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Yıl:2016; Cilt: 53; Sayı: 2>> Özet
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Nöropsikiyatri Arşivi; 2016;53(2):108-114
Psikiyatri Polikliniğine ve Aile Hekimi Polikliniğine Başvuran Yaşlılarda Majör Depresif Bozukluk ve Yas Belirtileri Arasındaki İlişkinin Değerlendirilmesi
İ Taymur, K Özdel, C Aypak, V Duyan, Ö Türedi, BB Güngör, Y Selvi
Şevket Yılmaz Eğitim Araştırma Hastanesi, Bursa
Amaç: Aile hekimliği polikliniği ve psikiyatri polikliniklerine başvuran 65 yaş üstü bireylerde var olan yas belirtilerinin düzeyi ile majör depresyon ve depresif belirtilerin şiddeti arasındaki ilişkinin değerlendirilmesi amaçlanmıştır. Yöntem: Dışkapı Yıldırım Beyazıt Eğitim Araştırma Hastanesi Hasköy Semt Polikliniği Psikiyatri ve Aile Hekimliği polikliniklerine Ocak-Nisan 2012 döneminde başvuran ve sevdiği birini kaybettiği belirlenen 65 yaş üstü hastalar çalışmaya dâhil edildi. Bilişsel fonksiyonların değerlendirilmesi amacıyla“Eğitimliler ve Eğitimsizler için Standardize Mini Mental Test (SMMT/SMMT-E)” uygulanarak 23 ve üstü puan alanlar çalışmaya dâhil edildi. Majör Depresif Bozukluk (MDB) tanısı DSM-IV için Yapılandırılmış Klinik Görüşme Formu (Structurel Clinical Interview For DSM- IV Axis I Disorders; SCID-I) ile belirlenmiştir. Yas ve depresif belirti düzeyleri için Yaşlılar İçin Depresyon Ölçeği (YDÖ) ile Temel Yas Unsurları (TYU) Ölçeği uygulanmıştır. Bulgular: Her iki grubun psikiyatrik değerlendirmesi sonucunda psikiyatri polikliniğine başvuran 67 kişiden 33’ünde (%49,2) ve Aile Hekimliği polikliniğine başvuran 43 kişiden 7’sinde (%16,3) MDB tespit edildi. Her iki polikliniğe başvurup MDB tanısı alanlarda almayanlara göre TYU ölçeği puanları anlamlı düzeyde yüksek bulunmuştur (sırasıyla p=0,012 ve p=0,001). Bununla birlikte TYU ölçeği puanları; psikiyatri polikliniğe başvuran kişilerde akut (p=0,047) ve kronik stres (p=0,007) varlığı ile aile hekimi polikliniğine başvuranlarda ise kronik stres (p=0,001) varlığı ile anlamlı düzeyde yükseklik göstermiştir. Sonuç: Yaşlı bireylerde kayıp yaşantısının sorgulanması ve kayıp yaşantısına verilen tepkilerin değerlendirilmesi MDB’nin belirlenmesinde, şiddetinin değerlendirmesinde, bilişsel bozulmaların takibinde ve stres yönetiminde faydalı olacaktır. Toplum ruh sağlığının geliştirilmesi bağlamında ileri yaşta olan insanlara özgü programların geliştirilmesi ve sosyal destek unsurlarının artırılması koruyucu olabilir.
Evaluation of the Relationship between Major Depressive Disorder and Bereavement Symptoms in Elderly Patients Who Present Either to Psychiatry or Family Medicine
Introduction: We aimed to determine the level of bereavement and depression symptoms among elderly patients who experience the loss of a significant other and the relationship between depressive symptoms and bereavement symptoms. Methods: The study sample consisted of elderly adults who lost a significant other at least 6 months prior to the submission time. Participants were recruited from patients who presented to either the psychiatry or family medicine outpatient unit of a Training and Research Hospital. Cognitive functions were assessed using Standardized Mini Mental Examinations for Educated and Uneducated People (SMME/ SMME-U). Participants were excluded from the study if their SMME or SMME-U scores were lower than 23 points. To assess the severity of depressive and bereavement symptoms, the Geriatric Depression Scale (GDS) and Core Bereavement Items (CBI) scales were used, respectively. Results: Overall, 33 out of 67 individuals (49.2%) who presented to the psychiatry unit and 7 out of the 43 individuals (16.3%) who presented to the family medicine unit were diagnosed with major depressive disorder (MDD). CBI scale score means were higher in the MDD groups than in the non-depressive groups (p=0.012 and p=0.001, respectively). CBI scores were significantly correlated to acute (p=0.047) and chronic stress (p=0.007) in the psychiatry group and to chronic stress in the family medicine group (p=0.001). Conclusion: Probing loss experiences and reactions to them can be important to understand depression, to evaluate its symptoms, and to help manage the relevant symptoms. Considering the significant contributions of bereavement to depressive symptom severity in elders, interventions specific to bereavement symptoms should not be ignored.

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