Prevalencia y factores de riesgo psicosociales de la depresión en un grupo de adultos mayores en Bogotá / Prevalence and psychosocial risk factors of depression in a group of older adults in Bogota

Introducción: la depresión es una enfermedad de alta prevalencia en adultos mayores. En Colombia su prevalencia se ha descrito entre 1,2 a 12% en mayores que viven en comunidad. Objetivo: estimar la prevalencia de depresión en un muestra de adultos mayores de Bogotá y describir los factores de riesgo psicosocial asociados. Material y métodos: se realizó un estudio de corte transversal observacional-descriptivo, en 889 adultos mayores autónomos. La depresión fue evaluada con el test de depresión geriátrica Yesavage y los factores de riesgo con la sección de acontecimientos vitales del cuestionario Predict. Resultados: el 74% de la muestra estuvo constituida por mujeres, la media de edad fue de 72,51 (DS 9,4) años y la escolaridad promedio en años fue de 7,50 (DS 5,64). Así mismo, se estimó una prevalencia de depresión del 18,6%, siendo mayor en mujeres (20%) y (18%) en sujetos entre 70 y 79 años, los adultos con baja escolaridad sumaron un 43%, y el 22% lo constituyeron personas dependientes económicamente. Por otra parte, se encontró relación entre la depresión y cinco de los factores de riesgo psicosocial conocidos como acontecimientos vitales adversos: insomnio, vivir solo, padecer enfermedades crónicas, haber sufrido una crisis económica, y la muerte de un familiar o amigo cercano en el último año. Conclusión: la prevalencia de depresión en un grupo de personas mayores de la comunidad en Bogotá es más alta que lo descrito previamente en Colombia y por la Organización Mundial de la Salud (OMS). Programas que reduzcan la soledad en la vejez y protejan a la mujer y a los mayores con menos escolaridad podrían mitigar esta condición.

Introduction: depression is one of the most prevalent diseases in the elderly. In Colombia, the prevalence of depression in this population ranges from 1,2 to 12%. Objective: to estimate the prevalence of depression in a group of independent elderly subjects in Bogota and describe the psychosocial risk factors associated with it. Material and methods: a cross-observational and descriptive study was done. The sample was constituted of 889 autonomous elderly subjects of Bogota city. Depression was assessed by applying the Test of Geriatric Depression-Yesavage-. Besides, the psychosocial risk factors were measured through the life events section, which is part of the Predict Questionnaire. Results: 74% of the sample was made up of women, the mean age was 72,51 years old (DS.9,4) and the average of education was of 7.50 years (DS.5,64). Besides, it was found a prevalence of depression of 18,6%. This prevalence was higher in the women (20%) and elderly between 70 and 79 years old (18%), adults with low education with 43% or 22% in economically dependent people. A relationship between depression and five psychosocial risk factors, known as adverse life events-insomnia, living alone, suffering a chronic disease or economic crisis or the death of the couple, a close friend or a relative. Conclusion: results showed a higher prevalence of depression in this sample in comparison to the findings yielded in previous studies developed in Colombia and the WHO. Programs that help to reduce the long lines protect women and older with less schooling ageing could mitigate the condition.

Puntuaciones del MoCA y el MMSE en pacientes con deterioro cognitivo leve y demencia en una clínica de memoria en Bogotá / MoCA and MMSE scores in patients with mild cognitive impairment and dementia in a memory clinic in Bogotá

Introducción. Diferentes pruebas neuropsicológicas permiten explorar las funciones cognitivas del adulto mayor, en un tiempo corto. En Colombia se dispone de pocos estudios sobre puntuaciones y puntos de corte para el MMSE y para el MoCA en relación al diagnóstico de deterioro cognitivo. Objetivo. Describir la distribución de las puntuaciones del MMSE y el MoCA y los puntos de corte con mejor discriminación, para el diagnóstico de deterioro cognitivo leve y demencia, en una muestra de pacientes de Bogotá. Material y métodos. Se evaluaron 248 pacientes por un equipo multidisciplinario, que consultaron a la Clínica de Memoria del HIUSJ entre 2009-2012, siguiendo un protocolo establecido. Se identificaron las puntuaciones del MoCA y MMSE, que permitieron obtener el mayor porcentaje de pacientes correctamente clasificados. Resultados. En el 70% de los pacientes con DCL y en el 69 % de los sujetos normales, se encontraron puntuaciones del MMSE inferiores o iguales a 28. En 91% de pacientes con DCL y 84% de los sujetos normales, se presentaron puntuaciones del MoCA inferiores o iguales a 25. Los pacientes con cualquier tipo de demencia, presentaron puntuaciones del MMSE inferiores o iguales a 27 e inferiores o iguales a 24 en el MoCA. Conclusión. Según el presente estudio, el tamizaje de funciones cognitivas, utilizando el MoCA, clasifica de manera más acertada que el MMSE, a los sujetos con deterioro cognitivo. Creemos que en atención primaria, estos puntos de corte del MoCA, pueden ser considerados por ahora, cuando se trate especialmente de sujetos con alta escolaridad.

Introduction. Some cognitive tests allow the evaluation of cognitive functions on the elderly in a short period of time. There are few studies in Colombia about cut-off point for the MMSE and the MoCA test. Objectives. To describe the distribution on scores on MMSE and MoCA test and the cut-off point with a better discrimination criteria for the diagnosis of mild cognitive impairment and dementia, in a sample of patients from Bogotá. Materials and methods. Two hundred forty eight patients were included in this study, being evaluated by a multidisciplinary team that followed an established protocol, on patients who attended to the Memory Clinic of HIUSJ between 2009-2012. MoCA test and MMSE scores that allow higher percentages of correctly classified patients were identified. Results. Seventy percent of patients with mild cognitive impairment and 69% of normal individuals had scores on MMSE below or equal to 28. Ninety-one percent of patients with MCI and 89% of normal patients, had scores below or equal to 25. Patients with any type of dementia had scores on MMSE below or equal to 27 and below or equal to 24 in MoCA test. Conclusion. According to the study, the screening of cognitive functions, using MoCA test, is more accurate than MMSE in patients with cognitive decline. The cut-off points, identified in our study, can be considered useful until now in primary attention, in patients with a high level of education.

Is the secure base phenomenon evident here, there, and anywhere? A cross-cultural study of child behavior and experts' definitions.

The evolutionary rationale offered by Bowlby implies that secure base relationships are common in child-caregiver dyads and thus, child secure behavior observable across diverse social contexts and cultures. This study offers a test of the universality hypothesis. Trained observers in nine countries used the Attachment Q-set to describe the organization of children's behavior in naturalistic settings. Children (N = 547) were 10-72 months old. Child development experts (N = 81) from all countries provided definitions of optimal child secure base use. Findings indicate that children from all countries use their mother as a secure base. Children's organization of secure base behavior was modestly related to each other both within and across countries. Experts' descriptions of the optimally attached child were highly similar across cultures.

Through Colombian lenses: ethnographic and conventional analyses of maternal care and their associations with secure base behavior.

According to attachment theory, the quality of care plays a key role in the organization of infants' secure base behavior across contexts and cultures. Yet information about attachment relationships in a variety of cultures is scarce, and questions remain as to whether Ainsworth's conceptualization of early care quality (sensitivity; M. D. S. Ainsworth, M. C. Blehar, E. Waters, & S. Wall, 1978) is appropriate for characterizing caregiving behavior in different groups and whether culturally specific descriptions of early care are related to conventional measures of maternal sensitivity and to infants' security. In this naturalistic study of mother-infant interactions in Colombia, scores on different domains of maternal care were obtained through ethnographic methodology, and conventional Q-sort scores for maternal and infant behavior were obtained. Findings are discussed in terms of the cross-cultural generality of the sensitivity construct and the sensitivity-security link and of the relevance of naturalistic open-ended studies in different contexts.