Depression Underdiagnosed in India for Adults

Arokiasamy Perianayagam, PhD

Depression rates among adults are substantially higher in India than self-reported rates indicate, according to new research.

A team, led by Arokiasamy Perianayagam, PhD, International Institute for Population Sciences, identified the prevalence of depression and the association with several sociodemographic correlates and co-existing health conditions for adults aged 45 years and older in India and its states.

Depression has been an issue among adults aged 45 years and older in India, leading to poor health outcomes and disabilities.

The Study

In the prospective cohort study, the investigators used data from wave 1 of the Longitudinal Ageing Study in India for 72,250 adult participants. This baseline data was used to estimate the national and subnational state level age-standardized prevalence of depression, gauged by major depressive episodes, using the Composite International Diagnostic Interview-Short Form (CIDI-SF) scale.

The investigators used hierarchical mixed effect multivariate logistic regression models to study the sociodemographic correlates and co-existing health conditions of major depressive episodes.

The team also examined the associations between depression and self-rated health, co-morbid conditions, functional health, and life satisfaction measures.

The study included patients ranging from 45-116 years, with a median age of 58 years.

Discovering Trends

The investigators found the overall age-standardized prevalence of depression based on the CIDI-SF scale was 5.7% (95% CI, 5.5-5.8%). This was significantly higher than the 0.5% (95% CI, 0.5-0.6%) self-reported prevalence of depression for adults aged 45 years and older in India.

There was also a wide range of subnational variations found in the results. For example the prevalence of depression ranged from 0.8% (95% CI, 0.3-1.3) in the Mizoram state to 12.9% (95% CI, 11.6-14.2%) in the Madhya Pradesh.

There were also trends found based on sex, region, type of region, marital status, education, and economics.

The prevalence of depression was 6.3% in females (95% CI, 6.1-6.6) compared to 4.3% (95% CI, 4.1-4.6%) for India. This prevalence was also more pronounced in some of the northern states

The risk of depression was also higher in individuals living in rural areas, widowed, with no or low education, and in the poorest quintile.

Poor self-reported health was also strongly associated with depression (OR, 2.39; 95% CI, 2.21-2.59; P <0.0001), with 1 or more limitation in the activities of daily living (OR, 1.60; 95% CI, 1.46-1.75; P <0.001), instrumental daily living activity limitations (OR, 1.51; 95% CI, 1.40-1.64; P <0.0001), and low cognitive judgement of life satisfaction (OR, 1.94; 95% CI, 1.78-2.10; P <0.0001).

“Despite the substantial burden, depression remains undiagnosed and strongly linked with poor health and wellbeing outcomes in adults aged 45 years and older in India,” the authors wrote. “The ageing population of India and the subnational variations amplify the implications of this new evidence to address the substantial gaps in prevention and treatment of depression.”

The study, “Sub-national patterns and correlates of depression among adults aged 45 years and older: findings from wave 1 of the Longitudinal Ageing Study in India,” was published online in The Lancet Psychiatry.