|Year : 2013 | Volume
| Issue : 3 | Page : 309-312
Prevalence of depression among geriatric population in a rural area in Tamilnadu
Shankar Radhakrishnan1, Abdul Nayeem2
1 Department of Community Medicine, Vinayaka Missions Kirupananda Variyar Medical College, Salem, India
2 Department of Community Medicine, Annapoorna Medical College, Salem, Tamilnadu, India
|Date of Submission||14-Aug-2012|
|Date of Acceptance||22-Sep-2012|
|Date of Web Publication||10-Jul-2013|
Departments of Community Medicine, Vinayaka Missions Kirupananda Variyar Medical College, Chinna Seeragapadi, Salem, Tamilnadu
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Ageing is a universal process that is associated with deteriorating health status. Even though depression is the commonest psychiatric disorder in the elderly, it is commonly misdiagnosed and under treated. This could be due to the misconception that depression is part of aging rather than a treatable condition. Aim: To assess the prevalence of depression and the factors influencing depression among the geriatric population in a rural area in Tamil Nadu Settings and Design: A cross sectional study was conducted among 400 geriatric population at Attayampatti village in Salem district which is a rural field practicing area for our medical college for a period of 6 months between June 2011 and December 2011. Materials and Methods: A validated depression assessment scale was used to assess their depression status and the various demographic factors like age, sex, education, monthly income, spouse living status were analysed to see for any association with depression. Statistical Analysis: Mean proportions, Chi square and odds ratio. Results: Of the total population 41.2% were normal, 37.8% were having mild depression and 21% were severely depressed. Of the various demographic factors advanced age, sex, education, monthly income, spouse living status, history of chronic ailments and smoking showed a statistically significant association with depression. Conclusion: The results reaffirm that there is a high prevalence of depression among the geriatric population and adequate measures to detect and control this psychiatric disorder in elderly by specialized geropsychiatric services are needed.
Keywords: Depression, geriatric, rural area
|How to cite this article:|
Radhakrishnan S, Nayeem A. Prevalence of depression among geriatric population in a rural area in Tamilnadu. Int J Nutr Pharmacol Neurol Dis 2013;3:309-12
|How to cite this URL:|
Radhakrishnan S, Nayeem A. Prevalence of depression among geriatric population in a rural area in Tamilnadu. Int J Nutr Pharmacol Neurol Dis [serial online] 2013 [cited 2019 Jul 17];3:309-12. Available from: http://www.ijnpnd.com/text.asp?2013/3/3/309/114880
| Introduction|| |
The rise in the proportion of the ageing population represents one of the most significant demographic shifts in history. In 1950 there were 205 million people who were over 60, in a2000 it was 606 million people and by 2050 there will be around twobillion elderly people living in India. Social and cultural shift had also encroached the rural India, which for centuries it was boasted of joint family system with high respect for its elderly members, but now it is more of nuclear families ignoring the elderly.  Ageing is a universal process that is associated with deteriorating health status. Today depression is one of the commonestcause of disability in the elderly. The various consequences due to depression are reduced life satisfaction and quality, social deprivation, loneliness, increased use of health and home care services, cognitive decline, impairments in activities of daily living, suicide, and increased nonsuicide mortality. 
Over the past decades India's health programs and policies have been focussing on issues like population stabilisation, maternal and child health care and disease control activities, whereas the current statistics for the elderly in India gives a prelude to a new set of medical, social and economic problems. There is a need to highlight the medical and social problems that are being faced by the elderly population. Strategies for bringingabout rehabilitation and improvement in their quality of life are also the need of the hour.  Even though depression is the commonest psychiatric disorder in the elderly, it is commonly misdiagnosed and under treated. This could be due to the misconception that depression is part of aging rather than a treatable condition.  World wide interest in geriatric depression has increased in recent years, and several population studies across the world have examined its prevalence, with results ranging from 1to 20% however, methodological differences may account for this variability  but studies to assess the depression among the elderly population has hardly been done in this part of the country and very few in the rural community. So this study would throw some light to know about the magnitude of depression among geriatrics in a rural area of South India.
| Aim|| |
To assess the prevalence of depression and the factors influencing depression among the geriatric population in a rural area in Tamil Nadu.
| Methodology|| |
A cross sectional study was conducted in Attayampatti village in Salem district which is the rural field practicing area for our medical college for a period of sixmonths between June 2011 and December 2011. Attayampatti village has a population of 10,000 and in that the geriatric population is 800 (keeping the national average of 8%). Keeping the prevalence of depression as 50% (quoted from previous study) in the geriatric population and taking the confidence interval as 95% and the maximum allowable error as 10%. Applying these values in the standard formula for calculation of sample size (4PQ/e 2 ), the study population came to 400. A line listing of all elderly population in the selected village was made by doing a house to house survey and totally it came to around 837. So 837 geriatric people were in the sampling frame out of which 400 were included and selected by using a simple random technique. The non respondents and those who are not willing to participate in the study were excluded and an informed consent was acquired from the study subjects who had participated in the study. A validated depression assessment scale  was used to assess their depression status and apart from that general demographic details were collected by using a semi structured questionnaire. The depression was scored by 0-9 as normal, 10-19 as mild depression and 20-30 as severe depression. The study subjects who were found to have severe depression were referred to our hospital for further management.
| Results|| |
The [Table 1] shows the age and sex wise distribution of the study population. Of the 400 study population 168 were males and 232 were females. It is seen that the maximum number of the population were in the age group between 60-70 years. The sex wise distribution of the depression score among the study population was shown in [Table 2]. Of the total population 41.2% (95% CI 39.04-43.36) were not depressed, 37.8% (95% CI 35.57-40.03) were having mild depression and 21%(95% CI 18.54-23.46) were severely depressed. Among males it was found that 54.8% were normal and 13.1% were severely depressed whereas among females 31.5% were normal and 26.7% were severely depressed. In our study population the females were found to be more depressed than males and it was found to be statistically significant (P < 0.0001).
|Table 2: Gender wise distribution of the depression score among the study population|
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The age and sex wise distribution of the depression score among the study population [Table 3] found that majority of population who were normal (0-9) were in the age group of 60-70 years and those with mild (10-19) to severe (20-30) depression were more than 70 years in both the sexes, and in females this was found to be statistically significant (P < 0.05). A multiple logistic regression [Table 4] was done to see the various factors influencing depression in the study population and among those factors education shows a statistical significant association (P < 0.05) for depression in both the sexes, which means the depression seems to be more common among the not literate people than the literate people. In males apart from education, other factors like monthly income (<2000), people with some chronic illness like diabetes, hypertension or some orthopedic problems, people with a history of smoking for more than 20 years showed a statistical significant association (P < 0.05) with depression. Whereas among females apart from education, the other factor which showed a statistical significant association with depression was the spouse status (widowed).
|Table 3: Age and sex wise distribution of depression score among the study population|
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|Table 4: Multilogistic regression for various factors infl uencing depression among the study population|
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| Discussions|| |
A systematic review by Ankur Barua et al., on 74 community-based mental health surveys on depression in geriatric population revealed that older age group and female gender found to be significantly associated with depression in geriatric population and potentially some modifiable risk factors like low socioeconomic status, loss of spouse, living alone, chronic co-morbidities were also had a significant association with depression.  A similar results was published in a study done by Sherina et al.  where asour study which was a rural community based survey had shown that the prevalence of depression was almost 60% and in that 20% were suffering from severe depressionwith predominance among female gender and other demographic factors like educational status, the income, chronic morbidity and the spouse status had shown significant association like that of other studies. Depression which was once thought to be an urban based problem has now even becoming more common among the rural population because of the change the social and cultural milieu.
A study by Singh et al. on geriatric population showed that 48.07% of the sample were suffering from most major mood disorder and in that 89.6% were having depression and in that males outnumbered females and majority were in the age group between 60-65 years. He also further stated that 17.23% were divorcee, 39.78% were house wives and 33.7% are retired persons.  A study done by Raj kumar et al. among elderly in a rural South Indian community revealed that the prevalence of depression was 12.7% and also stated that low income, history of cardiac illness, diabetes and hunger showed a statistical significant association towards developing depression where as age and female sex did not show any association and having more friends was protective towards depression.  As depression being the most common psychiatric disorder, the present study had still substantiated the statement by showing the prevalence of severe depression as almost 20% and our study differed from the previous study by showingthe prevalence of depression being more common among the females than the males (26.7 vs. 13.1%) and that was found to be statistically significant and the demographic variables which were influencing depression were almost similar like economic status, spouse status, smoking and chronic illness like diabetes, hypertension etc.
A study by Sanghamitra Maulik et al. found that the prevalence of depression was 53.7%. Female sex, illiteracy, higher age, separated/divorced, widowed, poor socio economic status, absence of personal income, staying without spouse, not being consulted for decisions andfeeling of ill being were significant risk factors for depression  and a similar study by Tiwari et al. found theprevalence of psychiatric morbidity among the geriatric population was 43.32% and in that majority were suffering fromneurotic depression, manic-depressive psychosis depression, and anxiety state in descending order of frequency and also found that socially, economically, and educationally disadvantaged subjects were more psychiatrically ill.  A study by Chi et al. on Chinese population showed the prevalence of depression was 11% and 14.5% among males and females respectively and the factors related to it was almost similar to as stated by the previous studies.  Another study by Paula M. Trief showed that diabetes had a significant association with depression among the geriatric population  and a meta-analysis study by Cole et al. revealed that disability, new medical illness, poor health status and female gender were significant risk factors for depression,  comparing with these international based studies the present study also had not shown much difference in the prevalence and the factors associated with depression so it is apt to say that depression is a major psychiatric problem not only in developed countries but also among the developing countries like India.
Still a large sample study would have shown the real burden of depression, as it is one of the iceberg diseases. Since because of the logistics constraints we were only able to carry of this study on a small sample of the population.
| Conclusions|| |
The present study had shown the prevalence of mild depression among the elderly was 37.8% and that of severe depression was 21%. The prevalence of depression had a significant association with education, occupation, income, spouse status, smoking and history of chronic illness. So the results reaffirm that there is a high prevalence of depression among the geriatric population and adequate measures should be taken to detect this psychiatric disorder in elderly outpatients by specialized geropsychiatric services. Already existing mental health programme should emphasize more on depressive disorders in aged is the demand of the current scenario in our country. With more studies like the current study in the elderly, it is hoped that the truer picture of depression in the elderly in India will emerge out and the delivery of services to those dependant population can improve, as their wellness and disability play a major role in determining the health and wellbeing of the society in general.
| References|| |
|1.||Barua A, Kar N. Screening for depression in elderly Indian population. Indian J Psychiatry 2010;52:150-3. |
|2.||Steffens DC, Skoog I, Norton MC, Hart AD, Tschanz JT, Plassman BL et al. Prevalence of depression and its treatment in an elderly population: The Cache County study. Arch Gen Psychiatry 2000;57:601-7. |
|3.||Biswas SS, Gupta R, Vanjare HA, Bose S, Patel JA, Selvarajan S, et al. Depression in the elderly in Vellore, South India: The use of a two-question screen. Int Psychogeriatr 2009;21:369-71. |
|4.||Barua A, Ghosh M, Kar N, Basilio M. Distribution of depressive disorders in the elderly. J Neurosci Rural Pract 2010;1:67-73. |
|5.||Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, et al. Development and Validation of a Geriatric Depression Screening Scale: A Preliminary Report. J Psychiatr Res 1982;17:37-49. |
|6.||Barua A, Ghosh MK, Kar N, Basilio MA. Socio-demographic factors of geriatric depression. Indian J Psychol Med 2010;32:87-92. |
|7.||Sherina MS, Rampal L, Mustaqim A. The prevalence of depression among the elderly in Sepang, Selangor. Med J Malaysia 2004;59:45-9. |
|8.||Singh GP, Chavan BS, Arun P, Lobraj Sidana A. Geriatric out-patients with psychiatric illnesses in a teaching hospital setting: A retrospective study. Indian J Psychiatry 2004;46:140-3. |
|9.||Rajkumar AP, Thangadurai P, Senthilkumar P, Gayathri K, Prince M, Jacob KS, et al. Nature, prevalence and factors associated with depression among the elderly in a rural south Indian community. Int Psychogeriatr 2009;21:372-8. |
|10.||MaulikS, Dasgupta A. Depression and its determinants in the rural elderly of West Bengal: A cross sectional study. Int J Biol Med Res 2012;3:1299-302. |
|11.||Tiwari SC. Geriatric psychiatric morbidity in rural Northern India: Implications for the future. Int Psychogeriatr 2000;12:35-48. |
|12.||Chi I, Yip PS, Chiu HF, Chou KL, Chan KS, Kwan CW, et al. Prevalence of depression and its correlates in Hong Kong's Chinese older adults.Am J Geriatr Psychiatry 2005;13:409-16. |
|13.||Trief PM. Depression in elderly diabetes patients. Diabetes spectrum 2007;202:71-5. |
|14.||Cole MG, Dendukuri N. Risk factors for depression among elderly community subjects: A systematic review and meta-analysis. Am J Psychiatry 2003;160:1147-56. |
[Table 1], [Table 2], [Table 3], [Table 4]