Title: Effect
of Stress management on depression, anxiety,
stress, insomnia, and dementia
in the elderly population of Burdwan district of West Bengal- A
quasi-experimental
non-randomized study
Synopsis:
The mental health needs of the global population have been gaining
attention as a major public health concern in recent times. The postmodern
world has presented human civilization with numerous
challenges, and stress
has become an integral part of our lives.
Stress is a major contributor to sleep disturbances, one of the most important
concerns in public health in recent times. Insomnia hurts the quality of life across the globe. Sleep
disturbances are associated with a variety of physical and mental health
complications.
Depressed older adults usually display cognitive changes, somatic
symptoms, and loss of interest, so insomnia may often be overlooked as a risk
factor for late-life depression. The proportion and size of the elderly
population are increasing over time worldwide, and according to the Indian
Population Census 2011, there are nearly 104 million elderly persons (aged 60
years or above). Depression is less prevalent among older adults, but it can
have serious consequences. The devastating consequences of late-life depression
are an important public health problem. Late-life depression is associated with
an increased risk of dementia, and late-life depression may be an early
manifestation of dementia rather than an increased risk for dementia. Research
on the correlation between
Depression, Anxiety, Stress,
Insomnia, and Dementia has important implications for understanding the
underlying biology and for providing information for the early identification
of dementia. Considering the above facts, the
present study will be conducted among the elderly
population attending Burdwan
Medical College and Hospital so that early cognitive impairment and
mental health problems, and their consequences can be recognized, and possible
remedial measures can be implemented.
Introduction:
The mental health necessities of the global population have been gaining
attention as a major
public health concern in recent times. The postmodern world has put human
civilization to multiple challenges and stress has become a part and parcel of
our lives. Stress is a major contributor to sleep disturbances, one of the most
important concerns in public health in recent times and insomnia has a negative
impact on the quality of life across the globe.13-15 Lack of sleep
has significant negative effects on personal life and results in the reduction
of work performance. Sleep disturbances are associated with a variety of
physical and mental health complications.1-6
Depressed older adults usually display cognitive changes, somatic
symptoms, and loss of interest, so insomnia may often be overlooked as a risk
factor for late-life depression. The proportion and size of the elderly
population are increasing over time worldwide, and according to the Indian Population Census 2011,
there are nearly 104 million elderly persons
(aged 60 years or above). Depression has been found to be less prevalent among older adults, but it can have serious
consequences. Suicide rates in the elderly are still higher than in younger
adults and are more closely associated with depression. The devastating consequences
of late-life depression are an important public health problem. The risk
factors leading to the development of late-life depression comprise complex
interactions among genetic vulnerabilities, cognitive
diathesis, age-associated neurobiological changes, as well as
stressful events.
Late-life depression is associated with an increased risk of dementia,
and late-life depression may be an early manifestation
of dementia rather than an increased risk for dementia. Many longitudinal studies
conducted on large populations have shown that depression is associated
with an increased risk of cognitive decline, mild cognitive impairment,
dementia, and
Alzheimer’s disease (AD)1-10.
The correlation between Depression, Anxiety, Stress, Insomnia,
Dementia, and cardiovascular profile has important implications for
understanding the underlying biology and for providing information for the early identification
of dementia 7-11 Keeping the above facts in mind the present study
will be conducted among the elderly population attending Burdwan Medical
College and Hospital
so that early cognitive impairment and mental health problems and consequences can be
recognized and possible remedial measures can be intervened.
Aims: To determine the effect of Stress management on Depression, Anxiety,
Stress, Insomnia, and Dementia
in the elderly population attending
Burdwan Medical College.
Objectives:
1.
To
assess and compare
Depression, Anxiety, and Stress levels
using the Depression, Anxiety, Stress, Insomnia severity
index, and Dementia scores among the elderly male and female population
attending Burdwan Medical College.
2.
To
compare the Cardiovascular profile of the elderly population attending Burdwan
Medical College with different levels of Depression, Anxiety, Stress, Insomnia
severity index, and Dementia scale scores.
3.
To
correlate Dementia levels
with Depression, Anxiety,
Stress, and Insomnia Severity Index scores among the elderly
population attending Burdwan Medical College.
4.
To
assess the impact
of the stress management program
on Depression, Anxiety,
and Stress, Insomnia severity index,
Depression levels, and cardiovascular profile of the elderly population
attending Burdwan Medical College.
Review of literature:
Aging may decrease
the ability to handle stress.
Untreated, chronic stress accelerates many of
the degenerative changes correlated with aging, including cognitive decline.
Stress management programs may counterbalance many aspects of the stress
response and protect the brain specifically from the ravages of aging combined
with stress overload1-4.
Stress may injure hippocampal cells via the release of cortisol from
the adrenal gland in response to hypothalamic and pituitary stimulatory
signals. Such injury may result in dysfunction
and atrophy of important brain structures responsible for memory and emotion1-5.
Dementia is a clinical syndrome
characterized by progressive impairments of cognitive skills and the ability to function independently. Many
assessment scales for dementia have been developed over the decades. Ideal
scales used in dementia need to demonstrate face validity and concurrent validity against
gold-standard assessments. They should be reliable, practical, and rely on objective
information1-6.
A review by Khalsa DS highlighted that Kirtan Kriya (KK), is an
easy, cost-effective meditation technique that can be successfully employed to
improve memory in people with subjective cognitive decline and mild cognitive
impairment. KK has also been shown in different studies to improve
sleep and decrease
depression and anxiety.
It also downregulates inflammatory genes and
upregulates immune system genes. Improvement in insulin and glucose regulatory
genes and increased telomerase have also been observed in individuals
practicing KK3.
Paller KA studied the effects of mindfulness training among patients
with cognitive impairment and their caregivers. Weekly group sessions were
arranged over 8 weeks. Analysis of results
showed that there were increased
quality-of-life ratings, fewer
depressive symptoms, and better subjective sleep quality among all
participants following the intervention8.
Materials and Methods: This longitudinal study will be conducted in a three-year span of
three years after taking institutional ethical clearance and informed consent
of the participants. Inclusion criteria:
Males and females above the age of 60 with a minimum educational level
of 12th standard
of education attending the Medicine outpatient department of Burdwan Medical College will be included.
Exclusion criteria:
1. Subjects having
severe cognitive impairment.
Sampling procedure and
sample size calculation: Participants will be recruited
randomly (using random numbers generated with an online randomizer) for the
study from the Medicine Outpatient Department. Nearly 600 elderly patients with
the 12th standard minimum education level attend the Medicine OPD in a month. As per the Population Census 2011, SRS Report 2013 proportion of
the elderly population is 8.6%. Taking these figures into consideration sample size was calculated using an online
sample size calculator available at calculator.net, Confidence level of 95% a margin of
error 5%. The calculated sample size came to 101. Considering dropouts, 110
participants will be included in the present study.
History will be taken, followed by a general physical examination.
Body mass index and Waist/Hip ratio will be calculated. A Mini-Mental State examination (MMSE) will be done
for screening and excluding subjects with severe cognitive impairment; a
validated questionnaire will be used for this purpose. MRI will be done for
participants who need it. will be asked to fill up three scales on the first
appointment, and scores will be calculated.
1.
Depression, Anxiety
and Stress Scale -21 Items (DASS-21)11: The Depression, Anxiety and Stress Scale -21 Items (DASS-21) is a
set of three self-report scales designed to measure the emotional states of
depression, anxiety, and stress.
2.
Insomnia Severity
Index (ISI): The ISI consists of 7 questions
concerning sleep. The total
score ranges from 0 to 28. Higher ISI scores indicate higher chances of
insomnia and more severe insomnia. 9-10
3.
Revised Hasegawa’s dementia scale (HDS-R), consisting of 9 simple
questions with a maximum score
of 30.2
ECG will be conducted. The following blood
tests will be done: Serum
Cortisol, FBS, PPBS, and Lipid Profile in the Department
of Biochemistry of Burdwan Medical College.
Participants will be provided feedback regarding their physical and
mental health, and counseling will be done regarding the importance of taking care of one’s
mental health with the advancement of age. Participants
will be encouraged to take up any stress relaxation program; support will be
provided to them by the Department of Physiology of Burdwan Medical College.
Stress management program support that will
be provided:
a. Progressive Muscle
relaxation:
Participants will be followed up every week, either physically or
virtually, for the first three months during the implementation of the stress
management program and thereafter monthly. Every six months, blood tests and
ECGs will be repeated, and the three-scale scores will be reassessed. All
participants will be examined four 4 times in a span of two years.
Data will be collected, and appropriate statistical tests will be applied. SPSS version 16 will
be used to analyze the data.
References:
1.
Lupien SJ, McEwen BS, Gunnar MR, Heim
C. Effects of stress throughout the lifespan
on the brain, behavior and cognition. Natl Rev Neurosci.
2009: 10: 434-45.
2.
Sheehan B. Assessment scales
in dementia. Ther Adv Neurol
Disord 2012; 5(6):
349– 58.
3.
Khalsaa DS, Ashford JW. Stress, Meditation, and Alzheimer’s Disease
Prevention: Where The Evidence Stands. J Alzheimers Dis. 2015; 48(1):
1–12.
4.
Silva-Costa A, Griep RH, Rotenberg
L. Associations of a short sleep duration, insufficient sleep, and sleep disturbances with self-rated health
among nurses. PLoS One. 2015;10(5): e0126844.
5.
Yazdi Z. Sleep quality and sleep disturbances in nurses with
different circadian chronotypes: Morningness and eveningness orientation. Work. 2014; 47: 561–7.
6.
Cohen, S., Kamarck, T., andMermelstein, R. (1983). A global measure
of perceived stress. J.
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Pappaa S, Ntellac V, Giannakasc T,
Giannakoulisc VG, Papoutsic E, Katsaounouc P. Prevalence of depression, anxiety,
and insomnia among healthcare workers
during the COVID-19 pandemic:
A systematic review and meta-analysis. Brain, Behavior, and Immunity. 2020; 88:
901–907.
8.
Paller KA, Creery JD, Florczak SM, Weintraub S, Mesulam MM, Reber PJ. Benefits
of Mindfulness Training for Patients with Progressive Cognitive Decline and
their Caregivers. J Alzheimers Dis Other Demen. 2015; 30(3): 257–67
9.
Veqar, Z., and Hussain, M. E.
(2020). Validity and reliability of insomnia severity index and its correlation
with pittsburgh sleep quality index in poor sleepers among Indian university students. Int. J. Adolesc. Med. Health 32. doi: 10.1515/ijamh-2016- 0090.
10. Chatterjee
SS, Chakrabarty M, Banerjee D, Grover S, Chatterjee SS, Dan U (2021) Stress, Sleep
and Psychological Impact
in Healthcare Workers
During the Early Phase
of COVID-19 in India: A Factor Analysis. Front. Psychol. 2021; 12:611314. doi: 10.3389/fpsyg.2021.611314.
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IN, Weert-Van Oene GHD, Buwalda VAJ, Leeuw JRJD, Goudriaan AE. The Depression, Anxiety and Stress
Scale (DASS-21) as a Screener
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