title: Health, Social, and Economic Variables Associated with Depression Among Older People in Low and Middle Income Countries: World Health Organization Study on Global AGEing and Adult Health.
abstract: Although depression among older people is an important public health problem worldwide, systematic studies evaluating its prevalence and determinants in low and middle income countries (LMICs) are sparse. The biopsychosocial model of depression and prevailing socioeconomic hardships for older people in LMICs have provided the impetus to determine the prevalence of geriatric depression; to study its associations with health, social, and economic variables; and to investigate socioeconomic inequalities in depression prevalence in LMICs.
  
  
  
  The authors accessed the World Health Organization Study on Global AGEing and Adult Health Wave 1 data that studied nationally representative samples from six large LMICs (N = 14,877). A computerized algorithm derived depression diagnoses. The authors assessed hypothesized associations using survey multivariate logistic regression models for each LMIC and pooled their risk estimates by meta-analyses and investigated related socioeconomic inequalities using concentration indices.
  
  
  
  Cross-national prevalence of geriatric depression was 4.7% (95% CI: 1.9%-11.9%). Female gender, illiteracy, poverty, indebtedness, past informal-sector occupation, bereavement, angina, and stroke had significant positive associations, whereas pension support and health insurance showed significant negative associations with geriatric depression. Pro-poor inequality of geriatric depression were documented in five LMICs.
  
  
  
  Socioeconomic factors and related inequalities may predispose, precipitate, or perpetuate depression amongolder people in LMICs. Relative absence of health safety net places socioeconomically disadvantaged older people in LMICs at risk. The need for population-based public health interventions and policies to prevent and to manage geriatric depression effectively in LMICs cannot be overemphasized.
authors.affiliation: Section for Health Promotion and Health Services Research, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Ethel M
authors.initials: EM
authors.lastname: Brinda
authors.affiliation: Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, UK; Mental Health of Older Adults and Dementia Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK. Electronic address: Anto.Rajamani@kcl.ac.uk.
authors.forename: Anto P
authors.initials: AP
authors.lastname: Rajkumar
authors.affiliation: Section of Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Jǿrn
authors.initials: J
authors.lastname: Attermann
authors.affiliation: Health Economics Unit, Department of Clinical Sciences, Lund University, Lund, Sweden; Institute of Economic Research, Health Economics & Management, Lund University, Lund, Sweden.
authors.forename: Ulf G
authors.initials: UG
authors.lastname: Gerdtham
authors.affiliation: Section for Health Promotion and Health Services Research, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Ulrika
authors.initials: U
authors.lastname: Enemark
authors.affiliation: Department of Psychiatry, Christian Medical College, Vellore, India.
authors.forename: Kuruthukulangara S
authors.initials: KS
authors.lastname: Jacob
mesh_terms: D000368:Aged; D000375:Aging / Q000523:psychology; D003863:Depression / Q000453:epidemiology / Q000209:etiology*; D003906:Developing Countries / Q000706:statistics & numerical data*; D004522:Educational Status; D005260:Female; D014943:Global Health / Q000706:statistics & numerical data; D006304:Health Status; D054624:Health Status Disparities; D006801:Humans; D000067010:Literacy / Q000523:psychology / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D011203:Poverty / Q000523:psychology / Q000706:statistics & numerical data; D015995:Prevalence; D012737:Sex Factors; D012959:Socioeconomic Factors; D014944:World Health Organization
keywords: depression; developing countries; geriatric psychiatry; socioeconomic factors