There were much higher rates of late life depression evident in Bulgarian villages than in a Romanian one studied. In 2007 the comparison between Romanian and Bulgarian elderly persons on the basis of the HAD-D scale revealed a significant difference in the level of depression (Romanian mean 7.3; Bulgarian mean 12.0) . It is not possible to give a definitive explanation of this striking difference. Despite a common recent history of communist rule followed by a return of capitalism, a number of historical, social and cultural differences between the two countries could play a part. One possible protective factor that has been identified is religious belief and practice. This continues to be much higher in Romanian than Bulgarian society [8,12].
There were consistent negative associations between self-evaluation rates and depression. Using in 2008 the two parts of the Self-Evaluation Test with 15 scales  we confirmed that low self-ratings could indicate depressive symptoms. Of the 55 persons considered 24 (43.6%) have chosen positions on the scale of happiness below the middle of the vertical line. Calculating the sum of the positions below the middle on all 15 scales of the test we found 22 persons (40.0%) having 6 or more low positions on different lines. So the findings from the SET are very close to the findings indicating the presence of moderate or severe depression from the three depressive scales, especially from the HAD-D scale (43.6%), and Zung (41.8%).
Our previous study of the 1970’s was on 708 elderly representing 20% random sample of all population aged 70 and over from 46 villages near Sofia . Two of the same villages, nowadays already part of Sofia city, were subject of our studies also in 2007 and 2008. The data on prevalence of depression in these studies are difficult to compare because of the differences in historical and social circumstances. Moreover in the 1970’s study the appraisal of depressions was mostly clinical, and we found 22.2% mild or more pronounced depressions. Calculated for the population of the two discussed villages 11 from 50 elderly persons (22.0%) were appraised to be affected by depressions. The cases of another 6 persons from the 1972 study have been thought then to lay in the border zone between normal ageing and depression [5,13,14]. It is well known from numerous studies that the depressive scales find higher prevalence of depressive symptoms than do studies based on clinical appraisal.
In the 1970’s rural study we firstly used the SET and we found a significant correlation between the lower self-ratings and the presence of depression. The scale of happiness proved to be the most sensitive p<0.001), followed by the scales of health, intellectual capacity and character (at p<0.05) [5,7,15]. In order to examine more closely the relations between depression and lower Self-Evaluation (SE) we compared two subgroups from the 55 elderly persons examined in 2008:
- 15 elderly persons with scores around the norm on the three depressive scales HAD-D, GDS and Zung Self Rating Depression Scale;
- 10 persons with moderate or severe depression according to the three scales i.e., with HAD-D ≥11, as well GDS ≥10 and Zung ≥60;
- 4 women from the 15 elderly in the group (A) were widows, but all they lived with some of their children and/or grandchildren. No one lived alone. In the group (B) from 10 elderly 8 were widows or widowers and four of them lived lonely
- 9 persons from (A) had positive SE of happiness above the middle score vs. no one from (B), whereas the middle position on the scale of happiness was occupied by 6 persons from (A) vs. only one on from the group (B)
- Low SE with a position below the middle had no one from A, but 9 persons from (B)
- No one from (A), but 9 persons from (B) have chosen six and more positions below the middle rank along all scales
Regarding the motives of dissatisfaction shared along the SET:
- 8 from 10 persons in group B shared health problems vs. 6 from 15 in group A
- 6 from 10 persons within group B shared financial difficulties vs. 5 from 15 in group A
- 5 from 10 persons in group B shared problems in their families including death of a close person vs. 3 from 15 in group A. Three elderly shared they felt loneliness, all women and all from group B
- 4 from 10 persons in group B indicated that they felt themselves physically too weak vs. 1 person from group A
- 4 from 10 persons in the group B spontaneously shared complaints about their memory vs.1 from group A
Remarkably, to the question related to the self-evaluation of happiness - “what is missing to be higher in happiness” - 4 persons from group A answered approximately that there was nothing needed, that they were fully satisfied with their lives.
Finally, in comparing self-ratings from the SET in 2008 and 1972, we also found statistically significant differences using chi-square test. In 1972 the first part of the test was performed by 228 rural elderly aged 70 years and over. Nearly half of them (106 persons or 46.5%) had mostly positive SE of happiness and chose positions above the middle of the line. The very middle of the scale was chosen by 27.2%. Definitely negative self-evaluation scores with positions below the middle of the line were chose by 60 (26.3%). In 2008 44 from 55 persons were in the age group 70 and over. Of them 14 (31.8%) had positive, 11 (25.0%) mid and 19 persons (43.1%) low SE positions of happiness. There is a trend to lower self-evaluation of happiness in 2008, but without statistical significance according chi-square (p>0.05). Striking are the differences on the scale of health. In 1972 89 persons or 39.0% had positive, 28.1% mid and 75 elderly (32.9%) mostly negative SE. In 2008 only 4 persons (9.1%) had positive SE of health, 31.8% chose the middle, and the majority (30 persons or 68.2%) chose ratings below the middle of the line (p<0.001). These sharp differences might partly reflect social and cultural differences between the two historical periods. In 2008 elderly people living in the villages near Sofia had undoubtedly higher level of education and much wider information, including health information, than was possible in 1972. It is an open question whether the differences in self-evaluation reflect also a more pessimistic view on the contemporary post-communist-transition period in the history of the country .
The content analysis of leading themes of personal dissatisfaction shared verbally during the self-evaluation of happiness showed differences too. In 2008 50.0% of the elderly explaining “what was missing to being happier” noted health problems (vs. 22.4% in 1972) (p<0.01) and 43.2% financial difficulties (vs. 28.9% in 1972) (p<0.05). The issue of the feelings and attitudes of the people towards the changes in the mode of life during 1990’s is complicated. Some idea of this was given in one small study undertaken by the first author in Sofia in 1992-1993 with independent elderly people living active lives [17,18]. The study was directed on their feelings and attitudes way towards the life changes during the transition from totalitarianism towards democracy. The interviews with 61 elderly women and men (mean age 74 years), and the Self-evaluation test used, revealed a considerable variability of views confirming that old age is psychologically heterogeneous. Notwithstanding the richness of diverse views, 70% of the elderly could be polarized at the extremes: 35% showing a fully positive and optimistic attitude towards the changes and 35% definitely negative ones. The smallest groups had more mixed attitudes. The positive feelings of relief, joy, hope, were connected with ideas of liberation and freedom. The negative feelings of disappointment, pessimism and uncertainty implied worries about economic difficulties, delinquency, moral and cultural degradation, as well as fears of the restoration of communism, possible war and others dire consequences.