To our knowledge, this is the first study examining the prevalence of depression and anxiety in adults over 60 years seeking care in primary care centers in Palestine. Consistent with other studies, physical illness is a common risk factor for mental illness, particularly in the elderly. [20] In this context, we need to emphasize the importance of screening for anxiety and depression in PHC settings, especially when NCDs are present. ,
In our sample 41.1% suffer from depression, 39.2% from anxiety. These findings corroborate a meta-analysis that assessed the global prevalence of depression to be 31.7% and 40.7% in developing countries.[4] Research conducted in nearby Egypt reported a prevalence of depression and anxiety of 37.5% and 14.2%, respectively.[21]
Health professionals should routinely assess for depression and anxiety among the elderly. Professional organizations in Palestine should adopt guidelines and policies to encourage assessing the elderly for the WHO guidelines . Policymakers and other key stakeholders should allocate resources to facilitate screening and treatment.
Undiagnosed and untreated depression and anxiety can consume health care resources with unnecessary workups and testing for physical symptoms [3]
establish effective control measures and offer routine geriatric care. On the other hand, in a financially impoverished country such as Palestine, such mental illnesses can impose a significant financial and institutional load on primary health care facilities. [22].
Our results for both anxiety and depression were surprising because the female gender and single status, which are considered risk factors[23], are not significant in our sample. Age, on the other hand, was not significantly associated with either anxiety or depression.This is likely due to local culture and traditions that value the elderly and encourage people, particularly women and unmarried women, to assist them financially and socially.
Rural-urban differences in mental disorders have piqued the interest of researchers and policymakers involved in mental health care. Due to community ties and social isolation, city inhabitants may be more prone to depression than rural residents.[24] Inequalities of health care and access barriers could explain the apparent correlation between both anxiry and depression an rural and urban residence.
In the relationship between depression and education, low education was significantly associated with depression in developing and developed countries. In contrast, income was not strongly related to depression in low- to middle-income countries, contradicting our findings.[25] This could indicate that educated individuals better understand the issue and are more likely to seek medical treatment early. While in terms of income, as previously stated, a significant proportion of Palestinian families frequently rely on retired older people financially, increasing pressure and the possibility of economic violence; of course, this association warrants further examination to ascertain the patterns implicit in these complex relationships.
Our study limitations include , beginning with the global pandemic of COVID-19, which prevented the researchers and patients from accessing the primary health care centres. Nonetheless, we have a good response rate of 85 percent; participants' refusal to proceed with the interview was explained by a lack of time, tiredness, or simply a dislike of interacting with others. The nature of the participants' refusal was similar to that of the study participants. The social desirability bias could be expected in an interview-based questionnaire about sensitive objects because patients tend to answer positively to the questions, but we hypothesize that this may be minimal in our study because elderly people are fully aware of the consequences of their contribution, which may reflect in their quality of care. Finally, this is a cross-sectional study that measures the prevalence in a snapshot of time, and the prevalence may change over time.