Understanding depression in older Indians using diathesis-stress framework: The role of neighborhood safety and physical and functional health.

OBJECTIVES: The interplay between an individual's vulnerability and related stressors, effectively termed as diathesis, is an important contributor towards depressive symptoms. Utilizing the diathesis-stress model, the present study examines the role of perceived neighborhood safety along with specific indicators of health such as activities of daily living (ADL) and self-rated health (SRH), and their associations with depressive symptoms among older Indian adults. STUDY DESIGN: A cross-sectional study has been conducted. METHODS: Data were drawn from the Longitudinal Aging Study in India wave 1 that was collected during 2017-18. The present study is conducted on respondents aged 60 years and above and the sample included 31,464 older adults. Depressive symptoms were assessed using the Short Form Composite International Diagnostic Interview (CIDI-SF). RESULTS: In this study, approximately 14.3% of the older participants reported perceiving their neighborhood as unsafe. A total of 23.77% and 24.21% of older adults reported at least one difficulty in ADL and poor SRH, respectively. Older adults who had perceived their neighborhood as unsafe had higher odds of reporting depressive symptoms [AOR: 1.758, CI: 1.497-2.066] than those with the perception of a safe neighborhood. Those with a perceived unsafe neighborhood and low ADL functioning had approximately 3.3 times higher odds of reporting depressive symptoms [AOR: 3.298, CI: 2.553-4.261] than those with a safe perceived neighborhood and high ADL functioning. Further, older adults with unsafe perceived neighborhood, low ADL functioning and poor SRH had much greater odds of reporting depressive symptoms [AOR: 7.725, CI: 5.443-10.960] than those with a safe perceived neighborhood, high ADL functioning and good SRH. Additionally, depressive symptoms were pronounced among older women and those who resided in rural areas with unsafe perceived neighborhood, low ADL functioning and poor SRH than their male peers. CONCLUSIONS: The findings suggest that older women and rural-dwelling older adults are more prone to have higher prevalence of depressive symptoms than their male and urban-dwelling peers, especially when they have an unsafe neighborhood and poor functional and physical health, and thus, they should be given focused care and attention by healthcare practitioners.

Examining the Association of Pain and Pain Frequency With Self-Reported Difficulty in Activities of Daily Living and Instrumental Activities of Daily Living Among Community-Dwelling Older Adults: Findings From the Longitudinal Aging Study in India.

OBJECTIVES: We examined the prevalence and associations of self-reported difficulty in activities of daily living (ADL) and instrumental activities of daily living (IADL) with pain among community-dwelling older adults in India. We also explored the interaction effects of age and sex in these associations. METHODS: We used the Longitudinal Ageing Study in India (LASI) Wave 1 data (2017-2018). Our unweighted sample included 31,464 older adults aged 60 years and above. Outcome measures were having difficulty in at least 1 ADL/IADL. We conducted multivariable logistic regression analyses to examine the association of pain with functional difficulties controlling for selected variables. RESULTS: A total of 23.8% of older adults reported ADL and 48.4% reported IADL difficulty. Among older adults who reported pain, 33.1% reported difficulty in ADL and 57.1% reported difficulty in IADL. The adjusted odds ratio (aOR) for ADL was 1.83 (confidence interval [CI]: 1.70-1.96) and for IADL was 1.43 (CI: 1.35-1.51) when respondents reported pain compared with those without pain. Older adults who reported frequent pain had 2.28 and 1.67 times higher odds of ADL (aOR: 2.28; CI: 2.07-2.50) and IADL difficulty (aOR: 1.67; CI: 1.53-1.82) compared with those with no pain. Additionally, age and sex of the respondents significantly moderated the associations of pain and difficulty in ADL and IADL. DISCUSSION: Given the higher prevalence and likelihood of functional difficulties among older Indian adults who experienced frequent pain, interventions to mitigate pain in this vulnerable population are needed to ensure active and healthy aging.

Migration of adult male children and associated depression among community-dwelling older parents: A cross-sectional gender analysis from Longitudinal Ageing Study in India, 2017-2018.

OBJECTIVES: This study empirically examines the association of migration of an adult male child (ren) on the mental health of the older parents left behind. It also examines the interaction effects of sex of older parents and male child migration on major depression to explore whether there is a gender differential in the possible association. METHODS: The data for this study were obtained from the first wave of the Longitudinal Ageing Study in India (LASI, 2017-2018). The total sample size for the present study was 27,248 older adults aged 60 years and above (male-12,624; female-14,624). Descriptive statistics along with cross-tabulation were presented. Proportion test was used to evaluate the significance level of differences in depression by sex. Additionally, binary logistic regression analysis was used to find out the associations. Major depression with symptoms of dysphoria, was calculated using the Short-Form Composite International Diagnostic Interview (CIDI-SF). RESULTS: About 10.5% and 9.0% of older males and females had migrant sons. It was found that there was significant gender differential in depression in older age (male: 7.5% and female: 9.7%; p < 0.001). It was further found that the prevalence of depression was found among older men (9.3% vs. 7.3%) and women (12.5% vs. 9.4%) with migrant son. Older adults with migrant son had 26% significantly higher likelihood to be depressed in reference to older adults with non-migrant son (AOR: 1.26; CI: 1.02-1.56). Further, older women with a migrant son had 76% significantly higher likelihood to be depressed in reference to older men with migrant son (AOR: 1.76; CI: 1.32-2.39). CONCLUSIONS: This study invites policymakers' attention towards migration of adult children and its potential effects on mental health of left-behind older parents in community-settings and in women in particular. Policies should focus on spreading awareness to migrant children of older adults on maintaining frequent contacts and visits to their ageing parents.

The association between single and multiple chronic conditions and depression among older population in India: A comparative study between men and women.

OBJECTIVE: The study aimed to estimate the prevalence of depression and to explore the association of specific chronic conditions as well as multi-morbidity with depression among the older population. METHOD: The study utilized data from the Longitudinal Ageing Study in India Wave 1 (2017-2018). The total sample size for the present study was 31,464 older adults aged 60 and above, including 14,931 males and 16,533 females. Descriptive statistics along with bivariate and multivariate analyses were performed to fulfil the objectives. RESULTS: The overall prevalence of depression among the elderly population in India was 8.7%. Older women had shown a greater prevalence rate of depression than older men. Among chronic conditions, hypertension, stroke, and bone-related diseases were found to be significantly associated with depression in the case of both men and women. The prevalence of depression among older adults with three or more chronic conditions was higher in males (14.5%) than in females (11.2%). The association between the number of chronic conditions and depression exhibited a linear trend with an increased odds ratio indicating a higher risk of depression among older adults with multiple chronic conditions. CONCLUSION: Older individuals with a greater number of chronic illnesses have a higher risk of depression and the risk is proportional to the number of chronic conditions. This signifies the need for the identification of depressive symptoms at an early stage by focussing on the elderly suffering from chronic conditions and educating family members and the community about effective treatments and counselling.

Prevalence and correlates of pain and associated depression among community-dwelling older adults: Cross-sectional findings from LASI, 2017-2018.

BACKGROUND: Health practitioners often meet older persons suffering both from pain and depression. The study aimed to examine the factors associated with pain among older individuals and its association with major depression. In addition, the interaction between self-rated health (SRH), wealth status, and pain that is associated with depression are explored. METHODS: We used data from the Longitudinal Aging Study in India (LASI). Participants included 15,098 male and 16,366 female adults aged 60 years or older. Univariate and bivariate analyses along with χ2 tests were conducted in the initial stage. Binary logistic regression analyses were performed to fulfill the objectives. Major depression was calculated using Short Form Composite International Diagnostic Interview. RESULTS: A proportion of 39.6% older individuals (n = 12,686) reported pain and 8.7% older adults (n = 2657) suffered from depression. Older adults who suffered from pain frequently were more likely to be depressed than those who never suffered from pain (adjusted odds ratio [AOR]: 1.70; confidence interval [CI]: 1.38-2.09). The interaction of pain, SRH, and household wealth status on depression found that older adults with pain who reported poor SRH (AOR: 4.18; CI: 3.50-5.00) or belonged to rich households (AOR: 2.27; CI: 1.84-2.80) had higher odds of suffering from depression, compared to older adults with no pain and good SRH or no pain and belonged to poor households. CONCLUSION: It is highlighted that pain is quite common in older people, and is linked to depression especially among older people with poor SRH. Thus, routine evaluation of pain and associated symptoms of mental illnesses should be performed for ensuring healthy aging.