title: Nature, prevalence and factors associated with depression among the elderly in a rural south Indian community.
abstract: BACKGROUND
  Depression in old age is an important public health problem causing considerable morbidity and disability worldwide. There is a dearth of community studies from India investigating geriatric depression and its associated risk factors. This study aimed to establish the nature, prevalence and factors associated with geriatric depression in a rural south Indian community.
  
  
  METHODS
  We recruited 1000 participants aged over 65 years from Kaniyambadi block, Vellore, India. We assessed their socio-demographic profile, psychiatric morbidity, cognitive functioning, anthropometrics and disability status using the following structured assessment tools: Geriatric Mental State, Community Screening Instrument for Dementia, Modified CERAD 10 word list learning task, History and Aetiology Schedule Dementia Diagnosis and Subtype, WHO Disability Assessment Scale II, and Neuropsychiatric Inventory. We adopted a case control framework to study the factors associated with geriatric depression.
  
  
  RESULTS
  Prevalence of geriatric depression (ICD-10) within the previous one month was 12.7% (95% CI 10.64-14.76%). Low income (OR 1.78; 95% CI 1.08-2.91), experiencing hunger (OR 2.58; 95% CI 1.56-4.26), history of cardiac illnesses (OR 4.75; 95% CI 1.96-11.52), transient ischemic attack (OR 2.43; 95% CI 1.17-5.05), past head injury (OR 2.70; 95% CI 1.36-5.36) and diabetes (OR 2.33; 95% CI 1.15-4.72) increased the risk for geriatric depression after adjusting for other determinants using conditional logistic regression. Having more confidants (OR 0.13; 95% CI 0.06-0.26) was the significant protective factor. Age, female gender, cognitive impairment and disability status were not significantly associated with geriatric depression. DSM-IV diagnosis of major depression was significantly correlated with experiencing hunger, diabetes, transient ischemic attack, past head injury, more disability and less nourishment; having more friends was protective.
  
  
  CONCLUSIONS
  Geriatric depression is prevalent in rural south India. Poverty and physical ill health are risk factors for depression among elderly while good social support is protective.
authors.affiliation: Department of Psychiatry, Christian Medical College, Vellore, India.
authors.forename: A P
authors.initials: AP
authors.lastname: Rajkumar
authors.forename: P
authors.initials: P
authors.lastname: Thangadurai
authors.forename: P
authors.initials: P
authors.lastname: Senthilkumar
authors.forename: K
authors.initials: K
authors.lastname: Gayathri
authors.forename: M
authors.initials: M
authors.lastname: Prince
authors.forename: K S
authors.initials: KS
authors.lastname: Jacob
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003866:Depressive Disorder / Q000453:epidemiology*; D003906:Developing Countries; D005260:Female; D015577:Geriatric Assessment / Q000706:statistics & numerical data*; D006306:Health Surveys; D006801:Humans; D007194:India; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008609:Mental Status Schedule / Q000706:statistics & numerical data; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D016017:Odds Ratio; D010552:Personality Assessment / Q000706:statistics & numerical data; D011203:Poverty / Q000523:psychology / Q000706:statistics & numerical data; D011594:Psychometrics / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*