prevalencia de la enfermedad.
Conclusión: La depresión está presente en una parte importante de la población de adul-
tos mayores y está asociada a condiciones no solo de salud sino también demográcas y de
la capacidad funcional. Se hace necesario el abordaje de estos componentes desde la salud
pública que promueva la prevención de esta condición si se quiere contribuir con las metas
de envejecimiento activo, satisfactorio y saludable en Colombia y una mejor calidad de vida
para esta población.
Palabras clave: Depresión, adulto mayor, salud, capacidad funcional.
INTRODUCTION
In Colombia, the population of 60 years or more
has growth rates higher than that of the total
population; In 2005, the number of elderly peo-
ple was 3,815,453, and 4,473,447 in 2010, with
an annual growth rate of 3.18 % in that period,
projecting an increase of 3.76 % by 2020. (1).
In developing countries, the health challenges
faced by this population include an increase in
the prevalence of chronic noncommunicable
diseases, as well as a functional and cognitive
deterioration that is aggravated by the socioeco-
nomic environment of the country (2).
Depression is the most frequent psychiatric
disorder among older adults (3); According to
the World Health Organization (WHO) unipolar
depression affects 7 % of people over 60 years
of age and represents 5.7 % of years lived with
disabilities in this population (4). In Colombia,
the last mental health study reported that in
people over 45 years of age, the prevalence
of any depressive disorder was 5 % (5). In
a study carried out in the department of
Antioquia, the estimated prevalence of risk
of depression in the elderly was 26.3 %, with
women representing 64.2 % of the popula-
tion at risk (6).
In the elderly, depression occurs with episo-
des of crying, sadness and apathy, accompa-
nied by hopelessness, negligence, suicidal
ideation, guilt, changes in sleep pattern,
alterations in appetite, bowel movements,
libido, among others (5,7). This symptomato-
logy affects different dimensions of the older
adult, including the physical, functional and
social state.
In older adults diagnosed with depression,
a high comorbidity has been found with
chronic noncommunicable diseases such as
diabetes mellitus (8), neoplastic pathology
(9), pulmonary disease (10), among others.
411
Salud Uninorte. Barranquilla (Col.) 2018; 34 (2): 409-419
D : A C
In addition, depression affects eating behavior
leading to malnutrition in older people (11).
In countries such as South Africa, where the
prevalence of geriatric malnutrition is high,
it has been identied that more than 70 % of
those who have this condition also experience
depressive symptoms (2).
On the other hand, adults with symptoms of
depression have a higher functional decit
(12), even geriatric depression has been nega-
tively correlated with muscle strength, body
resistance and exibility in the lower part of
the body, as well as muscle strength of the
arm, agility and dynamic balance (13), which
would affect the adequate performance in the
activities of daily life.
Starting from the above, depression is a disease
that decreases the quality of life of the elderly
(14) and those who suffer it are unable to take
advantage of the resources that surround
them, because they lose autonomy due to their
mental state. From this point of view, it could
be argued that older adults with depression
are in a state of vulnerability, understanding
this concept as the limitations that a person
has to take advantage of the resources gene-
rated by the state, the market and / or the
community (15).
In Colombia there are no studies comparing
depression in the elderly according to the city
of residence; An example of this is that in the
last National Mental Health Survey, conducted
in 2015, a comparison was made of the preva-
lence of depression according to the regions
of Colombia, but an analysis segregated by
cities was not carried out (5). The present stu-
dy aims to explore the demographic, health,
and functionality factors associated with
depression in older adults in three cities of
Colombia: Medellín, Barranquilla and Pasto,
in order to provide information to improve
the quality of life of this population.
MATERIALS AND METHODS
Type of study
An analytical cross-sectional study was
conducted in 2016, from a primary source
of information for the search of the factors
associated with depression in older adults
residents in three cities of Colombia, selected
by the number of elderly people and classi-
ed as large, medium and small populations:
Medellín (391,429), Barranquilla (145,947)
and Pasto (42,271) in 2016, according to
DANE projections.
Participants
The study population corresponded to a
probabilistic sample of 1514 adults 60 year of
age and older, living in the urban area of the
cities of Medellín (495), Barranquilla (513)
and Pasto (506). This study is part of a macro
project funded by Colciencias, where the
calculation of sample size was made using
the formula for nite populations, with a
condence level of 95 %, a sampling error of
5 %, a proportion of good health condition
of 50 % and a design effect of 1.0, the sam-
ple size being enlarged by 15 % to correct
possible information losses. The selection
of the sample was carried out by means of
a probabilistic sampling, by conglomerate,
two-stage, according to the geographical
and administrative distribution of each city.
The present study on depression took the
database of the macro project.
412 Salud Uninorte. Barranquilla (Col.) 2018; 34 (2): 409-419
Alejandra Segura-Cardona, Jonathan Hernández-Calle, Doris Cardona-Arango,
Angela Segura-Cardona, Diana Muñoz-Rodríguez, Daniel Jaramillo-Arroyave
Instruments
A survey was applied to selected older adults,
which consisted of questions related to de-
mographic characteristics (age, sex, marital
status, educational level, place of residence,
etc.), and physical health status (diabetes,
heart problems, nutritional, bone health,
hypertension, etc.). To evaluate the depres-
sion, the Yesavage Geriatric Abbreviated
Depression Scale was used, which consists
of 15 questions (10 positive and 5 negative)
and explores cognitive symptoms of a major
depressive episode during the last fteen
days. The scale is widely used given that its
completion requires ve minutes on average,
in addition, it presents an internal consistency
and construct reliability in the Colombian
population of 0.78 and 0.87, respectively (16).
For the measurement of functional capacity
Barthel’s instrument was used to evaluate in-
dependence in basic activities of daily life such
as eating, bathing, dressing and undressing,
going up and down stairs and moving around.
The instrument shows good interobserver
reliability with Kappa indexes between 0.47
and 1.00, and a Cronbach’s alpha of 0.86 (17).
Finally, the Lawton and Brody Scale was used
to evaluate some instrumental activities of
daily life such as using the telephone, using
public transportation, taking medication, and
managing economic matters; This instrument
has an inter and intra-observer coefcient of
0.94 (18).
Process
A pilot test was conducted on 20 people over
60 years old living in the urban area of the city
of Medellín, with a duration of 8 days, in order
to calibrate the instruments to be applied, stan-
dardize the pollsters, verify that the questions
were correctly elaborated and categorized,
and also select the most appropriate techni-
ques for quality control of the information
collected. The present study was approved
by the Institutional Ethics Committee of the
CES University and written informed consent
was requested from older adults, following
application of the instruments, in accordance
with Resolution 8430 of 1993 of the Ministry
of Health of Colombia that regulates research
on human subjects.
Analysis of data
The Chi-square test was used to evaluate the
association between depression and demo-
graphic, health, and functional conditions in
older adults, assigning a level of signicance
of 0.05 to reject the null hypothesis. Additio-
nally, with the variables that met the Hosmer
Lemeshow criterion of a p-value less than
0.25 in the association test, crude prevalence
ratios (PR) were calculated and were taken to
an adjusted multivariate model to estimate
adjusted prevalence ratios, with 95 % con-
dence intervals, to determine the strength of
the association. The statistical analyzes were
carried out through the SPSS program, version
21 (CES University License).
Results
It was found that 83.6 % (1266) of the older
adults evaluated did not report having de-
pression, while 12.9 % (196) had symptoms of
depression, while in 3.4 % (52) of the sample
there was no response to the scale applied.
By sex, a statistically signicant difference
was found between men and women, with a
higher proportion of women with symptoms
of depression.
413
Salud Uninorte. Barranquilla (Col.) 2018; 34 (2): 409-419
D : A C
When discriminating by city, in the group
without depression the highest percentage
corresponded to the city of Barranquilla, in
contrast to the city of Pasto where the largest
sample with depression was located, nding
a statistically signicant association between
the city where the elderly person resides and
the presence of depression.
It was found that the economic income in the
last month was not associated with depres-
sion in the elderly, with the civil status and
educational level was found association with
the presence of depression. Older adults with
depression were the most likely to report that
they were unmarried and with a primary level
of education (see table 1).
According to health conditions, older adults
with depression reported more problems
with heart, bone health, hypertension, and
hyperthyroidism / hypothyroidism than their
peers without depression. While diabetes,
nutritional problems, lung disease and the
presence of tumors were conditions that were
not associated with the presence or absence
of depressive symptoms (See table 2).
Table 1. Presence of depression according to the demographic conditions
of the older adult of Barranquilla, Medellín and Pasto
Demographic
Conditions
Without depressive
sympthoms
With depressive
sympthoms X2 P value
n % n %
Sex Men 449 35,47 54 27,55 4,711 0,030*
Women 817 64,53 142 72,45
City
Barranquilla 486 38,39 17 8,67
146,671 0,000*Medellín 423 33,41 39 19,90
Pasto 357 28,20 140 71,43
Economic
Income
Yes 718 56,71 107 54,59 0,311 0,577
No 548 43,29 89 45,41
Civil status Single 610 48,18 115 58,67 7,471 0,006*
Not single 656 51,82 81 41,33
Education Level
None 111 8,77 29 14,80
28,344 0,000*
Primary 651 51,42 126 64,29
Secundary 378 29,86 33 16,84
Tertiary 126 9,95 8 4,08
*p value <0,05 statistically signicant. Researchers’ calculations
414 Salud Uninorte. Barranquilla (Col.) 2018; 34 (2): 409-419
Alejandra Segura-Cardona, Jonathan Hernández-Calle, Doris Cardona-Arango,
Angela Segura-Cardona, Diana Muñoz-Rodríguez, Daniel Jaramillo-Arroyave
Table 2. Presence of depression according to health conditions
in the elderly of Barranquilla, Medellín and Pasto
Health conditions
Without depressive
sympthoms
With depressive
sympthoms X2 P value
n % n %
Heart problems
Yes 49 3,87 17 8,72
9,205 0,002No 1217 96,13 178 91,28
No 1262 99,68 195 100
Bone health
problems
Yes 42 3,32 16 8,21 10,588 0,001
No 1224 96,68 179 91,79
Hypertension Yes 626 49,45 114 58,46 5,493 0,019
No 640 50,55 81 41,54
Hyperthyroidism
/hypothyroidism
Yes 59 4,66 28 14,36
28,381 0,000No 1207 95,34 167 85,64
No 1248 98,58 189 96,92
*p value <0,05 statistically signicant. Researchers’ calculations
In the functional conditions, it can be seen
that of the basic activities of daily life, in-
dependence in the bathroom was the only
one that was associated with depression,
nding a greater proportion of older adults
with depression dependent on this activity,
in contrast to the group without depression;
however, instrumental activities of daily life
such as using the telephone, using public
transportation, taking medication and ma-
naging economic issues were associated with
depression, with a higher proportion of older
adults with depression dependent on these
activities (see table 3).
Additionally, the prevalence ratio (PR) was
calculated as a measure of strength of asso-
ciation, observing that living in the city of
Pasto increased the occurrence of depression
symptoms up to 4.25 times, while it was con-
rmed that living in the city of Barranquilla
reduced it by 63 %. On the other hand, having
no educational level increased more than
other demographic variables the association
to develop depression in the older adult (PR
= 4.11), even in the model adjusted for demo-
graphic covariates, morbidity, and functiona-
lity, was the variable that most increased the
prevalence of depression. Hyperthyroidism
/ hypothyroidism was the health condition
that increased the association (RP = 3.43),
while in the instrumental activities it was the
dependence to use the telephone (RP = 3.80)
(see table 4). Some morbidity variables such
as problems in bone health and tumors; and
some of functionality such as bathing, going
up and down stairs, using public transpor-
tation, taking medications and handling
economic issues, lost their signicance when
the association was adjusted for confounding
variables.
415
Salud Uninorte. Barranquilla (Col.) 2018; 34 (2): 409-419
D : A C
Table 3. Presence of depression according to the conditions of functionality
in the older adult of Barranquilla, Medellín and Pasto
Characteristics Categories
Without depressive
sympthoms
With depressive
sympthoms X2 P value
n % n %
Bath Independent 1249 98,66 189 96,43 5,221 0,022*
Dependent 17 1,34 3 3,57
Use the phone Independent 1034 81,74 106 54,08 75,720 0,000*
Dependent 231 18,26 90 45,92
Use public transport Independent 1048 82,85 145 73,98 8,906 0,003*
Dependent 217 17,15 51 26,02
Take the medication Independent 1147 91,32 155 81,15 19,017 0,000*
Dependent 109 8,68 36 18,85
Handling economic
matters
Independent 1108 87,73 146 74,87 23,199 0,000*
Dependent 155 12,27 49 25,13
*p value <0,05 statistically signicant. Researchers’ calculations
Table 4. Factors associated with depression in the elderly of Barranquilla, Medellín and Pasto
Characteristics Categories PR Crude IC 95 % PR Adjusted IC 95 %
Demographic factors
City
Barranquilla 0,37 0,21; 0,68 0,37 0,20 - 0,69
Pasto 4,25 2,90 ; 6,23 4,07 2,64 - 6, 27
Medellín 1,00 - 1,00 -
Civil status Single 1,53 1,13 ; 2,07 1,55 1,03 - 2,34
Not single 1,00 - 1,00 -
Education Level
None 4,11 1,81 ; 9,38 4,71 1,74 - 12,73
Primary 3,05 1,45 ; 6,39 3,59 1,48 - 8,70
Secundary 1,37 0,62 ; 3,05 2,20 0,87 - 5,56
Tertiary 1,00 - 1,00 -
Health factors
Heart problems Yes 2,37 1,34 ; 4,21 2,52 1,28 - 4,99
No 1,00 - 1,00 -
Hyperthyroidism
/hypothyroidism
Yes 3,43 2,13 ; 5,53 2,04 1,18 - 3,51
No 1,00 - 1,00 -
Functionality factors
Use the phone Dependent 3,80 2,77 ; 5,20 1,68 1,10 - 2,57
Independent 1 - 1 -
PR= Prevalence Ratio. Researchers’ calculations
416 Salud Uninorte. Barranquilla (Col.) 2018; 34 (2): 409-419
Alejandra Segura-Cardona, Jonathan Hernández-Calle, Doris Cardona-Arango,
Angela Segura-Cardona, Diana Muñoz-Rodríguez, Daniel Jaramillo-Arroyave
DISCUSSION
In the three cities of Colombia where the study
was conducted, it was found that demogra-
phic factors such as sex, city of residence,
marital status and educational level were
associated with depression in the elderly.
These results conrm the ndings of studies
in mental health in the country, in which it has
been reported that women show more symp-
toms of depression than men (5-6); This can
be explained by genetic, neuroendocrine, and
personality factors, as well as by patterns of
socialization and social culture, including the
differences between sexes in living conditions
and in the distribution of opportunities (19).
The results of the present investigation are
also in agreement with other studies carried
out in older Colombian adults where it has
been identied as risk factors for depression
being a woman, being widowed or single and
having a low educational level (20-21).
Likewise, the National Mental Health Study
in Colombia found that the prevalence of
depression was higher in the Pacic region,
where the city of Pasto is located, in compa-
rison with the central and Atlantic regions,
where the cities of Medellín and Barranqui-
lla are located, respectively (5). However,
depressive symptoms in elderly residents of
the city of Pasto have been explained by the
demographic conditions, income level and
health status of this population (22), which
is related to high poverty rates and social
inequality found in the pacic region (23).
On the other hand, health conditions were
also associated with depression in the elderly,
especially hypertension, hyperthyroidism /
hypothyroidism, heart problems, and bone
problems. According to Giner et al. (24), the
comorbidity between depression and physical
illnesses is very frequent and has an important
impact on the deterioration of health, even
depression can mediate the pharmacological
treatment of these diseases.
On a functional level, depression was as-
sociated with dependence to bathe, use the
telephone, use public transportation, take me-
dication and handle economic issues. In this
regard, Krony et al. (25) carried out a study
with people over 75 years of age and found
that depression affected the basic activities of
daily life, but not the instrumental activities,
therefore, the differences between the studies
what is evidence is the inuence of the social
context on the perception that the older adult
has of his state of functionality.
A possible limitation of this study is the intro-
duction of some biases in the measurement
of depression as a measure of self-report and
not necessarily an established medical diag-
nosis, which may overestimate its prevalence.
However, the use of the Yesavage scale has
been widely used and its consistency allows
us to consider that the observed values are
adjusted to reality. Although the design of
the study does not allow the establishment
of associations of a causal type because it
is not their intention, the associated factors
may suggest some conditions that should be
considered in preventive interventions with
the elderly population. This study excluded
rural population, hospitalized and residents
in geriatric homes where conditions may be
more precarious and may contribute to a
greater perception of depressive signs and
other factors associated with these conditions
in particular so that the ndings of this study
may limit extrapolation to older adults in these
particular conditions.
417
Salud Uninorte. Barranquilla (Col.) 2018; 34 (2): 409-419
D : A C
This study provides relevant information on
the mental health of the elderly in Colombia,
taking into account that it is a vulnerable
population to present mental disorders, due
to the physical changes generated by age and
social conditions that do not favor adaptation
to these changes. This study conrms that
depression is a phenomenon associated with
multiple modiable factors that can be inter-
vened in a timely manner, from public health
for example and therefore, its understanding is
not limited to the ndings reported, although
these become a precedent for future research
on aging in the country.
CONCLUSION
The high prevalence of depression in the
elderly, is associated with demographic and
health conditions, and globally affects the
functionality of the elderly. Faced with this
situation, public health actions are needed that
promote the prevention of depression in the
elderly, including through the establishment
of support networks for this population, es-
pecially in the city of Pasto where the largest
occurrence of the disease was obtained.
The information generated by this research
can be useful for public policies that are ai-
med at active, satisfactory and healthy aging
in Colombia and therefore it is necessary to
address it from public health that promotes
the prevention of this condition if you want to
contribute to the goals of active, satisfactory
and healthy aging in Colombia and a better
quality of life for this population.
Funding: This research project was funded
by the Administrative Department of Science,
Technology and Innovation -Colciencias- of
Colombia (Contract: 122871149710), with the
support of the CES University of Medellín,
Colombia (University Code: INV.082016.001).
Conict of interests: In the development of
the investigation, there was no conict of
interest between the parties involved in the
agreement: elderly people, researchers and
funders.
Funding: Universidad de CES.
Conict of interests: None to declare.
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