Harnessing

4.6.1 Socio-demographic Questionnaire

The socio-demographic parameters of the selected subjects such as age, sex, marital status, level of education, employment status, occupation (previous occupation if retired), religion, and length of stay at the address was obtained using a 33-item questionnaire designed by the candidate. Previous occupation was coded according to the highest status job held using the Classification of Occupational Groups by Boroffka & Olatawura²⁰⁹.

The questionnaire also assessed the following: average monthly income, the source of income, present living situation, availability of a caregiver, relationship with children, bereavement in the past six months, frequency of involvement with religious activities and involvement with friends or other organization in the community. These questions ascertained the level of social support available to the subjects.

4.6.2 The Geriatric Depression Scale (GDS)

This is a self-report screening instrument for depressive disorders in the geriatric population. The GDS is a 30-item scale developed specifically for use in elderly populations⁹⁸. It has been used extensively in the United States²¹⁰ as well as in other countries²¹¹. This instrument has been used in Nigeria by many reseachers^4,58. It has been validated and used for screening of depression among the elderly in both primary health care setting and in the community⁴. The GDS Long Form is a brief, 30-item questionnaire in which participants are asked to respond by answering yes or no in reference to how they felt over the past week. A Short Form GDS consisting of 15 questions was developed in 1986. Questions from the Long Form GDS which had the highest correlation with depressive symptoms in validation studies were selected for the short version. The Short Form is more easily used by physically ill and mildly to moderately demented patients who have short attention spans and/or feel easily fatigued. It takes about 5 to 7 minutes to complete. In a validation study comparing the Long and Short Forms of the GDS for self-rating of symptoms of depression, both were successful in differentiating depressed from non-depressed adults with a high correlation (r = .84, p < .001)²¹².

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The GDS was found to have 92% sensitivity and 89% specificity when evaluated against diagnostic criteria;

however a sensitivity of 84% and specificity of 95% has been documented in Nigeria for a cut-off point 11/12⁴. In this study the 30-item version of the GDS was administered by the interviewer to the subjects due to high level of illiteracy in the community. Similar method was used by Sokoya & Baiyewu⁴ and Baiyewu et al⁵⁸.

4.6.3 Mini International Neuropsychiatric Interview (M.I.N.I) 4.6.3.1 Depression module:

The M.I.N.I is a short structured diagnostic interview developed in 1990 for DSM-IV and ICD-10 psychiatric disorders. The aim is to assist in the assessment and tracking of patients with greater efficiency and accuracy. It is a tool that facilitates accurate data collection. It has acceptably high validation and reliability scores when compared with other structured diagnostic interview schedules, but can be administered in a much shorter period of time. It can be used by clinicians, after a brief training session. Lay interviewers require more extensive training. With an administration time of approximately 15minutes and to keep the interview as brief as possible, patients are informed that a more structured interview requiring precise answers of yes or no will be asked.

The M.I.N.I is divided into modules identified by letters each corresponding to a diagnostic category. At the beginning of each diagnostic module (except for psychotic disorders module) screening question(s) corresponding to the main criteria of the disorder are asked. At the end of each module, diagnostic box(es) permit the clinician to indicate whether diagnostic criteria are met. Each module assesses for a diagnostic category. Major Depressive Episode module of MINI which is grouped as ‘A module’ has six sections A1 to A6. In this study questions A1 to A3 were used since the study assesses major depressive episode (current).

4.6.3.2 Suicidality module:

The suicidality module of this instrument which is grouped as ‘C Module’ was used to assess for suicidality in the participants. There are nine questions in this module labelled C1 to C9. Questions C1 to C8 assess events in the past one month while question C9 assess for suicide attempt in a patient’s lifetime. This module assessed suicidal behaviour which included suicidal intent, plan and attempt. Scores were graded as low, medium or high.

165 4.6.4 Modified Mini Mental State Examination (mMMSE)

Cognitive impairment was assessed using modified Mini Mental State Examination (mMMSE)²¹³ tool. In older subjects, cognitive functioning is likely to decline especially during illness or injury. The standard Mini Mental State Examination (MMSE)²¹⁴ is a tool that can systematically and thoroughly assess mental status. It is a 20-question measure that tests five areas of cognitive functions: orientation, registration, attention and calculation, recall and language. The maximum score is 30 and a score of 23 or lower is indicative of cognitive impairment. It takes about 5-10 minutes to administer and is therefore practical to use repeatedly and routinely. The instrument relies heavily on verbal response, reading and writing. The mMMSE was designed to cater for the low level of literacy in our environment especially among the elderly²¹³. It is similar to the original tool except that the items used are those that the subjects are most likely to be more familiar with and it involves no reading or writing. The measures, content, assessment and administration are about the same.

The mMMSE is effective as a screening tool for cognitive impairment with older community dwelling, hospitalized and institutionalized adults. It can be used as a screening instrument in separating patients with cognitive impairment from those without it. In addition, when used repeatedly the instrument is able to measure changes in cognitive status that may benefit from intervention. The mMMSE has been validated and extensively used in both clinical practice and research²¹³.

4.6.5 WHOQoL-100/WHOQoL-BREF

In 1991, the World Health Organization (WHO) began a project to define and create a measure for quality of life that would be applicable cross-culturally. This effort led to the production of two instruments for the assessment of Health Related Quality of life (HRQoL) namely: WHOQoL-100 and WHOQoL-BREF, the latter derives from the former.

The World Health Organization Quality of Life (WHOQoL) assessment instruments bear some similarities to life satisfaction scales. It differs from these however in that it carefully defines 24 facets of life which it then explored, determining the subject’s satisfaction (or lack of it) for each²¹⁵. These instruments set out to be purely subjective evaluation, assessing perceived QoL²⁹ and in this way differ from many other instruments used to assess QoL such

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as the MOS SF-36¹⁹⁰, the Nottingham Health Profile scale¹⁸⁹ and QoL enjoyment and satisfaction questionnaire²⁰³ which contain a mixture of both subjective and objective questions.

The World Health Organization Quality of Life Assessment (100-item version) (WHOQoL-100) is a comprehensive multidimensional, multilingual profile for subjective assessment. Following field testing in 15 centres, 100 items were selected for inclusion in the WHOQoL-100 Field Trial Version. These included four items for each of 24 facets of quality of life and four items relating to ‘overall quality of life and general health facet’. In certain instances however, the WHOQoL-100 may be too lengthy for practical use. The WHOQoL-BREF Field Trial Version was therefore developed to provide a shorter version.

The WHOQoL-BREF contains a total of 26 questions. It is a self-reported measure with 2 general questions (on overall quality of life and general health) and 24 specific questions assessing four QoL domains: Physical (7 items), Psychological (6 items), Social Relationships (3 items), and Environment (8 items). All items are rated on a 5-point scale with a higher score indicating a higher QoL. Four domain scores were derived which denote an individual’s perception of quality of life in each particular domain. Domain scores were scaled in a positive direction (i.e higher scores denote higher quality of life). The mean score of items within each domain was used to calculate the domain score. Questions 3, 4 and 26 were reverse-scored in their respective domains. The raw scores derived from the domain scores were later converted to transformed scores.