Ageing and mental health in a developing country: Who cares? Qualitative studies from Goa, India
Ageing and mental health in a developing country: Who cares? Qualitative studies from Goa, India
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DOI：
10.1017/s0033291799003098
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发表时间：
2001-01-01
影响因子：
6.9
通讯作者：
Prince, M
中科院分区：
文献类型：
--
作者：
Patel, V;Prince, M
背景虽然有越来越多的流行病学证据表明，在发展中国家的晚年精神疾病的患病率，有有限的数据对精神疾病的文化观念和老年人的护理安排。本定性研究采用焦点小组讨论与老年人和关键线人调查老年人的地位和概念的晚年心理健康状况，特别是痴呆症和抑郁症，在印度的果阿。抑郁症和痴呆症的小插曲被广泛认可。然而，这两种情况都不被认为构成健康状况。痴呆症被解释为衰老的正常部分，不被视为需要医疗护理。因此，初级保健医生很少在他们的临床工作中看到这种情况，但社区卫生工作者经常认识到痴呆症患者。抑郁症是一种常见的表现在初级保健，但很少诊断。这两种晚年精神障碍都被归因于虐待、忽视或孩子对父母缺乏爱。有证据表明，对老年人的家庭照顾和支助制度并不像人们所声称的那样可靠。照料往往取决于子女是否希望继承父母的财产。对有抚养需要的人的照顾几乎完全是以家庭为基础的，很少或根本没有正规服务。不出所料，对未来的恐惧，特别是“依赖性焦虑”是常见的老年Goans。需要提高社区和卫生专业人员对晚年精神障碍的认识，并改善患有精神疾病的老年人获得适当医疗保健的机会。该研究为今后发展适合当地的支助服务提出了方向，例如让社区卫生工作者全面参与。
Background. While there is a growing body of epidemiological evidence on the prevalence of mental illnesses in late-life in developing countries, there is limited data on cultural perceptions of mental illnesses and care arrangement for older people.Method. This qualitative study used focus group discussions with older people and key informants to investigate the status of older people and concepts of late-life mental health conditions, particularly dementia and depression, in Goa, India.Results. Vignettes of depression and dementia were widely recognized. However, neither condition was thought to constitute a health condition. Dementia was construed as a normal part of ageing and was not perceived as requiring medical care. Thus, primary health physicians rarely saw this condition in their clinical work, but community health workers frequently recognized individuals with dementia. Depression was a common presentation in primary care, but infrequently diagnosed. Both late-life mental disorders were attributed to abuse, neglect, or lack of love on the part of children towards a parent. There was evidence that the system of family carl and support for older persons was less reliable than has been claimed. Care was often conditional upon the child's expectation of inheriting the parent's property. Care for those with dependency needs was almost entirely family-based with little or no formal services. Unsurprisingly, fear for the future, and in particular 'dependency anxiety' was commonplace among older Goans.Conclusions. There is a need to raise awareness about mental disorders in late-life in the community and among health professionals, and to improve access to appropriate health care for the elderly with mental illness. The study suggests directions for the future development of locally appropriate support services, such as involving the comprehensive network of community health workers.