Variation in the prevalence of depression and patterns of association, sociodemographic and lifestyle factors in community-dwelling older adults in six low- and middle-income countries

Abstract

Background: Data from the World Health Organization Study on global AGEing and adult health (SAGE) were used to estimate the prevalence of depression in older adults in six low- and middle-income countries (LMICs), namely China, Ghana, India, Mexico, the Russian Federation, and South Africa, and to examine the relationship between demographic and lifestyle characteristics and depression. Method: A total of 33,421 participants aged ≥ 50 years were included. A set of diagnostic questions from the World Mental Health Survey was used within SAGE to define depression. Results: The crude population prevalence of depression was 7.4% [95%CI: 6.5%–8.3%] ranging from 1.5% in China to 15.2% in India. It was higher in females 8.6% [7.6%–9.6%] compared to males 6.1% [5.0%–7.2%]. The age-standardized prevalence of depression was 7.8% [6.3%–9.6%] in pooled data, 8.9% [6.9%–11.1%] in females and 6.6% [4.6%–9.0%] in males. Greater fruit (0.89[0.84–0.93]) and vegetable intake (0.94 [0.89–1.00]) was associated with a lower prevalence of depression. Furthermore, those who were older, female, underweight, and with lower education and lower wealth, had higher prevalence of depression. Limitations: The cross-sectional design of this study precluded conclusions on causality. Conclusion: In nationally-representative samples of older adults in six LMICs, an average of one in every 13 participants suffered from depression. The prevalence of depression varied considerably between countries, sexes, and with wealth and educational disadvantage. Increased fruit and vegetable intake appeared to co-occur with significantly lower rates of depression, suggesting diet as a modifiable factor for addressing depression burden.