Research paperDeterminants of depressive symptoms among older people in Bangladesh
Introduction
Depressive symptoms are common among older people (Jongenelis et al., 2004; Li et al., 2015; Zhong et al., 2020). Late-life depression is detrimental for older people as it is associated with disability, cardiovascular disease, stroke, arthritis, physical deterioration, suicide, self-neglect, cognitive impairment, diabetes mellitus, morbidity, and mortality (Alexopoulos, 2005; Islam et al., 2015a,Islam, Rawal and Niessen, 2015b; Jongenelis et al., al.,2004; Kim et al., 2009; Penninx et al., 2000; Rodda et al., 2011). A previous research reported that mortality rates were 70% greater among clinically depressed older people (Mykletun et al., 2009).
Findings from a systematic review indicated the prevalence of minor depression in older adults ranged from 4.5% to 37.4%, while for the prevalence of major depression ranged from 4.6% to 25% (Meeks et al., 2011). Minor or subsyndromal depression has three core symptoms: empty mood, anhedonia, and decreased energy levels (Alexopoulos, 2005). Minor depression in older adults is clinically important as it leads to major depression, which it is one of the most serious disorders among the ageing population (McCall et al., 2002). Symptoms of major depression include feelings of hopelessness and helplessness, fatigue, difficulty in concentration, sleeping problems, memory loss, poor appetite, suicidal ideation, feeling restless, low interest level, feelings of guilt, and anxiety along with the minor depressive symptoms for at least two weeks (World Health Organization, 2001).
Different factors can be associated with depressive symptoms in older adults. A range of risk factors for depressive symptoms among older people had been identified in previous studies in different countries, including being female (Biderman et al., 2002; Chen et al., 2013; Green et al., 1992; Islam, 2019; Moula et al., 2011; Wahlin et al., 2015; Weyerer et al., 2008; Woo et al., 1994; Zhong et al., 2020), older age (Islam, 2019; Wahlin et al., 2015; Weyerer et al., 2008; Woo et al., 1994), being widowed, separated, or divorced (Islam, 2019; Moula et al., 2011; Sjöberg et al., 2017; Wahlin et al., 2015), having a lower level of education (Chen et al., 2013; Domènech-Abella et al., 2018; Islam, 2019; Simkhada et al., 2018; Wahlin et al., 2015; Zhong et al., 2020) and living alone (Islam, 2019; Weyerer et al., 2008); all associated with higher levels of depressive symptoms. In addition, cognitive dysfunction (Biderman et al., 2002; Woo et al., 1994), visual impairment (Chou, 2008; Jongenelis et al., 2004; Woo et al., 1994), functional limitations (Biderman et al., 2002; Jongenelis et al., 2004; Sjöberg et al., 2017; Simkhada et al., 2018; Weyerer et al., 2008), diabetes, heart diseases, stroke and comorbid physical illness (Biderman et al., 2002; Chen et al., 2013; Islam, 2019; Jongenelis et al., 2004; Kim et al., 2009; Simkhada et al., 2018; Zhong et al., 2020) were associated with greater risk of depression. Other factors, including having a history of falls (Alexopoulos, 2005; Biderman et al., 2002; da Costa Dias et al., 2019; Iaboni and Flint, 2013; Green et al., 1992; McCall et al., 2002; Rodda et al., 2011; Wahlin et al., 2015), fear of falling (Iaboni and Flint, 2013; Painter et al., 2012), and loneliness (Green et al., 1992; Jongenelis et al., 2004; Li et al., 2015; Rodda et al., 2011; Theeke et al., 2010; Zhong et al., 2020) were also significantly associated with depressive symptoms among older people.
The prevalence of depression in older adults is an international concern, given that the proportion of ageing persons is increasing as a result of the reduction in fertility as well as lower mortality rate (Gavrilov and Heuveline, 2003). A study in Bangladesh among older adults aged 60 years and over found that almost 50% of respondents experienced some degree of depressive symptoms, with 8.4% of participants being severely depressed (Moula et al., 2011). A recent study in Bangladesh found the prevalence of depressive condition among adults aged 60 years and older was 62% (Islam, 2019). The high rates of depressive symptoms among older adults in Bangladesh highlight the importance of further research in this population. Previous studies in Bangladesh included participants from only rural (Islam, 2019; Wahlin et al., 2015) or urban areas (Moula et al., 2011). Besides, none of the studies considered fall, fear of falling and loneliness which are common determinants of depression among older people (Biderman et al., 2002; Iaboni and Flint, 2013; Painter et al., 2012; Rodda et al., 2011; Theeke et al., 2010). Investigating the predictors of depressive symptoms among older adults in Bangladesh can inform the development of policies to reduce this significant public health problem. The aim of this study was therefore to investigate the risk factors for depressive symptoms among community dwelling older adults from rural and urban areas in Bangladesh.
Section snippets
Study area
This cross-sectional study was carried out in Meherpur district which is situated at South-Western region of Bangladesh. The country is divided into 64 districts with around 163 million people (Statistics, B.B.O. 2011). Each district is divided into smaller sub-district or Upazilla and an Upazilla is further divided into Unions in rural areas and a Pourashavas in urban areas. Meherpur district consists of 3 Upazilla, 18 Unions and 3 Pourashavas with total area of 716.1 km2. The population of
Background information of the participants
Table 1 shows the participants’ demographic and socio-economic characteristics. More than half of the participants were female, aged 70+ years, and lived in rural areas. Nearly one-third were divorced or widowed, most lived with another person, and half had a secondary education or higher. Nearly half of the participants lived with at least one comorbid illness, and the large majority had visual impairment. One-third of the participants had experienced at least one fall within one year, and
Discussion
This is the first study to investigate the predictors of depressive symptoms among community dwelling older adults living in urban and rural areas in Bangladesh. More than half (55%) of the participants experienced depressive symptoms which is similar to previous reports from Bangladesh (45%–62%) (Wahlin et al., 2015; Islam, 2019). The prevalence of depression in our sample is higher than some Asian countries, including China (20.3%) (Zhong et al., 2020) and Singapore (32.9%) (Li et al., 2015).
Limitations
This study had several limitations. First, we used a convenience sampling method for data collection among older people from selected communities in a district of Bangladesh. The results do not represent the entire population of Bangladesh. Second, it was a cross-sectional study, and causality cannot be determined. Longitudinal studies would reveal more accurate outcomes. Third, participants who were totally dependent in daily activities were excluded, which would have affected the
Conclusions
The study identified a high prevalence of depressive symptoms among older adults in Bangladesh. Older age, being female, low level of education, being widowed or divorced, visual impairment, comorbid illness, feelings of loneliness, having fall experience, and concerns about falling were significantly associated with different levels of depressive symptoms. Knowledge about factors associated with depressive symptoms may be useful in developing multidimensional strategies to decrease depressive
CRediT authorship contribution statement
Md. Sazedur Rahman: Conceptualization, Data curation, Methodology, Writing - original draft, Formal analysis. Md. Ashfikur Rahman: Conceptualization, Methodology, Writing - original draft, Writing - review & editing. Mohammad Ali: Conceptualization, Data curation, Methodology, Formal analysis, Writing - review & editing, Investigation. Md. Saidur Rahman: Methodology, Writing - original draft, Writing - review & editing. Md. Maniruzzaman: Formal analysis, Methodology, Writing - review & editing,
Declaration of Competing Interest
None.
Acknowledgments
The authors wish to acknowledge to the authority of the Statistics Discipline, Khulna University, for approving the research. They are also thankful to the participants in this study for their kind assistance. They would like to thank Dr. Suzanne McLaren (Professor, School of Psychology, Charles Sturt University, Port Macquarie, NSW, Australia) for her assistance in reviewing the manuscript.
Funding
This research received no funding.
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