Title

Prevalence of depression and it's associated factors in the elderly population of Karachi, Pakistan: a cross sectional study

Date of Award

2009

Document Type

Thesis

Degree Name

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

Department

Community Health Sciences

Abstract

Introduction: Globally, depression is among the most common psychiatric disorders in geriatric population. The life of elderly is adversely affected by depression, the extent of which is immeasurable. Not only it has an impact on their mental health but their physical, social and economical well-being is also affected. Unfortunately, the health and wellbeing of elderly people is among the neglected domains of public health in our region as the focus has been mainly on children and maternal health and infectious diseases. There is a dearth of information on social and health issues of elderly population from Pakistan. The increasing number of elderly due to population aging together with the inferior quality of existing health-care system offer sufficient provocation to initiate acquaintance with their prevailing problems. The purpose of our study is to estimate the prevalence of depression and its associated factors among elderly (age 60 and above). The recognition of magnitude of depression along with its factors might help us to take appropriate measures in light of scientific evidence. Subjects and Methods: A population based cross-sectional study was conducted on elderly of 60 years and above in Karachi, Pakistan from July to September 2008. Face-to-face interviews were conducted with 953 eligible individuals recruited through multi-stage cluster sampling technique, drawing samples from 46 clusters from 18 towns of Karachi. Prevalence of depression and its associated factors were determined with the help of a detailed questionnaire. Depression status was assessed through 15 item Geriatric Depression Scale (GDS). Those, scoring 5 and above were considered depressed. Multivariable models were built using binary logistic regression analysis to determine the independent association of factors with depression. Results: The overall prevalence of depression among elderly persons is 40.6%. The prevalence in females is 50% whereas in males it is 32%. The factors associated with depression are poor self perception of health status (ORadj=10.7, 95% CI=4.9-23.6), currently living without spouse (Oltadj=1.6, 95% CI=1.3-2.1) and not considering children as future security (ORadj=2.1, 95% CI=1.4-3.1). However, factors like ability to perform activities of daily living (ORadj=0.9, 95% CI=0.8-0.9), spending >310 minutes (> 5.2 hrs) per week for physical activities (ORadj=0.4, 95% CI=0.2-0.7), above matriculation level of education (ORadj=0.4, 95% CI=0.2-0.7) and number of adult male children alive (ORadj=0.9, 95% CI=0.8-0.9) show protection against depression. Conclusion: The prevalence of depression among elderly population of Karachi is high. Selfperception of poor health, feeling of loneliness and future insecurity make the elderly vulnerable to depression. Whereas feeling of independence as evident by physical activity and education, and security by having male children protected elderly from getting depressed. We strongly recommend that physical, social and mental wellbeing of elderly population should be given due consideration in the health policy of the country and awareness about healthy behaviours should be provided to the elderly through outreach activities. Moreover, effective health insurance schemes should be introduced for the elderly by the government or NGOs with the intentions to arrange both health-care and communal programmes to promote healthy living among elderly and to encourage their participation in various social activities to make them feel useful member of the society.

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