Depression in the Elderly – reviewed by Kyle W. West

‘Depression in the Elderly’ by Patricia-Luciana Runcan (Cambridge Scholars Publishing, 2013)

0064327_depression-in-the-elderly_300Depression in the Elderly by Patricia-Luciana Runcan addresses the growing problem of clinical depression and its impact upon the lives of elderly Romanians.  Romania is a nation that seems largely under-represented on the stage of global public health, and Runcan’s focus on her native country provides an interesting perspective not found in much of the current literature on depression.  The book endeavors to answer why elderly people are more susceptible to depression, and suggests ways in which mental health care to this often neglected population can be enhanced, such as improved cooperation between psychiatry and social services and more tailored treatment options.

This book is divided into two parts.  Part one thoroughly defines depression (types of depression, risk factors, treatment) in terms that are easily understood, even if the reader has no familiarity with the topic.   The section continues by discussing the ageing processes from a gerontological perspective, and examines the family situations common among elderly people with depression.  Part two outlines Runcan’s research and includes quantitative data, qualitative data, and conclusions and recommendations for changes in both policy and mental health care delivery.

The book reads rather like a doctoral dissertation.  Despite her use of dry language, Runcan is effective in giving the reader some background information concerning depression.  Diagnostic criteria and a short history of depression are followed by a brief explanation of the ‘four classical types of depression – normal, masked, neurotic and psychotic’ (P. 7) and a simpler, two-type classification. Without noting a supporting reference, Runcan states, ‘we may be tempted to believe that depression is a recent malady, a condition that occurred only from the twentieth century…’ (P. 4).  It is unclear why Runcan makes this assertion, but it seems baseless to anyone who has made a serious study of depression.   Runcan then succinctly lists the most common expressions of depression (persistent feelings of sadness, hopelessness, frequent bouts of crying, etc.), and then gets right to the heart of the matter by delving into an in-depth discussion of the risk factors for depression that are unique to the elderly.

The section continues by discussing the causes for increased depression among the elderly.  Runcan notes that retirement, loss of a spouse or friend, poverty, loneliness or institutionalisation are some of the social pressures which often cause repression amongst the elderly, these issues will not likely surprise readers. Several physical causes are also delineated as being linked with depression, such as hormonal changes, genetic predisposition, and the interaction of medicines with the body’s chemistry. Much of the information in this section is applicable to elderly people outside of Romania, but certain aspects of mental health care (institutionalisation in particular) are more prominent in Eastern Europe.

Runcan goes on to give readers an understanding of the ageing process as understood by social gerontology, and explains that the concept of old age is a social construction and affects each individual differently.  She expands upon this by saying, while old age ‘is seen as a state affecting everybody alike, in reality it includes heterogeneous groups of people, some of which consider themselves old, while others consider themselves still young’ (P. 39).  The book then discusses the two conceptions of age: chronological age (how many years have passed since birth), and functional age (a person’s self-perspective based on their state of mind).  The key difference between the two is that chronological age is simply a measure of quantity of life, where functional age is a measure of the quality of life.  This is an undoubtedly important distinction to be made when dealing with an extremely diverse population, such as the elderly.

Examining the demographics of elderly people, Runcan points out that ‘Romanian ageing has its own features’ (P. 48), and then discusses the country’s unquestionably turbulent recent political and socioeconomic history.  She points out how recent political and social changes have affected the elderly, and specifically points to the post-1990s adoption of Western values that she blames for the decentralisation of the family:

‘In modern [Romanian] societies, families and communities have decreased the social importance of old age; moreover, it has become one of the most despised stages of life’ (P. 73).

Despite these mercurial social changes that are occurring in Romania, Runcan points to the value of state and community level social services as a possible avenue to preventing depression in elderly people.  After outlining the various modes of mental health care, she favors the specialized services that provide for people based on their individual needs while allowing the person to retain as much agency as possible.

The second part of the book is purely data-driven.  Starting with the quantitative data, Runcan covers her research design in admirable detail.  Her working hypothesis is based on the psycho-social factors of retirement (and its associated loss of identity and/or social standing), loss of loved ones, poverty, and loneliness.  The research was conducted as a three-armed study.  The three populations were:

  • ‘The depressed’ – 50 people over the age of 55 who were receiving in-patient treatment for depression.
  • ‘The institutionalised’ – 50 people over the age of 55 who were institutionalised at the Home for the Elderly in Timisoara.  Members of this group had not been diagnosed with depression.
  • ‘The non-institutionalised’ – 50 people over the age of 55 who were not institutionalised and had not been diagnosed with depression.

Surveys were passed out among these three groups.  Runcan lists all the pertinent data in both written and graph form.  It is difficult to understand the data represented by the illustrations as the 31 color-coded graphs are printed in grayscale.  However, the data can be found in the accompanying text.  These data represent a wide variety of topics from demographics (age, gender, etc.) to perceptions of poverty and the role of family as a support system, and is more important for painting a credible image of the challenges faced by this diverse, but all-too-often generalised population.  That being said, Runcan did not state why the survey method was selected.  Surveys, while popular when dealing with very large study populations, are by their very nature limited as participants must choose from a preselected set of responses.  For the relatively small number of 150 participants, I firmly believe the semi-structured interview would have been a preferable method of data collection, and would have yielded much more accurate data.

Runcan follows up with the qualitative data, which is more subjective and required extensive use of interviewing.  While Runcan’s inclusion/exclusion criteria allowed for a much larger population of 150 total participants in the quantitative portion of the study, she only interviewed seven elderly women for the qualitative data.  The book goes into considerable detail concerning each of these seven informants.  However, the data would have been greatly augmented by the inclusion of a larger and wider variety of participants.  At no point does Runcan explain the decision to use such a small and homogeneous group.  As a result, the qualitative data is not applicable to the population of elderly people as a whole, but only a very specific subset.

The book closes with Runcan’s recommendations and conclusions.  She admonishes the Romanian mental health and social work systems by stating that, ‘there is no real cooperation between psychiatrists and social workers’ (P185), which is the major public health reform this book advocates.

While the quantitative research appears to be well-designed and highlights key areas for further investigation, the small and homogeneous population used for qualitative data greatly limits the impact of that portion of the study. This book will undoubtedly be an asset to those working with elderly people in Eastern Europe (Romania in particular), but it may not hold much appeal for those outside that sociocultural region.  Every nation has its own unique cultural hurdles, and its own ways of addressing them.  Runcan’s assertion that the westernization of Romania is to blame for robbing elderly Romanians of their former social position as venerated vessels of wisdom is illustrative of the nation’s ongoing struggle to adapt to a world without the Eastern Bloc.  Political shifts have led to cultural shifts and clearly impacted on the delivery of many public services, such as health care.  While her suggestions are no doubt of current value in Romania, they will have less applicability as one moves away from the region geographically, and away from the Eastern Bloc days chronologically.  However, given that Romania does not appear to be as widely represented in psychological literature as the UK, US, and Western Europe, scholars of global mental health and gerontology will no doubt find great value in reading it.

Kyle W. West is a medical anthropologist and research assistant at UT Southwestern Medical Center in Dallas, TX.  He is currently working on a study investigating clinical depression in patients with chronic kidney disease.  He holds two degrees in anthropology (BA, MS) from the University of North Texas.

Correspondence to Kyle W. West

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