Sample and methods: Between 1971 and 1984 a comprehensive cross-sectional and longitudinal investigation on the mental health of 708 people of 70 years and over, representing 20% random sample of the population in that age of 46 villages near Sofia, was carried out by the first author. In that study, we used an interview, 9 psychometric (cognitive and psycho-motor) tests, and The Self-Evaluation Test (SET) which involved respondents situating themselves on scales represented by vertical lines. The SET was fulfilled in 1972. In 2007 we studied a sample of 80 persons of 60 years and over living in two of the same Bulgarian villages. In 2008 the same older persons, from the two villages, were studied again using also three depressive scales (HAD-D of Zigmond and Snaith, the Geriatric depression scale of Yesavage et al., and the Zung self-rating depression scale) as well as SET. Then we compared the self-evaluation as well the level of depression in 1972 and 2008 among the people aged 70 and over.
Results and discussion: At 1972 we estimated the depressive prevalence at the age group 70+ as 22.2%. In 2007 we found much higher depression states, surpassing 50% of the elderly from the two villages. The follow-up in 2008 confirmed that finding. The results indicated also close relations between depression and self-evaluation. The SET used is sensitive towards depressive symptoms; at the same time it has projective qualities giving information about personality values and motives of dissatisfaction. Depressive prevalence among Bulgarian rural people aged 70 and over seemed to be higher and the self-evaluation of these people, especially their self-evaluation of health, was lower in 2008 than it was in 1972. The leading motives of personal dissatisfaction, including lower self-evaluation on the scale of happiness of SET, according to the results of the 2008 study, proved to be ill health and financial difficulties, these motives being significantly more prevalent in 2008 than in 1972. The differences found might partly reflect social and cultural differences between the two historical periods. We discuss whether the rapid social and economic changes in Bulgaria after 1990 may contribute to some psychogenic increase of the number of depressive states together with a lowering of the self-evaluation.
Aging is a ‘universal experience’ since at the present time almost all individuals have the chance to reach old or very old age. Mental and somatic illnesses are common in late life: they both could develop independently of natural ageing, but in many cases these phenomena combine, overlap and aggravate one another. Dementias and depressions are among the commonest mental health problems in later life. The data on the prevalence of depressions in older age vary, but on the whole they are present in 10-15% or 15-20% of the people aged 65 and over [1,2]. At older ages the major depressions are not more prevalent than in middle age. The depressions with late onset are predominantly ‘minor’ and some parts of them seem to lie in the border area between characteristics common to aging and mental disorder.
Not only the incidence of (minor) depression, but also actual suicides increase with advancing age, especially among men. One part of old age suicides seem to be related with real life difficulties (e.g., loneliness in older men) and another part probably occurs as an outcome of major depression [3]. It is necessary to consider whether there is a phenomenal likeness between aging and depression or a causal pathogenic relationship. Natural aging itself resembles depression with some of its common characteristics: the retardation of reactions and behavior; the trends towards introversion of interests and mode of life; attitudes of increased incertitude, cautiousness and anxiety; some ‘normal’ decrease in feelings of joy; familiarization with thoughts of death [3]. The gradual drop in vitality, spontaneous activity and drive are also present in the course of the natural ageing of humans and animals. Social activities and interests also decline in humans despite their communal character. Behavior requiring physical and mental strain or competition decline as well as activities involving a broader extent of communication and contacts. Individual and quiet occupations within family life become more prevalent. As a result interests and activities do become more introverted and lose strength, swing, fight and strife [4]. Studying life satisfaction in different age groups, Traeldal calculated that the orientation toward personality compared to the orientation toward the environment could be 1:8 (between 18 and 29 years of age); 1: 4 (at 30-44 years); 1:2 (50-69 years) and 1:1 (over the age of 70 years), i.e., the trend towards introversion increases eight times with aging.
The lessening of spontaneous activity as well as the slowing of reactions are primary age-related changes. The trends towards incertitude, cautiousness, anxiousness, introversion and rigidity at older age are more complex in their origin. They also could be partly related with biological involution, including age decline in cognitive and psychomotor abilities. But at the same time they are influenced by adverse environmental factors e.g., the stereotypical undervaluation and rejection of the older people by younger people and society. The drop of vitality and of the adaptive capacities along with the trends toward incertitude and anxiousness contribute to an age change in value orientations with a concentration on vital themes of health, family and past life.
In the study on the representative sample of rural people aged 70 and over we found that the value orientations were focused on their own health, family relations in a narrow circle (children and spouse) and economic security. Their concepts of happiness and unhappiness expressed in many cases their need of help and family ties, the insecurity of the future, the increased dependence with age of the immediate surroundings with the ambivalent experience of (a) dissatisfaction with insufficient care and consideration on the part of the closest relatives and (b) worry to maintain the status achieved in the course of life - both in the family and in the sphere of economic security. The outline of the basic value orientation of older people helps to understand the trends of symptoms in the mental disorders arising in late life [5].
Results
The levels of depression among Bulgarians proved to be high in 2008 as well they were in 2007 (according to the HAD-D scale [8].
We then compared the depression scores from the three depression scales as well as the Self-Evaluation (SE) of 55 persons (38 females and 17 men) studied in 2007 and again in 2008. They were rural Bulgarians, with an age range of 61 to 88 years, living in two villages near to Sofia. The age distribution was as follows: 10 were 61-69; 34 were 70-79; 11 were aged 80-88 years. The rates of depression found by the three depressive scales were concordant. The rates found with the SET also were similar.
Instruments |
Probable Depression |
Very Probable Depression |
N |
HAD-D |
34 (63.6%) |
25 (45.5%) |
55 |
GDS |
32 (59.3%) |
16 (29.6%) |
55 |
Zung self-rating scale |
38 (69.1) |
24 (43.6%) |
55 |
Two consecutive studies in 2007 and 2008 on the elderly from two Bulgarian villages revealed an unusually high prevalence of depression - surpassing 50% - in the age 60+. Depressive prevalence in Bulgaria proved to be much higher than it was in Romania at the same time on a similar rural population. The high prevalence in Bulgaria was confirmed by three scales of depression complemented by a Self-Evaluation Test (SET). The SET projects the self-esteem on the scales of 15 consecutively drawn vertical lines. The scores of the four instruments used are highly concordant, particularly related to the rates of moderate or severe depression which are around 40%. The results indicate close relations between depression and Self-Evaluation (SE). The SET used is sensitive towards depressive symptoms; at the same time it has projective qualities giving information about personality values and motives of dissatisfaction.
The leading motives of personal dissatisfaction, including lower self-evaluation, according to the results of the 2008 study proved to be ill health and financial difficulties. In the 1970’s study they were ill health, financial difficulties and problems in the family. The presence of depression may influence the self-evaluation regarding the ratings chosen. Conversely, the leading self-evaluation motives of personal dissatisfaction may help to understand better the psychosocial sources of depression. In that sense we are reminded of the statements of Martin Roth as well of Felix Post that 85% of late life depressions could be regarded as mostly psychogenic and/or somatogenic [19,20]. Depressive prevalence among Bulgarian rural elderly people in 2008 seemed to be higher and the self-evaluation of these people lower than it was in 1972. The rapid social and economic changes in Bulgaria after 1990 may contribute to some psychogenic increase of the number of depressive states.
Citation: Petrov IC, Coleman PG (2019) Aging and Depression: Studies on Rural Populations in Bulgaria during Communist and Post Communist Period. J Gerontol Geriatr Med 5: 037.
Copyright: © 2019 Ignat C Petrov, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.