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Procedia - Social and Behavioral Sciences 114 (2014) 754 – 760

4th World Conference on Psychology, Counselling and Guidance WCPCG-2013

Depression and loneliness in disabled adults


Özlem Çağan a*, Alaettin Ünsal b
a
Eskişehir Osmangazi Üniversity Eskişehir,School of Health, Eskişehir 26480, Turkey
b
Eskişehir Osmangazi Üniversity, Public Health Department, Eskişehir 26480,Turkey

Abstract

The study is a cross-sectional type conducted on disabled individuals registered in Turkish Disabled Association Branch in the
province of Eskişehir between 27th of August 2012 – 15th of January 2013. 348 disabled individuals (54%), who agreed to
participate in the study and with whom communication could be established, constituted the study group. The existence of
disability, its type and degree in individuals were evaluated according to the medical reports obtained previously. In this
study, the Beck Depression Inventory was used to assess the level of depression and the UCLA Loneliness Scale was used to
assess loneliness. The working group consisted of 95 females (27.3%) and 253 males (72.7%). Their ages varied from 18 to
62 and the average age was 34.70 ± 12.22. In our study, the frequency of depression was determined as 57.8% (n = 201).
Those who are married, those with three or more children, smokers, those who consume alcohol, and those who need care in
their daily lives have a higher incidence of depression (for each, p <0.05). It has been found out that those who are 19 years
old and under this age, high school graduates and those with higher level of education, hearing-impaired patients and those
with 50-74% disability level, have a lower incidence of depression (for each, p <0.05). There is no correlation between
depression and loneliness (p> 0.05).
©
© 2013 The Authors.
2013 The Authors. Published
Publishedby
byElsevier
ElsevierLtd.
Ltd.Open access under CC BY-NC-ND license.
Selection and peer-review
Selection and peer-reviewunder
underresponsibility
responsibilityofofAcademic
Prof. Dr. World
Tülay Bozkurt,
EducationIstanbul KulturCenter.
and Research University, Turkey
Keywords: Adult, disability, depression, loneliness.;

1. Introduction

The word disabled is generally associated with someone with limited ability to move. Functional disorders,
innate or encountered during birth or acquired as a result of an illness or an accident can be counted among the
reasons for this restriction of movement.

The World Health Organization defined disability as the state in which a person fails to comply with the
requirements of a normal life as a result of absence or malfunction of an organ leading to permanent loss of
function and image of physical, mental and spiritual characteristics to a certain extent (Mutluer 1997).
Physical disability is a disorder which prevents or wholly removes physical skills by creating any disorder or
lack of it in the form of human structure and physical aspects. From the point of physical disability, there are also
differences among individuals with disabilities. These are classified as orthopedically handicapped, visually
impaired, hearing impaired and speech handicapped (Ranson 1983).

* Corresponding author name. Tel.: +009 0530 2270255


E-mail address: ocagan@ogu.edu.tr

1877-0428 © 2013 The Authors. Published by Elsevier Ltd. Open access under CC BY-NC-ND license.
Selection and peer-review under responsibility of Academic World Education and Research Center.
doi:10.1016/j.sbspro.2013.12.780
Özlem Çağan and Alaettin Ünsal / Procedia - Social and Behavioral Sciences 114 (2014) 754 – 760 755

It is a well-known fact that a large number of mental disorders such as despair, loneliness, anxiety and
depression are seen in disabled individuals (Altındağ 2008 & Zazove 2006 & Horowitz 2003). Depression is a
syndrome that involves such symptoms as slowdown and recession in thought, speech and movement,
worthlessness, smallness, weakness, reluctance, pessimism, suicidal thoughts and feelings and slowdown in
physiological functions in a mood of deep sadness (Köroğlu 2001). At the bottom of disabled individuals’ being
at risk with regard to depression are living conditions and prejudices which stem from the social environment
they belong to (Thompson 2010)

One of the major causes of depression is reported to be disability by the World Health Organization. More
than 17 million people each year in the United States are reported to suffer from depression and many of these
are reported to be impaired (Altındağ 2008 & Zazove 2006).

All people need to contact and interact with others in life. Resulting from the lack of social relations,
loneliness causes a lot of mental disorders in individuals. From this point of view, loneliness is expected to occur
more frequently in disabled people (Horowitz 2003). Loneliness is the perception of an individual that his social
relationships are not as expected and it develops as a result of a sense of belonging (Arkar 2004). Loneliness is
defined by different names according to the causes and symptoms. Weiss divides loneliness as emotional and
social loneliness in theory and states that emotional loneliness is related to the family, a special friend and
relationships while social loneliness is connected with friendships in the social environment (Beck 1961).

2. Materials and Methods

2.1. Participant:

The study is a cross-sectional survey conducted on disabled individuals registered in Turkish Disabled
People’s Association Branch in the province of Eskişehir between the dates of 27 August 2012 and 15 January
2013.
In Eskişehir Turkish Disabled People’s Association, 645 disabled individuals are registered. The study group
consists of 348 individuals with disabilities (54%). 108 of them (31.0%) were visually handicapped, 99 of them
(28.4%) hearing impaired, and 141 of them (40.5%) were orthopedically handicapped.

2.2 Instruments:
Questionnaire form, prepared for the purpose of this study properly, contains information about some of the
socio-demographic characteristics of disabled individuals, some of the features related to their disability, Beck
Depression Inventory and the UCLA Loneliness Scale.

In order to carry out the study, the necessary permission of officials in Turkish Disabled People's Association
Eskişehir Branch and dating 27.08.2012 and 2012/183 numbered approval of Eskişehir Osmangazi University
Medical Faculty Ethics Committee had been obtained.

A verbal consent of disabled individuals was taken after they were informed about the subject and the
purpose of the study in Disabled People’s Association. Pre-prepared questionnaires were filled by the disabled
people that constitute the study group under supervision. For visually handicapped people, the questionnaires
were filled by the researchers. This process took about 30-35 minutes. Those who were absent, although
registered in the association, those with mental retardation and the ones who did not agree to participate in the
study were excluded from the study.
756 Özlem Çağan and Alaettin Ünsal / Procedia - Social and Behavioral Sciences 114 (2014) 754 – 760

Beck Depression Inventory was used to assess depression in our study. The BDI was developed by Beck et
al. in 1961 (Beck 1961) and later modified by Hisli to suit the Turkish culture and norms in 1989 . The scale
includes 21 questions of four options. The answer for each item was evaluated as 0, 1, 2, and 3 points. The lowest
number of points was accepted as '0 'and the highest '63', with a cut-off point of 17. In accordance with the
implementation and evaluation format, the patients were asked to mark the appropriate options for themselves in
the last two weeks.

UCLA Loneliness Scale was used to evaluate loneliness. This scale was developed by Rusell et al. in 1980
and its reliability and validity study was conducted in 1989 by Demir. The scale consists of 20 questions and is a
likert-type scale. For each answer points of 1,2,3, and 4 can be obtained. The lowest score is 20 and the highest
score is 80. A high score of the scale is considered as an indicator of an individual's more intense feeling of
loneliness.

The presence of disability in individuals, its type and degree were evaluated according to the medical reports
taken previously.In this study, family income state was defined as poor, middle and well according to disabled
individuals’ own perceptions.

Those who smoke at least one cigarette per day were considered smokers (Tolonen 2002).In the current
study, alcohol consumers were evaluated as those who had consumed at least one standard drink per week (one
glass of raki / 1 cup vodka 1 cup gin / one glass of wine or one large glass of beer) (Ozfatura 2012).

The data obtained were evaluated in the IBM SPSS (version 20.0) statistical package program. For analysis,
the Chi-square test, Mann-Whitney U test, Kruskal-Wallis test and Spearman correlation analysis were used.
Statistical significance value was considered as p <0.05.

3. Findings

The study group consisted of 95 female (27.3%) and 253 male (72.7%), a total of 348 individuals with
disabilities. Their ages ranged from 18 to 62 and the average was 34.70 ± 12.22 years. In this study, 201 of
individuals with disabilities (57.8%) were detected likely to have depression. The distribution of some socio-
demographic characteristics of disabled individuals suspected of having depression and those who do not have it
in the study group is shown in Table 1.

Table 1. Some socio-demographic characteristics of disabled individuals suspected of having depression and
those who do not have it in the study group

Socio-demographics Depression Test value


No Yes Total X2 ; p
n (%)* n (%)* n (%)**
Gender
Female 40 (42.1) 55 (57.9) 95 (27.3)
Male 107(42.3) 146 (57.7) 253 (72.7) 0.001; 0.975
Age group
≤19 21 (58.3) 15 (41.7) 36 (10.3)
20-29 54 (49.5) 55 (50.5) 109 (31.3)
30-39 24 (32.9) 49 (67.1) 73 (21.0)
40-49 30 (37.0) 51 (63.0) 81 (23.3) 10.334; 0.035
≥50 18 (36.7) 31 (63.3) 49 (14.1)
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State of education
Illiterate 11 (32.4) 23 (67.6) 34 (9.8)
Primary 21 (33.9) 41 (66.1) 62 (17.8)
Secondary 28 (32.9) 57 (67.1) 85 (24.4)
High school 62 (54.4) 52 (45.6) 114 (32.8) 13.576; 0.009
University 25 (47.2) 28 (52.8) 53 (15.2)
Working condition
Working 45 (45.9) 53 (54.1) 98 (28.2)
Not working 102 (40.8) 148 (59.2) 250 (71.8) 0.756; 0.385
Family income state
Poor 70 (37.8) 115 (62.2) 185 (53.2)
Middle 48 (43.6) 62 (56.4) 110 (31.6) 4.939; 0.085
Well 29 (54.7) 24 (45.3) 53 (15.2)
Marital status
Single 100 (47.4) 111 (52.6) 211(60.6)
5.831; 0.016
Married 47 (34.3) 90 (65.7) 137 (39.4)
Number of children
None 109 (47.0) 123 (53.0) 232 (66.7)
1 13 (35.1) 24 (64.9) 37 (10.6)
2 21 (36.8) 36 (63.2) 57 (16.4) 8.804; 0.032
3≥ 4 (18.2) 18 (81.8) 22 (6.3)
Smoking
Yes 33 (30.8) 74 (69.2) 107 (30.7)
No 114 (47.3) 127 (52.7) 241 (69.3) 8.230; 0.004
Alcohol consumption
Yes 14 (28.6) 35 (71.4) 49 (14.1)
No 133 (44.5) 166 (55.5) 299 (85.9) 4.368; 0.037
Total 147 (42.2) 201 (57.8) 348 (100.0)
Percentages are determined *: According to line total, **: According to column.

In our study, the number of visually impaired individuals was 108 (31.0%), hearing impaired individuals
were 99 (28.4%) and the number of individuals with orthopedic disabilities was 141 (40.5%). The distribution of
those suspected of having depression and those who do not have it in the study group according to some
disability features is given in Table 2.

Table 2. Some disability characteristics of those suspected of having depression and those who do not have it

Depression
Disability features No Yes Total Test value
n (%)* n (%)* n (%)** X2 ; p
Disability type
Vision 37 (34.3) 71 (65.7) 108 (31.0
Hearing 57 (57.6) 42 (42.4) 99 (28.4) 13.613; 0.001
Orthopedic 53 (37.6) 88 (62.4) 141 (40.5)
Time of becoming disabled
Congenital 73 (42.4) 99 (57.6) 172 (49.4)
Later 74 (42.0) 102 (58.0) 176 (50.6) 0.006; 0.940
Degree of Disability (%)
<50 26 (32.1) 55 (67.9) 81 (23.3)
758 Özlem Çağan and Alaettin Ünsal / Procedia - Social and Behavioral Sciences 114 (2014) 754 – 760

50-74 92 (52.6) 83 (47.4) 175 (50.3) 15.402; 0.000


75 and over 29 (31.5) 63 (68.5) 92 (26.4)
Cause of disability
Hereditary disease 36 (43.9) 46 (56.1) 82 (23.6)
Connected to birth 42 (42.0) 58 (58.0) 100 (28.7)
Disease 55 (43.0) 73 (57.0) 128 (36.8) 0.577; 0.902
Accident-disaster 14 (36.8) 24 (63.2) 38 (10.9)
State of needing care in daily life
Needing 42 (34.4) 80 (65.6) 122 (35.1)
Not needing 105 (46.5) 121 (53.5) 226 (64.9) 4.703; 0.030
Total 147 (42.2) 201 (57.8) 348 (100)
Percentages are determined *: According to line total, **: According to column.

The scores that disabled individuals got from Beck Depression Scale ranged from 0 to 63 individuals and the
average score was 21.85 ± 16.10. The scores they obtained from UCLA Loneliness Scale ranged from 27 to 80
and the average was 60.26 ± 10.70. A relation could not be found between the scores of UCLA Loneliness Scale
and the Beck Depression Scale (rs = 0.008, p = 0.887).

4. Discussion

In our study, 57.8% of adults with disabilities were detected to have depression. On the other hand, different
results have been obtained in various studies on disabled adults: In the study Chen et al. (2012) conducted on
disabled people aged 65 and over with Short Psychiatric Evaluation Schedule Scale, the result was 29.3%
whereas Horowitz et al. (2003) obtained 33.7% in their study conducted again on the aged 65 and over with CES-
D. In the study Suttajit et al. (2010) carried out on the disabled people aged 60 and over with the EURO-D scale,
27.2% of them were observed to have depression. That higher depression was found in our study might stem
from the fact that the participants’ ages ranged from 18 to 62 or that different diagnostic criteria of depression
were used, or due to cultural differences.

There was no difference between males and females in the study group. (p> 0.05). This situation can be
explained by the fact that a large majority of the participants consisted of males. Similar results have been
reported in different studies.

Of the participants, those who were aged 19 and below were found to have a lower incidence of depression.
(p<0.05) Horowitz et al. (2003) reported that depression is the most common mental health problem among
adults and the prevalence increases with age.

In our study, as the level of education decreases, the level of depression increases (p <0.05). Whereas
Horowitz et al. (2003) did not find a relation between education and incidence of depression in their study, Chen
et al. (2012) reported in their study that illiterate individuals with disabilities have depressive symptoms more
frequently. Stordal et al. (2007) stated the most influential factor in the prevalence of depression is the low
education level. Low education level usually comes with low income and by preventing social support, the
frequency of depression could be increased. Therefore, high education level is considered to be a protective
factor for depression (Ku 2006).

The state of not working is known to affect individuals with disabilities adversely in terms of social,
psychological and financial aspects. Depending on their jobless state, the deterioration of their economic situation
is expected to bear negative consequences. In the study Kilzieh et al. (2010) carried out, it was reported that
people with low socio-economic status have higher level of depression . However, in our study, a relation could
Özlem Çağan and Alaettin Ünsal / Procedia - Social and Behavioral Sciences 114 (2014) 754 – 760 759

not be found between working state, family income status of disabled people and the incidence of depression (for
each p> 0.05).

Depression in married participants was significantly high (p <0.05). Similar results have been reported in
various studies (Zazove 2006 & Suttajit 2010 & Bernabeia 2011). This situation can be explained by the increase
in the responsibilities of marriage. Already going through quite a lot of trouble in their own responsibilities, the
disabled individual is expected to have depression more frequently as a result of taking over the responsibility of
the spouse and the children after marriage.

Those with 3 or more children of the participants showed a higher incidence of depression (p <0.05). Harlow
et al. stated that those with one child or more, compared to those without children, have a lower risk of mental
disorder. Disabled individuals face greater difficulties in their daily lives than the healthy people do. While
having difficulty in their own care, they have more responsibilities for their children and this may lead to
psychological problems such as depression (Harlow 1999). Smokers and alcohol consumers were found to have
a significantly high level of depression (p <0.05). In various studies, the prevalence of depression in smokers has
been reported to be higher than non-smokers. Because heavy alcohol use and daily smoking are each associated
with depression, people who do both may be at an increased risk for depression. This is a public health issue
because people who drink alcohol often also smoke and vice versa (Pomerleau 2003& Benjet 2004 & Adewuya
2006 & Jane-Lollips 2006).

When the participants' disability type and their level of depression were compared, it was found lower in the
hearing-impaired (p <0.05). This situation can be explained by the fact that the initiatives such as education,
employment, environmental regulation, social support in Turkey are not provided adequately to facilitate the
lives of people with disabilities and especially visually handicapped and orthopedically handicapped people live
more dependently.

There was no statistically significant difference between the time or cause of becoming disabled and
depression (p> 0.05).Depression was found to be significantly low in patients whose disability degree was
between 50-74% (p< 0.05).Depression is higher in those who need care for their daily tasks (p <0.05). This
condition may stem from the problems of being dependent on others.

5. Limitations
The fact that the study was a cross-sectional survey conducted only on the disabled people registered in
Eskişehir Turkish Disabled Association and that the scales used could not make definitive diagnosis might be
counted as the limitations of this study.

6. Conclusions and Recommendations

Depression is a major health problem among disabled adults. There is no relationship between the level of
depression and loneliness. Early detection and regular screening of depression for the purpose of treatment,
directing to advanced centers for definitive diagnosis of suspected cases and the provision of social support to
these individuals would be helpful.

References
Mutluer S.Y. (1997) Tekerlekli Sandalye Kullanan Bedensel Özürlüler İçin Uygun Konut Tasarımı ve Çevre
Düzenlemesi. Konya: Selçuk Üniversitesi, Yüksek Lisans Tezi.
Ranson L. (1983) Designing with Care: A Guide to Adaptation of the Built Environment for Disabled Persons.,
New York, United Nations.
760 Özlem Çağan and Alaettin Ünsal / Procedia - Social and Behavioral Sciences 114 (2014) 754 – 760

Altındağ Ö, Soran N, Demirkol A, Özkul MY. (2008) The Association Between Functional Status, Health
Related Quality of Life and Depression After Stroke, Turk J Phys Med Rehab. 54:89-91.
Zazove P, Meador HE, James E. (2006) Assessment of Depressive Symptoms in Deaf Persons. JABFM. Vol. 19
No. 2.
Horowitz A , Reinhardt JP, Boerner K, Travis LA. (2003) The influence of health, social support quality and
rehabilitation on depression among disabled elders. Aging & Mental Health. 7(5): 342–350
Amerikan Psikiyatri Birliği. Ruhsal Bozuklukların Tanısal ve Sayımsal El Kitabı, Yeniden Gözden Geçirilmiş 4.
Baskı (DSM-IV-TR). (E.Köroğlu, Çev.) Ankara, Hekimler Yayın Birliği. 2001.
Thompson K, Ph.D. Depression and Disability, a Practical Guide, The North Carolina Office on Disability and
Health. (01.03.2010). www.fpg.unc.edu/~ncodh/pdfs/depression.pdf.
Arkar H, Sarı Ö, Fidaner H. (2004) Relationships between quality of life, perceived social support, social
network and loneliness in a Turkish sample. Yeni Symposıum. 42(1):20-27.
Demir A. UCLA yalnızlık ölçeğinin geçerlik ve güvenirliği. Psikoloji Dergisi. 1989; 7(23),14-28.
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. (1961) An inventory for measuring depression. Arch Gen
Psychiatry. 4: 561-71
Hisli N. (1989) A study of the validity of the Beck Depression Inventory. Turkish J Psychol. 22 (6):118-26.
Russell D, Peplau, LA, and Cutrona CE. (1980) The revised UCLA Loneliness Scale: Concurrent and
discriminant validity evidence. Journal of Personality and Social Psychology, (39), 472–480.
Tolonen H, Wolf H, Jakovljevic D, Kuulasmaa K. (2002) European Health Risk Monitoring Project. Review of
surveys for risk factors of major chronic diseases and comparability of the results. European Health Risk
Monitoring (EHRM) Project. Available at: URL: http://www.ktl.fi/publications/ehrm/product1/title.htm.
URN:NBN:fi-fe20021442.
Ozfatura N. (2009) Yesilay Alkol Raporu, Available at: http://yesilay.org.tr/yesilay.asp?p=dokuman&id=70.
Accessed on Dcember 22, 2012.
Chen CM, Mullan J, Su YY. (2012) The Longitudinal Relationship Between Depressive Symptoms and
Disability for Older Adults: A Population-Based Study. Journal of Gerontology: Medıcal Scıences. Cite
journal as: J Gerontol A Biol Sci Med Sci. 67(10):1059–1067
Suttajit S, Punpuing S, Jirapramukpitak T. (2010) Impairment, disability, social support and depression among
older parents in rural Thailand. Psychological Medicine, 40, 1711–1721.
Stordal E, Mykletun A, Dahl AA. (2003) The association between age and depression in the general population: a
multivariate examination. Acta Psychiatr Scand.107:132-141
Ku YC, Liu WC, Tsai YF. (2006) Prevalence and risk factors for depressive symptoms among veterans home
elders in Eastern Taiwan. Int J Geriatr Psychiatry.21:1181-1186.
Kilzieh N, Rastam S, Ward KD, Maziak W. (2010) Gender, depression and physical impairment: an
epidemiologic perspective from Aleppo, Syria. Soc Psychiatry Psychiatr Epidemiol. 45(6): 595–602.
Bernabeia V, Morinia V, Morettia F, Marchioria A. (2011) Vision and hearing impairments are associated with
depressive–anxiety syndrome in Italian elderly. Aging & Mental Health. Vol.15, No.4,467–474
Harlow BL, Cohen LS, Otto MW, Spiegelman D, Cramer DW. (1999) Prevalence and predictors of depressive
symptoms in older premenopausal women: the Harvard Study of Moods and Cycles. Arch Gen Psychiatry.
56:418-424.
Pomerleau CS, Zucker AN, Stewart AJ. (2003) Patterns of depressive symptomatology in women smokers,
exsmokers, and never-smokers. Addict Behav. 28:575-582.
Benjet C, Wagner FA, Borges GG, Medina-Mora ME. (2004) The relationship of tobacco smoking with
depressive symptomatology in the Third Mexican National Addictions Survey. Psychol Med. 34:881-888.
Adewuya AO, Ola BA, Olutayo OA, Mapayi BM, Oginni OO. (2006) Depression amongst Nigerian university
students. Prevalence and sociodemographic correlates. Soc Psychiatry Psychiatr Epidemiol. 41:674-8.
Jane-Lollips E, Matystina I. (2006) Mental health and alcohol, drugs, and tobacco: A review of the comorbidity
between mental disorders and the use of alcohol, tobacco and illicit drugs. Drug Alcohol Review. 25:51536.