A cross sectional study on screening for depression among elderly in rural areas of Puducherry, India

Pamagal Kavithai, Anandaraj R., Buvaneswary S., Prakash M.


Background: Depression among elderly has been a neglected health issue. Various factors hinder its early diagnosis. The objectives of this study are to screen for depression among elderly using geriatric depression scale-15 and to determine its influencing factors.

Methods: A community based cross sectional study on geriatric depression was done in villages catered by a primary health centre in Puducherry. Permanent residents of the study setting, aged ≥60 years consenting for the study were included. Line listing of elderly individuals in the study setting was done and subjects were selected by simple random sampling. A pretested structured questionnaire was used to collect socio-demographic and clinic-psychological variables. Hindi mental state examination scale was used to screen for cognitive impairment (score <23). Geriatric Depression Scale (GDS-15) was used to screen for depression (score >5) among geriatric individuals. Appropriate statistical tests of significance were done.

Results: Among the 360 elderly individuals screened using GDS-15 tool, 41.4% of them were found to be at a higher risk of developing depression. Significant factors for risk of depression in univariate analysis include being female, illiterate, unemployed, widow/single, having sleep problems, dependency in activities of daily living and cognitive impairment. Predictors for risk of depression evident by multivariate analysis include presence of unemployment, sleep problems and cognitive impairment.

Conclusions: A higher proportion of elderly was observed to be at risk of depression.  Primary care physicians may consider screening for depression in elderly with identified risk factors and act accordingly.


Depression in elderly, Geriatric depression, Geriatric mental health, Geriatric depression scale

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Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1545-602.

Registrar General I. Census of India 2011: provisional population totals-India data sheet. Office of the Registrar General Census Commissioner, India. Census 2011. Available at: Accessed 17 May 2017.

Gururaj G, Varghese M, Benegal V, Rao GN, Pathak K, Singh LK, Misra R. National mental health survey of India, 2015-16: Summary. Bengaluru: National Institute of Mental Health and Neurosciences. 2016.

Nair SS, Hiremath SG, Nair SS. Depression among geriatrics: Prevalence and associated factors. Inter J Curr Res Rev. 2013 Apr 15;5(8):110-12.

Swarnalatha N. Prevalence of depression among the rural elderly in Chittoor district, Andhra Pradesh. J Clin Diagn Res. 2013;7:1356-60.

WHO. World Health Day-7 April 2017, 2017. WHO. Available at: Accessed 28 July 2017.

Grover S, Malhotra N. Depression in elderly: A review of Indian research. J Geriatr Ment Health. 2015;2:4-15.

Copeland JR, Prince M, Wilson KC, Dewey ME, Payne J, Gurland B. The Geriatric Mental State Examination in the 21st century. Int J Geriatr Psychiatry. 2002 Aug;17(8):729-32.

Irwin M, Artin KH, Oxman M. Screening for depression in the older adult: criterion validity of the 10‐item Center for Epidemiological Studies Depression Scale (CES‐D). Arch Intern Med. 1999;159:1701-4.

Spitzer RL, Kroenke K, Williams JBW. Patient Health Questionnaire Study Group. Validity and utility of a self‐report version of PRIME‐MD: the PHQ Primary Care Study. JAMA. 1999;282:1737-44.

Goldberg D, Bridges K, Duncan-Jones P, Grayson D. Detecting anxiety and depression in general medical settings. Br Med J. 1988;297:897-9.

Sheikh JI, Yesavage JA. Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clin Gerontol. 1986;5:165-73.

Koenig HG, Meador KG, Cohen HJ, Blazer DG. Self-rated depression scales and screening for major depression in the older hospitalized patient. J Am Geriatr Soc. 1998; 36(8):699-706.

Friedman B, Heisel MJ, Delavan RL. Psychometric properties of the 15‐item Geriatric Depression Scale in functionally impaired, cognitively intact, community‐dwelling elderly primary care patients. J Am Geriatr Soc. 2005;53:1570-6.

N S. The Prevalence of Depression among the Rural Elderly in Chittoor District, Andhra Pradesh. J Clin Diagn Res. 2013 Jul;7(7):1356-60.

Pilania M, Bairwa M, Khurana H, Kumar N. Prevalence and predictors of depression in community-dwelling elderly in rural Haryana, India. Indian J Community Med. 2017;42:13-8.

Ganguli M, Ratcliff G, Chandra V, Sharma S, Gilby J, Pandav R, et al. A Hindi version of the MMSE: the development of a cognitive screening instrument for a largely illiterate rural elderly population in India. Int J Geriat Psychiatry. 1995 May;10(5):367-77.

Ganguli M, Chandra V, Gilby JE, Ratcliff G, Sharma SD, Pandav R, et al. Cognitive test performance in a community based non demented elderly sample in rural India: The Indo-US cross national dementia epidemiology study. Int Psychogeriatr. 1996;8:507-24.

Pandav R, Fillenbaum G, Ratcliff G, Dodge H, Ganguli M. Sensitivity and specificity of cognitive and functional screening instruments for dementia: The Indo-US cross national dementia epidemiology study. J Am Geriatr Soc. 2002;50:554-61.

Geriatric Depression Scale. Available at: Accessed 24 March 2017.

Sengupta P, Benjamin AI. Prevalence of depression and associated risk factors among the elderly in urban and rural field practice areas of a tertiary care institution in Ludhiana. Indian J Public Health. 2015;59:3-8.

Seby K, Chaudhury S, Chakraborty R. Prevalence of psychiatric and physical morbidity in an urban geriatric population. Indian J Psychiatry. 2011;53(2):121-7.

Manjubhashini S, Krishnababu G, Krishnaveni A. Epidemiological study of depression among population above 60 years in Visakhapatnam, India. Int J Med Sci Pub Heal. 2013;2:695-702.

Sekhon H, Minhas S, Ahmed S, Garg R. A study of depression in geriatric population in a rural area of north India. Sch Acad J Biosci. 2015;3:26-9.

Djernes JK. Prevalence and predictors of depression in populations of elderly: a review. Acta Psychiatr Scand. 2006;113(5):372-87.

Castro-Costa E, Dewey M, Stewart R, Banerjee S, Huppert F, Mendonca-Lima C, et al. Prevalence of depressive symptoms and syndromes in later life in ten European countries: the SHARE study. Br J Psychiatry. 2007;191:393-401.

Naik PR, Nirgude AS. Depression among the elderly: A cross sectional study in a rural community of south India. Ntl J Comm Med. 2015;6(3):394-97.

Arumugam B, Nagalingam S, Nivetha R, Balaji A. Geriatric depression among rural and urban slum community in Chennai: A cross sectional study. J Evol Med Dent Sci. 2013 Feb 18;3:795-801.

Rajkumar AP, Thangadurai P, Senthilkumar P, Gayathri K, Prince M, Jacob KS. Nature, prevalence and factors associated with depression among the elderly in a rural south Indian community. Int Psychogeriatr. 2009 Apr;21(2):372-8.

Pushparani JP, Chitrasena S, Ramasubramanian R. A study on the prevalence of depression and its associated factors among the elderly in Kancheepuram district, South India. Nat J Res Community Med. 2017;6(4):288-94.

Kamble SV, Dhumale GB, Goyal RC, Phalke DB, Ghodke YD. Depression among elderly persons in a primary health centre area in Ahmednagar, Maharastra. Ind J Pub Heal. 2009;53(4):253-5.

Park K. Park’s textbook of preventive and social medicine. 24th edition. Jabalpur: M/s Banarsidas Bhanot Publishers; 2017:976.

Patil K, Kulkarni M, Dharmadhikari P. Depression among elderly people in an urban slum of Central India. Panacea J Med Sci. 2016 Dec 30;6(3):128-33.

Rajender A, K Kanwal, Gaurav R. Current trends of geriatric depression at an Indian tertiary care center. Inter J Indian Psychol. 2016;3(3):58-65.

Steffens DC, Hays JC, Krishnan KR. Disability in geriatric depression. Am J Geriatr Psychiatry. 1999;7(1):34-40.

Yadav SP, Doibale MK, Aswar NS, Inamdar IF, Sonkar VK, Gadekar RD. Assessment of socio-demographic correlates of depression among the elderly in an urban area in Maharashtra. J Evolution Med Dent Sci. 2013;2(51):9895-900.

Pracheth R, Mayur SS, Chowti JV. Geriatric depression scale: A tool to assess depression in elderly. Int J Med Sci Pub Heal. 2013;2:31-5.

Ganguli M, Dube S, Johnston JM, Pandav R, Chandra V, Dodge HH. Depressive symptoms, cognitive impairment and functional impairment in a rural elderly population in India: A Hindi version of GDS (GDS-H). Int J Geriatr Psychiatry. 1999;14(10):807-20.

Jorm AF. History of depression as a risk factor for dementia: An updated review. Aust NZ J Psychiatry. 2001;35:776-81.