ADULTS’ SERVICES SYSTEMATIC MAP REPORT 03
DECEMBER 2008
The extent and impact of depression on
BME older people and the acceptability,
accessibility and effectiveness of social
care provision
SM2
The extent and impact of depression on BME
older people and the acceptability, accessibility
and effectiveness of social care provision
All SCIE publications and resources are free.
Systematc Map Report 03
The extent and mpact of depresson on BME
older people and the acceptablty, accessblty
and effectveness of socal care provson
Frst publshed n Great Brtan n December 2008 by the Socal Care Insttute for Excellence
© SCIE 2008 All rghts reserved
Wrtten by Nadra Sharf, Walt Brown and Deborah Rutter
This report is available online www.scie.org.uk
Socal Care Insttute for Excellence Goldngs House
Acknowledgements v
Contacts v
Introducton 1
Ams 2
Background 3
Method 4
Results 8
Report types 9
Lmtatons 15
Gaps n research 16
Implcatons of the map 17
What the map s beng used for 18
References 19
Appendx 1: Defntons of key map terms 21
Appendx 2: Incluson/excluson crtera 23
Appendx 3: Search strategy 24
Appendx 4: Keywordng tools 67
Acknowledgements
Thanks to Jll Manthorpe, Jo Morarty, Martn Stevens, Shereen Hussen and Jess Harrs from the Socal Care Workforce Research Unt for ther valuable nput.
Thanks also to the followng people for nput on search terms and map questons:
Caron Sanders-Crook, ndependent consultant Valma James, Lambeth Socal Servces
Mchele Lee and Stephen Lowe, Age Concern
Nana Patel and Vkrant Bhata, Polcy Research Insttute for Ageng and Ethncty Nat Levesley, Centre for Polcy on Ageng
Contacts
For further detals about the project topc contact: Nadra Sharf [email protected]
Introduction
Aims
Ths s a report of SCIE’s thrd systematc map whch focuses on depresson n older people from black and mnorty ethnc (BME) communtes and contans the man fndngs of sgnfcance. The topc has been chosen because t s an area that has been neglected n wder polcy and practce debates. The map questons were:
• What s the extent and mpact of depresson n older people from BME communtes n the UK?
• Are there barrers to recognton of depresson for these groups?
• What socal care provson s avalable for BME older people wth depresson? Is ths provson acceptable, accessble and effectve and does t promote well-beng?
These are sgnfcant questons n an envronment where the wder older communty as well as BME older people have generally been excluded from manstream mental health strateges and receve nequtable servce provson n comparson wth adults under the age of 65. Ths problem s further exacerbated by the fact that government polces and ntatves relatng to BME older people have tradtonally focused on targetng physcal llness such as dabetes, heart dsease and stroke, whlst largely gnorng mental health condtons such as depresson.
Ths systematc map ncludes research on the experence of depresson n varous BME older populatons and the use of servces n the UK. In partcular, t provdes an overvew of and access to research on:
• the man ethnc groups assessed for depresson
• the factors assocated wth the ncdence of depresson
• the languages used by dfferent BME communtes to descrbe depresson, and the meanngs attached to depressve symptoms
• the screenng tools for depresson used by healthcare and other professonals
• some types of nterventons avalable to older BME people.
Despte the coverage of broad ssues on depresson n BME older people, the map hghlghts consderable gaps partcularly around the ssue of socal care provson.
The systematc map s avalable onlne as a searchable database of ctatons:
http://epp.oe.ac.uk/webdatabases
Background
Most older people have good mental health, but they are prone to rsk factors for later lfe depresson: ncludng physcal dsablty, llness, and cogntve mparment and ts effects on daly functonng; as well as socal solaton and lonelness, whch may be assocated wth bereavement; poverty; relocaton; and carng dutes.1,2
Despte beng the most common mental health condton n older people,3 depresson
s often dsmssed as a normal part of the ageng process.
The two most mportant barrers to the effectve management of depresson are under-detecton and undertreatment.4 Compared wth older people lvng n
communty settngs, the prevalence of depresson s sgnfcantly hgher n older resdents (of unspecfed ethncty) lvng n care homes, wth around 40 per cent sufferng from clncal depresson5. One thrd of older people recevng home care
servces are depressed, but only a few receve any nterventon or treatment6.
Depresson affects well-beng, daly functonng and mortalty7 and s a leadng
rsk factor for sucde among older people.8 Improvng detecton and treatment s
therefore an essental element of mprovng well-beng among older people.
Depresson n BME communtes s poorly understood and recognsed by health and socal care professonals and the potental for treatment or other nterventon to make mprovements s therefore not made avalable to those who mght beneft. Economc and socal factors ncludng the experence of mgraton, loss of contact wth the extended famly, poverty, poor housng, and nadequate access to transport9
are common experences among some BME older people and these may ncrease the lkelhood of depresson wthn these communtes. Access to approprate treatment may be mpeded by several factors ncludng: the somatzaton of symptoms by the older person whch make dagnoss problematc; the older person’s lack of knowledge about avalable health and socal care servces; reluctance to seek professonal help because of socal stgma; dscrmnaton wthn servces; and the use of culturally napproprate dagnostc tools and nterventons. Wth the expected growth n numbers and proporton of the BME older populaton10, the polcy and practce
Method
Systematc maps requre a rgorous and transparent methodology and consderable resources. Fgure 1 provdes an overvew of the process. For complete wrtten detals of the stages of producng a systematc map, please see a prevous SCIE publcaton at:
http://www.sce.org.uk/publcatons/map/map01.pdf
A partnershp model of workng has been employed n ths map. The Socal Care Workforce Research Unt collaborated wth SCIE at crtcal stages ncludng developng the map questons, undertakng defntonal work, developng keywords, codng papers and revewng ths document. These functons have undergone the most rgorous of qualty assurance procedures, whch s an essental element of any mappng work.
Fgure 1 opposte provdes an overvew of the process.
Definitions
In ths map, the key terms: ‘depresson’, ‘black and mnorty ethnc’, ‘older people’ and ‘socal care’ are defned n Appendx 1. It was vtal to have consensus defntons for these key terms so that the subject area was descrbed and understood consstently by people developng the map. The mportance of defntonal work cannot be overemphassed and t s the crtcal frst step before embarkng on any map. It has mplcatons for the varous stages of the mappng process ncludng decdng on the depth and breadth of the map queston, runnng approprate database searches that nclude relevant search terms, screenng papers for excluson, and codng papers selected for ncluson n the map. Clear defntons therefore helped to allevate ambguty and mprove the rgour of the map.
The defntons employed n ths map are by no means absolute as defntons may change over tme and depend on the context and ntended purpose. For example, the term depresson may be used very dfferently wthn a lay, socal care or clncal context.
Inclusion and exclusion criteria
The PICOS structure (partcpants, nterventons, comparsons, outcomes, study type) was used as a framework to devse the ncluson and excluson crtera.
Adapted from Coren et al (2006)11
Figure 1: Stages of mapping
2. METHODS DEVELOPMENT Developing inclusion criteria and
search strategy
3. INFORMATION RETRIEVAL/ MANAGEMENT
•Developing software filters for records
• Saving results to EPPI- Reviewer •Quality checks
1. AGREE MAP QUESTION
5. RETRIEVAL OF PAPERS 4. SCREENING (1) TITLES/ABSTRACTS
•Quality checks
6. SCREENING (2) FULL PAPER
•Quality checks
7. KEYWORDING/CODING PAPERS ONLINE
• Development of coding tools
•Quality control
• Debriefing
8. SEARCHABLE DATASET
• Data cleaning
•Upload of records
•Analysis of records
However, the searches of health databases (Medlne, Cnahl, Embase) retaned socal care as a search term, so as to exclude the many papers whch concerned treatment n psychatrc medcal facltes.
Papers dentfyng sucdes by ethnc background were ncluded because of the lkelhood of assocaton between sucde and depresson. Papers on well-beng and qualty of lfe ssues for older people from BME backgrounds were also ncluded because they can tell us about avodng or managng depresson.
The ncluson and excluson crtera used to select studes are lsted n full n Appendx 2.
Search strategy
The search strategy used a mxture of free text and ndex terms. Index terms are keywords that a database provder assgns to a resource. Free text terms are words or phrases used to supplement the ndex terms. Index terms were developed by explorng related search terms or keywords n consultaton wth the Socal Care Workforce Research Unt and project steerng group.
Research was dentfed from:
• bblographc databases – AgeInfo, ASSIA, Campbell Collaboraton, CINAHL, Cochrane Lbrary, EMBASE, Internatonal Bblography of the Socal Scences, MEDLINE, PsychINFO, ReFeR, Socal Care Onlne, Socal Servces Abstracts, Socal Work Abstracts, Socologcal Abstracts, Wlson Socal Scence Abstracts, Zetoc
• webstes – DH, INVOLVE, Joseph Rowntree Foundaton, Natonal Insttute for Mental Health
• research project databases
• portals and resource collectons
• journals
• searchng on key authors and harvestng reference lsts from key documents
• personal contacts
• drect requests to key nformants.
The search strategy (see Appendx 3) was devsed usng search terms for the followng:
• depresson
• black and mnorty ethnc groups
• older people
• socal care provson.
Where databases allowed, searches were restrcted to publcaton dates between 1990 and 2007. The NHS and Communty Care Act (1990) n England and Wales rased expectatons that local authortes would have an explct role n assessng people for socal care and set n place a requrement to publsh Communty Care Plans outlnng the development of communty-based servces. The Department of Health polcy document underlyng the Act, Caring for People (1989)12, had earler
dentfed BME communtes as havng partcular care needs.
Keywording (coding)
Keywordng tools were used to code and organse the map records. Each study was keyworded aganst three sets of tools (see Appendx 4). The frst s a core keywording tool for socal care13 developed for use wth all maps produced at SCIE that focused
on study desgn, language, country, focus, populaton and so on. The second tool s a map specific tool14 and dentfes keywords on topc-specfc areas relevant to
the questons set for ths map, such as: factors assocated wth depresson; standard measures for depresson; nterventon types; and access to nterventons. Ths tool underwent extensve plotng followng each amendment pror to ts use. Thrdly, a
quality of reporting tool was used to capture the qualty of the reportng of studes ncluded n the map. 15
All ncluded papers were double coded, whch essentally means that pars of coders workng ndependently coded the same set of papers. The whole keywordng process was subject to a strct qualty assurance procedure whch nvolved scrutny of each other’s work wth an external person cross-checkng a sample of ths work. Codng nevtably requres judgements whch are not necessarly clear cut, and t s therefore mperatve that the process of scrutny s bult n from an early stage and appled ntermttently after varous batches of codng. Ths allows for correctons to be made early on n the process through dalogue and rethnkng about applcaton of codes and ensures greater consstency between all coders. In the early stages, where codng among raters was felt to be nconsstent, codng tools were revsed n the lght of further dscusson between partcpants, and papers already coded were recoded to reflect the new gudance.
Results
[image:15.595.125.501.180.726.2]From an ntal 3,038 unque records dentfed, 60 coded reports have been ncluded n the map. The process of selecton of these s presented n Fgure 2, adapted from EPPI-Centre (2004).16
Figure 2: Flow of literature
Records within the map Excluded papers Studies meeting inclusion and mapped n=60 Papers excluded: Total n=568
Reason for exclusion*: Papers excluded: Total n=1,716
Reason for exclusion*:
Location (not UK) n=1,524 (+9) ***
Study design (not research) n=61 Population (not BME) n=12 (+5) ***
Depression (not) n=32 (+14) ***
Population (not older people) n=55 (+1) ***
Date n=30
Publication availability n=0
Papers excluded: Total n=110
Reason for exclusion*: Abstracts and title screened n=2,413 Identification of records n=3,038 Full text screening n=697+41**= 738 Keywording and QA n=170 Duplicates removed n=625
Location (not UK) n=395 Study design (not research) n=40 Population (not BME) n=72 Depression (not) n=11 Population (not older people) n=4 ***
Books n=22
Publication availability n=8 Language (not English) n=2 ReFeR records** n=14
Location (not UK) n=5 Study design (not research) n=19 Population (BME) n=49 (+4) ***
Depression (not) n=28 (+1) ***
Report types
The majorty of studes (43) were about exploraton of relatonshps or correlatons between dfferent factors. 92% of the papers were journal artcles. There were no evaluatons of the effectveness of socal care nterventons.
Focus
All 60 studes ncluded n the map were focused on depresson, mpled depresson or mantanng mental health. Over half the studes had been undertaken n urban locatons such as London and Bradford. Ths may reflect the dstrbuton and settlement of people from BME communtes. Nne papers ether dd not report or dd not make clear where the studes were based.
Country of origin
At the ntal screenng of abstracts and ttles, from a total of 2413 papers screened, 63% of papers were removed because the studes were not located n the UK. At full text screenng stage a further 54% were excluded on locaton. All papers were publshed n the Englsh language.
Population
All 60 studes made some reference to older people from black and mnorty ethnc groups wth depresson. In some cases they were almost ncdentally ncluded as they were not the subject of the paper. These studes are dsplayed n Fgure 3 below.
[image:16.595.105.528.477.694.2]Half of the studes ncluded Carbbean older people. The second largest ethnc mnorty group represented was Indan studes (26); followed by 24 from any other Asan background (ncludng Sr Lankan, East Afrcan/Carbbean Asan); 23 Pakstan; and 16 studes whch ncluded Bangladesh people. 29 studes ncluded Whte Brtsh
Figure 3: Number of studies that refer to each ethnic group
17 24
4 4
3 14
16 30
9 26
19
23 29
10
0 5 10 15 20 25 30 35
samples although ther ncluson does not necessarly always mply that these were comparson studes. Included n an ‘Any other whte’ category were people of Polsh, Greek and Spansh natonalty, mentoned brefly n some papers. Notably, specfc references to refugees and asylum seekers, and people of Roma and Traveller orgn, were absent from the map lterature, although t s lkely that some of the older people were refugees, for example, those of Indan background from East Afrca or some Jewsh older people.
As defned wthn the ncluson crtera, the majorty of studes focused on adults aged 55 upwards but a sgnfcant proporton, a thrd, dd not report a specfc age range for the populaton sample and were assumed to nclude them, or reported an age range whch ncluded people over 55. Only 12 from the 60 ncluded studes descrbed the relgon of the populaton sample whlst 14 studes dscussed mgraton.
Extent of depression
Some of the lterature was coded (see map-specfc codng tool) to hghlght materal whch descrbed the extent of depresson at the pont of a census n partcular, usually local, BME older communtes, or a census of populatons of users of mental health or prmary care servces by ethncty. However, ths nformaton was not clearly reported n all the studes, and t s therefore dffcult n most papers to consder whether BME older people are overrepresented n the populaton sufferng from depresson. A summary of the papers dealng wth ths ssue s presented below.
Less than half (24) of the studes descrbed the extent of depresson or mood dsorders n a populaton. The man older populatons ncluded wthn studes were Whte Brtsh, Indan, Pakstan, Bangladesh, Carrbean and people from other Asan backgrounds. There were very few papers whch reported on Chnese and Irsh older people. None of the studes attempted to gauge and compare levels of depresson n older people from a large populaton sample, whch mght represent a gude to natonal or regonal polcy and provson.
Factors that the studies associate with depression
Identification of depression
Interestngly, nearly half of the 60 studes dd not dscuss how or where depresson was dentfed or recognsed n the populaton sample. Where dentfcaton was mentoned n a study (19 studes), ths was manly through the research tself, where, for nstance, a communty sample were not attendng a mental health servce
but were assessed for depresson by the researchers undertakng the study. Those studes whch descrbed people attendng a servce dd not clarfy how and where depresson was dentfed and how people were referred to the servce. Three studes mentoned depresson beng recognsed wthn a prmary care settng, but none cted dentfcaton of depresson by socal care staff.
Assessment tools
Assessment tools for depresson are an mportant part of the process through whch decsons about access to treatment or care are based.
The lterature n the map on ths ssue s sparse, however, wth an overwhelmng majorty (78%) of papers not makng any reference to tools – whether standard or adapted. Ten papers descrbed the use of standard tools such as the Geratrc Depresson Scale or Mn Mental State Examnaton. Only eght studes descrbed the use or valdaton of adapted measures for use among BME older people. For nstance, Bhatnagar and Frank’s study17 explored the prevalence of psychologcal dsorders n
older South Asans lvng n Bradford through the use of the Hnd translaton of the communty verson of the Geratrc Mental State schedule (GMS-A). Despte beng a relable dagnostc tool, t has lmtatons for South Asans whose frst language s not Hnd.
[image:18.595.128.542.82.311.2]Culturally specfc language s an mportant factor to consder where, despte broad parallels n the expresson of depresson across cultures, there are also dfferences n the expresson of symptoms. Only fve studes focused on ths ssue. Abas et al18
Figure 4: Factors that the studies associate with depression
23 7
2
6 4
7 8 3
0 5 10 15 20 25
Other Gender Employment status Income or socio-economic group Migration history Physical health issues/disability
descrbed the development of a new culture-specfc screen for emotonal dstress n the older Carbbean communty. Ths was based on dentfyng over 100 culturally specfc doms for depresson through varous approaches ncludng sem-structured ntervews wth ‘non-psychatrcally traned carers’ (such as practce nurses and church mnsters) of older black Carbbeans and wth older people dentfed by those workers as emotonally dstressed. Intal valdty testng showed the tool to perform qute well, but ts wder applcaton to older people from other Carbbean slands s questonable gven that the termnology was based on that of Jamacan orgn.
The map would suggest that there has been very lttle development of culturally approprate dagnostc tools. Ths may partly explan why detecton and treatment of depresson amongst BME older people s stll a challenge. Furthermore, t should be acknowledged that the successful use of such tools would depend on mplementaton by staff traned to ‘translate’ cultural concepts nto dagnostc crtera.
Interventions
Papers where nterventons were mentoned n any context were coded nto two areas: frstly, the type of servce sector n terms of whether ths was the responsblty of health or socal care; and secondly, detals of the specfc type of servce provded. A lack of clear reportng n papers meant that codng nterventons was often dffcult.
[image:19.595.142.538.416.650.2]In terms of type of servce sector mentoned n papers (see Fgure 5), 30 studes dd not feature any specfc servce. Sgnfcantly 16 papers of the remanng 30 papers descrbed servces that were provded entrely by the health sector; seven studes Figure 5: Service sector referred to in papers
2
30 7
16 1
4
0 5 10 15 20 25 30 35
Other No specific service specified Provided mainly by statutory health services with some social care input Provided entirely by statutory health
servces; and about the ablty of socal care provders to dentfy and manage depresson. Sx studes were coded as ‘other’ or ‘unclear who provdes’ so t was dffcult to determne whether the nterventon was health or socal care based.
There were no papers descrbng servces delvered solely by, or n partnershp wth, the ndependent sector.
As regards the type of servce provded (see fgure above), the most frequently mentoned type of servce provded was by a GP or other prmary care servce, referred to n 15 papers. Some of these papers were exploratons of the ncdence of depresson n a prmary care populaton, dentfyng ethncty of servce
users, and none descrbed the management of depresson. Four papers referred to psychogeratrc servces. The almost complete absence of descrptons of management of depresson n ths populaton by communty mental health teams s notable: ths was only mentoned n one paper. Smlarly, psychologcal therapes have only been mentoned once and ths may be because, despte beng more popular wth older people than among other treatments, they are often reserved for more complex mental health problems. Seven papers were coded under the ‘other/more than one servce’ category as reportng was too vague to determne the nature of nterventons.
Accessibility, acceptability and effectiveness issues
[image:20.595.124.536.218.432.2]Although the papers demonstrate some awareness of factors that hnder access to servces for BME communtes, ths has not been reflected approprately n the map lterature. Both accessblty and acceptablty ssues were rased n only 18 of the 60 papers but not dscussed n any explct detal. Only three studes ponted out the presence or absence of pror contact wth mental health servces among BME older
Figure 6: Type of service provision referred to in papers
2
15 1
7 4
1 1
0 2 4 6 8 10 12 14 16
people consdered lkely to be depressed because they subsequently commtted sucde. Smlarly, effectveness of both general and specfc servces s mentoned superfcally n four papers, but the map contaned no effectveness studes.
Evaluatons of servces for BME older people wth depresson s an area where there appears to be a huge gap n the lterature.
Limitations
• Ths project has mapped and categorsed the research lterature n the feld. Full qualty assurance of the lterature (full assessment of methodologcal qualty) and data extracton has not taken place because ths s not part of systematc mappng methodology.
• The map s based on publshed research lterature and therefore does not reflect practce that has not been evaluated and publshed. Gaps n the map may reflect a lack of evaluaton, a real gap n practce provson, and/or specfc gaps n the publshed evdence base.
• A decson was made to nclude only drectly relevant descrptve or emprcal studes that were UK based and publshed n Englsh. General dscusson papers, polcy papers, commentares, theoretcal and conceptual papers were excluded from the map.
• Rgorous efforts were made to ensure a hgh standard of codng by employng two coders to code each study followed by qualty assurance of a proporton of these studes. Despte ths, users of the map should be aware that codng s open to ndvdual nterpretaton due to the nature of the subject materal.
• There were some lmtatons to codng the lterature because of the reportng qualty of the studes. Age, extent and factors assocated wth depresson were not always clearly reported. Smlarly, the servce sector or type of servce provded was not always clarfed.
• Search terms were matched to avalable ndex terms n the databases. Terms n the databases are controlled and ths lmts the range of terms that can be used. Search strngs for each database are thus unque.
• The search strngs were desgned to be comprehensve and senstve. Senstvty s ensured by usng search terms that return resources related to the topc. Ths strategy was chosen over a specfc search strategy that returns resources only f they are exactly on topc. Resources that were relevant but napproprately ndexed by the database provders may not have been returned by ths search strategy.
• Books and polcy papers were excluded from ths map due to resource constrants n terms of codng.
• There were lmtatons n accessng grey lterature. The Brtsh Lbrary no longer updates SIGLE (System for Informaton on Grey Lterature n Europe). Tme and resources dd not allow for a full search of the grey lterature.
• The studes were lmted to UK only and lmted to Englsh-only studes, and therefore do not represent an nternatonally comprehensve collecton of lterature on BME older people wth depresson.
• Ths map only ncluded studes that were publshed n, or after, 1990.
• The map does not provde comprehensve coverage of the medcal lterature on detecton. Ths s a result of the socal care facet beng appended to searches of medcal databases. Ths was done to refne the search results so that only resources that have socal care content were returned
Gaps in the reserch
• The lterature does not adequately descrbe the detecton, prevalence and management of depresson n black and mnorty ethnc older people n the UK.
• The most common ethnc groups descrbed n the map are Indan, Bangladesh, Pakstan and Carbbean but sample szes are often small. These are usually comparson studes wth no real n-depth analyss of the experence of any one partcular group.
• The experence of Chnese and Afrcan (especally recently arrved such as Somal) communtes have not been nvestgated extensvely by the map studes.
• Generally there s poor reportng of mportant dfferences between ethnc groups, for example, South Asan people are commonly aggregated; and whte ndgenous populatons are mentoned wthout any detal of the composton of ths group.
• Much of the research s small scale and localsed. Whlst broad conclusons can be drawn, t would not be approprate to generalse (lmted) fndngs to smlar communtes n other areas.
• Despte an attempt to dentfy lterature concernng socal care nterventons and clent groups, the map lterature s domnated by papers dervng from medcal lterature, and from the medcal model of depresson.
• Publshed materal on accessblty, acceptablty and effectveness of both health and socal care provson s lackng and appear to be under-nvestgated n the body of research dentfed n ths map.
• It has often been dffcult to ascertan whether servces are commssoned, funded, or organsed from the health or socal care sector as these detals have been poorly reported.
• Where studes menton servces, there s lttle detal on the referral system, access to and effectveness of servces.
• There s a complete lack of studes descrbng servces that are culturally specfc for BME older people.
• Effectveness of general or specfc servces for BME older people has not been the subject of any thorough nvestgaton n any of the studes n the map.
• There appears to be a general lack of robust UK evaluaton of whch generc, and whch specfcally targeted, servces work best for older people wth depresson and other mental health needs.
• Wth the rse n the numbers of older people, research nto economc outcomes and fnancal mplcatons of socal care servces addressng depresson n older people of dfferent ethnc backgrounds s needed.
• More accurate nformaton s needed on dagnoss and extent of depresson, the use of culturally approprate dagnostc tools, types and outcomes of treatment.
• Despte the fact that depresson s common n care homes, hosptals and
domclary settngs, there s no evdence n the map of exstng studes consderng the dentfcaton, management and treatment of depresson n these contexts.
• There appears to be very lttle research generated by servce users n ths area.
Implications of the map
• The map offers an overvew of the research lterature on the experence of depresson n BME older communtes lvng n the UK but hghlghts sgnfcant gaps.
• The map s based towards a medcal model of depresson, rasng questons about the percepton and functon of socal care-led nterventons n communty-based mental health servces.
• The map ndcates that there may be mportant gaps n research on the access and use of socal care servces for BME older people wth depresson, carer and famly outcomes, servce user research, soco-economc and nequalty ssues, economc and fnancal outcomes and servce provson n rural contexts.
• The descrpton and evaluaton of specfcally socal care nterventons targeted at BME older people wth depresson s absent from the avalable lterature. If ths reflects a lack of socal care provson to prevent and manage depresson n all socal care contexts, there are lkely to be ssues for commssoners to consder. It s unclear from the map whether avalablty, or perhaps the accessblty and acceptablty, of such servces s the major problem.
What the map is being used for
The lmtatons n the studes mean t s not feasble to undertake the lterature revew element of a SCIE Knowledge Revew. The map has demonstrated the need for a practce survey: (a) because the lterature s not a gude to effectve servce commssonng and practce; (b) because we suspect there are servces wthn the (ndependent and statutory) socal care sector that do address depresson, and/or the enhancement of mental health and qualty of lfe, for older people from BME communtes.
References
1Age Concern (2006) Promoting mental health and well-being in later life: A first report
from the UK inquiry into mental health and well-being in later life, London: Age Concern England and Mental Health Foundaton.
2 Alexopoulos, G.S. (2005) ‘Depresson n the elderly’, Lancet, vol 365, pp 1961–70.
3 Ncholls, A. (2006) SCIE guide 3: Assessing the mental health needs of older people,
London: Socal Care Insttute for Excellence.
4 Scott, J. (2006) ‘Edtoral: depresson should be managed lke a chronc dsease’, BMJ, vol
332, pp 985–86 (http://bmj.bmjjournals.com/cg/content/full/332/7548/985?ck=nck).
5 Godfrey, M. and Denby, T. (2004) Depression and older people: Towards securing
well-being in later life, Brstol/London: The Polcy Press/Help the Aged.
6 Age Concern (2007) Improving services and support for older people with mental health
problems, London: Age Concern England/Mental Health Foundaton.
7 Beekman, A., Geerlngs, W., Deeg, D., Smt, J., Schoevers, R., De Beurs, E., Braam, A.,
Pennnx, B. and Van Tlburg, W. (2002) ‘The natural hstory of late-lfe depresson: a 6-year prospectve study n the communty’, Archives of General Psychiatry,vol 59, pp 605–11.
8 Age Concern (2007) Improving services and support for older people with mental health
problems, London: Age Concern England/Mental Health Foundaton.
9 Butt, J. and O’Nel, A. (2004) Let’s move on: Black and minority ethnic older people’s views
on research findings, York: Joseph Rowntree Foundaton.
10 Rat, G. and Burns, A. (1998) ‘Screenng for depresson and cogntve mparment n
older people from ethnc mnortes’, Age and Ageing, vol 27, pp 271–5.
11 Coren, E., Kavanagh, J., Bates, S. and Homewood, J. (2006) ‘Improvng systematc
revews n socal welfare – the benefts of collaboraton’, Poster for the 5th Annual Campbell Colloquum, Los Angeles, USA.
12 Secretares of State for Health, Socal Securty, Wales and Scotland (1989) Caring for
People: Community Care in the Next Decade and Beyond, Cm 849, London: HMSO.
13 Bates, S., Brown, W., Coren, E., Dxon, L., Homewood, J., and Kavanagh, J. (2006) SCIE
social care keywording strategy, Cm 849, London: Socal Care Insttute for Excellence.
14 Sharf, N., Brown, W., Rutter, D., Coren, E., Manthorpe, J., Morarty, J. and Stevens, M.,
15 Coren, E. (2007) Qualty of reportng tool, London: Socal Care Insttute for Excellence.
16 EPPI-Centre (2004) Structure for a review report, London: EPPI-Centre, Socal Scence
Research Unt, Insttute of Educaton, Unversty of London.
17 Bhatnagar, K. and Frank, J. (1997) ‘Psychatrc dsorders n elderly from the Indan
sub-contnent lvng n Bradford’, International Journal of Geriatric Psychiatry, vol 12, pp 907–12.
18 Abas, M., Phllps, C., Rchards, M., Carter, J. and Levy R. (1996) ‘Intal development
of a new culture-specfc screen for emotonal dstress n older Carbbean people’,
Appendix 1: Definitions of key map terms
Below are the broad defntons arsng n consultaton wth the Socal Care Workforce Research Unt and experts n the feld. The key terms are: ‘depresson’, ‘black and mnorty ethnc’, ‘older people’ and ‘socal care’.
Depression
Depresson s a term used n lay and clncal contexts. It s a mental health condton and the key features nclude symptoms of low mood, low energy, loss of appette, sleep dsturbance, poor concentraton, mpared memory and rrtablty, all occurrng most of the tme for longer than two weeks. Major depresson nvolves feelngs of hopelessness and helplessness, and n ts severest form leads to sucdal thoughts or actons.
In the search terms used to comple the map, synonyms for depresson ncluded mood or affectve dsorders aswellasfactors assocated wth sucde (attempts or actual). Alternatve terms ncluded: anxety; clncal depresson; depressve state; depresson and psychoss; sucde; mental health later lfe/old age. Any studes about dual dagnoss were ncluded n the map, but studes not about perceved (dagnosed and undagnosed) depresson were excluded. For the full lst of search terms used see Appendx 3.
Black and minority ethnic
Black and mnorty ethnc (BME) ncludes UK resdents whose famly orgns are n Afrca, Asa and the Carbbean, those who are Irsh born, Jewsh, Gypsy or Traveller, and other mnorty ethnc groups who are Whte. It also ncludes asylum seekers and refugees, people of mxed ethncty, and those not born n the UK who because of ther race share smlar experences of dscrmnaton and dsadvantage when usng servces and tryng to access support.
Search terms used n the map ncluded: ethnc mnorty; mnorty ethnc; ethncty; ethnc groups; BME; BAME; black communty; race; mxed race peoples; refugees; ethnc dversty; antracsm; mmgrants; bracalty; multculturalsm; and mmgrants. For the full lst of terms see Appendx 3.
older people
connotatons t has n some Western cultures, s appled at a dfferent stage than t may be to whte majorty people.
Examples of map search terms ncluded: elderly; pensoners; old age; aged; ageng; end of lfe; senors; retrement; and mddle age. For the full lst of terms see Appendx 3.
Social care
Socal care ncludes provson of servces and support, provded drectly by councls wth socal servces responsbltes (local authortes) or commssoned on ther behalf from the ndependent sector or jontly funded wth the NHS. Socal care ncludes servces and support, some of whch may be culturally or relgously specfc servces for BME people. Examples of socal care servces for older people nclude care homes, day care and personal care for older people at home. Publcly funded socal care s based on assessment and t s means-tested.
Appendix 2: Inclusion/exclusion criteria
Relevant studes were defned accordng to the followng crtera, usng relevant parts of the PICOS structure (partcpants, nterventons, comparsons, outcomes, study type).
L: Locaton – Exclude f no UK sample (can be collaboraton/comparson)
T: Study desgn – Exclude f theoretcal, conceptual or thnk peces (nclude personal accounts from BME people wth depresson)
E: Populaton – Exclude f partcpants are not BME populaton (at least one case n sample must be)
D: Depresson – Exclude f not about (perceved dagnosed and undagnosed) depresson (nclude dual dagnoss)
P: Populaton – Exclude f sample s chld or young adult-based
Y: Date – Exclude f publshed before 1990
Q: Query
Appendix 3: Search strategy
Bibliographic databases
General facets
Black and Mnorty Ethnc people Older People
Depresson
Socal Care (for non-socal care databases)
= (Black and Mnorty Ethnc people) AND (Older People) AND (Depresson)
Where the database was prmarly health focused (such as Medlne and EMBASE) an addtonal socal care facet was added to make the results more focused and manageable.
= (Black and Mnorty Ethnc people) AND (Older People) AND (Depresson) AND (Socal Care)
Where databases allowed, search was restrcted to date of publcaton 1990–2007 and Englsh language only.
1. AgeInfo
AgeInfo, CPA
Date search conducted: 08/02/07 Date lmts set on search: 1990 - 2007 Language lmt set on search – N/A
Notes: Free text and ndex terms were used. Date lmt was appled at end of combned search. Only a lmted combned search could be run due to techncal dffcultes wth ths database.
No age facet ncluded for ths age specfc database.
BME facet
“SOCIAL GROUPS@”/”SOCIAL CHARACTERISTICS [ELDERLY]@”/”SEMITIC PEOPLE@”/ ”RACISM@”/
= 7,312
Depression facet
“NEUROSES@”/”APATHY@”/”SUICIDE@”/”PSYCHOLOGY [RETIREMENT]@”/ ”PSYCHOTIC DEPRESSION@”/”ANXIETY@”/”DEPRESSION@”/
DEPRESSIONS/DEPRESSIVE/DEPRESSIVES/DEPRESS/DEPRESSANT/DEPRESSED/ DEPRESSING/
= 2,013
Combined keyword and free text search
(FREE TEXT or depresson facet) and BME facet
{[(DEPRESSION/DEPRESSION-26/DEPRESSION-ASSOCIATED/DEPRESSION-EVOKING/ DEPRESSION-HEALTH/DEPRESSION-IN-DEMENTIA/DEPRESSION-RELATED/
DEPRESSIONS/DEPRESSIVE/DEPRESSIVES/DEPRESS/DEPRESSANT/DEPRESSED/ DEPRESSING) oR (“NEUROSES@”/”APATHY@”/”SUICIDE@”/”PSYCHOLOGY [RETIREMENT]@”/”PSYCHOTIC DEPRESSION@”/”ANXIETY@”/”DEPRESSION@”/)]
AnD (“SOCIAL GROUPS@”/”SOCIAL CHARACTERISTICS [ELDERLY]@”/”SEMITIC PEOPLE@”/”RACISM@”/)}
AND (1990 ~ 2007)
= 439 (08/02/07 - fnal)
2. PsycInFo
PsycInfo, Ovd
Date search conducted: 08/02/2007 Date lmts set on search: 1990 - 2007 Language lmt set on search: none
Notes: Free text and ndex terms were used.
BME facet
Dfferences/ or exp *AntSemtsm/ or exp *Ethnocentrsm/ or exp *Racsm/ or exp *Stereotyped Atttudes/ or exp *Immgraton/ or exp *Refugees/ or exp *Human Mgraton/ or exp *Foregn Natonals/ or eastern european.mp. or asylum seekers.mp. or exp *Relgon/ or exp *Prejudce/ or east afrcan.mp. or exp *Judasm/ or kurds.mp. or somals.mp. or ethnc mnorty.mp. or mnorty ethnc.mp. or (black and mnorty ethnc).mp. [mp=ttle, abstract, headng word, table of contents, key concepts] or BME.mp. or BAME.mp. or exp *Interracal Offsprng/ or non-whte.mp. or rsh.mp.)
= 148 804
Depression facet
(exp *Major Depresson/ or exp *Treatment Resstant Depresson/ or exp *Clmacterc Depresson/ or exp *Recurrent Depresson/ or exp *Zungs Self Ratng Depresson Scale/ or exp *Beck Depresson Inventory/ or exp *Reactve Depresson/ or exp *Atypcal Depresson/ or exp *”Depresson (Emoton)”/ or exp *Anacltc Depresson/ or exp *Spreadng Depresson/ or exp *Endogenous Depresson/ or exp *Anxety/ or exp *Death Anxety/ or exp *Socal Anxety/ or exp *Generalzed Anxety Dsorder/ or exp *Anxety Management/ or exp *Taylor Manfest Anxety Scale/ or exp *Anxety Dsorders/ or exp *State Trat Anxety Inventory/ or clncal depresson.mp. or exp *Trcyclc Antdepressant Drugs/ or exp *Antdepressant Drugs/ or (depresson and psychoss).mp. [mp=ttle, abstract, headng word, table of contents, key concepts] or exp *Sucde Preventon/ or exp *Sucde Preventon Centers/ or exp *Attempted Sucde/ or exp *Asssted Sucde/ or exp *Sucde/ or mental health later lfe.mp. or mental health old age.mp. or later lfe mental health.mp. or old age mental health. mp. or exp *Apathy/ or exp *Hopelessness/ or exp *Sadness/ or exp *Pessmsm/)
= 146 910
Age facet
(exp *Agng/ or exp *Age Dfferences/ or exp *Physologcal Agng/ or exp *”Aged (Atttudes Toward)”/ or exp *”Agng (Atttudes Toward)”/ or exp *Geratrcs/ or exp *Geratrc Psychotherapy/ or exp *Geratrc Patents/ or exp *Geratrc Psychatry/ or exp *Geropsychology/ or exp *Alzhemers Dsease/ or exp *Senle Dementa/ or exp *Dementa/ or exp *Gerontology/ or exp *Nursng Homes/ or old$ people.mp. or old$ person$.mp. or exp *Elder Care/ or exp *Elder Abuse/ or elder$.mp. or exp *Retrement Communtes/ or exp *Retrement/ or pensoner$.mp. or old$ age.mp. or old$ adult$.mp. or late$ lfe.mp. or end of lfe.mp. or senors.mp. or senor ctzen$. mp. or old$ generaton.mp. or advanced adult$.mp. or late adult$.mp. or gettng old$.mp. or exp Psychodagnoss/ or geratrc depresson scale.mp. or phladelpha geratrc morale scale.mp. or Cornell scale for depresson n dementa.mp. or geratrc depresson score.mp.)
= 125 082
Lmt to yr=”1990 - 2007”
= 494 (08/02/07)
3. Medline
Medlne, Ovd, 1950 to Week 2, February 2007 Date search conducted: 08/02/2007
Date lmts set on search: 1990 - 2007 Language lmt set on search: none
Notes: Free text and ndex terms were used. To focus the results ths database was searched usng an added socal care facet, please see below.
1. BME facet
2. Depression facet
(exp *Depresson/ or exp *Depresson, Chemcal/ or exp *Depresson, Postpartum/ or exp *”Long-Term Depresson (Physology)”/ or exp *Spreadng Cortcal Depresson/ or exp *Depressve Dsorder/ or exp *Depressve Dsorder, Major/ or exp *Bpolar Dsorder/ or exp *Antdepressve Agents/ or exp *Antdepressve Agents, Second-Generaton/ or exp *Antdepressve Agents, Trcyclc/ or exp *Somatoform Dsorders/ or exp *Psychatrc Status Ratng Scales/ or Geratrc depresson scale.mp. or
Phladelpha Geratrc Center Morale Scale.mp. or Beck Depresson Inventory.mp. or Cornell Scale for Depresson n Dementa.mp. or exp *Personalty Assessment/ or geratrc depresson score.mp. or exp *”Qualty of Lfe”/ or exp *Adjustment Dsorders/ or exp *Manfest Anxety Scale/ or exp *Anxety/ or exp *Ant-Anxety Agents/ or exp *Anxety Dsorders/ or exp *Test Anxety Scale/ or exp *Atttude to Death/ or exp *Serotonn Uptake Inhbtors/ or exp *Panc Dsorder/ or clncal$ depress$.mp. or exp *Sucde/ or exp *Sucde, Asssted/ or exp *Sucde, Attempted/ or mental health later lfe.mp. or mental health old age.mp. or later lfe mental health.mp. or old age mental health.mp. or old age depresson.mp. or later lfe depresson.mp. or elder$ depresson.mp. or exp *Motvaton/ or exp *Mood Dsorders/ or hopelessness.mp. or sadness.mp. or pessmsm.mp. or apathy.mp. or depresson scales.mp. or depresson nstrument$.mp. or depresson assessment$.mp.)
= 289,350
3. Age facet
(exp *Aged/ or exp *Agng/ or exp *Mddle Aged/ or exp *Homes for the Aged/ or exp *”Aged, 80 and over”/ or exp *Health Servces for the Aged/ or exp *Age Factors/ or exp *Geratrcs/ or exp *Geratrc Nursng/ or exp *Geratrc Assessment/ or exp *Geratrc Psychatry/ or exp *Alzhemer Dsease/ or exp *Dementa/ or exp *Nursng Homes/ or old$ people.mp. or old$ adult$.mp. or late$ lfe.mp. or end of lfe.mp. or senors.mp. or senor ctzen$.mp. or old$ generaton$.mp. or advanced adult$.mp. or late adult$.mp. or gettng old$.mp.)
= 237,432
4. Social care facet
or exp *Intensve Care/ or exp *Case Management/ or exp *Patent-Centered Care/ or exp *Nursng, Team/ or exp *Counselng/ or exp *Drectve Counselng/ or exp *Emergency Servces, Psychatrc/ or exp *Socal Work, Psychatrc/ or exp *Rsk Assessment/ or exp *Needs Assessment/ or exp *Nutrton Assessment/ or exp *Geratrc Assessment/ or exp *”Self Assessment (Psychology)”/ or exp *Nursng Assessment/ or exp *Patent Care Plannng/ or care programme approach.mp. or communty psychatrc nurses.mp. or exp *Therapeutc Communty/ or communty care plan$.mp. or meal servce$.mp. or exp *Food Servces/ or outreach servce$. mp. or bereavement counsellng.mp. or counsellor$.mp. or day centre$.mp. or drop-n cedrop-ntre$.mp. or exp *Socal Support/ or famly support$.mp or famly cedrop-ntre$.mp. or exp *Nursng Homes/ or home help$.mp. or nformal care$.mp. or long stay care. mp. or exp *Negotatng/ or medaton.mp. or exp *Mentors/ or mentor$.mp. or exp *Vstors to Patents/ or exp *Voluntary Workers/ or befrend$.mp. or exp *Hosptal Volunteers/ or mult-dscplnary.mp. or exp *”Delvery of Health Care, Integrated”/ or ntegrated servce$.mp. or mult-agency.mp. or exp *Internsttutonal Relatons/ or exp *Homes for the Aged/ or exp *Resdental Facltes/ or resdental care$.mp. or admsson to care.mp. or exp *Holstc Nursng/ or old$ people$ home$.mp. or respte care$.mp. or short term care$.mp. or socal care provson.mp. or socal care provder$.mp. or transtonal servce$.mp. or exp *”Contnuty of Patent Care”/)
= 1,056,682
Combined search
mp. [mp=ttle, orgnal ttle, abstract, name of substance word, subject headng word] or BME.mp. or BAME.mp. or exp *Race Relatons/ or nterracal.mp. or non-whte.mp. or rsh.mp.) AnD (exp *Depresson/ or exp *Depresson, Chemcal/ or exp *Depresson, Postpartum/ or exp *”Long-Term Depresson (Physology)”/ or exp *Spreadng Cortcal Depresson/ or exp *Depressve Dsorder/ or exp *Depressve Dsorder, Major/ or exp *Bpolar Dsorder/ or exp *Antdepressve Agents/ or exp *Antdepressve Agents, Second-Generaton/ or exp *Antdepressve Agents, Trcyclc/ or exp *Somatoform Dsorders/ or exp *Psychatrc Status Ratng Scales/ or Geratrc depresson scale.mp. or Phladelpha Geratrc Center Morale Scale.mp. or Beck Depresson Inventory.mp. or Cornell Scale for Depresson n Dementa.mp. or exp *Personalty Assessment/ or geratrc depresson score.mp. or exp *”Qualty of Lfe”/ or exp *Adjustment Dsorders/ or exp *Manfest Anxety Scale/ or exp *Anxety/ or exp *Ant-Anxety Agents/ or exp *Anxety Dsorders/ or exp *Test Anxety Scale/ or exp *Atttude to Death/ or exp *Serotonn Uptake Inhbtors/ or exp *Panc Dsorder/ or clncal$ depress$.mp. or exp *Sucde/ or exp *Sucde, Asssted/ or exp *Sucde, Attempted/ or mental health later lfe.mp. or mental health old age.mp. or later lfe mental health.mp. or old age mental health.mp. or old age depresson. mp. or later lfe depresson.mp. or elder$ depresson.mp. or exp *Motvaton/ or exp *Mood Dsorders/ or hopelessness.mp. or sadness.mp. or pessmsm.mp. or apathy.mp. or depresson scales.mp. or depresson nstrument$.mp. or depresson assessment$.mp.) AnD (exp *Aged/ or exp *Agng/ or exp *Mddle Aged/ or exp *Homes for the Aged/ or exp *”Aged, 80 and over”/ or exp *Health Servces for the Aged/ or exp *Age Factors/ or exp *Geratrcs/ or exp *Geratrc Nursng/ or exp *Geratrc Assessment/ or exp *Geratrc Psychatry/ or exp *Alzhemer Dsease/ or exp *Dementa/ or exp *Nursng Homes/ or old$ people.mp. or old$ adult$. mp. or late$ lfe.mp. or end of lfe.mp. or senors.mp. or senor ctzen$.mp. or old$ generaton$.mp. or advanced adult$.mp. or late adult$.mp. or gettng old$.mp.) AnD
care plan$.mp. or meal servce$.mp. or exp *Food Servces/ or outreach servce$. mp. or bereavement counsellng.mp. or counsellor$.mp. or day centre$.mp. or drop-n cedrop-ntre$.mp. or exp *Socal Support/ or famly support$.mp or famly cedrop-ntre$.mp. or exp *Nursng Homes/ or home help$.mp. or nformal care$.mp. or long stay care. mp. or exp *Negotatng/ or medaton.mp. or exp *Mentors/ or mentor$.mp. or exp *Vstors to Patents/ or exp *Voluntary Workers/ or befrend$.mp. or exp *Hosptal Volunteers/ or mult-dscplnary.mp. or exp *”Delvery of Health Care, Integrated”/ or ntegrated servce$.mp. or mult-agency.mp. or exp *Internsttutonal Relatons/ or exp *Homes for the Aged/ or exp *Resdental Facltes/ or resdental care$.mp. or admsson to care.mp. or exp *Holstc Nursng/ or old$ people$ home$.mp. or respte care$.mp. or short term care$.mp. or socal care provson.mp. or socal care provder$.mp. or transtonal servce$.mp. or exp *”Contnuty of Patent Care”/) AnD
lmt to yr=”1990 - 2007”
= 439 (08/02/07 – final and exported)
4. Cinahl
CINAHL, Ovd
Date search conducted: 08/02/2007 Date lmts set on search: 1990 - 2007 Language lmt set on search: none
Notes: Free text and ndex terms were used. To focus the results ths database was searched usng an added socal care facet, please see below.
1. BME facet
mp. or exp *RACE FACTORS/ or exp *RACE RELATIONS/ or exp *”Relgon and Relgons”/ or exp *”Atttude of Health Personnel”/ or exp *Socoeconomc Factors/ or exp *Immgrants/ or culture$ group$.mp. or exp *DISCRIMINATION/ or exp *ACCULTURATION/ or exp *Multlngualsm/ or ndan.mp. or bangladesh.mp. or cross cultural counsellng.mp. or exp *Cultural Deprvaton/ or culture change.mp. or exp *Descrptve Statstcs/ or exp *Geographc Factors/ or regonal dfference$. mp. or exp *Prejudce/ or ethnocentrsm.mp. or exp *STEREOTYPING/ or exp *IMMIGRATION/ or exp *Refugee/ or exp *MIGRATION/ or eastern european.mp. or asylum seekers.mp. or east afrcan.mp. or kurds.mp. or somals.mp. or ethnc mnorty.mp. or mnorty ethnc.mp. or BME.mp. or nterracal.mp. or non-whte.mp. or rsh.mp.)
= 84980 (28/01/2007)
2. Depression facet
(exp *DEPRESSION/ or exp *DEATH DEPRESSION SCALE/ or exp *CENTER FOR EPIDEMIOLOGICAL STUDIES DEPRESSION SCALE/ or exp *BECK DEPRESSION INVENTORY, REVISED EDITION/ or exp *DEPRESSION, POSTPARTUM/ or exp *DEPRESSION, REACTIVE/ or exp *EDINBURGH POSTNATAL DEPRESSION SCALE/ or exp *GERIATRIC DEPRESSION SCALE/ or exp *HAMILTON RATING SCALE FOR DEPRESSION/ or exp *SELF-RATING DEPRESSION SCALE/ or exp *Antdepressve Agents/ or exp *Psychologcal Tests/ or exp *”Qualty of Lfe”/ or exp *Seasonal Affectve Dsorder/ or zung’s self ratng depresson scale.mp. or exp *Antdepressve Agents, Trcyclc/ or exp *ANXIETY/ or exp *ANTICIPATORY ANXIETY/ or exp *”ANXIETY CONTROL (IOWA NOC)”/ or exp *ANXIETY DISORDERS/ or exp *”ANXIETY (NANDA)”/ or exp *”ANXIETY REDUCTION (IOWA NIC)”/ or exp *”ANXIETY (SABA CCC)”/ or exp *DEATH ANXIETY SCALE/ or exp *SELF-RATING ANXIETY SCALE/ or exp *SEPARATION ANXIETY/ or exp *STATE-TRAIT ANXIETY INVENTORY/ or clncal depresson.mp. or (depresson and psychoss).mp. [mp=ttle, subject headng word, abstract, nstrumentaton] or exp *SUICIDE/ or exp *SUICIDE, ASSISTED/ or exp *SUICIDE, ATTEMPTED/ or exp *”SUICIDE PREVENTION (IOWA NIC)”/ or exp *”SUICIDE RISK (SABA CCC)”/ or exp *”SUICIDE SELF-RESTRAINT (IOWA NOC)”/ or mental health later lfe.mp. or mental health old age.mp. or later lfe depresson.mp. or later lfe mental health.mp. or old age mental health. mp. or exp *Motvaton/ or apathy.mp. or hopeless$.mp. or exp *Gref/ or sadness. mp. or exp *PESSIMISM/ or psychodagnoss.mp. or geratrc depresson.mp. or exp *Clncal Assessment Tools/ or exp *Geratrc Assessment/ or exp *Instrument Valdaton/ or exp *Psychologcal Tests/ or exp *Geratrc Functonal Assessment/ or geratrc depresson.mp. or exp *Geratrc Depresson Scale/ or phladelpha geratrc morale scale.mp. or exp *Scales/ or exp *Personal Satsfacton/ or cornell scale for depresson n dementa.mp. or geratrc depresson score.mp.)
= 55103 (29/01/07)
3. Age facet
exp *Gerontologc Care/ or exp *GERONTOLOGIC NURSE PRACTITIONERS/ or exp *GERONTOLOGIC NURSING/ or exp *Nursng Homes/ or old$ people.mp. or old$ person$.mp. or exp *ELDER ABUSE/ or elder$.mp. or exp *RETIREMENT/ or pensoner$.mp. or exp *Pensons/ or exp *Age Factors/ or exp *Accdental Falls/ or old$ age$.mp. or old$ adult$.mp. or late$ lfe.mp. or end of lfe.mp. or senors.mp. or senor ctzen$.mp. or old$ generaton.mp. or advanced adult$.mp. or late adult$.mp. or gettng old$.mp. or exp *Atttude to Agng/)
= 60650 (29/01/2007)
4. Social care facet
(exp *Socal Welfare/ or exp *Socal Work/ or exp *Health Servces Accessblty/ or exp *Socal Work Servce/ or exp *Socal Workers/ or socal care.mp. or exp *Communty Servce/ or socal work$.mp. or exp *Socal Scences/ or exp *Prvate Sector/ or exp *Publc Sector/ or exp *Socal Work, Psychatrc/ or exp *Communty Mental Health Servces/ or exp *Communty Mental Health Nursng/ or exp
Combined search
(exp *Ethnc Groups/ or (racal and ethnc groups).mp. [mp=ttle, abstract, subject headngs, headng word, drug trade name, orgnal ttle, devce manufacturer, drug manufacturer name] or exp *FAMILY PRESSURES SCALE-ETHNIC/ or exp *FAMILY SCHEMA-ETHNIC/ or ethnc.mp. or (black and mnorty).mp. [mp=ttle, abstract, subject headngs, headng word, drug trade name, orgnal ttle, devce manufacturer, drug manufacturer name] or exp *BLACKS/ or (racal and ethnc dfference$).mp. [mp=ttle, abstract, subject headngs, headng word, drug trade name, orgnal ttle, devce manufacturer, drug manufacturer name] or (racal and ethnc).mp. [mp=ttle, abstract, subject headngs, headng word, drug trade name, orgnal ttle, devce manufacturer, drug manufacturer name] or exp *Cultural Values/ or exp *ARABS/ or exp *ASIANS/ or exp *CAMBODIANS/ or exp *CHINESE/ or exp *FILIPINOS/ or exp *JAPANESE/ or exp *KOREANS/ or exp *LAOTIANS/ or exp *VIETNAMESE/ or exp *GYPSIES/ or exp *HISPANICS/ or exp *Indgenous Peoples/ or exp *JEWS/ or exp *WHITES/ or exp *ETHNOGRAPHY/ or exp *ETHNOLOGY/ or exp *ETHOLOGY/ or exp *FOLKLORE/ or exp *SUPERSTITIONS/ or travellers.mp. or exp *Transcultural Nursng/ or exp *Cultural Senstvty/ or exp *Transcultural Care/ or exp *Cultural Competence/ or exp *Ethnologcal Research/ or exp *Cultural Dversty/ or cross cultural.mp. or exp *Cultural Senstvty/ or exp CULTURAL BIAS/ or exp *CULTURAL COMPETENCE/ or exp *CULTURAL DEPRIVATION/ or exp *CULTURAL SAFETY/ or exp *CULTURAL VALUES/ or exp *CULTURE/ or exp *CULTURE MEDIA/ or exp
*”LEININGER’S THEORY OF CULTURE CARE DIVERSITY AND UNIVERSALITY”/ or ethnc$.mp. or exp *Mnorty Groups/ or multculturalsm.mp. or exp *RACE FACTORS/ or exp *RACE RELATIONS/ or exp *”Relgon and Relgons”/ or exp *”Atttude of Health Personnel”/ or exp *Socoeconomc Factors/ or exp *Immgrants/ or culture$ group$.mp. or exp *DISCRIMINATION/ or exp
*ACCULTURATION/ or exp *Multlngualsm/ or ndan.mp. or bangladesh.mp. or cross cultural counsellng.mp. or exp *Cultural Deprvaton/ or culture change.mp. or exp *Descrptve Statstcs/ or exp *Geographc Factors/ or regonal dfference$.mp. or exp *Prejudce/ or ethnocentrsm.mp. or exp *STEREOTYPING/ or exp
*IMMIGRATION/ or exp *Refugee/ or exp *MIGRATION/ or eastern european.mp. or asylum seekers.mp. or east afrcan.mp. or kurds.mp. or somals.mp. or ethnc
NIC)”/ or exp *”SUICIDE RISK (SABA CCC)”/ or exp *”SUICIDE SELF-RESTRAINT (IOWA NOC)”/ or mental health later lfe.mp. or mental health old age.mp. or later lfe depresson.mp. or later lfe mental health.mp. or old age mental health.mp. or exp *Motvaton/ or apathy.mp. or hopeless$.mp. or exp *Gref/ or sadness.mp. or exp *PESSIMISM/ or psychodagnoss.mp. or geratrc depresson.mp. or exp *Clncal Assessment Tools/ or exp *Geratrc Assessment/ or exp *Instrument Valdaton/ or exp *Psychologcal Tests/ or exp *Geratrc Functonal Assessment/ or geratrc depresson.mp. or exp *Geratrc Depresson Scale/ or phladelpha geratrc morale scale.mp. or exp *Scales/ or exp *Personal Satsfacton/ or cornell scale for
depresson n dementa.mp. or geratrc depresson score.mp.) AnD (exp *AGE FACTORS/ or exp *”AGE OF ONSET”/ or exp *AGE SPECIFIC CARE/ or exp *MIDDLE AGE/ or exp *Agng/ or exp *AGED/ or exp *”AGED, 80 AND OVER”/ or exp *AGED, HOSPITALIZED/ or exp *HEALTH SERVICES FOR THE AGED/ or exp *GERIATRICS/ or exp *Nursng Home Patents/ or exp *Geratrc Psychatry/ or exp *Gerontologc Care/ or exp *GERONTOLOGIC NURSE PRACTITIONERS/ or exp *GERONTOLOGIC NURSING/ or exp *Nursng Homes/ or old$ people.mp. or old$ person$.mp. or exp *ELDER ABUSE/ or elder$.mp. or exp *RETIREMENT/ or pensoner$.mp. or exp *Pensons/ or exp *Age Factors/ or exp *Accdental Falls/ or old$ age$.mp. or old$ adult$.mp. or late$ lfe.mp. or end of lfe.mp. or senors.mp. or senor ctzen$.mp. or old$ generaton.mp. or advanced adult$.mp. or late adult$.mp. or gettng old$.mp. or exp *Atttude to Agng/) AnD (exp *Socal Welfare/ or exp *Socal Work/ or exp *Health Servces Accessblty/ or exp *Socal Work Servce/ or exp *Socal Workers/ or socal care.mp. or exp *Communty Servce/ or socal work$.mp. or exp *Socal Scences/ or exp *Prvate Sector/ or exp *Publc Sector/ or exp *Socal Work,
Psychatrc/ or exp *Communty Mental Health Servces/ or exp *Communty Mental Health Nursng/ or exp *Psychatrc Care/ or exp *Multdscplnary Care Team/ or communty care$.mp. or exp *Phlanthropy/ or exp *Communty Servce/ or human servce$ organsaton$.mp. or exp *Support Groups/ or socal agences.mp. or exp *”Health and Welfare Plannng”/ or socal programme.mp. or socal servce$.mp. or exp *Home Health Care/ or home care servces.mp. or exp *”Referral and
Consultaton”/ or socal servce$ department$.mp. or low level support.mp. or exp *Day Care/ or exp *Patent Care Conferences/ or exp *After Care/ or exp *Prehosptal Care/ or exp *”Dressng-Groomng Self Care Defct (NANDA)”/ or exp *”Delvery Care (Saba CCC)”/ or exp *Patent Centered Care/ or exp *Psychatrc Care/ or exp *Patent Care/ or exp *Sprtual Care/ or exp *Crtcal Care Famly Needs Inventory/ or exp *Gender Specfc Care/ or exp *Gerontologc Care/ or exp *Managed Care Programs/ or exp *Long Term Care/ or exp *Nursng Care Plans/ or exp *Health Care Delvery, Integrated/ or exp *Total Patent Care Nursng/ or exp *Preoperatve Care/ or exp *Famly Centered Care/ or exp *Respte Care/ or exp *Lfe Support Care/ or exp *Support, Psychosocal/ or exp *Postoperatve Care/ or exp *Patent Care Plans/ or exp *Nursng Care Delvery Systems/ or exp *Age Specfc Care/ or exp
Servces/ or exp *Nursng Homes/ or home help.mp. or nformal care.mp. or long stay care.mp. or exp *Negotaton/ or exp *Fundng Source/ or exp *Mentorshp/ or exp *VISITORS TO PATIENTS/ or exp *Volunteer Workers/ or befrendng.mp. or mult-dscplnary.mp. or ntegrated servce$.mp. or mult-agency.mp. or exp *Internsttutonal Relatons/ or exp *Housng for the Elderly/ or admsson to care. mp. or exp *Holstc Nursng/ or old$ people$ home$.mp. or socal care provson.mp. or socal care provder$.mp. or exp *Transtonal Programs/ or transtonal servce$. mp. or exp *Mental Health Servces/) AnD lmt yr=”1990 - 2007”
= 493 (08/02/2007 – final and exported)
5. EMBASE
EMBASE, Ovd
Date search conducted: 08/02/2007 Date lmts set on search: 1990 - 2007 Language lmt set on search: none
Notes: Free text and ndex terms were used. To focus the results ths database was searched usng an added socal care facet, please see below.
1. BME facet
devce manufacturer, drug manufacturer name] or BME.mp. or nterracal.mp. or non-whte.mp. or rsh.mp.)
= 139206 (29/01/2007)
2. Depression facet
(exp *DEPRESSION/ or exp *AGITATED DEPRESSION/ or exp *ATYPICAL DEPRESSION/ or exp *BECK DEPRESSION INVENTORY/ or exp *BIPOLAR DEPRESSION/ or exp *BONE MARROW DEPRESSION/ or exp *CENTER FOR EPIDEMIOLOGICAL STUDIES DEPRESSION SCALE/ or exp *CENTRAL NERVOUS SYSTEM DEPRESSION/ or exp *DEATH DEPRESSION SCALE/ or exp *EDINBURGH POSTNATAL DEPRESSION SCALE/ or exp *ENDOGENOUS DEPRESSION/ or exp *GERIATRIC DEPRESSION SCALE/ or exp *”HOSPITAL ANXIETY AND DEPRESSION SCALE”/ or exp *INBREEDING DEPRESSION/ or exp *INVOLUTIONAL DEPRESSION/ or exp *LONG TERM DEPRESSION/ or exp *MAJOR DEPRESSION/ or exp *MASKED DEPRESSION/ or exp *”MIXED ANXIETY AND DEPRESSION”/ or exp *”MIXED DEPRESSION AND DEMENTIA”/ or exp *”MIXED MANIA AND DEPRESSION”/ or exp *MONTGOMERY ASBERG DEPRESSION RATING SCALE/ or exp *ORGANIC DEPRESSION/ or exp *POSTOPERATIVE DEPRESSION/ or exp *PUERPERAL DEPRESSION/ or exp *REACTIVE DEPRESSION/ or exp *RECURRENT BRIEF DEPRESSION/ or exp *SELF-RATING DEPRESSION SCALE/ or exp *SPREADING CORTICAL DEPRESSION/ or exp *ST SEGMENT DEPRESSION/ or Zungs self ratng depresson nventory.mp. or exp *Antdepressant Agent/ or exp *Trcyclc Antdepressant Agent/ or exp *Serotonn Uptake Inhbtor/ or exp *Psychologcal Ratng Scale/ or Phladelpha geratrc morale scale$.mp. or Cornell scale for depresson n dementa.mp. or exp *”Qualty of Lfe”/ or exp *Adjustment Dsorder/ or exp *ANXIETY/ or exp *ANTICIPATORY ANXIETY/ or exp *ANXIETY DISORDER/ or exp *ANXIETY NEUROSIS/ or exp *BECK ANXIETY INVENTORY/ or exp *DEATH ANXIETY SCALE/ or exp *GENERALIZED ANXIETY DISORDER/ or exp *HAMILTON ANXIETY SCALE/ or exp *SELF-RATING ANXIETY SCALE/ or exp *STATE TRAIT ANXIETY INVENTORY/ or exp *SUICIDE/ or exp *ASSISTED SUICIDE/ or exp *SUICIDE ATTEMPT/ or exp *SUICIDE GENE/ or Gerontopsychatry/ or mental health late$ lfe.mp. or mental health old$ age.mp. or later lfe mental health.mp. or old$ age mental health.mp. or old$ age depresson.mp. or late$ lfe depresson. mp. or elder$ depresson.mp. or exp *MOTIVATION/ or exp *Mood Dsorder/ or exp *HOPELESSNESS/ or exp *BECK HOPELESSNESS SCALE/ or exp *Gref/ or exp *PESSIMISM/ or exp *APATHY/ or depresson scales.mp. or depresson nstrument$. mp. or depresson assessment$.mp.)
= 201231 (29/01/2007)
3. Age facet
4. Social care facet
(exp *socal work/ or exp *caregver support/ or exp *compensaton/ or exp
*psychosocal care/ or exp *socal nsurance/ or exp *socal securty/ or exp *socal support/ or exp *socal work practce/ or exp *sprtual care/ or exp *termnal care/ or exp *socologcal theory/ or exp *crss theory/ or exp *crtcal theory/ or exp *famly systems theory/ or exp *famly theory/ or exp *role theory/ or exp *socal cogntve theory/ or exp *socal learnng theory/ or exp *socal worker/ or exp *psychologst/ or exp *Socal Care/ or exp *”care and carng”/ or exp *nsttutonal care/ or exp *communty care/ or exp *elderly care/ or exp *self care/ or exp *Socal Welfare/ or exp *Home Care/ or socal servce$.mp. or socal work$.mp. or exp *Socology/ or exp *COMMUNITY/ or exp *COMMUNITY ASSESSMENT/ or exp *COMMUNITY BASED REHABILITATION/ or exp *COMMUNITY CARE/ or exp *COMMUNITY DYNAMICS/ or exp *COMMUNITY HEALTH
NURSING/ or exp *COMMUNITY HOSPITAL/ or exp *COMMUNITY LIVING/ or exp *COMMUNITY MEDICINE/ or exp *COMMUNITY MENTAL HEALTH/ or exp *COMMUNITY MENTAL HEALTH CENTER/ or exp *COMMUNITY PROGRAM/ or exp *COMMUNITY PSYCHIATRIC NURSING/ or exp *COMMUNITY REINTEGRATION/ or exp *COMMUNITY STRUCTURE/ or exp *COMMUNITY SUCCESSION/ or exp *COMMUNITY TRIAL/ or exp *THERAPEUTIC COMMUNITY/ or exp *Geratrc Nursng/ or exp *Patent Care/ or exp *mental health servce/ or exp *psychosocal care/ or exp *home mental health care/ or exp *mental hosptal/ or exp *day
hosptal/ or exp *halfway house/ or exp *psychogeratrc nursng/ or exp *psychatrc treatment/ or human servce$ organsaton$.mp. or socal agences.mp. or socal programme.mp. or socal servce$ department$.mp. or exp *Health Care Access/ or exp *RESPITE CARE/ or exp *home respratory care/ or exp *home rehabltaton/ or exp *home physotherapy/ or exp *home oxygen therapy/ or exp *home montorng/ or exp *home mental health care/ or exp *home health agency/ or exp *home dalyss/ or exp *Long Term Care/ or exp *follow up/ or exp *treatment plannng/ or exp *home for the aged/ or exp *aftercare/ or exp *age specfc care/ or exp *tertary health care/ or exp *transcultural care/ or exp *counselng/ or exp *antcpatory gudance/ or exp *bereavement counselng/ or exp *drectve counselng/ or exp *famly counselng/ or exp *nutrtonal counselng/ or exp *parent counselng/ or exp *patent counselng/ or exp *patent gudance/ or exp *peer counselng/ or exp *Rsk Assessment/ or exp *Needs Assessment/ or exp *Nutrtonal Assessment/ or exp *Geratrc Assessment/ or exp *Geratrc Care/ or exp *COMMUNITY ASSESSMENT/ or exp *ENVIRONMENTAL IMPACT ASSESSMENT/ or exp *FALL RISK ASSESSMENT/ or exp *FAMILY ASSESSMENT/ or exp *FUNCTIONAL ASSESSMENT/ or exp *OUTCOME ASSESSMENT/ or exp *Patent Care Plannng/ or care programme approach.mp. or meal servce$.mp. or outreach servce$.mp. or drop-n centre$.mp. or famly support. mp. or exp *Famly Therapy/ or exp psychotherapy/ or nformal care.mp. or long stay care.mp. or medaton.mp. or mentor$.mp. or exp *HEALTH VISITOR/ or exp *VOLUNTEER/ or befrend$.mp. or mult-dscplnary.mp. or ntegrated servce$. mp. or mult-agency.mp. or nternsttutonal.mp. or nter-nsttutonal.mp. or exp *HOLISTIC CARE/ or exp *HOLISTIC NURSING/ or old$ people$ home$.mp. or socal care provson.mp. or socal care provder$.mp. or transtonal servce$.mp. or contnuty of patent care.mp.)
Combined search
(exp *”ETHNIC AND RACIAL GROUPS”/ or exp *ETHNIC DIFFERENCE/ or exp *ETHNIC GROUP/ or exp *”ETHNIC OR RACIAL ASPECTS”/ or exp *Cultural Factor/ or exp *Race Dfference/ or ethnc$.mp. or (racal and ethnc group$).mp. [mp=ttle, abstract, subject headngs, headng word, drug trade name, orgnal ttle, devce manufacturer, drug manufacturer name] or (black and mnorty).mp. [mp=ttle, abstract, subject headngs, headng word, drug trade name, orgnal ttle, devce manufacturer, drug manufacturer name] or exp *Negro/ or (racal and ethnc dfferences).mp. [mp=ttle, abstract, subject headngs, headng word, drug trade name, orgnal ttle, devce manufacturer, drug manufacturer name] or (racal and ethnc).mp. [mp=ttle, abstract, subject headngs, headng word, drug trade name, orgnal ttle, devce manufacturer, drug manufacturer name] or exp *AFRICAN
CARIBBEAN/ or exp *Arab/ or exp *BRITISH ASIAN/ or exp *ASIAN/ or exp *Gpsy/ or travellers.mp. or exp *Cultural Anthropology/ or exp *cultural bas/ or exp *cultural senstvty/ or culture bound syndromes.mp. or exp *Ethnology/ or exp *mnorty group/ or multculturalsm.mp. or exp *race/ or exp *Relgous Group/ or
sococultural.mp. or exp *jew/ or exp *moslem/ or (race and ethnc dscrmnaton). mp. [mp=ttle, abstract, subject headngs, headng word, drug trade name, orgnal ttle, devce manufacturer, drug manufacturer name] or exp *CHINESE/ or japanese. mp. or korean.mp. or Bangladesh.mp. or south asan.mp. or southeast asan.mp. or vetnamese.mp. or acculturaton.mp. or blngualsm.mp. or cross cultural.mp. or exp *TRANSCULTURAL CARE/ or exp *Cultural Deprvaton/ or exp *ETHNOGRAPHY/ or regonal dfferences.mp. or antsemtsm.mp. or ethnocentrsm.mp. or exp *RACISM/ or exp *Stereotypy/ or exp *mmgraton/ or exp *REFUGEE/ or exp *MIGRATION/ or foregn natonal$.mp. or eastern european.mp. or exp *INDIAN/ or asylum seeker$. mp. or exp *RELIGION/ or prejudce.mp. or east afrcan.mp. or kurds.mp. or somals. mp. or ethnc mnorty.mp. or mnorty ethnc.mp. or (black and mnorty ethnc).mp. [mp=ttle, abstract, subject headngs, headng word, drug trade name, orgnal ttle, devce manufacturer, drug manufacturer name] or BME.mp. or nterracal.mp. or non-whte.mp. or rsh.mp.) AnD (exp *DEPRESSION/ or exp *AGITATED DEPRESSION/ or exp *ATYPICAL DEPRESSION/ or exp *BECK DEPRESSION INVENTORY/ or exp *BIPOLAR DEPRESSION/ or exp *BONE MARROW DEPRESSION/ or exp *CENTER FOR EPIDEMIOLOGICAL STUDIES DEPRESSION SCALE/ or exp *CENTRAL NERVOUS SYSTEM DEPRESSION/ or exp *DEATH DEPRESSION SCALE/ or exp *EDINBURGH POSTNATAL DEPRESSION SCALE/ or exp *ENDOGENOUS DEPRESSION/ or exp *GERIATRIC DEPRESSION SCALE/ or exp *”HOSPITAL ANXIETY AND DEPRESSION SCALE”/ or exp *INBREEDING DEPRESSION/ or exp *INVOLUTIONAL DEPRESSION/ or exp *LONG TERM DEPRESSION/ or exp *MAJOR DEPRESSION/ or exp *MASKED DEPRESSION/ or exp *”MIXED ANXIETY AND DEPRESSION”/ or exp *”MIXED DEPRESSION AND DEMENTIA”/ or exp *”MIXED MANIA AND DEPRESSION”/ or exp *MONTGOMERY ASBERG DEPRESSION RATING SCALE/ or exp *ORGANIC
or exp *ANXIETY/ or exp *ANTICIPATORY ANXIETY/ or exp *ANXIETY DISORDER/ or exp *ANXIETY NEUROSIS/ or exp *BECK ANXIETY INVENTORY/ or exp *DEATH ANXIETY SCALE/ or exp *GENERALIZED ANXIETY DISORDER/ or exp *HAMILTON ANXIETY SCALE/ or exp *SELF-RATING ANXIETY SCALE/ or exp *STATE TRAIT
ANXIETY INVENTORY/ or exp *SUICIDE/ or exp *ASSISTED SUICIDE/ or exp *SUICIDE ATTEMPT/ or exp *SUICIDE GENE/ or Gerontopsychatry/ or mental health late$ lfe. mp. or mental health old$ age.mp. or later lfe mental health.mp. or old$ age mental health.mp. or old$ age depresson.mp. or late$ lfe depresson.mp. or elder$
depresson.mp. or exp *MOTIVATION/ or exp *Mood Dsorder/ or exp
*HOPELESSNESS/ or exp *BECK HOPELESSNESS SCALE/ or exp *Gref/ or exp *PESSIMISM/ or exp *APATHY/ or depresson scales.mp. or depresson nstrument$. mp. or depresson assessment$.mp.) AnD (Age/ or Aged/ or exp *Agng/ or exp *onset age/ or exp *age specfc care/ or Adult/ or exp *Elderly Care/ or exp
geratrcs/ or exp *Nursng Home/ or exp *gerontology/ or exp *GERONTOLOGICAL RESEARCH/ or old$ people.mp. or old$ person$.mp. or elder$.mp. or exp
*Retrement/ or exp *pensoner/ or exp *Penson/ or old$ age$.mp. or old$ adult$. mp. or late$ lfe.mp. or end of lfe.mp. or senors.mp. or old$ generaton$.mp. or advanced adult$.mp. or late adult$.mp. or gettng old$.mp.) AnD (exp *socal work/ or exp *caregver support/ or exp *compensaton/ or exp *psychosocal care/ or exp *socal nsurance/ or exp *socal securty/ or exp *socal support/ or exp *socal work practce/ or exp *sprtual care/ or exp *termnal care/ or exp *socologcal theory/ or exp *crss theory/ or exp *crtcal theory/ or exp *famly systems theory/ or exp *famly theory/ or exp *role theory/ or exp *socal cogntve theory/ or exp *socal learnng theory/ or exp *socal worker/ or exp *psychologst/ or exp *Socal Care/ or exp *”care and carng”/ or exp *nsttutonal care/ or exp *communty care/ or exp *elderly care/ or exp *self care/ or exp *Socal Welfare/ or exp *Home Care/ or socal servce$.mp. or socal work$.mp. or exp *Socology/ or exp *COMMUNITY/ or exp *COMMUNITY ASSESSMENT/ or exp *COMMUNITY BASED REHABILITATION/ or exp *COMMUNITY CARE/ or exp *COMMUNITY DYNAMICS/ or exp *COMMUNITY HEALTH NURSING/ or exp *COMMUNITY HOSPITAL/ or exp *COMMUNITY LIVING/ or exp *COMMUNITY MEDICINE/ or exp *COMMUNITY MENTAL HEALTH/ or exp *COMMUNITY MENTAL HEALTH CENTER/ or exp *COMMUNITY PROGRAM/ or exp *COMMUNITY PSYCHIATRIC NURSING/ or exp *COMMUNITY REINTEGRATION/ or exp *COMMUNITY STRUCTURE/ or exp *COMMUNITY SUCCESSION/ or exp *COMMUNITY TRIAL/
