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

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.

Conclusions

Socioeconomic factors and related inequalities may predispose, precipitate, or perpetuate depression among older people in LMICs. Relative absence of health safety net places socioeconomically disadvantaged older people in LMICs at risk. The need for population-based public health interventions and policies to prevent and to manage geriatric depression effectively in LMICs cannot be overemphasised.