Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China.
Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
BMJ Open. 2020 Dec 10;10(12):e041921. doi: 10.1136/bmjopen-2020-041921.
Loneliness is a significant and independent risk factor for depression in later life. Particularly in Asian culture, older people may find it less stigmatising to express loneliness than depression. This study aimed to adapt a simple loneliness screen for use in older Chinese, and to ascertain its relevance in detecting depressive symptoms as a community screening tool.
DESIGN, SETTING AND PARTICIPANTS: This cross-sectional study was conducted among 1653 older adults aged 60 years or above living in the community in Hong Kong. This was a convenient sample recruited from four local non-governmental organisations providing community eldercare or mental healthcare services. All data was collected by trained social workers through face-to-face interviews.
Loneliness was measured using an adapted Chinese version of UCLA 3-item Loneliness Scale, depression symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), and social support with emotional and instrumental support proxies (number of people who can offer help). Basic demographics including age, gender, education and living arrangement were also recorded.
The average loneliness score was 3.9±3.0, and it had a moderate correlation with depressive symptoms (r=0.41, p<0.01). A loneliness score of 3 can distinguish those without depression from those with mild or more significant depressive symptoms, defined as a PHQ-9 score of ≥5 (sensitivity 76%, specificity 62%, area under the curve=0.73±0.01). Loneliness explained 18% unique variance of depressive symptoms, adding to age, living arrangement and emotional support as significant predictors.
A 3-item loneliness scale can reasonably identify older Chinese who are experiencing depressive symptoms as a quick community screening tool. Its wider use may facilitate early detection of depression, especially in cultures with strong mental health stigma.
ClinicalTrials.gov NCT03593889.
孤独感是老年人患抑郁症的一个重要且独立的危险因素。特别是在亚洲文化中，老年人可能会觉得表达孤独感比表达抑郁感的污名程度更低。本研究旨在为中国老年人改编一个简单的孤独感筛查工具，并确定其作为社区筛查工具检测抑郁症状的相关性。
设计、地点和参与者：这是一项横断面研究，对象为香港社区中 1653 名年龄在 60 岁及以上的老年人。该研究采用方便抽样法，从 4 家提供社区老年护理或精神卫生保健服务的非政府组织中招募了这一人群。所有数据均由经过培训的社会工作者通过面对面访谈收集。
孤独感采用改良的 UCLA 3 项孤独量表中文版进行测量，抑郁症状采用患者健康问卷-9（PHQ-9）进行评估，社会支持采用情感支持和工具性支持的代理指标（能够提供帮助的人数）进行测量。还记录了基本人口统计学信息，包括年龄、性别、教育程度和居住安排。
平均孤独感评分为 3.9±3.0，与抑郁症状呈中度相关（r=0.41，p<0.01）。孤独感评分为 3 时，可以区分没有抑郁症状的人与有轻度或更严重抑郁症状的人，定义为 PHQ-9 得分≥5（敏感性 76%，特异性 62%，曲线下面积为 0.73±0.01）。孤独感解释了抑郁症状 18%的独特方差，是年龄、居住安排和情感支持作为重要预测因素之外的附加因素。
3 项孤独量表可以合理地识别出有抑郁症状的中国老年人，作为一种快速的社区筛查工具。更广泛地使用它可能有助于早期发现抑郁症，尤其是在心理健康污名化严重的文化中。
ClinicalTrials.gov NCT03593889。
