Culturally Appropriate Assessment of Depression and Anxiety in Older Torres Strait Islanders: Limitations and Recommendations

ABSTRACT

Objectives

The aim of the study was to assess the prevalence of anxiety and depression in older Aboriginal and Torres Strait Islander adults.

Methods

A modified version of the PHQ-9 (KICA-dep) and the Geriatric Anxiety Inventory (GAI) were administered as part of a wider dementia prevalence study conducted in the Torres Strait. Results were compared to diagnoses obtained on Geriatric review to evaluate their applicability in the region.

Results

A total of 236 participants completed the KICA-dep and 184 completed the GAI short form. Of these, 10.6% were identified with depression and 15.8% with anxiety. Some participants found questions about suicide ideation and self-harm offensive and others had difficulty understanding concepts on the GAI. The KICA-dep performed poorly in comparison to diagnosis on geriatric clinical review, so results are unlikely to reflect the true prevalence of depression in the region.

Conclusions

Further research is required to explore the underlying dimensions of depression and anxiety and terminology used to express mood symptoms in the Torres Strait.

Clinical Implications

• Current mental health screening tools are not applicable for the Torres Strait

• More work is required to determine how symptoms of depression and anxiety are expressed within Torres Strait communities

KEYWORDS:

• First Nations
• mental health
• assessment tools
• PHQ-9
• KICA-dep
• Geriatric Anxiety Inventory
• Torres Strait

Acknowledgments

The authors wish to thank the residents of the Torres Strait who participated in this study and the staff at the primary health centres without whom the study would never have been completed. The team also wish to thank the members of the Key Stakeholder Working Group for their cultural guidance and expertise throughout the study.

The authors report there are no competing interests to declare.

Biographical note

Dr Sarah Russell is an Associate Professor with the College of Medicine and Dentistry, James Cook University and a founding member of the Healthy Ageing Research Team (HART). Her research focuses on healthy ageing, with a particular focus on Aboriginal and Torres Strait Islander communities in FNQ. . She holds a Masters and PhD in Clinical Neuropsychology and combines her research work with a clinical role as a Neuropsychologist.

Rachel Quigley is a physiotherapist working in the field gerontology for over 20 years. She has worked in the UK, Saudi Arabia, Bahrain and Australia. She holds a clinical role in Cairns Hospital, as the Older Persons Liaison Advanced Clinician and has completed a MPhil through Griffith University focusing on the experiences of carers of older adults as they navigate aged care and health care systems. Rachel also holds a senior research position with the Health Ageing Research Team (HART) at James Cook University, Queensland, Australia. This research role focuses on projects involved with dementia and ageing within Aboriginal and Torres Strait Islander populations in Far North Queensland as well as models of integrated care. She is undertaking a PhD through JCU, developing a framework of healthy ageing for the Torres Strait.

Fintan Thompson has qualifications in epidemiology and clinical neuropsychology. He works as a Data Analyst at James Cook University and a Clinical Neuropsychologist Registrar at the Cairns Hospital. He has previously worked in epidemiology for governments, academia and humanitarian organisations. As a clinical neuropsychologist, Fintan has worked in rehabilitation, geriatrics, psychiatry and pediatrics. This combination of epidemiology and clinical experience provides Fintan with an understanding of how injury and disease at the population level impacts people at the individual level. He is from Far North Queensland and has an interest Indigenous health, including how midlife risk and protective factors influence cognitive functioning in later life.

Betty Sagigi is a Torres Strait Islander Indigenous Health Worker. She is the Aged Care Assessment Team Coordinator and Assessor for the Torres Strait and Northern Peninsula Area, working as part of Thursday Island’s Primary Health Post-Acute Rehab and Aged Care Program within Torres and Cape Hospital & Health Services for the last 10 years. Prior to this role, she managed Commonwealth Funding Agreements for the Primary Health Care Indigenous Health Programs and managed initiatives under Queensland State Government Department of Aboriginal and Torres Strait Islander Policy. Betty has been an integral part of the Healthy Ageing Research Team and has worked on the Dementia Prevalence study from design, data collection and through to knowledge translation. She has ensured the screening tools for dementia are culturally appropriate, facilitated maximum community participation and ensured that community consultation and engagement is conducted in a culturally safe and appropriate way.

Dr Gavin Miller studied Medicine as University of Newcastle and is a Senior Medical Officer in Geriatric Medicine with Cairns and Hinterland Hospital and Health Service. He is an Investigator on the Reducing risk in Aboriginal and Torres Strait Islander Communities and A Framework for Healthy Ageing in the Torres Strait, with HART.

Dr Eddy Strivens is a practising clinician and national leader in geriatric medicine and dementia, working in Far North Queensland for over 20 years. He has held an academic appointment with James Cook University since the commencement of the Clinical School in Cairns and is currently an Adjunct Professor. His research interests are in Culturally Appropriate Assessment, Healthy Ageing, Integrated Care and Models of Service Delivery. He has worked extensively with Aboriginal and Torres Strait Islander Communities in Far North Queensland and has validated the use of culturally appropriate cognitive assessment tools in this population. He is practised in linking research with clinical outcomes in these communities.

Dina LoGiudice Associate Professor Dina LoGiudice is a geriatrician at Royal Melbourne Hospital, visiting specialist at the Victorian Aboriginal Health Service and clinical researcher at the Royal Melbourne Hospital Department of Medicine, University of Melbourne. She has over 20 years’ experience specialising in the area of dementia and is especially interested in the cross-cultural influences on this condition. Since 2003, Dina has been working with Aboriginal researchers and community members to address the significance of dementia and cognitive impairment particularly for those living in remote Australia, and working with communities to develop and evaluate models of care for people with dementia, their carers and families.

Dr Kate Smith is the Research Lead and a Lecturer at the Centre for Aboriginal Medical and Dental Health, School of Medicine, University of Western Australia, on Nyoongar Country. She is an Occupational Therapist and has coordinated concurrent high impact Indigenous ageing well research since 2003, including the development and validation of the Kimberley Indigenous Cognitive Assessment; the development and trial of a model of community care for older Aboriginal Australians; the prevalence, incidence and protective factors for dementia in Aboriginal Australians; and the co-design of a quality of life package for older Aboriginal Australians (Good Spirit, Good Life assessment). She is currently leading the five year DAMPAA study, trialling and evaluating an Aboriginal health practitioner led dementia risk management program for Aboriginal Australians, and is co-director of the Good Spirit Good Life Centre for Research Excellence in Indigenous ageing and a chief investigator on the OnTrack Centre for Research Excellence in Indigenous Dementia.

She is a member of the Department of Health funded National Advisory Group for Aboriginal and Torres Strait Islander Aged Care (NAGATSIAC) and advocated for and co-chaired the development of the NHMRC Aboriginal and Torres Strait Islander Roadmap for Dementia Research and Translation.

Nancy A. Pachana is Professor of Clinical Geropsychology and Program Lead, Age Friendly University and Healthy Ageing Initiatives, at The University of Queensland. She has an international reputation in geriatric mental health, particularly late-life anxiety, assessment and interventions for persons living with dementia, and driving in later life. She has published over 300 peer-reviewed articles, book chapters and books in the field of ageing. Pachana was elected a Fellow of the Academy of Social Sciences in Australia in 2014. In 2019, she was awarded the M. Powell Lawton Award, the American Psychological Association’s Society of Clinical Geropsychology Lifetime Achievement Award.

Clinical implications

• Mainstream mental health tools may not be sufficient to measure the dimensions of depression and anxiety in the Torres Strait.

• More work is required to determine how language is used to describe symptoms of depression and anxiety and investigate how mental health symptoms are expressed within different First Nations communities.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the National Health and Medical Research Council [APP 1106175].