title: Cross-sectional associations of depressive symptom severity and functioning with health service use by older people in low-and-middle income countries.
abstract: BACKGROUND
  Comprehensive understanding of the determinants of health service use (HSU) by older people with depression is essential for health service planning for an ageing global population. This study aimed to determine the extent to which depressive symptom severity and functioning are associated with HSU by older people with depression in low and middle income countries (LMICs).
  
  
  METHODS
  A cross-sectional analysis of the 10/66 Dementia Research Group population-based surveys dataset. Participants (n = 4590) were those aged 65 or older, in the clinical range for depressive symptoms (defined as scoring four or more on the EURO-D), living in 13 urban and/or rural catchment areas in nine LMICs. Associations were calculated using Poisson regression and random-effects meta-analysis.
  
  
  RESULTS
  After adjustment for confounding variables, (EURO-D) depressive symptom severity was significantly associated with "any community HSU" (Pooled Prevalence Ratios = 1.02; 95% CI = 1.01-1.03) but not hospital admission. Conversely, after adjustment, (WHODAS-II) functioning was significantly associated with hospital admission (Pooled PR = 1.14; 95% CI = 1.02-1.26) but not "any community HSU".
  
  
  CONCLUSIONS
  Depressive symptom severity does not explain a large proportion of the variance in HSU by older people with depression in LMICs. The association of functioning with this HSU is worthy of further investigation. In LMICs, variables related to accessibility may be more important correlates of HSU than variables directly related to health problems.
authors: Faculty of Social and Human Sciences, School of Psychology, University of Southampton, Southampton SO17 1BJ, UK. c.twomey@soton.ac.uk.
authors: Conal D
authors: CD
authors: Twomey
authors: Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK. martin.prince@kcl.ac.uk.
authors: Martin
authors: M
authors: Prince
authors: Faculty of Social and Human Sciences, School of Psychology, University of Southampton, Southampton SO17 1BJ, UK. a.cieza@soton.ac.uk.|Research Unit for Biopsychosocial Health, Department of Medical Informatics, Biometry and Epidemiology-IBE, Ludwig-Maximilians-University (LMU), Munich 81377, Germany. a.cieza@soton.ac.uk.|Swiss Paraplegic Research (SPF), Nottwil 6207, Switzerland. a.cieza@soton.ac.uk.
authors: Alarcos
authors: A
authors: Cieza
authors: Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK. d.s.baldwin@soton.ac.uk.
authors: David S
authors: DS
authors: Baldwin
authors: Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK. matthew.prina@kcl.ac.uk.
authors: A Matthew
authors: AM
authors: Prina
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003153:Community Health Services / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology* / Q000523:psychology; D003866:Depressive Disorder / Q000453:epidemiology* / Q000523:psychology; D003906:Developing Countries; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence