Correlates of depressive disorders and quality of life among older adults in six low and middle-income countries: WHO country-wide study on global ageing and adult health

Abstract

Background The diagnosis and treatment of Depressive Disorders (DD) remain a challenge in low and middle-income countries (LMICs). Identifying the most important correlate of DD would serve as a guide in the design and implementation of targeted intervention in resource-constrained LMICs. This study determined whether there is/are common risk factor(s) of DD across the six LMICs and whether there is a risk factor that can be ranked consistently as the most important predictor of DD in all the six LMICs. We further estimated the impact of DD on the quality of life (QoL).Methods We used data from the World Health Organization Study on Global Ageing and Adult Health. Weighted dominance analysis was performed to determine the most important risk factor of DD. We applied inverse probability weighting Poisson regression adjustment to estimate the impact of DD on QoL for each country and further estimated the overall effect of DD on QoL in the six countries by computing a weighted average of the country-specific estimate using the technique of meta-analysis.Results Among the 58 risk factors investigated, Asthma was the most common and the most important predictor of DD across all six LMICs. DD contributed to a 12% increase in the poor QoL in China, (prevalence difference (PD)=0.12; 95% CI: 0.07-0.18, p<0.001). In India (PD=0.08; 95% CI: 0.04-0.13, p<0.01) and Russian Federation (PD=0.08; 95% CI: 0.01-0.15, p<0.01). Although there was some increase in poor QoL in Mexico, Ghana, and South Africa due to DD, the increase was not statistically significant.Conclusions Asthma is a major contributing factor to the high prevalence of DD among older adults and could have a direct or indirect effect on QoL. We recommend integrated intervention for Asthma patients that incorporates the diagnosis and treatment of DD. Access to quality mental healthcare should be a major government priority in LMICs.