International Journal of Community Medicine and Public Health

Chauhan P et al. Int J Community Med Public Health. 2016 Jan;3(1):236-239

http://www.ijcmph.com pISSN 2394-6032 | eISSN 2394-6040

DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20151569
Research Article

A study on prevalence and correlates of depression among elderly

population of rural South India
Pooja Chauhan*, Prashant R. Kokiwar, Kotina Shridevi, Sushma Katkuri

Department of Community Medicine, Malla Reddy Institute of Medical Science, Hyderabad, Telangana, India

Received: 05 November 2015

Revised: 14 November 2015
Accepted: 11 December 2015

*Correspondence:
Dr. Pooja Chauhan,
E-mail: drpoojachauhan@yahoo.com

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: Globally the population is ageing rapidly. According to WHO it is projected that the number of persons
aged 60 or over is expected to more than triple by 2100. As estimated by WHO, unipolar depression occurs in 7% of
the general elderly population. Multiple social, psychological, and biological factors determine the level of mental
health of a person. Depression is both under diagnosed and undertreated in primary care settings. Only sporadic data
has been collected on mental health conditions of the elderly in India. Hence, the present study was planned to
estimate the prevalence of depression among elderly and to determine its correlates in a rural setting.
Methods: A community based cross-sectional study was conducted in a rural area. A semi-structured questionnaire
assessing the socio-demographic characteristics and risk factors for depression was administered to 290 geriatric
people. Geriatric Depression Scale (short version) and Activities of Daily Living (Basic and Instrumental) were used
to assess the prevalence of depression and physical dependence respectively. Data was analysed using Epi-info
version 7. Chi square test was performed to determine the statistical significance of the differences observed.
Results: 9.3% of the elderly had depression. Depression was found to be significantly associated with increased age,
co-morbid conditions, economic dependence and physical dependence for daily activities.
Conclusions: Provision general health care service along with economic support can reduce the dependency and
ultimately depression among the elderly.

Keywords: Geriatric, Depression, Correlates

INTRODUCTION problems, and require some form of long-term care. In

fact, depression is a common cause of disability in older
Globally the population is ageing rapidly. According to adults. Among its consequences are reduced life
WHO it is projected that the number of persons aged 60 satisfaction and quality, social deprivation, loneliness,
or over is expected to more than triple by 2100. Mental cognitive decline, ADL limitations, suicide and increased
health and emotional well-being are as important in older non-suicide mortality. Mental health has an impact on
age as at any other time of life. As estimated by WHO, physical health and vice versa. All of these factors can
unipolar depression occurs in 7% of the general elderly result in isolation, loss of independence, loneliness and
population.1 Multiple social, psychological, and psychological distress in older people. Depression is both
biological factors determine the level of mental health of under diagnosed and undertreated in primary care
a person at any point of time. As well as the typical life settings. Symptoms of depression in older adults are often
stressors common to all people, many older adults lose overlooked and untreated because they coincide with
their ability to live independently because of limited other late life problems.
mobility, chronic pain, frailty or other mental or physical

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 Chauhan P et al. Int J Community Med Public Health. 2016 Jan;3(1):236-239

In India, although the percentage of aged persons is low Processing and analysis of data
as compared to developed countries, nevertheless the
absolute size is considerable. For the year 2010 the The data were entered and analysed by using Epi-info
estimates are 8% of the total population were above the software. Chi square test was done to determine statistical
age of 60 years, and is likely to rise to 19% by 2050.2 significance of the differences observed.
With an overwhelming majority of geriatric care being
offered in tertiary hospitals in urban areas, the rural elders RESULTS
face medical indifference. Not only hospital care, but
elder nursing homes, recreation facilities and old age A total of 290 elderly people were studied, out of whom
centres are overwhelmingly present in urban areas. 98 (33.8%) were males and 192 (66.2%) were females.
Gerontology in India is very much in a nascent stage. Depression was found among 27 (9.31%) elderly people.
With such a huge mismatch in the urban-rural population Table 1 shows the differences in prevalence of depression
and health care system, geriatric medicine in India faces according to the various characteristics under study.
an uphill task. Only sporadic data has been collected on Elderly above 70 years of age were 28.62% (n=83). The
mental health conditions of the elderly in India.3-7 It is prevalence of depression in age group 70-79 years was
important to prepare health providers and societies to 30.50% and in age group above 80 years it was 25%. It
meet the specific needs of older populations. Hence, the was observed that the prevalence of depression was
present study was planned to estimate the prevalence of significantly higher in people above 70 years of age
depression among elderly and to determine its correlates (χ22df=53.547, p=0.000). Depression was more in females
in a rural setting. (9.38%) as compared to males (9.18%) but the difference
was not statistically significant (χ21df=0.0028,p=0.958).
METHODS Widow/widower and those living single had more
depression (10.49% and 33.33% respectively) than
A cross-sectional, community based, descriptive study married persons (7.2%), though not statistically
was conducted from September 2010 to March 2011 to significant (χ22df= 2.978, p=0.226). According to ADL
know the prevalence of depression and its correlates scale, 12.4% of individuals were dependent on their
among elderly population. The study was carried at family members and 17.6% were partly dependent for
Venkatachalem village, which is a field practice area of performing their daily activities. Depression was
Narayana Medical College, Nellore district located in significantly higher among dependents (41.67%), as
Southern Indian state of Andhra Pradesh. The total compared to independent (1.48%) and partially
population of this village at the time of study was 5012. dependent (17.65%). Complete economic dependence
The study universe consisted of the villagers above 60 was found among 45.17% of the elderly. The prevalence
years of age and resident of the village. Universal of depression was significantly higher (χ22df= 10.227,
sampling technique was used, in which every household p=0.006) among those who were economically dependent
in the village was visited and all elderly above 60 years (prevalence = 15.27%). Also the number of co-morbid
of age, who are willing to participate in the study were condition had an influence on the presence of depression,
included. Out of the 307 villagers in the target group, 8 with 36.67% of elderly having more than 6 co-morbid
refused to participate in the study and 9 were away from conditions suffering from depression. And this finding
the dwelling. was statistically significant (χ22df= 31.1168, p=0.000).

Data collection DISCUSSION

All the participants were interviewed personally. First, An increasing geriatric population is associated with
oral informed consent was taken from the study subject. rising prevalence of chronic non-communicable diseases;
A semi-structured questionnaire assessing the socio- therefore, the magnitude of depression is also expected to
demographic characteristics and risk factors for grow. In the present study the prevalence of depression
depression was used. Geriatric Depression Scale (GDS was found to be 9.31%. According to WHO the
short version) and activities of daily living (Basic and prevalence of unipolar depression among general elderly
Instrumental) were used to assess the prevalence of population is 7%.1 Similar results were obtained by
depression and physical dependence for daily activities Sengupta and Benjamin in Ludhiana with prevalence of
respectively.8,9 Score more than 5 on GDS was 8.9%.6 A meta-analysis of 74 studies, including 487,275
considered as depression. Activities of Daily Living score elderly individuals found the worldwide prevalence rate
10-17 was considered as dependent, 18-26 as partially of depressive disorders to be between 4.7 to 16%. This
dependent and score 27-30 as independent. B G Prasad’s study indicates a comparatively higher prevalence of
socio-economic scale was used to classify the socio- geriatric depression in India (21.9%).12 A higher
economic status of the study population, updated for per- prevalence of depression was also observed in Surat city
capita income according to All India Whole Sale Price where the prevalence was 39.04%.3 In another study
Index (AIWPI) for October 2010.10,11 conducted in Udupi Karnataka the prevalence of
depression was found to be 48%.13 A study done by Sati P
in a rural area in Tamil Nadu showed a prevalence of

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 Chauhan P et al. Int J Community Med Public Health. 2016 Jan;3(1):236-239

42.7% and by Ankur barua in Manipal showed a also their different sample size. In the present study
prevalence of 21.7%.4,5 The prevalence of depression in depression was found more among females as compared
the present study is comparatively less. This difference in to males, but this difference was not statistically
the prevalence with this study might be due to the significant. Similar observation was made by Ankur
different instruments used for measuring depression and Barua in Manipal.5

Table 1: Correlates of depression among elderly.

Correlates under study Depression No depression Total χ2 and p value

60-69 years 3 (1.45%) 204 (98.55%) 207
χ2 2df=53.547
Age 70-79 years 18 (30.50%) 41 (69.5%) 59
p=0.000
≥80 years 6 (25%) 18 (75%) 24
Male 9 (9.18%) 89 (90.81%) 98 χ21df= 0.0028
Sex
Female 18 (9.38%) 174 (90.62%) 192 p=0.958
Currently married 9 (7.2%) 116 (92.8%) 125
χ22df= 2.978
Marital status Widow/widower 17 (10.49%) 145 (89.51%) 162
p=0.226
Single 1 (33.33%) 2 (66.67%) 3
Independent 2 (3.17%) 61 (96.83%) 63
χ22df= 10.227
Economic dependence Partly dependent 5 (5.02%) 91 (94.79%) 96
p=0.006
Dependent 20 (15.27%) 111 (84.73%) 131
≤2 2 (2.7%) 72 (97.29%) 74
χ22df= 31.1168
Co-morbid conditions 3-5 14 (7.52%) 172 (92.47%) 186
p=0.000
≥6 11(36.67%) 19 (63.33%) 30
Dependent 15 (41.67%) 21 (58.33%) 36
χ22df= 62.7868
Activities of Daily Living Partially dependent 9 (17.65%) 42 (82.35%) 51
p=0.000
Independent 3 (1.48%) 200 (98.52%) 203
Total 27 (9.31%) 263 (90.69%) 290

In the present study, depression was found to be decreases an individual's quality of life and increases
associated with increased age. Age more than 70 years dependence on others. People are less healthy and more
was associated with increase prevalence of depression dependent for their daily activities. In the present study
and this difference was statistically significant. Similar we have observed a strong relation between prevalence of
trends in the prevalence of depression with increasing age depression and physical dependence for daily activities.
was observed by Ankur Barua in Manipal and Sengupta In another study, depression in elderly was found to be
and Benjamin in Ludhiana.5,6 The prevalence of strongly associated with lower score on Activities of
depression was more among widows/widowers and those Daily Living scale in three different Asian countries.9 In
living single, but the difference was not statistically the present study it was found that 45.17% of elderly
significant. Similar observations were made by others.5,6 were completely dependent for economic support and
Our findings were not consistent with similar studies prevalence of depression in this group was significantly
where depression was more among widow/widowers and high. Economic insecurity reveals the problem of
was statistically significant.3,4 A study in Pakistan also maintaining day to day livelihood and results in lack of
reported female gender, elderly without a spouse, low access to resources to maintain minimum level of living.
level of education, and unemployment to be independent At the national level more than 70 percent of the elderly
predictors of depression.14 However, a study among females are fully dependent in both rural and urban areas
community-dwelling elderly in Tamil Nadu found that (72.07 and 72.12) while it is just over 30 in the case of
age, female gender, cognitive impairment, and disability elderly men (32.7 and 30.11).17 The financial support
status were not significantly associated with geriatric system for the elderly is a crucial factor in determining
depression.15 their health and wellbeing. In the present study, it was
observed that elderly who were economically
People with depression suffer from various medical independent were less depressed. This shows that by
conditions. They are at higher risk of chronic conditions providing economic support in form of old age pension,
like coronary heart disease, hypertension, diabetes we can reduce the feeling of helplessness and
mellitus, cancers etc.15 Here we found that the number of dependence, and thereby reducing depression among
co-morbid condition is more in elderly having depression elderly.
and the difference is statistically significant. Depression

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 Chauhan P et al. Int J Community Med Public Health. 2016 Jan;3(1):236-239

CONCLUSION 8. Geriatric depression scale: short version.

http://www.mhsfopcls.com/downloads/ger_dep_scl.p
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major determinant of depression. By improving the activities of daily living, and quality of life of
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performing their daily activities and thereby less countries: Indonesia, Vietnam, and Japan. Arch
depressed and also economic support in form of pension Gerontol Geriatr. 2005;41:271-80.
can reduce their feeling of helplessness and improve their 10. Agarwal AK. Social Classification, the need to
mental status. update in the present scenario. Indian J of
Community Med. 2008;33(1):50-1.
Funding: No funding sources 11. All India Whole Sale Price Index. Available at:
Conflict of interest: None declared http://www.eaindustry.nic.in/home.asp. Assessed on
Ethical approval: The study was approved by the 17 December 2010.
Institutional Ethics Committee Narayana Medical 12. Barua A, Ghosh MK, Kar N, Basilio MA. Prevalence
College, Nellore, Andhra Pradesh of depressive disorders in the elderly. Ann Saudi
Med. 2011;31(6):620-4.
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