Old age and depression in Ghana: assessing and addressing diagnosis and treatment gaps

Figures & data

Table 1. Items included in the WHO SAGE depression diagnostic algorithm.

During the last 12 months, have you had a period lasting several days when you felt sad, empty or depressed?

During the last 12 months, have you had a period lasting several days when you lost interest in most things you usually enjoy such as personal relationships, work or hobbies/recreation?

During the last 12 months, have you had a period lasting several days when you have been feeling your energy decreased or that you are tired all the time?

INTERVIEWER: IF ANY ONE OF RESPONSES TO PREVIOUS QUESTIONS IS ‘YES’, CONTINUE

Was this period [of sadness/loss of interest/low energy] for more than 2 weeks?

Was this period [of sadness/loss of interest/low energy] most of the day, nearly every day?

During this period, did you lose your appetite?

Did you notice any slowing down in your thinking?

Did you notice any problems falling asleep?

Did you notice any problems walking up too early?

During this period, did you have any difficulties concentrating; for example, listening to others, working, watching TV, listening to the radio?

Did you notice any slowing down in your moving around?

During this period, did you feel anxious and worried most days?

During this period, were you so restless or jittery nearly every day that you paced up and down and couldn’t sit still?

During this period, did you feel negative about yourself or like you had lost confidence?

Did you frequently feel hopeless-that there was no way to improve things?

During this period, did your interest in sex decrease?

Did you think of death, or wish you were dead?

During this period, did you ever try to end your life?

Table 2. Distribution % [n] of characteristics WHO SAGE Ghana, 2007.

	Total sample (n=4725)	Self Reported	Chi-square p- value	Symptom-based	Chi-square p-value
Prevalence		1.6[67]		9.3[395]
Age (years)			<0.0001***		<0.0001***1
[50-59]	1883	0.7[11]		7.0[117]
[60-69]	1305	1.4[17]		9.9[118]
[70-79]	1071	2.5[24]		10.6[103]
[80+]	473	3.5[15]		13.4[57]
Sex			<0.0001***		<0.0001***
Males	2379	0.9[20]		7.4[167]
Females	2345	2.3[47]		11.3[228]
Marital status			0.001**		<0.0001***
Never married	58	0.0[0]		14.0[7]
Married/Cohabiting	2739	1.0[23]		7.2[174]
Separated/Divorced	624	2.8[17]		11.2[68]
Widowed	1276	2.3[27]		12.3[146]
Education			0.063*		0.022*
None	2380	1.5[35]		10.3[244]
Primary	894	2.5[22]		8.4[75]
Secondary	878	0.9[8]		8.3[73]
Higher	151	1.3[2]		4.0[6]
Location			0.0578		0.314
Urban	1927	2.0[35]		9.8[172]
Rural	2803	1.3[32]		8.9[226]
Wealth quintile			0.343		0.019*
Poorest	939	0.8[7]		8.0[68]
Q2	940	2.0[17]		12.1[102]
Q3	949	1.5[13]		9.4[80]
Q4	934	1.7[15]		9.3[81]
Richest	961	1.7[15]		7.8[67]

Table 3. Odds ratio (with 95%CI) of symptom-based depression and diagnosis.

Characteristics	OR(95%CI) for reporting symptom-based depression	P values	OR (95%CI) for reporting symptoms of depression but not a diagnosis	P values
Age in years
50–59	1.00		1.00
60–69	1.28 (0.94–1.73)	0.115	1.23(0.89–1.70	0.206
70–79	1.27(0.91–1.74)	0.155	1.08(0.77–1.52)	0.766
80+	1.96(1.24–3.02)	0.004	1.26(0.79–2.01)	0.785
Sex
Male	1.00		1.00
Female	1. 35(1.01–1.82)	0.046	1.30(0.98–1.72)	0.068
Educational status
None	1.00		1.00
Primary	0.94(0.68–1.31)	0.733	0.83(0.58–1.18)	0.304
Secondary	0.89(0.62–1.28)	0.523	0.84(0.57–1.24)	0.377
Higher	0.65(0.20–2.09)	0.472	0.26(0.09–0.79)	0.018
Marital Status
Never married	1.00		1.00
Currently Married/cohabiting	0.76(0.32–1.83)	0.547	0.64(0.27–1.53)	0.316
Separated/divorced	1.08(0.44–2.64)	0.874	0.81(0.33–1.99)	0.644
Widowed	1.08(0.44–2.63)	0.869	0.94(0.39–2.27)	0.884
Location
Urban	1.00		1.00
Rural	0.86(0.66–1.12)	0.275	0.81(0.61–1.07)	0.644
Wealth quintile
Poorest	1.00		1.00
Q2	1.51(1.04–2.19)	0.027	1.22(0.84–1.75)	0.291
Q3	1.25(0.86–1.82)	0.246	1.15(0.78–1.70)	0.482
Q4	1.40(0.95–2.07)	0.087	1.19(0.79–1.80)	0.397
Richest	1.21(0.76–1.93)	0.423	1.20(0.75–1.93)	0.453

Table 4. SAGE respondents reporting diagnosis and treatment of depression.

	Diagnosed (% of all respondents and n)	Treated in last 2 weeks (% of diagnosed and n)	Treated in last 2 weeks but reporting symptoms (n)	Treated in last 12 months (% of diagnosed and n)	Treated in last 12 months but reporting symptoms (n)
Male	0.8[20]	25.0[5]	29.4[5]	50.0[10]	58.8[10]
Female	2.3[47]	19.2[9]	24.2[8]	36.2[17]	51.5[17]
Urban	2.0[35]	20.0[7]	30.4[7]	37.1[13]	56.5[13]
Rural	1.3[32]	21.9[7]	22.2[6]	43.8[14]	51.9[14]
Total	67	20.9[14]	13	40.3[27]	27

Table 5. Selected characteristics of study participants.

		60–69 years old	70–79 years old	80+ years old
Sex	Male	3	6	3
	Female	10	7	6
Marital status	Single	0	3	0
	Married	4	2	3
	Separated	1	3	1
	Widowed	8	5	5
Pension	Yes	6	10	5
	No	7	3	4
Total		13	13	9

Table 6. Comparison of depression evaluations from SAGE and psychiatric evaluation.

	N	%
Not Depressed (Both)	20	57.1
Depressed SAGE/Not Depressed Psyc	5	14.3
Not Depressed SAGE/Depressed Psyc	0	0.0
Depressed (Both)	10	28.6
Agreement	30	85.7
Discordant	5	14.3
Total	35
Sensitivity of SAGE tool		10/10 = 100.0%
Specificity of SAGE tool		20/25 = 80.0%