Depression in the elderly in Karachi, Pakistan: a cross sectional study

BACKGROUND: Depression in elderly is a major global public health concern. There has been no population-based study of depression in the elderly in Pakistan. The aim of the study was to estimate the prevalence of depression and its association with family support of elderly (age 60 years and above) in Karachi, Pakistan. METHODS: A population based cross-sectional study was carried out in Karachi from July-September 2008. Questionnaire based interviews were conducted with individuals (n = 953) recruited through multi-stage cluster sampling technique, using the 15- item Geriatric Depression Scale (GDS). RESULTS: Prevalence of depression was found to be 40.6%, with a higher preponderance in women than men (50% vs. 32%). Elderly currently not living with their spouses were 60% more depressed than those living with their spouses (Adjusted OR = 1.6, 95% CI = 1.3-2.1). Elderly who did not consider their children as future support were twice as likely to be depressed as those considering their children to be old age security (Adjusted OR = 2.1, 95% CI = 1.4-3.1). An increase in one male adult child showed 10% decrease in depression after adjusting for other variables (Adjusted OR = 0.9, 95% CI = 0.8-0.9). CONCLUSION: A relatively high prevalence of depression was found in the elderly in Karachi. There appeared to be a strong association between depression and family support variables such as living with spouse, considering children as future security and number of male adult children in the sample studied. Mental wellbeing of the elderly in Pakistan needs to be given consideration in the health policy of the country. In collectivistic societies like Pakistan family support plays an important part in mental health of the elderly that needs to be recognized and supported through various governmental and non-governmental initiatives. KEYPOINTS: Assessment of depression in elderly, Cross-sectional study in Karachi-Pakistan