|Year : 2016 | Volume
| Issue : 2 | Page : 133-141
Anxiety and its impact on quality of life among urban elderly population in India: An exploratory study
Kathika Chattopadhyay1, Anand Pratap Singh2
1 Department of Psychiatry, Bakson Homoeopathic Medical College and Hospital, Greater Noida, Uttar Pradesh, India
2 Department of Psychology and Mental Health, Gautam Buddha University, Greater Noida, Uttar Pradesh, India
|Date of Submission||18-Jan-2016|
|Date of Acceptance||02-May-2016|
|Date of Web Publication||10-Jun-2016|
Department of Psychiatry, Bakson Homoeopathic Medical College and Hospital, 36B, Knowledge Park, Phase 1, Greater Noida - 201 306, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Background: Persistent suffering in anxiety can cause various health problems in old age and impairment of quality of life (QOL).
Objectives: The objectives of this study are to assess the pattern of covert and overt anxiety among elderly population, to study the nature of relationship between the pattern of anxiety and domains of World Health Organization-QOL (WHO-QOL) among elderly population, to study the gender difference on the pattern of anxiety and WHO-QOL among elderly population.
Materials and Methods: An exploratory cross-sectional survey under a health camp approach was conducted by using two types of questionnaire, i.e., Institute for Personality and Ability Testing self-analysis questionnaire and WHOQOL-BREF.
Results: The gender wise comparative profile of covert and overt anxiety with total, standard, and sten score shows that covert anxiety is higher in male in different background characteristics, except male group educated between 5 th and 12 th standard showing higher overt anxiety, whereas female group shows higher overt anxiety in different background characteristics. Spearman's rank correlation shows that overt anxiety has an inverse relation with domain-1 in both sexes, a negative relationship is found between domain-2 of WHO-QOL and the covert and overt anxiety among female, a significant negative relationship in domain-3 of WHO-QOL with covert and overt anxiety among male, and also a significant negative association between the domain-4 of WHO-QOL and overt anxiety in female.
Conclusion: The functional ability of both male and female elderly on various domains is related and influenced by the pattern of anxiety.
Keywords: Domains, Elderly population, India, Institute for Personality and Ability Testing, Overt anxiety, Survey, World Health Organization quality of life-BREF
|How to cite this article:|
Chattopadhyay K, Singh AP. Anxiety and its impact on quality of life among urban elderly population in India: An exploratory study. Indian J Res Homoeopathy 2016;10:133-41
|How to cite this URL:|
Chattopadhyay K, Singh AP. Anxiety and its impact on quality of life among urban elderly population in India: An exploratory study. Indian J Res Homoeopathy [serial online] 2016 [cited 2019 Oct 17];10:133-41. Available from: http://www.ijrh.org/text.asp?2016/10/2/133/183880
| Introduction|| |
Epidemiological evidence suggests that anxiety is a common major health problem in later part of life. It can substantially impair the quality of life (QOL)  and it has also been associated with an increased risk of mortality , and disability  It has been identified as a risk factor for greater disability among older adults in general and has been associated with less successful geriatric rehabilitation services.  Several biological, psychological, and social risk factors for anxiety disorders have been identified for older adults. Biological risk factors include chronic health conditions and functional limitations. Psychological risk factors include external locus of control, poor coping strategies, neuroticism, and psychopathology.  Social risk factors include low frequency of contact,  smaller network,  lack of social support, , and lower education level.  The high co- morbidity of anxiety with medical illnesses is multidimensional. Anxiety is complex and may be a reaction to a medical illness, may be expressed as somatic symptoms, or may be a side effect of medications. Studies have found an association between anxiety and medical illnesses such as diabetes,  dementia,  coronary heart disease, ,, cancer, ,, chronic obstructive pulmonary disease, , postural disturbance and vestibular disease,  chronic pain, and Parkinson's disease. , The consequences of anxiety in later part of life are potentially serious. In a prospective investigation, anxiety did not generally remit spontaneously over 2-3 years.  Hypertension, hypoglycemia, and coronary heart disease can be worsened through chronic stress and anxiety. 
The United Nations World Assembly on Ageing, held at Vienna in 1982, formulated a package of recommendations which gave high priority to research related to developmental and humanitarian aspects of aging. The phenomenon of population aging is becoming a major concern for the policy makers all over the world, for both developed and developing countries, during the last two decades. 
In India, the problems and issues of its gray population have not been given serious consideration and only a few studies on them have been attempted in our country. With the rapid changes in the social scenario and the emerging prevalence of nuclear family setups in the recent years, the elderly people are likely to be exposed to emotional, physical, and financial insecurity in the years to come. 
A recent review by Wolitzky-Taylor et al.  reported the prevalence of anxiety disorders in older adults, ranging from 3.2% to 14.2%.  In India, the elderly population (aged 60 years and above) are more than 103 million, i.e. 8.6% of the total population of India. A recent study says that it will reach 12.2% by 2026. For a developing country, this population may pose mounting pressures on various socioeconomic fronts including pension outlays, health-care expenditures, fiscal discipline, and savings levels. Again, this segment of population faces multiple medical and psychological problems. 
The present survey was conducted with the aim to study the anxiety level and its impact to QOL among urban elderly population. The objectives of the present study are to assess the pattern of covert and overt anxiety among elderly population, to study the nature of relationship between the pattern of anxiety and domains of World Health Organization-QOL (WHO-QOL) among elderly population, and to study the gender difference on the pattern of anxiety and WHO-QOL among elderly population.
| Materials and methods|| |
Adopting camp approach, a cross-sectional survey was conducted in an urban population of Greater Noida, Gautam Buddha Nagar, Uttar Pradesh (UP), India. The Postgraduate Psychiatry Department of Bakson Homoeopathic Medical College and Hospital, Greater Noida, organized three camps in different places, namely at Rail Vihar Apartment, IRWO Palm Court, Alpha-1, Greater Noida, on 2 nd and 3 rd May 2015; OPDs of the Medical University and Associated Hospital, Kasna, Greater Noida, on 7 th May, 2015, and OPDs of the Bakson Homoeopathic Medical and Hospital, Knowledge Park, Phase-1, Greater Noida, from 1 st to 8 th May, 2015. Written informed consent from different organizations of Greater Noida, namely, Varishtha Nagarik Samaj, Welcome Age Society, Bhartiya Yog Sansthan, Rail Vihar Residential Society, and Medical University and Associated Hospital, Greater Noida, was obtained prior to enrollment. A total of 98 elderly people, aged 60 years and above, participated in this survey. This study was conducted by a team of internship under graduation and post graduation students of Bakson Homoeopathic Medical College and Hospital, Greater Noida, U.P. who were trained for a week before the survey program, to take written consent from each elderly individual and give them basic instructions how to fill up the survey questionnaires. A group of experts (psychiatrist, homoeopath, psychotherapist, and yoga expert) were involved in these camps to provide basic advice to elderly people, guide them wherever required, and make them aware about the scope of different medical disciplines for maintaining and promoting mental health as well as QOL.
After taking informed written consent as mentioned above from different senior citizens' organizations/societies and from individual participants, the data were collected on a predesigned proforma: The QOL questionnaire "BREF" of WHO  and Self-Analysis Anxiety Rating Scale of the Institute for Personality and Ability Testing, USA (English version). 
World Health Organization quality of life BREF scale.
The WHOQOL-BREF  instrument comprises 26 items, which measure the following broad domains: Domain-1 (physical health), Domain-2 (psychological health), Domain-3 (social health), and Domain-4 (environment health) [Table 1].
Institute for Personality and Ability Testing anxiety scale
Institute for personality and ability testing anxiety scale  is a brief, valid, and no stressful questionnaire scale measuring anxiety levels in adults and young adults. It gives an accurate appraisal of free anxiety level, supplementing clinical diagnosis and facilitating all kinds of research or mass screening operations, where very little diagnostic or assessment time could be spent with the examinee.  It reflects the covert anxiety score (where anxiety is felt by person internally and hidden from the perception of others), the overt anxiety score (where the manifestation of anxiety can be seen by others) and the sten score. It indicates an individual's approximate position (as a range of values) with respect to the population of values and, therefore, to other people in that population. The individual sten scores are defined by reference to a standard normal distribution.
The covert and overt anxiety in different domains of WHO-QOL was analyzed by using SPSS VERSION 19.0. Nonparametric statistics, i.e. Spearman's rank correlation was used to compare and ascertain the correlation between variables, namely WHO-QOL and covert and overt anxiety in males and females separately.
Being an exploratory study, the survey under health camp approach covered a sample of 98 individuals aged 60 years and above, of both sexes, different religions, education background, marital status, and medical conditions. The sample consisted of 25 females (25.5%) and 73 males (74.5%). Fifty individuals were in the age group of 60-69 (51%), 39 in the age group of 70-79 (39.8%), and nine in the age group of 80+ (9.2%). They belonged to various religions, namely Hindu 90 (91.8%); Muslim and Jain one each (each 1%); and Christian and Sikh three each (each 3.1%). As regards to educational background, seven were illiterate (7.1), four were literate up to 4 th standard (4.1%), 21 were literate from 5 th to 12 th standard (21.4%), and 66 were educated above 12 + standard (67.3%). Seventy-eight persons were married (79.6%), 15 were divorcee/widowed (15.3%), and five were living separately (5.1%) [Table 2].
| Results|| |
[Table 3] shows the sex wise comparative profile of covert and overt anxiety by selected characteristic of respondents. It is observed that the mean score of covert anxiety is slightly greater in male group (16.0) than female group (15.4), whereas the mean score of overt anxiety is one point greater in females (17.6) than males (16.4) in the age group of 60-69 years; in relation to education, male respondents those who have passed class 12 th standard or more educated, their mean score of covert anxiety is same as female around 16.0, but mean score of overt anxiety (15.7) is smaller than female group (18.8). Male group educated from 5 th standard up to 12 th standard shows same covert anxiety as female around 15.0, but shows greater overt anxiety score (18.2) than female respondents (17.6).
|Table 3: Gender wise comparative profile in relation to covert (A score) and overt (B score) anxiety with total, standard Sten score (T score)|
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In case of married person, where the person living with spouse, mean score of overt anxiety (16.0) among elderly males is smaller than female group (18.0) whereas there is a greater covert anxiety in males (16.2) than females (15.9) among those who are living with spouse. In divorced/widowed persons, in the context of covert anxiety, the mean score of female (14.9) is slightly greater than male group (14.7) and again in overt anxiety, the mean score of female group (18.8) is greater than male group (17.2). The comparison between other groups is not considered as the sample size is inadequate in female group.
[Table 4] shows nonparametric statistics; Spearman's rank correlation was used to compare and ascertain the correlation between variables, namely covert and overt anxiety and WHO-QOL in males and females separately. The outcome is given below.
|Table 4: Spearman's correlation matrix between World Health Organization- quality of life, covert and overt anxiety|
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In elderly population, there is a significant negative relation between physical health domain (domain-1) of WHO-QOL and overt anxiety in both females (r = −0.45, P = 0.025) and males (−0.24, P = 0.041). Overt anxiety is showing an inverse association with QOL indicators contained in physical health domain (domain-1). Hence, those having lesser overt anxiety have better quality of physical health domain under WHO-QOL. There is no association between covert anxiety and physical health domain (domain-1) in both sexes.
A significant negative relationship is found between WHO-QOL of psychological domain (domain -2) and the covert (r = −0.624, P = 0.001) and overt (r = −0.533, P = 0.006) anxiety among elderly female population. Hence, those having lesser covert and overt anxiety have better quality of psychological health domain (domain-2) under WHO-QOL among female population. There is no significant relationship found in elderly male population in between psychological health domain, WHO-QOL, and covert and overt anxiety.
There is a significant negative relationship in between social relation domain (domain-3) of WHO-QOL and covert (P = −0.288, r = 0.013) and overt (r = −0.039, r = 0.002) anxiety among elderly male population. Hence, those having lesser covert and overt anxiety among males have better quality of social relationship domain (domain-3) under QOL. However, in females, there is no significant relationship between social relationship domain of WHO-QOL and covert and overt anxiety.
There is also a significant negative association between the environment domain (domain-4), WHO-QOL, and overt anxiety (r = −0.496, P = 0.012) in elderly female population. It means that those having lesser overt anxiety have better environment domain (domain-4) QOL among elderly female population. There is no significant relationship between covert anxiety and WHO-QOL of domain-4 in elderly female population. There is no specific association between the environment domain of WHO-QOL and covert and overt anxiety in elderly male population.
| Discussion|| |
It was recognized by the WHO that health is not merely the absence of disease but the "state of complete physical, mental, and social well-being," and the international efforts over the past three decades have led to the development of multiple scales combining objective and subjective elements to measure functional capacity, broader health status, psychological well-being, social support, and the broader concept of QOL of population, , Hence, WHO-QOL is an important health index for the elderly in every country, playing a key role in assessing interventions and establishing essential medical and social care needs for the aging population.
The present study finds that the covert and overt anxiety has an inverse association with various domains of QOL. By nonparametric statistics, i.e. Spearman's rank correlation, we find that out of 98 samples of elderly population, there is a significant negative outcome in Domain-1 of WHO-QOL  with overt anxiety in both sexes, in Domain-2 of WHO-QOL  with both covert and overt anxiety in females, in Domain-3 of WHO-QOL  with both covert and overt anxiety in males, and in domain-4 WHO-QOL  with overt anxiety in females. The study result positively concludes that the functional ability of both male and female elderly population on various domains of WHO-QOL is related and influenced by covert and overt anxiety. Hence, for the reduction and controlling of covert and overt anxiety of elderly citizens as well as maintaining healthy and balanced QOL, adequate mental health care by intervention of various health disciplines is mandatory.
The present study also validates the earlier findings of the survey conducted in rural Bangladesh  and a rural and urban comparative study of Vietnam  The inverse relationship between socioeconomic status and QOL  is well known and has been confirmed in recent studies among elderly populations of Vietnam and Indonesia as well as Bangladesh. , The search for culturally compatible instruments that maintain links with international understandings of QOL  while acknowledging local social cultural realities, places researches in difficult positions of deciding whether to adapt existing scales or develop independent instrument, with experience from Bangladesh, India, Lebanon, Taiwan, and Thailand, presenting a range of approaches and solutions. ,,,,,, Functional isorders increased with increasing age; women were more likely to report functional problems, , Another study showed that the low physical health scores were associated with a low frequency of meeting with relatives (which is common in urban nuclear society) and with living far from relatives, higher education, and in female sex.  The study has shown a supportive result through a with a limited sample size and in a short survey period, which is required to be replicated using a larger sample size and may be substituted by institutional approach. The findings of the present study may play a vital role in planning and strengthening interventional health care program for elderly population of the country by various health disciplines, individually or in an integrated method. On that basis, a pilot study can be formulated in the near future.
| Conclusion|| |
The functional ability of both male and female elderly population on various domains of WHO-QOL is related and influenced by covert and overt anxiety. The present study also observed the gender differences, i.e., physical and environment domains of WHO-QOL are affected in an inverse relationship with overt anxiety, and the psychological domain is inversely influenced by both the covert and overt anxiety in female elderly population in comparison to their male counterpart whereas the physical domain WHO-QOL is inversely influenced by overt anxiety and social relationship domain of WHO-QOL is influenced by both the covert and overt anxiety in elderly male population. This implies that at the time of designing of intervention program with elderly population, the findings of the present study may play a vital role in strengthening the same.
We are thankful to Dr. S P S Bakshi, CMD, Bakson Homoeopathic Medical College and Hospital, Greater Noida, for giving consent and support for this work. We do acknowledge the constant motivation of Prof. Dr. C Nayak, former Director General of Central Council for Research in Homoeopathy and Director-Professor of Bakson Homoeopathic Medical College and Hospital, Greater Noida, to do this survey by the Psychiatry Department. We acknowledge our gratitude to Dr. Arvind Pandey, Director and Dr. Damodar Sahu, Scientist E, of National Institute of Medical Statistics, ICMR, New Delhi, for compilation and analysis of data and for persistent guidance. We are thankful to Dr. M Ghosh, formerly principal; Dr. C P Sharma, Principal; Dr. Sunil Awana (Psychiatrist), visiting faculty, Psychiatry Department; Dr. Kalpana Dasmana, yoga therapist; and the other staff of Bakson Homoeopathic Medical College and Hospital, who persistently encouraged for conducting such work. Special thanks to Dr. Kiran Sankar Bera, PG Scholar, Department of Psychiatry, for his sincere involvement in the survey during camps and for giving adequate technical support through the entire survey program. Last but not the least, we are thankful to all the PG students and UG interns, who were in the survey team and to all the organizations who wholeheartedly co-operated with us to fulfill our mandate.
Financial Support and Sponsorship
Bakson Homoeopathic Medical College and Hospital, Greater Noida, Uttar Pradesh, India, provided the required funding for this study.
Conflicts of Interest
There are no conflicts of interest.
| References|| |
Revicki DA, Brandenburg N, Matza L, Hornbrook MC, Feeny D. Health-related quality of life and utilities in primary-care patients with generalized anxiety disorder. Qual Life Res 2008;17:1285-94.
van Hout HP, Beekman AT, de Beurs E, Comijs H, van Marwijk H, de Haan M, et al.
Anxiety and the risk of death in older men and women. Br J Psychiatry 2004;185:399-404.
Allgulander C, Lavori PW. Causes of death among 936 elderly patients with ′pure′ anxiety neurosis in Stockholm County, Sweden, and in patients with depressive neurosis or both diagnoses. Compr Psychiatry 1993;34:299-302.
Brenes GA, Guralnik JM, Williamson JD, Fried LP, Simpson C, Simonsick EM, et al.
The influence of anxiety on the progression of disability. J Am Geriatr Soc 2005;53:34-9.
Bowling A, Farquhar M, Grundyu E. Association with changes in life satisfaction among three samples of elderly people living at home. Int J Geriatr Psychiatry 1996;11:1077-87.
Schoevers RA, Beekman AT, Deeg DJ, Jonker C, Van Tilbung W. Comorbidity and risk patterns of depression, generalized anxiety disorder and mixed anxiety- depression in later life: Result from longitudinal aging study Amsterdam. Int J Geriatr Psychiatry 2003;18:994-1001.
Forsell Y, Palmer K, Fratiglioni L. Psychiatric symptoms/syndromes in elderly persons with mild cognitive impairment. Data from a cross-sectional study. Acta Neurol Scand Suppl 2003;179:25-8.
Beekman A, van Balkom A, Deeg D, van Dyck R, van Tilburg W. Anxiety and depression in later life: Co-occurrence and communality of risk factors. Am J Psychiatry 2000;157:89-95.
Blazer DG. Geriatric psychiatry. In: The American Psychiatric Publishing Textbook of Clinical Psychiatry. Washington, DC: American Psychiatric Publishing; 2003. p. 1535-50.
Wragg RE, Jeste DV. Overview of depression and psychosis in Alzheimer′s disease. Am J Psychiatry 1989;146:577-87.
Artero S, Astruc B, Courtet P, Ritchie K. Life-time history of suicide attempts and coronary artery disease in a community-dwelling elderly population. Int J Geriatr Psychiatry 2006;21:108-12.
Kubzansky LD, Cole SR, Kawachi I, Vokonas P, Sparrow D. Shared and unique contributions of anger, anxiety, and depression to coronary heart disease: A prospective study in the normative aging study. Ann Behav Med 2006;31:21-9.
Todaro JF, Shen BJ, Raffa SD, Tilkemeier PL, Niaura R. Prevalence of anxiety disorders in men and women with established coronary heart disease. J Cardiopulm Rehabil Prev 2007;27:86-91.
Deimling GT, Bowman KF, Sterns S, Wagner LJ, Kahana B. Cancer-related health worries and psychological distress among older adult, long-term cancer survivors. Psychooncology 2006;15:306-20.
Goodwin JS, Zhang DD, Ostir GV. Effect of depression on diagnosis, treatment, and survival of older women with breast cancer. J Am Geriatr Soc 2004;52:106-11.
Ostir GV, Goodwin JS. Anxiety in persons 75 and older: Findings from a tri-ethnic population. Ethn Dis 2006;16:22-7.
Karajgi B, Rifkin A, Doddi S, Kolli R. The prevalence of anxiety disorders in patients with chronic obstructive pulmonary disease. Am J Psychiatry 1990;147:200-1.
Vögele C, von Leupoldt A. Mental disorders in chronic obstructive pulmonary disease (COPD). Respir Med 2008;102:764-73.
Gagnon N, Flint AJ, Naglie G, Devins GM. Affective correlates of fear of falling in elderly persons. Am J Geriatr Psychiatry 2005;13:7-14.
Stein MB, Heuser IJ, Juncos JL, Uhde TW. Anxiety disorders in patients with Parkinson′s disease. Am J Psychiatry 1990;147:217-20.
Pontone GM, Williams JR, Anderson KE, Chase G, Goldstein SA, Grill S, et al.
Prevalence of anxiety disorders and anxiety subtypes in patients with Parkinson′s disease. Mov Disord 2009;24:1333-8.
Livingston G, Watkin V, Milne B, Manela MV, Katona C. The natural history of depression and the anxiety disorders in older people: The Islington community study. J Affect Disord 1997;46:255-62.
Hersen M, Van Hasselt VB. Behavioral assessment and treatment of anxiety in the elderly. Clin Psychol Rev 1992;12:619-40.
Wolitzky-Taylor KB, Castriotta N, Lenze EJ, Stanley MA, Craske MG. Anxiety disorders in older adults: A comprehensive review. Depress Anxiety 2010;27:190-211.
Das SK, Situation Analysis of Elderly India. A Report. Officers of Social Statistics Division, Central Statistics Office, Ministry of Statistics and Programme Implementation, Government of India, New Delhi; 2011.
World Health Organization. World Health Organization Constitution. Geneva: World Health Organization; 1948.
Krug SE, Cattell RB, Scheier IH. Hand Book for the IPAT Anxiety Scale. New Delhi: 1976.
Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M, et al.
Trends in alternative medicine use in the United States, 1990-1997: Results of a follow-up national survey. JAMA 1998;280:1569-75.
Nilsson J, Parker MG, Kabir ZN. Assessing health-related quality of life among older people in rural Bangladesh. J Transcult Nurs 2004;15:298-307.
Bowling A, BANISTER D, Sutton S, Evans O, Windsor J. A multidimensional model of the quality of life in older age. Aging Ment Health 2002;6:355-71.
Huong NT, Hai Ha le T, Quynh Chi NT, Hill PS, Walton T. Exploring quality of life among the elderly in Hai Duong province, Vietnam: A rural-urban dialogue. Glob Health Action 2012 22;5:1-12.
Nilsson J, Rana AK, Luong DH, Winblad B, Kabir ZN. Health-related quality of life in old age: A comparison between rural areas in Bangladesh and Vietnam. Asia Pac J Public Health 2012;24:610-9.
Minh HV, Ng N, Byass P, Wall S. Patterns of subjective quality of life among older adults in rural Vietnam and Indonesia. Geriatr Gerontol Int 2012;12:397-404.
Saxena S, Chandiramani K, Bhargava R. WHOQOL-Hindi: A questionnaire for assessing quality of life in health care settings in India. World Health Organization Quality of Life. Natl Med J India 1998;11:160-5.
Sabbah I, Drouby N, Sabbah S, Retel-Rude N, Mercier M. Quality of life in rural and urban populations in Lebanon using SF-36 health survey. Health Qual Life Outcomes 2003;1:30.
Hwang HF, Liang WM, Chiu YN, Lin MR. Suitability of the WHOQOL-BREF for community-dwelling older people in Taiwan. Age Ageing 2003;32:593-600.
Ingersoll-Dayton B, Saengtienchai C, Kespichayawattana J, Aungsuroch Y. Measuring psychological well-being: Insights from Thai elders. Gerontologist 2004;44:596-604.
Ministry of Health. Health Statistics Yearbook 2006. Vietnam: Ministry of Health; 2007. p. 13.
McDowell I, Newell C. Measuring Health: A guide to Rating Scales and Questionnaires. Oxford: Oxford University Press; 1996.
Lamb VL. A cross-national study of quality of life factors associated with patterns of elderly disablement. Soc Sci Med 1996;42:363-77.
Zimmer Z, Amornsirisomboon P. Socioeconomic status and health among older adults in Thailand: An examination using multiple indicators. Soc Sci Med 2001;52:1297-311.
DE Belvis AG, Avolio M, Spagnolo A, Damiani G, Sicuro L, Cicchetti A, et al.
Factors associated with health-related quality of life: The role of social relationships among the elderly in an Italian region. Public Health 2008;122:784-93.
[Table 1], [Table 2], [Table 3], [Table 4]