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PREVALENCE AND CORRELATES OF

DEPRESSION AMONG SAUDI ELDERLY


SULAIMAN A. AL-SHAMMARI
1
* AND ABDULLAH AL-SUBAIE
2
1
Professor and Chairman, College of Medicine, King Saud University, Riyadh, Saudi Arabia
2
Associate Professor, College of Medicine, King Saud University, Riyadh, Saudi Arabia
SUMMARY
Objectives. To assess the prevalence of depression and associated factors in elderly people in Saudi Arabia.
Method. A cross-sectional national survey of the elderly population of Saudi Arabia was conducted
between January 1994 and December 1995. A stratied two-stage sampling technique was used to select the study
subjects. In the rst stage, a random sample of primary health care centres (PHCs) was selected in each of the ve
administrative regions of the country. The family health records (FHR) of each selected PHC were reviewed and a list
of the elderly (60 years and over) was compiled. In the second stage, a sample of the subjects was selected from the
FHR and contacted for a personal interview. The subjects' physical, social and environmental health status were
assessed by an interview during which a structured questionnaire was completed. The Geriatric Depression Scale
(GDS) was used to screen for depression. Other items of information in the questionnaire included subjects'
sociodemographic characteristics, activities of daily living (ADL), laboratory and radiological investigations.
Results. The total number of elderly subjects included in this study was 7970. Their mean age+standard deviations
was 68.8+7.7 (male 69.1+.7.7; and female 67.7+7.5) years. Depressive symptoms were reported in 3110 (39%) of
the subjects, and 8.4% were in the severe depressive symptoms score group. Personal characteristics that correlated
strongly with depression were poor education ( p 0.001), unemployment ( p 0.001), divorced or widowed status
( p 0.001), old age and being a female ( p 0.001). Living in a remote rural area with poor housing arrangements
and limited accessibility within the house and poor interior conditions were also signicantly associated with high
depressive symptoms ( p 0.001). Limited privacy, such as having a particular room specied for the elderly, was
associated with more depressive symptoms than sharing a room with another person ( p 0.001). Lower incomes
inadequate for personal needs as well as depending on charity or other relatives were associated with more cases of
depression ( p 0.001). The proportion of cases of depression correlated positively with the number of medical
diagnoses and medications received ( p 0.001). Signicant depression was associated with loss of a close relative,
living alone and limited participation in recreational activities. Perception of poor health and dependence on others
for daily activities were associated with more depressive symptoms ( p 0.001). Also health problems, especially
faecal or urinary incontinence, were associated with more depressive symptoms ( p 0.001).
Conclusion. Depressive symptoms are common among Saudi elderly. Detection and management rates were low.
Primary care teams could help these patients if properly trained. A simple instrument such as the Geriatric Depression
Scale is useful and easily administered. Copyright # 1999 John Wiley & Sons, Ltd.
KEY WORDSdepression; Saudi; elderly; geriatric depression scale
The Kingdom of Saudi Arabia has a population of
16.9 million (12.7 million Saudi) and occupies an
area of over 2 250 000 km
2
, giving a population
density of 6.6 per km
2
(Al-Maalomat, 1994). Saudi
Arabia houses the two Muslim holy mosques,
namely Mecca and Madina. The Saudi population
is homogeneous, with about 50% younger than
16 years of age. The Saudi elderly constitute
about 600 000 (5%) of the total population
(Nutfaji, 1981). This percentage is expected to
further increase due to improvement in socio-
economic standards and health care. Studies on
utilization of psychiatric services showed an under-
representation of the elderly population (Al-Subaie
et al., 1996; El-Esra and Amin, 1988; El-Rufaie,
CCC 08856230/99/09073909$17.50 Received 3 April 1998
Copyright # 1999 John Wiley & Sons, Ltd. Accepted 4 February 1999
INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY
Int. J. Geriat. Psychiatry 14, 739747 (1999)
*Correspondence to: Professor S. Al-Shammari, Dept. of
Family & Community Medicine, College of Medicine, King
Saud University, PO Box 2925, Riyadh 11461, Saudi Arabia.
Tel: 4670836. Fax: 966-1-4671967.
Contract/grant sponsor: King Abdulaziz City for Science and
Technology.
1988; Al-Subaie, 1989). This, however, may reect
help-seeking patterns, the small proportion of this
age group in the Saudi society, or may be a true
nding, indicating low prevalence of psychiatric
disorders in the Saudi elderly. Western community-
based studies show the prevalence of severe
depression which warrants treatment in elderly
people to be about 15%; these rates are nearly
twice as great among primary care attenders (Tylee
and Katona, 1996; Macdonald, 1986). UK studies
show that the cost of depression in old age (in terms
of excess health and social service utilization) is
likely to be very high, even after allowing for the
eects of associated social isolation and physical
disability (Tylee and Katona, 1996). Other primary
care studies show that only a minority of the
depressed elderly are identied or treated (Macdo-
nald, 1986). Elderly patients may not recognize
their symptoms as constituting an emotional rather
than a physical illness or believe that little can be
done to help. Diagnostic diculties often arise from
the absence of overtly low mood in older depressed
patients, whose presenting symptoms are more
likely to be altered sleep and appetite, agitation
and multiple somatic complaints (Kivela and
Pahkala, 1988). Depression is also likely to be
missed in the presence of physical illness (Tylee
et al., 1993) and psychological symptoms are much
less likely to result in a correct diagnosis of
depression if detected late in the consultation
(Tylee et al., 1995).
Depression in old age carries a worse prognosis
than earlier in life in terms of persistence and
recurrence, increased mortality ( particularly in
men, Murphy et al., 1988) and higher risk of suicide
(Lindesay, 1991; Cattell and Jolley, 1995). As many
patients with depression respond favourably to
treatment, there are potential benets inherent in
the early detection and treatment of depressive
disorders. The Geriatric Depression Scale (GDS)
(Williams and Wallace, 1993; Sheikh and Yesavage,
1986) is a simple instrument that can help in
detection of depression among the elderly, for
whom it was specically developed. In Saudi
Arabia there is scarcity of data on various aspects
of health of the elderly and available studies are
hospital-based, describing to a limited extent the
health situation of the elderly (Al-Shammari et al.,
1995; Alballa et al., 1993; Al-Shammari, 1994).
The objectives of this household study are to
determine the prevalence of depression in Saudi
elderly and to identify the associated social and
health factors.
METHOD
The design was a cross-sectional national survey
conducted between January 1994 and December
1995. A two-stage stratied sampling technique was
used in the selection of the elderly subjects, who
were all Saudi nationals. There are about 600 000
people over the age of 60 in Saudi Arabia. The study
sample was estimated to be 7600 elderly using the
formula N P(1-P)/e
2
, where N sample size,
P prevalence of disorder taken at 15%, standard
error 0.25%. The rst-stage sampling units were the
list of primary health centres (PHC) in each of the
ve administrative regions of the Kingdom (ie
North, West, East, South and Central). A random
sample of PHCs was selected from both urban and
rural areas of each region. In the rural and nomadic
areas, the number of health centres selected was
proportional to the size of the village or collection
of Bedouins. The family health records (FHR) in a
(PHC) catchment area population served as the
second-stage sampling frame. It is compulsory
for the primary health care centres to locate and
update catchment area population households
for the purpose of opening a family health record.
A systematic random sample of the elderly was
selected from the FHRs. Each selected elderly
person was contacted by telephone or other avail-
able means to arrange for a personal visit to his/her
house. The information collected during the
visit included: (1) sociodemographic data, which
included personal information, socioeconomic
aspects of life and housing conditions; (2) physical
health information; (3) level of activityfor this
purpose we used the Activity of Daily Living Scale
(ADL) (Katz et al., 1970); (4) the Geriatric
Depression Scale (GDS), a 30-item instrument
that requires responses of yes or no to the presence
or absence of depressive symptoms in the elderly
population (Fillenbaum, 1984; Yesavage et al.,
1983).
Those elderly subjects who scored 1020 on the
Geriatric Depression Scale (Yesavage et al., 1983)
were considered to suer from mild depression; a
score of 2130 suggests severe depression. Subjects
who were unable to read were helped by the GP,
who was trained in the ADL, GDS and diagnosis of
depression. Each statement was read to subjects in a
standard fashion. The ADL and GDS scales were
translated into Arabic by one of the authors and
then independently back-translated into English
until the two versions became almost identical. The
translated questions were found to have the same
Copyright # 1999 John Wiley & Sons, Ltd. Int. J. Geriat. Psychiatry 14, 739747 (1999)
740 S. A. AL-SHAMMARI AND A. AL-SUBAIE
meaning in Saudi culture. They were tested against
a clinical interview by a psychiatrist in a pilot
sample and validity was satisfactory. For the
purpose of the study the GDS was used as screening
instrument and patients with depressive symptoms
were referred to their own area psychiatrists, with
no further follow-up from the researchers.
Data collected in each region were entered in the
mainframe computer at the College of Medicine in
Riyadh. Health morbidity was measured by
responses to interview on questionnaires. Inter-
national classication of diseases ICD-9 was used
to classify the clinical diagnoses made through
history, physical examination and appropriate
laboratory tests. These included blood analysis
for count, haemoglobin, ESR, urea, creatinine and
sugar. The subject's urine was tested microscopi-
cally and bacteriologically. Chi-square test was
calculated between depression score as polytomous
dependent variable and other variables to test for
association.
RESULTS
The total number of elderly subjects included in
this study was 7970. The response rate was 98.8%
in males and 79.8% in females. The research team
visited the subjects about four times on average to
encourage them to complete the study. The male
dropouts were replaced rather more easily, which
led to over-representation of male over female
subjects. Their mean age and standard deviations
were 68.8+7.7 with no gender dierence (male
69.1+7.7 and female 67.7+7.7 years). Thirty-nine
per cent of the elderly scored above 10 on the GDS.
Mild depressive symptoms (1020 score) were
present in 30.6%, with more severe depressive
symptoms (a score of more than 20) shown by
8.4%. As shown in Table 1, signicant depressive
symptoms were more common in the poorly
educated, unemployed, divorced or widowed, very
old and the female sex as well as in those living in
rural and remote areas.
Also, depressive symptoms were more common
among those who had poor housing arrangements
such as limited space and accessibility within the
house and poor interior upkeep of the house
(Table 2).
Interestingly, limited privacy, such as having a
particular room specied for the elderly, was
associated with more depressive symptoms than
sharing a room with another person.
Table 3 shows the depression scores relating to
nancial status. Lower incomes that do not full
personal needs as well as depending on charity or
other relatives were associated with more cases of
depression. The proportion of cases of depression
correlated positively with the number of medical
diagnoses and medication received, as shown in
Table 4.
Also, as shown in Table 5, signicant depression
was associated with loss of a close relative, living
alone and limited participation in recreational
activities.
Perception of poor health and dependence on
others for daily activities were associated with more
depressive symptoms. Also health problems, especi-
ally faecal or urinary incontinence, were associated
with more depressive symptoms (Table 6).
DISCUSSION
The nding of more depression in the divorced
and widowed is in keeping with numerous other
studies (Pfeitter and Murrell, 1986; Murphy, 1982;
Linn et al., 1980). Likewise, poor education and
unemployment are expected to be associated with
depressive ndings. The rapid industrialization and
modernization probably contribute to the dissatis-
faction with housing standards in the elderly. Like
unemployment, lower incomes, social isolation and
being dependent on others for fullment of
personal needs were associated in this study with
depressive feelings and disorders, as suggested by
other researchers, who also found that loneliness
and loss events were important contributing factors
to the development of depression (Linn et al., 1980;
Katona, 1994). As reported by previous studies,
poor physical health and limited activities of daily
living were associated with more depression and
depressive symptoms (Murphy, 1982; Katona,
1994).
The Saudi culture and traditional social values
dictate high respect for and care of the elderly by
members of the extended family (El-Eslam, 1983;
El-Sendiony, 1981) and this may explain the small
number of the Saudi elderly in this study who were
living alone compared to the elderly in other
communities (Vida, 1994; Coolen, 1993). The
association between more privacy and depression
can be explained by the tendency of the elderly in
the extended family system of Saudi Arabia to
associate more privacy with alienation and neglect
by other family members.
Copyright # 1999 John Wiley & Sons, Ltd. Int. J. Geriat. Psychiatry 14, 739747 (1999)
DEPRESSION AMONG SAUDI ELDERLY 741
The prevalence of depressive symptoms in our
study was about 39%, which is somewhat higher
than gures reported by previous workers (Blazer,
1982; Marwijk et al., 1994). Also, the proportion of
signicant depression (a score of more than 20) was
8.4%, which is higher than the 1.7% of Weisman
(Weisman et al., 1985) and the 3.7% of Blazer and
Williams (Blazer and Williams, 1980) but lower
than the 15% of Macdonald (1986).
The lack of epidemiological studies on the
prevalence of depression in other age groups in
Saudi Arabia makes it dicult for us to examine
the eect of age in our study, although it seems
that the proportion of depressed subjects increases
with age. This is supported by similar western
studies (Fiprichs et al., 1981) but contrasts with
some other western studies reporting no eect of
age on depressive symptomatology (Eaton and
Kessler, 1981).
Major depression (in contrast to symptoms) was
reported to be less prevalent among the elderly in
the USA than in other stages of the life cycle
(Weisman et al., 1985). It is, nevertheless, expected
that the ageing process brings with it more physical
ailments, losses and dependence that are known
to be associated with depression. Deliberate self-
harm and suicide are uncommon in Saudi Arabia
(Al-Subaie, 1989) but further investigation is
needed to assess and compare our elderly with
others (Lindesay, 1991; Pierce, 1987). The male
to female ratio in our study was 1: 1.7 for severe
depression and 1: 1.4 for depressive symptoms,
which is in keeping with worldwide gures of more
prevalence of depression and depressive symptoms
Table 1. Depression by sociodemographic characteristics of elderly (N 7970)
Characteristics N
7970 (100)
Depression score p-value
010
4860 (61.0)
1120
2440 (30.6)
2130
670 (8.4)
Residence
Urban 5249 (65.9) 3338 (63.6) 1512 (28.8) 399 (7.6) w
2
25.2224
Rural 2525 (31.7) 1415 (56.0) 862 (34.1) 248 (9.8) df 4
Remote 196 (2.5) 107 (54.6) 66 (33.7) 23 (11.7) p 0.001
Sex
Male 4938 (62.0) 3304 (66.9) 1305 (26.4) 329 (6.7) w
2
196.1691
Female 3032 (38.0) 1556 (51.3) 1135 (37.4) 341 (11.3) df 2
p 0.0001
Age
6064 2805 (35.2) 1909 (68.1) 737 (26.3) 159 (5.7)
6569 2060 (25.9) 1248 (60.6) 657 (31.9) 155 (7.5) w
2
161.0870
7079 2261 (28.4) 1301 (57.5) 721 (31.9) 239 (10.6) df 8
8089 692 (8.7) 338 (48.8) 258 (37.3) 96 (13.9) p 0.0001
90 152 (1.9) 64 (42.1) 67 (44.1) 21 (13.8)
Marital status
Single 748 (9.4) 502 (67.1) 186 (24.9) 60 (8.0) w
2
128.1276
Married 5585 (70.1) 3548 (63.5) 1631 (29.2) 406 (7.3) df 4
Divorced/widowed 1637 (20.5) 810 (49.5) 623 (38.1) 204 (12.5) p 0.001
Educational level
Illiterate 6320 (79.3) 3608 (57.1) 2119 (33.5) 593 (9.4) w
2
147.4074
Read and write 1337 (16.8) 1002 (74.9) 269 (20.1) 66 (4.9) df 2
More than read and write 313 (3.9) 250 (79.9) 52 (16.6) 11 (3.50) p 0.001
Occupation
Not working 4390 (55.1) 2433 (55.4) 1500 (34.2) 457 (10.4) w
2
155.8625
Unskilled work 2675 (33.6) 1767 (66.1) 747 (27.9) 161 (6.0) df 8
Semi-skilled work 696 (8.7) 513 (72.7) 145 (20.8) 38 (5.5) p 0.001
Skilled work 61 (0.8) 46 (75.5) 11 (18.0) 10 (6.8)
Intermediate work 148 (1.9) 101 (68.2) 37 (25.0) 10 (6.8)
Copyright # 1999 John Wiley & Sons, Ltd. Int. J. Geriat. Psychiatry 14, 739747 (1999)
742 S. A. AL-SHAMMARI AND A. AL-SUBAIE
Table 2. Depression by housing
Characteristics N
7970 (100)
Depression score p-value
010
4860 (61.0)
1120
2440 (30.6)
2130
670 (8.4)
Housing
Villa/palace 2432 (30.5) 1653 (68.0) 608 (25.0) 171 (7.0) w
2
94.1042
Small house 3092 (38.8) 1746 (56.5) 1056 (34.2) 290 (9.4) df 6
Flat 1778 (22.3) 1102 (62.0) 541 (30.4) 135 (7.6) p 0.001
Other 668 (8.4) 359 (53.7) 235 (35.2) 74 (11.1)
Private room
No specic 1342 (16.8) 774 (57.7) 430 (32.0) 138 (10.3) w
2
872.0132
Specied shared 3884 (48.7) 2498 (64.3) 1116 (28.7) 270 (7.0) df 4
Specied for me 2744 (34.4) 1588 (57.9) 894 (32.6) 262 (9.6) p 0.001
Accessibility within house
Good 3072 (38.5) 1995 (64.9) 818 (26.6) 259 (8.4) w
2
143.6002
Acceptable 4052 (50.8) 2498 (61.7) 1259 (31.1) 295 (7.3) df 2
Poor 846 (10.6) 367 (43.4) 363 (42.9) 116 (13.7) p 0.001
Interior condition of house (interviewer)
Optimum 1963 (24.6) 1376 (70.1) 482 (24.6) 105 (5.4) w
2
358.5225
Acceptable 4824 (60.5) 3038 (63.0) 1406 (29.2) 380 (7.9) df 4
Poor 1183 (14.8) 446 (37.7) 552 (46.7) 185 (15.6) p 0.001
Satisfaction (interviewee)
Optimum 1885 (23.7) 1336 (70.9) 453 (24.0) 96 (5.1) w
2
371.6411
Adequate 4912 (61.6) 3087 (62.9) 1430 (29.1) 395 (8.0) df 4
Poor 1173 (14.7) 437 (37.3) 557 (47.5) 179 (15.3) p 0.001
Table 3. Depression by nancial status
N
7970
Depression score p-value
010
4860 (61.0)
1120
2440 (30.6)
2130
670 (8.4)
Monthly income
52500 4048 (50.8) 2198 (54.3) 1475 (36.4) 375 (9.3) w
2
91.1703
25004999 2351 (29.5) 1563 (66.5) 625 (26.6) 163 (6.9) df 2
500014 999 1225 (15.4) 828 (67.6) 282 (23.0) 115 (9.4) p 0.001
15 000 346 (4.3) 271 (78.3) 58 (16.8) 17 (4.9)
Source of nance
Self 2589 (32.5) 1798 (69.5) 632 (24.4) 159 (6.1) w
2
243.9108
Children 2393 (30.0) 1304 (54.5) 839 (35.1) 250 (10.5) df 10
Other relation 178 (2.2) 82 (46.1) 80 (44.9) 16 (9.0) p 0.0001
Charity 292 (3.7) 122 (41.8) 134 (45.9) 36 (12.3)
Government 2004 (25.1) 1303 (65.0) 531 (26.5) 170 (8.5)
Others 514 (6.5) 251 (48.8) 224 (43.6) 39 (7.6)
Fullment of needs
Very good 1193 (15.0) 850 (71.3) 281 (23.6) 62 (5.2) w
2
177.7653
Fair 4324 (54.3) 2764 (63.9) 1213 (28.1) 347 (8.0) df 4
Poor 2453 (30.8) 1246 (50.8) 946 (38.6) 261 (10.6) p 0.001
Copyright # 1999 John Wiley & Sons, Ltd. Int. J. Geriat. Psychiatry 14, 739747 (1999)
DEPRESSION AMONG SAUDI ELDERLY 743
in females (Weisman et al., 1985; Livingston and
Hinchlie, 1993).
It seems that many cases of depression do not
seek treatment in our study. Similarly low detection
and treatment rates were reported by western
studies (Mullan et al., 1994; Copeland et al., 1992).
The gap between recognition and intervention is
striking and explanations might be related to the
erroneous and ageist beliefs held by doctors that
depression is inevitable and `normal' in the face of
multiple losses, deteriorating health and impending
death and that older people are too frail to tolerate
physical treatment or too inexible to benet from
psychotherapy. In addition, some PHC doctors
may feel helpless to induce improvement in their
patients' social circumstances. Others may feel
lacking in expertise in initiating treatment of
depression in older patients (Freer, 1987).
The primary care physician is uniquely placed
to initiate and monitor care (Murry, 1989; Russell
and Hime, 1988). The other PHC team members,
such as nurses, occupational therapists and health
visitors, as well as volunteers, may be eectively
recruited in such programmes (Murry, 1989;
Table 4. Depression by number of diagnoses and medication
N
7970
Depression score p-value
010
4860 (61.0)
1120
2440 (30.6)
2130
670 (8.4)
No. of diagnoses
Nil 2903 (36.4) 1828 (63.0) 883 (30.4) 192 (6.6) w
2
104.8495
One 2805 (35.2) 1783 (63.6) 832 (29.7) 190 (6.8) df 8
Two 1555 (19.5) 880 (56.6) 497 (32.0) 178 (11.5) p 0.0001
Three 512 (6.4) 275 (53.7) 163 (31.8) 74 (14.5)
Four 195 (2.5) 94 (48.2) 65 (33.7) 36 (18.5)
No. of medications
Nil 2245 (28.2) 1615 (71.9) 492 (21.9) 138 (6.2) w
2
283.810
One 1529 (19.2) 1014 (66.3) 403 (26.4) 112 (7.3) df 12
Two 1558 (19.6) 912 (58.5) 524 (33.6) 122 (7.8) p 0.0001
Three 1236 (15.5) 628 (50.8) 487 (39.4) 121 (9.8)
Four 614 (7.7) 304 (49.5) 232 (37.8) 78 (12.7)
Five 340 (4.3) 154 (45.3) 140 (41.2) 46 (13.5)
Six 448 (5.6) 233 (52.0) 162 (36.2) 53 (11.8)
Table 5. Depression by living arrangements, loss of close relative and recreational activities
N
7970
Depression score w
2
1
df
1
p-value
010
4860 (61.0)
1120
2440 (30.6)
2130
670 (8.4)
Living arrangements
Alone 430 (5.4) 229 (53.3) 134 (31.2) 67 (15.6) w
2
32.3
df 3
With family 7540 (94.6) 4631 (58.1) 2306 (28.9) 603 (7.6) p-value 50.0001
Loss of close relative
No 7299 (91.6) 4466 (61.2) 2242 (30.7) 591 (8.1) w
2
10.8
df 3
Yes 671 (8.4) 394 (58.7) 198 (29.5) 79 (11.8) p-value 0.01
Participation in recreational activities
No 6436 (80.8) 3818 (59.3) 2030 (31.5) 588 (9.1) w
2
45.6
df 3
Yes 1534 (19.3) 1042 (67.9) 410 (26.7) 82 (5.4) p-value 50.001
Copyright # 1999 John Wiley & Sons, Ltd. Int. J. Geriat. Psychiatry 14, 739747 (1999)
744 S. A. AL-SHAMMARI AND A. AL-SUBAIE
Greengross, 1987; Collins et al., 1995). They need
proper training and back-up support from mental
health professionals to perform this task well. As
reported by Al-Faris et al., training of PHC
doctors in Saudi Arabia to recognize mental illness
resulted in a better identication of cases and less
use of laboratory investigation and prescription
(Al-Faris et al., 1997). The `at risk' registers
Table 6. Depression by health perception, activities of daily living and other health problems
N
7970
Depression score p-value
010
4860 (61.0)
1120
2440 (30.6)
2130
670 (8.4)
Health perception
Good 5730 (71.9) 4012 (70.0) 1438 (25.1) 280 (4.9) w
2
779.5457
Poor 1876 (23.5) 707 (37.7) 834 (44.5) 335 (17.9) df 4
Cannot say 364 (4.7) 141 (38.7) 168 (46.2) 55 (15.1) p 0.001
Activities of daily living
Independent 6518 (81.8) 4390 (67.4) 1767 (27.1) 361 (5.5) w
2
731.9718
Dependent 1452 (18.2) 470 (32.4) 673 (46.4) 309 (21.3) df 2
p 0.0001
Health problems
Joint pain
No 4069 (66.3) 2885 (70.9) 998 (24.5) 186 (4.6) w
2
269.1024
Yes 1759 (28.7) 704 (40.0) 800 (45.5) 255 (14.5) df 2
Cannot say 311 (5.0) 164 (52.7) 107 (34.4) 40 (12.9) p 0.001
Eyes
Normal 4277 (53.7) 2858 (66.8) 1150 (26.9) 269 (6.3) w
2
142.7816
Abnormal 3693 (46.3) 2002 (54.2) 1290 (34.9) 401 (10.9) df 2
p 0.0001
Hearing diculty
No 6493 (81.5) 4186 (64.5) 1851 (28.5) 456 (7.0) w
2
200.6130
Yes 1477 (18.5) 674 (45.6) 589 (39.9) 214 (14.5) df 2
p 0.0001
Cardiorespiratory problem
No 4904 (79.9) 3159 (64.4) 1428 (29.1) 317 (6.5) w
2
130.1822
Yes 1235 (20.1) 594 (43.1) 477 (38.6) 164 (13.3) df 2
p 0.0001
Headache
No 3637 (45.6) 2668 (73.4) 768 (21.1) 201 (5.5) w
2
431.2540
Yes 4333 (54.4) 2192 (50.6) 1672 (38.6) 469 (10.8) df 2
p 0.0001
GIT diculty
No 3041 (49.5) 2050 (67.4) 791 (26.0) 200 (6.6) w
2
103.8178
Yes 2858 (46.6) 1581 (55.3) 1025 (35.9) 252 (8.8) df 4
Cannot say 240 (3.9) 122 (50.8) 89 (37.1) 29 (12.1) p 0.0001
Faecal incontinence
No 7874 (98.8) 4827 (61.3) 2403 (30.5) 644 (8.2) w
2
53.5929
Yes 96 (1.2) 33 (34.4) 37 (38.5) 26 (27.1) df 2
p 0.0001
Urinary incontinence
No 7425 (93.2) 4662 (62.8) 2187 (29.5) 576 (7.8) w
2
160.4266
Yes 545 (6.8) 198 (36.3) 253 (46.4) 94 (17.3) df 2
p 0.001
Copyright # 1999 John Wiley & Sons, Ltd. Int. J. Geriat. Psychiatry 14, 739747 (1999)
DEPRESSION AMONG SAUDI ELDERLY 745
currently maintained in the primary health centres
could be extended to include a special note of older
people with specic diculties or vulnerability.
ACKNOWLEDGEMENTS
This study was supported by the King Abdulaziz
City Institute for Science and Technology.
The authors are grateful to all doctors, nurses,
social workers and other medical and non-medical
personnel, without whose support and under-
standing the study could not have been performed.
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