Health, Social, and Economic Variables Associated with Depression Among Older People in Low and Middle Income Countries: World Health Organization Study on Global AGEing and Adult Health

Abstract

Objective: Although depression among older people is an important public health problem worldwide, systematic studies evaluating its prevalence and determinants in low and middle income countries (LMICs) are sparse. Biopsychosocial model of depression and prevailing socioeconomic hardships for older people in LMICs have provided the impetus to determine the prevalence of geriatric depression, to study its associations with health, social, and economic variables, and to investigate socioeconomic inequalities in depression prevalence in LMICs. Methods:We accessed World Health Organisation-Study on global AGEing and adult health (WHO-SAGE) wave-1 data that studied nationally representative samples from six large LMICs (N=14,877). A computerised algorithm derived depression diagnoses. We assessed hypothesised associations using survey multivariate logistic regression models for each LMIC, and pooled their risk estimates by meta-analyses. We investigated related socioeconomic inequalities using concentration indices. Results:Cross-national prevalence of geriatric depression was 4.7% (95% CI 1.9-11.9%).Women, illiteracy, poverty, indebtedness, past informal-sector occupation, bereavement, angina, and stroke had significant positive associations, while pension support and health insurance showed significant negative associations with geriatric depression. We documented pro-poor inequality of geriatric depression in five LMICs. 4 population-based public health interventions and policies to prevent and to manage geriatric depression effectively in LMICs cannot be overemphasised.

Socioeconomic status and prevalence of chronic non-communicable diseases in Chinese women: a structural equation modelling approach

“… 45 However, another study in LMICs revealed a negative association between medical insurance and depression. 46 Medical insurance may influence health through various channels. A lack of medical insurance limits access to preventive services.…”

Unrecognized Geriatric Depression in the Emergency Department of a Teaching Hospital in Nepal: Prevalence, Contributing Factors, and Metric Properties of 5 item Geriatric Depression Scale in this Population

“…The mean GDS-15 score was 4.43 (95% CI :4.11-4.78, SD ±2.87, range 0-13). Among all the positively screened patients (n=128), 104 (81.3%, 95% CI:73.4-87.6) screened positive for mild depression (score [5][6][7][8] and 24 (18.8%, 95% CI:12.4-26.6) were screened positive for severe depression (score >8) ( Table 1). When GDS-5 was used as the screening tool with a cutoff score of 2/3, 103 (36.8%, 95% CI:31.1-42.7) screened positive for depression with mean score of 1.3 (95% CI:1.16-1.43, SD ±1.146, Range 0-5) (Table2).…”

“…Nepal is one of the world's poorest countries, and considered a fragile state by the World Bank [6]. The WHO Study on Global AGEing and Adult Health (SAGE) identi ed depression in LMICs to be 4.7% [7]. However, in Nepal, from 17.3% to 89.1% of elders in elder care homes, 25.5%-60.6% of elders living in the community, and 53.2% to 57.1% of elders in hospitals suffer from depression [8].…”

How does the environment affect human ageing? An interdisciplinary review

“…As people age, the environment plays an increasingly important role and defines whether and to what degree an individual participates in social interaction, community engagement and physical activity 98 . Accordingly, geriatric depression is triggered by social and economic variables 99 . Research has found a strong correlation between social participation and positive health status in elderly among different communities in North America, Asia and Europe 96 .…”