Health, Social, and Economic Variables Associated with Depression among Older People in Low and Middle Income Countries: WHO Study on Global AGEing and Adult Health

Objective Although depression among older people is an important public health problem worldwide, systematic studies evaluating its prevalence and determinants in low and middle income countries (LMICs) are sparse. The biopsychosocial model of depression and prevailing socioeconomic hardships for older people in LMICs have provided the impetus to determine the prevalence of geriatric depression; to study its associations with health, social, and economic variables; and to investigate socioeconomic inequalities in depression prevalence in LMICs. Methods The authors accessed the World Health Organization Study on Global AGEing and Adult Health Wave 1 data that studied nationally representative samples from six large LMICs (N = 14,877). A computerized algorithm derived depression diagnoses. The authors assessed hypothesized associations using survey multivariate logistic regression models for each LMIC and pooled their risk estimates by meta-analyses and investigated related socioeconomic inequalities using concentration indices. Results Cross-national prevalence of geriatric depression was 4.7% (95% CI: 1.9%–11.9%). Female gender, illiteracy, poverty, indebtedness, past informal-sector occupation, bereavement, angina, and stroke had significant positive associations, whereas pension support and health insurance showed significant negative associations with geriatric depression. Pro-poor inequality of geriatric depression were documented in five LMICs. Conclusions Socioeconomic factors and related inequalities may predispose, precipitate, or perpetuate depression amongolder people in LMICs. Relative absence of health safety net places socioeconomically disadvantaged older people in LMICs at risk. The need for population-based public health interventions and policies to prevent and to manage geriatric depression effectively in LMICs cannot be overemphasized

Exploring the prevalence of clozapine phenotypic poor metabolizers in 4 Asian samples: they ranged between 2 and 13%

Purpose/Background: Clozapine clearance is influenced by sex, smoking status, ethnicity, co-prescription of inducers or inhibitors, obesity and inflammation. In 126 Beijing inpatients, we measured repeated trough steady-state serum concentrations and identified 4% (5/126) who were phenotypical poor metabolizers (PMs); none were ultrarapid metabolizers (UMs). They were defined as being 2 standard deviations beyond the means of total clozapine concentration/dose ratios stratified by sex and smoking. Using this definition, this study explores the prevalences of PMs and UMs using data from 4 already-published Asian samples. Three samples were East Asian (Beijing 2, Taipei and Seoul); one was from South India (Vallore). Findings/Results: The prevalence of phenotypical PMs ranged from 2-13%, but inflammation was not excluded. The prevalence was 7.3% (14/191) for Beijing 2, 11% (8/70) for Taipei, 13% (9/67) for Seoul, and 2% (2/101) for the Vellore sample. Five phenotypical PMs appeared to be associated with extreme obesity. Phenotypic UM prevalence ranged from 0-1.6%, but may be partly explained by lack of adherence. A Vellore phenotypic UM appeared to be associated with induction through high coffee intake. Implications/Conclusions: Around 10% of Asians may be clozapine PMs and may only need 50-150 mg/day to get therapeutic concentrations. Future studiescombining gene sequencing for new alleles with repeated concentrations and careful control of confounders including inhibitors, inflammation and obesity should provide better estimations of the prevalence of phenotypic clozapine PMs across races. Clozapine UM studies require excluding potent inducers, careful supervision of compliance in inpatient settings and multiple serum concentrations