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

Research output: Contribution to journalArticle


Objective 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. Methods 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. Results 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. Conclusions 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.


  • Ethel M. Brinda
  • Anto P. Rajkumar
  • Jǿrn Attermann
  • Ulf G. Gerdtham
  • Ulrika Enemark
  • Kuruthukulangara S. Jacob
External organisations
  • Aarhus University
  • King's College London
  • South London and Maudsley NHS Foundation Trust
  • Christian Medical College & Hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Geriatrics
  • Psychiatry
  • Public Health, Global Health, Social Medicine and Epidemiology


  • depression, developing countries, geriatric psychiatry, socioeconomic factors
Original languageEnglish
Pages (from-to)1196-1208
Number of pages13
JournalAmerican Journal of Geriatric Psychiatry
Issue number12
Publication statusPublished - 2016 Dec 1
Publication categoryResearch