Didone Thiago Vinicius Nadaleto, Boffino Catarina Costa, Seward Nadine, Nakamura Carina Akemi, Shimozato Illora Aswinkumar Darbar, Araya Ricardo, Peters Tim J, Scazufca Marcia
Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil.
Departamento de Saúde Coletiva, Centro de Ciências da Saúde, Universidade Estadual de Londrina, Londrina, Brazil.
Int J Geriatr Psychiatry. 2025 May;40(5):e70081. doi: 10.1002/gps.70081.
Age-related balance deficits and depression are common among older people and challenging for public health. However, the association between postural imbalance and depression has scarcely been investigated in large samples, especially in low- and middle-income countries (LMICs) whose populations are ageing rapidly. Here, we estimated the prevalence of postural imbalance and examined its association with depressive symptomatology among older adults living in a socioeconomically deprived area of Brazil.
The analysis used screening data from the PROACTIVE cluster randomised controlled trial-specifically, socioeconomic, demographic and health information from individuals aged 60 years and older registered at one of 20 primary health clinics in Guarulhos and who provided complete data for our analyses. Self-reported postural imbalance was the outcome and it was assessed with a single question. Participants who reported postural imbalance were asked about the number of falls they had experienced in the previous 6 months. The prevalence of postural imbalance and postural imbalance with or without falls was estimated. Depressive symptomatology was assessed using the Patient Health Questionnaire-9 (PHQ-9). The association between depressive symptomatology (PHQ-9 score ≥ 10) and three ordered categories of the outcome (no postural imbalance, postural imbalance without falls and postural imbalance with falls) was investigated using adjusted mixed-effects ordered logistic regression.
The study included 2999 individuals. Postural imbalance was reported by 1183 participants (39.4%; 95% confidence interval: 37.7%, 41.2%), comprising 792 non-fallers and 391 fallers (26.4% and 13.0% of all participants, respectively). For participants with depressive symptomatology, the odds of having postural imbalance with or without falls versus not having postural imbalance is 2.88 (95% confidence interval: 2.44, 3.40) times that of participants without depressive symptomatology. Likewise, for participants with depressive symptomatology, the odds of having postural imbalance with falls versus having postural imbalance without falls combined with not having postural imbalance is 2.88 (95% confidence interval: 2.44, 3.40) that of participants without depressive symptomatology.
Postural imbalance is a common occurrence in a vulnerable older population in Brazil. Importantly, we found that depressive symptomatology was associated with increased odds of having postural imbalance and postural imbalance with falls experienced in the previous 6 months. Notwithstanding our analyses' exploratory nature, these issues should receive greater attention in primary care practice and research.
与年龄相关的平衡能力缺陷和抑郁症在老年人中很常见，对公共卫生构成挑战。然而，姿势不平衡与抑郁症之间的关联在大样本中鲜有研究，尤其是在人口迅速老龄化的低收入和中等收入国家（LMICs）。在此，我们估计了姿势不平衡的患病率，并研究了其与生活在巴西一个社会经济贫困地区的老年人抑郁症状之间的关联。
该分析使用了来自PROACTIVE整群随机对照试验的筛查数据——具体而言，是来自瓜鲁柳斯20家初级保健诊所之一登记的60岁及以上个体的社会经济、人口统计学和健康信息，这些个体为我们的分析提供了完整数据。自我报告的姿势不平衡是研究结果，通过一个单一问题进行评估。报告有姿势不平衡的参与者被问及他们在过去6个月中经历的跌倒次数。估计了姿势不平衡以及有或无跌倒的姿势不平衡的患病率。使用患者健康问卷-9（PHQ-9）评估抑郁症状。使用调整后的混合效应有序逻辑回归研究抑郁症状（PHQ-9评分≥10）与结果的三个有序类别（无姿势不平衡、无跌倒的姿势不平衡和有跌倒的姿势不平衡）之间的关联。
该研究纳入了2999名个体。1183名参与者报告有姿势不平衡（39.4%；95%置信区间：37.7%，41.2%），其中包括792名未跌倒者和391名跌倒者（分别占所有参与者的26.4%和13.0%）。对于有抑郁症状的参与者，有或无跌倒的姿势不平衡与无姿势不平衡相比的比值比是无抑郁症状参与者的2.88倍（95%置信区间：2.44，3.40）。同样，对于有抑郁症状的参与者，有跌倒的姿势不平衡与无跌倒的姿势不平衡加无姿势不平衡相比的比值比是无抑郁症状参与者的2.88倍（95%置信区间：2.44，3.40）。
姿势不平衡在巴西弱势老年人群中很常见。重要的是，我们发现抑郁症状与过去6个月中出现姿势不平衡以及有跌倒的姿势不平衡的几率增加有关。尽管我们的分析具有探索性，但这些问题在初级保健实践和研究中应受到更多关注。
