This study aimed to estimate the prevalence of depression and assess its correlates among elderly people in a rural area of Maharashtra, India. The researchers conducted a cross-sectional study of 290 elderly individuals aged 60 years and older using the Geriatric Depression Scale. The study found the prevalence of mild depression was 26.72% and severe depression was 15.17%. Significant correlates of depression included being female, widowed/separated/divorced, having a chronic illness, less decision-making ability, and experiencing abuse/neglect. The study highlights depression as an important but neglected health issue among elderly populations in rural India.
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Prevalence of Depression Among Elderly in Rural Maharashtra
1. Prevalence of depression and its
correlates among elderly population in
a rural area of Maharashtra: A cross
sectional study.
Authors:
S. Goswami1
, PR Deshmukh2
, AV Raut3
, R. Pawar4
,
AM Mehendale5
Junior Resident1
, Associate Prof3
, Assistant Prof4
, Professor2,5
Department of Community Medicine
1,2,3,5
MGIMS, Sewagram; 4
GMC Akola
PRESENTED IN INTERNATIONAL CONFERENCE ON GERIATRICS &
GERONTOLOGY, ISI, BANGALORE
3. Introduction
Ageing is a universal process that is
associated with deteriorating health status.
Even though depression is the commonest
psychiatric disorder in the elderly, it is
commonly misdiagnosed and under treated.
The magnitude of depression in India varies
between 13 – 25%
Exact burden in our area was not known and
hence the study was conducted.
4. Objectives
To estimate the prevalence of depression
among elderly population in rural Wardha,
Maharashtra.
To assess association of socio-
demographic parameters with depression
among elderly in a rural Indian community.
5. Methodology
Study type: Cross sectional study
Study area: This study was conducted in the
field practice area of RHTC Bhidi.
Study population: Included elderly(≥ 60 years)
population, residing in the study area.
Study duration: October - November 2015
6. Methodology contd..
Sample size: Assuming prevalence of 25%,
absolute precision of 5, we got the sample size of
287 (≈ 290) for 95% confidence level using
OpenEpi software.
Sampling technique: Convenient sampling
Ethical Consideration:
IEC approval taken
Written informed Consent from each participant
Facilitation for counseling and/or treatment
7. Methodology contd..
Data collection tools:
1.Geriatric Depression Scale (GDS) long form of
30 questions
a. Normal (0-9)
b. Mild (10-19)
c. Severe (20-30) depression.
2.Structured questionnaire for socio
-demographic information.
11. Table 2: Association of socio demographic characteristics
with depression (n = 290)
Characteristics DEP + DEP - OR(95%CI) Adjusted OR
Age group in years
60-69 (151) 56 (37.0%) 95 (63.0%) Ref Ref
70-79 (116) 51 (44.0%) 65 (56.0%) 1.3(0.81-2.18) 0.9(0.46-1.98)
≥80 (23) 14 (61.0%) 9 (39.0%) 0.5(0.19-1.26) 1.6(0.5-5.1)
Sex
Male (129) 43(33.3%) 86(66.7%) Ref Ref
Female (161) 78(48.5%) 83(51.5%) 1.8(1.16-3.04) 1.5(0.80-2.78)
Marital Status
Married(206) 73(35.4%) 133(64.6%) Ref Ref
Widow/Separat/
Divorced (81)
47(58.0%) 34(42.0%) 2.5(1.48-4.27) 1.4(0.69-2.71)
Never marry(03) 01(33.3%) 02(66.7%) 0.9(0.03-12.4) 2.5(0.19-31.96)
Schooling
Attended(157) 62(39.49%) 95(60.51%) Ref Ref
Not attend(133) 59(44.4%) 74(55.6%) 1.2(0.76-1.95) 0.6(0.36-1.23)
12. Continued….
Characteristics DEP + DEP - OR(95%CI) Adjusted OR
Working status
Not working(136) 62(45.6%) 74(54.4%) 1.3(0.84-2.16) 0.6(0.30-1.32)
Working(154) 59(38.3%) 95(61.7%) Ref Ref
Suffering from any Chronic disease
Yes (219) 109(49.7%) 110(50.3%) 4.8 (2.51-9.88) 1.9(0.50-2.5)
No (71) 12(16.9%) 59(83.1%) Ref
Role as decision maker in the family
Improved (15) 3(20.0%) 12(80.0%) Ref
Remained same
(116)
34(29.3%) 82(70.7%) 1.6(0.46-7.70) 0.9(0.20-4.05)
Declined (159) 84(52.8%) 75(47.2%) 4.4(1.28-20.31) 2.3(0.52-10.9)
Whether suffered from any abuse/violence/neglect since 60 years of age?
Yes 38(61.3%) 24(38.7%) 2.7(1.55-4.96) 0.5(0.30-1.18)
No 83(36.4%) 145(65.6% Ref Ref
13. Discussion
Study Description Preval Significant asso
Present study SS − 290;
Rural Hospital based;
GDS − 30;
Convenient sampling
41.72
%
Female,
widow/sep/divorced,
ch.Illness,
lack in desicion
making,
abuse/neglect
Sengupta P 2
et al
2011,
Ludhiana
SS − 2842;
Community based;
GDS 15; SRS
8.9% Urban female, older
elderly,alone,ileterate,n
ot working
Radhakrisnan
S et al 3
, 2011,
Salem, TN
SS −400;SRS;
community based;
Validated depression
assessment scale
58.8% Advanced
age,female,no
education,poor,no
spouse, ch. disease
Seby K et al 4
,
2002-03,
Ranchi
SS− 202;
Hospital based;
GDS-15;SRS
16.3% Female;single/widow;
nuclear
family;economic
14. Discussion contd..
Study Description Prev Significant aso
Sinha SP et al 9
;
2012,
Kanchipuram,TN
SS − 103;
Rural Community based
GDS− 15; SRS
42.7% Female, Widowed
Maulik S et al 14
;
2010, Hoogly,
WB
SS − 82;
Community based;
GDS − 15; SRS
53.7% Female,Iliteracy,o
personal
income,no
spouse,declined
decision making
ability,illness
15. Conclusion:
Our study showed the prevalence of mild
depression among elderly was 26.72% (95% CI
21.71-31.86) and that of severe depression was
15.17% (95% CI 11.38-19.65).
So, depression among elderly is an important
health problem which remains neglected.
Limitation:
Since we used convenient sampling , results
cannot be generalized
No variables were found to be significant, when we
did the multivariate logistic regression. There
could be other variable, which we did not study.
16. References
1. Ministry of Health and family welfare . Family welfare statistics in India
2011.[Internet] [ Upadated 2011; cited 2015 nov 10] Available fom:
mohfw.nic.in/WrtiteReadData/l892/35
2. Sengupta P, Benjamin AI. Prevalence of depression and associated risk
factors among the elderly in urban and rural field practice areas of a
tertiary care institution in Ludhiana. Indian J Public Health. 2015 Jan-
Mar;59(1):3-8.
3. Radhakrishnan S, Nayeem A. Prevalence of depression among geriatric
population in a rural area in Tamilnadu. Int J Nutr Pharmacol Neurol Dis
2013;3:309-12
4. Seby K, Chaudhury S, Chakraborty R. Prevalence of psychiatric and
physical morbidity in an urban geriatric population. Indian Journal of
Psychiatry. 2011;53(2):121-127.
5. World Health Organization. World report on ageing and health.
[Internet] [Updated 2015; cited 2015 Nov 2].
6. Open epi, version 3.03a [Internet] [Updated 2015 May 04; cite 2015 nov
8].
17. References contd..
7. Barua A, Ghosh MK, Kar N, Basilio MA. Distribution of depressive
disorders in the elderly. J Neurosci Rural Pract. 2010 Jul-Dec; 1(2): 67–
73.
8. Abhishekh HA, Karthik R, Shivakumar S, Balaji AL. Prevalence of
depression in community dwelling elderly: study from rural population.
J Neurosci Rural Pract. 2013 Aug; 4(Suppl 1): S138.
9. Sinha SP, Shrivastava SR, Ramasamy J. Depression in an older adult
rural population in India. MEDICC Review, October 2013, Vol 15, No 4: p
41-44.
10. Prina AM, Ferri CP, Guerra M, Brayne C, Prince M. Prevalence of
anxiety and its correlates among older adults in Latin America, India
and China: cross-cultural study. Br J Psychiatry. 2011 Dec; 199(6): 485–
491.
11. United Nations Population Fund. The status of elderly in select
states of India,2011.[Internet][Updated 2013 OCT; cited 2015 Nov 4].
Available from: AgeinginIndia-Surveyinstruments.pdf.
4.4.1 Inclusion criteria:
People of both sexes from the age of 60 years and above , who gave consent for the interview were included in the study.
4.4.2 Exclusion criteria:
i) Patients of dementia, who couldnot recall his /her past properly were excluded from the study.
ii) Terminally ill patients who couldnot speak properly due to their illness.
Exclusion criteria: 1. terminally ill and not giving consent…. But we did not come across any of such
WHO Geriatric Depression Scale(GDS) 11 long form of 30 questions was utilized to measure the depresion among the elderly population and to classify them into: a) Normal (0-9) b) Mild (10-19) and d) Severe (20-30) depression. This scale has already been used and validated in India.
4.10. Ethical Consideration:
Ethical approval was taken from the institutional ethical committee. Informed consent was taken from each participants before starting the interview. Severe depression cases were referrred to facilities and mild depressives were counselled by the interviewer himself.
Besides these, we saw association for dependency and individual income per annum also, but they were not significnt
As multiple logistic regression did not concluded any significant association with any of the factors in causing depression among the study population, so, it implied the presence of confounders, one of which could be the female gender, as they were the majority in numbers in our study with more of widowhood and were common suffers of abuse, neglect and lacked decision making power in the family.