Depression among older people in rural Thailand : Knowledge of population, experiences and perceptions of patients, families, and psychiatric nurses

Background: The number of older persons (defined as age 60 and over) in Thailand has grown rapidly, and will be projected to increase to over 20 million by 2035. With an aging population, the number of older people suffering from health problems (such as non-communicable and degenerative diseases) was increasing as well. Older people faced physical and mental health challenges that need to be recognized. Depression among older people is significantly high and associated with physical illness; however it remains overlooked, improperly diagnosed, and inadequately treated. Aim: The overall aim of the study was to gain deeper knowledge of the phenomenon of depression in older people in rural Thai areas. The aim of each the study was to describe and understand the experiences and perceptions of individual psychiatric nurses, patients, and their family members, as well as to study public knowledge about depression among older people in rural Thailand. Methods: The setting of this thesis was a rural area in Thailand. It included four studies. The first three studies involved qualitative research, and latent content analysis was used to analyze data. In-depth interviews were used to collect data. Purposive sampling was used to select participants for the first three studies, which included 13 psychiatric nurses (study I), 14 older people with depression (study II), and 13 family members of older patients suffering from depression (study III). The fourth study is a quantitative cross-sectional study with 2,636 respondents aged 18 years to 75 and living in a household while data was collected. Respondents were selected using multi-stage random sampling. Results: Study I - The psychiatric nurses’ experiences and perceptions of their professional role were mirrored in the following themes: 1) managing a central role in patient care; 2) conflicting interests between the professional needs of caregiving and other requests; and 3) being compassionate beyond their official duties. Study II - the experiences and perceptions of older Thai people with depression were abstracted into two themes. The first theme was 1) leading a life of detachment, and the second theme was 2) inconvenience of obtaining mental health treatment. Study III - the experiences and perceptions of family members of older people showing major depression were abstracted into two themes. The first theme was 1) perceiving a traditional rural view on mental illness, and the second was 2) experiencing complexity in everyday life when caring for older depressed family member. Study IV - The 2,636 respondents have moderate knowledge about depression among older people, with a respondent mean score of 5.86 (SD = 1.68). Education level was significantly associated with knowledge about depression. If education level changes from lower to higher, the odds for level of knowledge about depression increase. This result may indicate the need for enhanced mental health literacy in rural areas. Conclusion: Older people with depression in a rural Thai area were the responsibility of an inadequate number of psychiatric nurses. The resultsshowed sign of lacking knowledge about depression among older people and an imbalance between the needs of patients and the mental health care provided by the psychiatric nurses in rural areas. The patients and their relatives, and psychiatric nurses felt burdened in daily life. An immediate concern for mental healthcare providers is providing mental literacy in rural areas. These primary results can be used by mental health authorities to develop plans to enhance quality of care for older people with depression, and as such, provide psychosocial support for patients and their family. This would reduce the burden on psychiatric nurses and adjust human resources in mental health services in district hospitals.Vid tidpunkten för disputationen var följande delarbeten opublicerade: delarbete 3 (manuskript), delarbete 4 (inskickat).At the time of the doctoral defence the following papers were unpublished: paper 3 (manuscript), paper 4 (submitted).