A Comparative, cross-cultural study of the prevalence and correlates of late life depression in low and middle income countries

Student thesis: Doctoral ThesisDoctor of Philosophy


Background: Population ageing is happening fast in low and middle income countries where there is an urgent need to act in order to attend the needs of this growing population. Late-life depression is one of the most important causes of disability in this age group. Evidence on the epidemiology of late-life depression comes essentially from studies carried out in Europe, North America and Asia. There is a need to understand better the frequency and the correlates of depression in this part of the world. Methods: A one-phase cross-sectional survey involving over 17,000 participants aged 65 years and over living in urban and rural catchment areas in 13 sites from 9 countries (Cuba, Dominican Republic, Puerto Rico, Mexico, Venezuela, Peru, China, India and Nigeria). Depression was determined according to ICD-10 depressive episode; DSM-IV major depression; GMS-AGECAT stage 1 depression and EUE.O-D criteria. Results: Depression prevalence varied according to diagnostic criteria. The lowest prevalence was observed for DSM-IV major depression (females from 0% to 10.9%; men from 0% to 11.3%) and ICD-10 depressive episode (females from 0% to 16.2%; men from 0% to 15.9%). The most important correlates of ICD-10 depressive episode were: low level of education, less wealth, food insecurity, not being currently married, infrequent or no contact with friends, and with all chronic health conditions and impairment studied. Compositional variables explained little of the variation in the prevalence of depression between sites. The EURO-D scale was validated against ICD-10 depressive episode and DSM-IV major depression. Sub-syndromal depression, defined as those scoring above the EURO-D cut point but not meeting ICD-10 criteria, was strongly associated severe disability. Effects of 10/66 dementia, stroke and physical impairment on depression were mainly mediated by disability and to a lesser degree by dependence.
Conclusions: The 10/66 DRG has been able to carry out the first large community-based prevalence study on late-life depression in LMIC, the findings being of interest for each country in particular and for mental health knowledge in general. Contextual factors such as the influence of cultures, social and income inequalities, and policies for the social protection of older people may explain the residual variance at site level. The high proportion of depression cases with a first onset late in life is a concern given the probable increased risk of developing future cognitive disorders. Rapid population ageing in LMIC presents a major challenge to health care policy-makers. Within this, attention will need to be given to significant prevalence of late-life depression, comorbid with, and complicating chronic physical health conditions, and with a chronic, relapsing and generally poor prognosis.
Date of Award2012
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorMartin Prince (Supervisor) & Cleusa Ferri (Supervisor)

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