Factors associated with depression among elderly in Karachi Pakistan: a matched case control study

Date of Award


Document Type


Degree Name

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


Community Health Sciences


Background: There has been a dramatic increase in the world's elderly population mainly due to epidemiologic transition. The increase in life expectancy has brought about increased numbers of certain chronic mental illnesses, namely depression. It is a silent disorder and can have devastating effect on an elderly quality of life. Since, none of the analytical base comprehensive epidemiological studies on depression have been conducted in Pakistan, this study aims to identify the factors associated with depression among elderly (_> 60 years) living in Karachi, Pakistan Methods: We conducted a mutlicentre based matched case control study between July to September 2008 in Karachi. The cases were defined as those elderly (>60 years), either male or female who visited the psychiatric outpatient department of study hospitals, had depression for < 6 months and were also confirmed to be depressed by Geriatric Depression Scale and the attending psychiatrist. For each depressive elderly, two sex and age- matched non depressive controls (psychiatrist confirmed) were selected from the other outpatient department of study hospitals. There was substantial agreement between the psychiatrists for diagnosing depression (Kappa: 0.66) Results: A total of 234 depressed cases and 468 non depressed controls were selected. In the final multivariable conditional logistic regression model, following factors were found to be risk factors for depression. Living in nuclear family system, (MOR adj= 4.0, 95% CI: 2.1-4.9), living alone during past one year, (MOR adj 9, 95% CI: 6.0-19.7), self reported difficulty in hearing and vision both (MOR adj 4.5, 95% CI: 2.0-9.8), presence of two or more non communicable diseases (MOR adj: 2, 95% CI: 1.0-3.4) living in low socioeconomic status (MOR adj :3.3, 95% CI: 1.8-6.0), and being unable to perform religious practices (MOR adj 1.2, 95% CI:0.4-1.3). However, visiting or talking with friends or relatives at least thrice a week had a protective effect against depression (MOR adj: 0.3, 95% CI:0.3-0.7) Conclusion: Living in nuclear family system is independent risk factor for depression among elderly. Although potentially modifiable, thus interventions should be applied to reduce the nucleation of families. On the other hand, some indentified risk factors are non-modifiable as, number of non-communicable diseases, factors like these should be used to identify a high risk group for primary prevention that decreases the occurrence of disease. However, the factors identified through this study may vary in its association with depression across different communities.

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