Original article
Oral health and depression in older Japanese people Tomoya Takiguchi1, Akihiro Yoshihara2, Naoko Takano1 and Hideo Miyazaki1 1
Division of Preventive Dentistry, Department of Oral Health Science, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, Japan; 2Division of Oral Science for Health Promotion, Department of Oral Health and Welfare, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, Japan
Gerodontology 2015; doi:10.1111/ger.12177 Oral health and depression in older Japanese people Objective: The aim of this study was to investigate the relationship between oral dysfunction and depressive symptoms in Japanese community-dwelling seniors. Materials and methods: Participants included 351 community-dwelling seniors (189 men, 162 women) aged 77 years. During dental examination, teeth and periodontal condition, including number of teeth, number of dental caries, pocket depth and clinical attachment level, were assessed, and unstimulated and stimulated salivary flow rates were measured. The General Health Questionnaire 30 (GHQ30) was used to assess depression. The Tokyo Metropolitan Institute of Gerontology (TMIG) Index of Competence was used to assess activities of daily living. Results: Multiple logistic regression analysis revealed that gender (odds ratio [OR] = 2.3), low unstimulated salivary flow rate (OR = 2.1), ‘Complaint of mouth pain’ (OR = 2.4), ‘Complaint of physical disorders’ (OR = 2.1), and the total TMIG Index of Competence score (OR = 2.0) were positively associated with the high GHQ-30 score. Conclusion: Subjective and objective oral dryness and oral pain are associated with depressive symptoms. Keywords: elderly, community-dwelling, depression, oral condition. Accepted 28 November 2014
Introduction Japanese society consists of a large proportion of seniors. In 2013, 25.1% of the population was aged 65 and older, and this number is expected to increase with time1. In general, there are many negative life events that accompany ageing, such as physical illness or injury, death of a spouse, relocation, work-related difficulties, legal problems, deterioration of financial situation and unemployment. These life events may be associated with physical and mental disorders. Depression or depressive symptoms represent a major mental disorder in seniors. According to international data, the incident rate of major depressive disorder in seniors ranges from 0.2 to 14.1/100 person-years, and the incidence of clinically relevant depressive symptoms is 6.8/100 person-years2. Functional impairment, cognitive impairment and smoking are predictors of depression in seniors3,
and lack of quality of life and chronic conditions, such as angina, asthma, arthritis and nocturnal sleep problems, are also associated with depression4. Moreover, psychological stress is associated with oral dysfunction. Stress and depressive symptoms are predictors of dental caries5 and are associated with periodontal problems6. Cross-sectional and longitudinal studies have shown that chronic oral and facial pain is associated with depressive symptoms7,8. It is well known that ageing is associated with low unstimulated salivary flow9. A reduced salivary flow increases susceptibility to dental caries and dental erosion10, as well as the risk for periodontal disease11. In addition, dry mouth is associated with dysfunction of speech, chewing, swallowing and taste12,13. Antidepressants such as tricyclic antidepressants and selective serotonin reuptake inhibitors have been shown to result in xerostomia in 15–25% of patients, and dysgeusia in 10–40% of patients14. They have also been
© 2015 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd
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T. Takiguchi et al.
shown to be associated with stomatitis and sialadenitis, both of which can affect oral health14. Other than functional impairment, which is capable of predicting depression in seniors, chronic somatic diseases are strongly associated with the onset of depressive disorders and symptoms15. Thus, oral impairment or dysfunction, a subset of functional impairment, may be associated with depressive symptoms among seniors. However, few studies have been published on the relationship between oral dysfunction and depressive symptoms in seniors. Furthermore, increased focus in the dental professional field on the successful reduction of oral dysfunction may improve the quality of life for seniors. The aim of this study was to assess the relationship between oral dysfunction and depressive symptoms in community-dwelling Japanese seniors.
Materials and methods Participants Participants were drawn from the Niigata study, which was a prospective community-based study to evaluate the relationship between an individual’s general health and dental disease. Letters of invitation for this survey were sent to all people (n = 4542) born in 1927, residing in the city of Niigata, Japan; all recipients were informed of the purpose of the study. After the invitation, 81.4% (n = 3965) agreed to participate in the survey. Due to the availability of resources, appointments for examination were arranged for 600 individuals. The preliminary study participants were randomly selected by PC software to yield an approximately equal number of men (306) and women (294) who gave written informed consent; none required special assistance for their daily activities. All 600 participants underwent an annual examination including oral and general physical examinations from 1998 to 2008. For the final study participants, 391 people (207 men, 184 women; aged 77–78 years) with a complete data set from the survey performed in 2005 were chosen (Fig. 1). The Ethics Committee of the Niigata University School of Dentistry approved this study. The General Health Questionnaire 30 (GHQ-30) was used to assess depression, containing 30 questions reflecting the mental state (e.g. depressive mood, sleeping problems and anxiety), social functioning, well-being and coping abilities. Fifteen of the questions are negatively worded, and fifteen are positively worded.
The GHQ-30 was scored in the Goldberg 0-0-1-1 format, where any response indicating deviation from the norm was scored as 1. The total possible score on the GHQ-30 ranges from 0 to 30. For the Japanese version of the GHQ-30, a cut-off score of 7 yielded the best sensitivity (92%) and specificity (85%) based on the diagnosis by psychiatrist; therefore, the seniors were categorised into a low GHQ-30 score group (the GHQ-30 score
Oral health and depression in older Japanese people Tomoya Takiguchi1, Akihiro Yoshihara2, Naoko Takano1 and Hideo Miyazaki1 1
Division of Preventive Dentistry, Department of Oral Health Science, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, Japan; 2Division of Oral Science for Health Promotion, Department of Oral Health and Welfare, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, Japan
Gerodontology 2015; doi:10.1111/ger.12177 Oral health and depression in older Japanese people Objective: The aim of this study was to investigate the relationship between oral dysfunction and depressive symptoms in Japanese community-dwelling seniors. Materials and methods: Participants included 351 community-dwelling seniors (189 men, 162 women) aged 77 years. During dental examination, teeth and periodontal condition, including number of teeth, number of dental caries, pocket depth and clinical attachment level, were assessed, and unstimulated and stimulated salivary flow rates were measured. The General Health Questionnaire 30 (GHQ30) was used to assess depression. The Tokyo Metropolitan Institute of Gerontology (TMIG) Index of Competence was used to assess activities of daily living. Results: Multiple logistic regression analysis revealed that gender (odds ratio [OR] = 2.3), low unstimulated salivary flow rate (OR = 2.1), ‘Complaint of mouth pain’ (OR = 2.4), ‘Complaint of physical disorders’ (OR = 2.1), and the total TMIG Index of Competence score (OR = 2.0) were positively associated with the high GHQ-30 score. Conclusion: Subjective and objective oral dryness and oral pain are associated with depressive symptoms. Keywords: elderly, community-dwelling, depression, oral condition. Accepted 28 November 2014
Introduction Japanese society consists of a large proportion of seniors. In 2013, 25.1% of the population was aged 65 and older, and this number is expected to increase with time1. In general, there are many negative life events that accompany ageing, such as physical illness or injury, death of a spouse, relocation, work-related difficulties, legal problems, deterioration of financial situation and unemployment. These life events may be associated with physical and mental disorders. Depression or depressive symptoms represent a major mental disorder in seniors. According to international data, the incident rate of major depressive disorder in seniors ranges from 0.2 to 14.1/100 person-years, and the incidence of clinically relevant depressive symptoms is 6.8/100 person-years2. Functional impairment, cognitive impairment and smoking are predictors of depression in seniors3,
and lack of quality of life and chronic conditions, such as angina, asthma, arthritis and nocturnal sleep problems, are also associated with depression4. Moreover, psychological stress is associated with oral dysfunction. Stress and depressive symptoms are predictors of dental caries5 and are associated with periodontal problems6. Cross-sectional and longitudinal studies have shown that chronic oral and facial pain is associated with depressive symptoms7,8. It is well known that ageing is associated with low unstimulated salivary flow9. A reduced salivary flow increases susceptibility to dental caries and dental erosion10, as well as the risk for periodontal disease11. In addition, dry mouth is associated with dysfunction of speech, chewing, swallowing and taste12,13. Antidepressants such as tricyclic antidepressants and selective serotonin reuptake inhibitors have been shown to result in xerostomia in 15–25% of patients, and dysgeusia in 10–40% of patients14. They have also been
© 2015 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd
1
2
T. Takiguchi et al.
shown to be associated with stomatitis and sialadenitis, both of which can affect oral health14. Other than functional impairment, which is capable of predicting depression in seniors, chronic somatic diseases are strongly associated with the onset of depressive disorders and symptoms15. Thus, oral impairment or dysfunction, a subset of functional impairment, may be associated with depressive symptoms among seniors. However, few studies have been published on the relationship between oral dysfunction and depressive symptoms in seniors. Furthermore, increased focus in the dental professional field on the successful reduction of oral dysfunction may improve the quality of life for seniors. The aim of this study was to assess the relationship between oral dysfunction and depressive symptoms in community-dwelling Japanese seniors.
Materials and methods Participants Participants were drawn from the Niigata study, which was a prospective community-based study to evaluate the relationship between an individual’s general health and dental disease. Letters of invitation for this survey were sent to all people (n = 4542) born in 1927, residing in the city of Niigata, Japan; all recipients were informed of the purpose of the study. After the invitation, 81.4% (n = 3965) agreed to participate in the survey. Due to the availability of resources, appointments for examination were arranged for 600 individuals. The preliminary study participants were randomly selected by PC software to yield an approximately equal number of men (306) and women (294) who gave written informed consent; none required special assistance for their daily activities. All 600 participants underwent an annual examination including oral and general physical examinations from 1998 to 2008. For the final study participants, 391 people (207 men, 184 women; aged 77–78 years) with a complete data set from the survey performed in 2005 were chosen (Fig. 1). The Ethics Committee of the Niigata University School of Dentistry approved this study. The General Health Questionnaire 30 (GHQ-30) was used to assess depression, containing 30 questions reflecting the mental state (e.g. depressive mood, sleeping problems and anxiety), social functioning, well-being and coping abilities. Fifteen of the questions are negatively worded, and fifteen are positively worded.
The GHQ-30 was scored in the Goldberg 0-0-1-1 format, where any response indicating deviation from the norm was scored as 1. The total possible score on the GHQ-30 ranges from 0 to 30. For the Japanese version of the GHQ-30, a cut-off score of 7 yielded the best sensitivity (92%) and specificity (85%) based on the diagnosis by psychiatrist; therefore, the seniors were categorised into a low GHQ-30 score group (the GHQ-30 score
