Relations sociales et troubles dépressifs chez les personnes âgées au Québec : interactions avec le genre et la région de résidence

Depression is an important public health problem among the elderly population due to its high prevalence and its association with disability, mortality and use of health services. Most studies have shown that lack of social networks is associated with depression but results are not clear. In Quebec and in Canada, little evidence exists on the prevalence of depression in the elderly population and on its associations with social relationships. Few studies have examined the associations between social relationships and health services utilisation among the depressed elderly patients. The aim of this work was to examine the role of social relationships on the presence of depression and on the consultation with a health professional by the elderly patient with depression, in Quebec. More specifically, this work aimed at examining if: 1) the associations between social relationships and depression varied in rural and urban areas; 2) the associations between social relationships and depression were different in men and in women and 3) assessing the role of social relationships in the consultation of a health professional by the elderly patients with depression.To attain these objectives we have written three articles using data from the ESA survey, conducted in 2005-2006 on a representative sample of 2670 community dwelling people over 65 in Quebec. Depressive disorders (including major and minor depression) were measured by the DSM-IV criteria using the ESA questionnaire developed by the research team which excludes the criteria on limitations of social functioning. Social relationships were measured by aspects of social networks (marital status and diversity of ties), engagement in community social activities (religious attendance, frequenting social centers, and volunteerism), social support and perception of usefulness and presence of conflict in the relationships with spouse, children, siblings and friends. Multiple logistic regressions were adjusted to estimate odds ratios and their 95 % confidence intervals. Prevalence of depression was higher among those living in urban and rural areas of Quebec compared with metropolitan Montreal. Volunteerism, social support and not having conflict with the spouse were associated with lower frequency of depression independently of the area of residence. Women had higher prevalence of depression compared with men. Lack of a confident was associated with higher frequency of depression both in men and in women. Men who were widows and those who were not involved in volunteer work had higher odds of depression than men in other marital situations and men who were volunteering. Marital status and volunteer work were not associated with depression in women. However, conflict in marriage was associated with depression in women. Relationships with children, siblings and friends are not associated with depression in this population of elderly people from Quebec. Concerning consultation with a health professional for symptoms of depression, we have shown that approximately half of those depressed elderly, both among men and among women, have not consulted for their symptoms in the last 12 months. Consultation is associated with high levels of support, but the immediate network (spouse and siblings) seems to act as a substitute for depressed elderly men, reducing their frequency of consultation. Given the scarcity of Canadian studies on depression prevalence among the elderly population, these results on depression and its associated factors provide important information for clinicians and decision makers for planning and targeting of services by area of residence and for both men and women.