Prevalence of and factors associated with anxiety and depression among individuals aged 40 and above in the general population, Karachi, Pakistan

Date of Award


Document Type


Degree Name

Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)


Community Health Sciences


Depression along with anxiety is an incapacitating mental illness that poses major health burden in developed as well as developing countries. Reliable and valid estimates of prevalence and identification of risk factors are essential for preparing effective prevention and control strategies for anxiety and depression. Hence, this study aimed to estimate the prevalence of and factors associated with anxiety and depression in the general population aged 40 years and above of Karachi, Pakistan using a validated screening tool. A population based cross sectional study was conducted during August 2003 to August 2004 on 1508 adults aged > 40 years, drawn from a sampling frame through simple random selection. Face to face interviews were performed, and the Aga Khan University Anxiety and Depression Scale (AKUADS) was administered. Multivariable models were built and logistic regression analysis was performed to identify factors associated with the primary outcome of anxiety and depression. In our study an individual screened positive for anxiety and depression was defined as having a cut off score of "19" on AKUADS. A total of 1635 subjects were selected and consented to participate which include 743 (50%) men and 752 (50%) women. Mean (± SD) age of subjects was 54 ± 10 years. The prevalence of anxiety and depression was estimated at 14.6 % (95% CI: 12.9, 16.5). The factors (adjusted odds ratio (OR), 95% CI) independently associated with the primary outcome were decreasing age (OR = 2.6, 95% CI: 1.36, 4.82 for age 40-49 years, OR= 2.0, 95%CI: 1.07,3.81, OR= 1.48, 95% CI: 0.76, 2.89), muhajirs versus non muhajirs ethnicity ( OR = 1.53, 95% CI: 1.09, 2.16), those living in an extended versus nuclear family (OR = 1.67, 95% CI: 1.13, 2.45); age <17 years versus >22 years at marriage (OR=1.71, 95% CI: 1.12, 2.62), those with versus without self reported memory loss (OR= 3.48, 95% CI: 2.41, 5.03); those who did versus did not experience domestic violence on themselves (OR = 1.81, 95% CI: 1.25, 2.62), subjects who reported three or more co-morbidities (OR=5.01, 95% CI: 3.10, 8.10) or two or more co-morbidities ( OR= 2.24. 95% CI: 1.41, 3.54) versus none, and those with versus without positive family history of neuro-psychiatric disorders (OR= 2.15, 95% CI: 1.55, 3.00), unemployed versus employed (OR= 1.62, 95% CI: 1.07, 2.43) and decreasing level of monthly household income ( OR =2.55, 95% CI: 1.55, 4.18 for income < Rs. 5000, ( OR = 3.85, 95% CI: 2.18, 6.78 for income Rs. 5001 to 7999), and ( OR = 2.02, 95% CI: 1.24, 3.27 for income Rs. 8000 to 12000). Our findings suggest a high burden of anxiety and depression among adults in the general population of Karachi, Pakistan. While the cross sectional design of our study cannot establish causality, programs to improve mental health that target the factors and vulnerable segments of population identified in our study are likely to be effective. Efforts are needed to promote such programs in Pakistan.

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