Depression among the Elderly in India

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Depression among the Elderly in India
Introduction
Depression is one of the major causes of the global burden of disease and in low-and-middle-
income (LMICs) countries. According to the World Health Organization (1), depression is
ranked as the only chief cause of non-severe health loss, representing 7.5% of worldwide years
lived with disability (YLDs) and 2.0% of worldwide disability adjusted life years. The 2015
worldwide health estimates attribute approximately 33% of the total disability-adjusted life years
to depressive disorders caused by mental health problems and substance abuse (2). It is
predicted that by 2030 depression will be the second leading cause of global disease burden and
the third leading cause of disease burden in low-and-middle-income countries (3).
4.4% of the global population have been diagnosed with symptoms of depression. The disorder is
highly prevalent among females (5.1%) than males (3.6%) with the age group of 55-74 years
being affected more in both genders. The incidence of the disorder fluctuates from 2.6% for
males in the Western Pacific Region to 5.9% in the African Region (1). Over 80% of years lived
with disability in low- and middle-income countries manifested depressive symptoms (2). (4)
observes that the global rate of depression increased by 18.4% between 2005 and 2015. Poor
quality life caused by depression also increased at relatively the same rate (18.2%) during the
same period.
India’s population represents 18% of the global population, 15% of the world-wide Disability
Adjusted life years (DALYs) due to mental disorders, and 37% due to depression (5). The
burden of depression in relation to disability-adjusted life years increased by 67% in 2013 from

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1990. It is projected that by 2025, the disability-adjusted life years caused by depression will
increase approximately 22.5% (2.6 million) as a result of the increase in the ageing population
(5). Multiple population-based studies have reported even much higher prevalence estimates
varying from 1.8% to 39.6%. However, these variations have been attributed to the different
sample sizes, nature of the population, lack of uniformity, different study tools and interpretation
of the outcomes and procedures of evaluation (6). Depression among the elderly population of
India is expected to increase due to the increase in the ageing population. (7) conducted a
systematic review of the prevalence of depression among the elderly in India and found out that
it ranged from 11.6% to 31.1% with the females and urban dwellers being much more affected.
Much higher rates were reported in community-based studies ranging from 3.9% to 47.0% with
the women and urban dweller being much more affected.
Common mental disorders are widely observed in primary care environments in low and
medium-income countries. Multiple research carried out across India have shown that
approximately 17-46% of patients visiting primary healthcare centres suffer common mental
disorders such as depression (8-9). Depression accounted for the most prevalent common mental
disorders (63.6%) (10). The latest reports carried out in Delhi indicate a 30.3% incidence of
depression among outpatients. Depressed individuals are 1.52 times more likely to succumb to
the condition than the overall population because of their mental or physical health issues that go
unaddressed 27. Moreover, depression has been linked to several terminal sicknesses which
further increases the mortality rate. Evidence-based research has also shown that 15% of the
victims of depression are likely to commit suicide (11).
Risk Factors for Depression among the Elderly in India

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Depression is as a result of several factors due to intricate mechanisms; thus, there is no one
identifiable cause. But there is evidence to show that multiple factors such as socioeconomic,
cultural, biological and environmental factors affect a maladaptive person, resulting in
depression (9,11). An elderly person may be depressed because of the loss of a loved one, or due
to life stress, a background of depression in the family, or as a result of the chronic medical
condition. However, some elderly people can undergo loneliness and feel discouraged without
any pertinent reason. It is therefore important the risk factor for depression among the elderly be
determined in order to ascertain the most appropriate intervention. This paper will, however,
address only two types of risk factors for depression among the elderly in India, namely
socioeconomic factors and psychological factors.
Socioeconomic status (SES)
Socioeconomic status does not only include income but also educational attainment, individual
opinions on social status and social class, and financial security. It generally includes the overall
features of quality life in addition to the opportunities and privileges offered to some individuals
in society. Nevertheless, the most common indicators of socioeconomic status that have
significant associations with depression include income and education (12).
Studies have attributed low socioeconomic status (SES) among the elderly in India to depression.
Income level and years of education have been used as elements SES index. The elderly aged 60
years and above have reduced the ability to work and thus are not able to comfortably support
themselves financially whereas those who are elderly and self-employed still face low household
income. The study by (9) found out that the elderly in India are at a higher risk of functional
decline and loneliness; all of which leads to high incidences of depression. Low SES increases