Aging & Mental Health

Vol. 12, No. 3, May 2008, 349356

Prevalence and predictors of depression among an elderly population of Pakistan
Hammad A. Ganatra
a
, Syed N. Zafar
a
, Waris Qidwai
b
*
and Shafquat Rozi
c
a
Medical College, Aga Khan University, Karachi, Pakistan;
b
Department of Family Medicine, The Aga Khan University,
Karachi, Pakistan;
c
Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
(Received 16 April 2007; final version received 3 August 2007)
Objective: To assess the magnitude and risk factors of the problem of depression in an elderly population of
Pakistan.
Method: A cross-sectional study was conducted using a sample of 402 people aged 65 and above visiting the
Community Health Center of the Aga Khan University, Karachi. Questionnaire based interviews were conducted
for data collection and the 15-Item Geriatric Depression Scale was used to screen for depression. Univariate and
multivariate logistic regression analyses were performed to identify factors associated with depression.
Results: Of the 402 participants; 69.7% (95% CI 4.5%) were men, 76.4% (95% CI 4.2%) were currently
married, 36.8% (95% CI 5%) had received 11 or more years of education and 24.4% (95% CI 4.2%)
were employed. The mean age was 70.57 years (SD5.414 years). The prevalence of depression was found to
be 22.9% (95% CI 4.1%) and multiple logistic regression analysis indicated that higher number of daily
medications ( p-value 0.03), total number of health problems ( p-value 0.002), financial problems
( p-value50.001), urinary incontinence ( p-value 0.08) and inadequately fulfilled spiritual needs
( p-value 0.067) were significantly associated with depressive symptoms.
Conclusion: We have identified several risk factors for depression in the elderly which need to be taken into
account by practicing family physicians and health care workers.
Keywords: geriatrics; elderly, depression; risk factors; prevalence; precipitators
Introduction
Depression is a severely debilitating psychiatric illness
that can challenge a persons ability to perform even
the simplest tasks of daily living. It usually involves
depressed or irritable mood and loss of interest or
pleasure in activities of life. At its worst, depression
brings about a feeling of worthlessness and suicidal
ideations or attempts (Szanto et al., 2002).
Fortunately, most cases of depression respond posi-
tively to anti-depressant therapy, leading to improved
quality of life (Wilson, Mottram, Sivanranthan, &
Nightingale, 2001).
In old age, depressive symptoms often affect people
with chronic medical illnesses, cognitive impairment,
or disability (Alexopoulos et al., 2002). In addition to
personal suffering and family disruption, depression
worsens the outcomes of many medical disorders and
aggravates disability (Alexopoulos et al., 2002; Blazer,
2003). Depression among elderly patients is always
a pathological process (Nelson, 2001). However, it may
be difficult to diagnose in the elderly because of factors
such as late onset, co-morbid medical illnesses,
dementia, and bereavement (Nelson, 2001). Studies
have shown that it remains under-diagnosed and
under-treated even in the developed countries
(Unutzer, 2002).
Several studies have been carried out in developed
countries (Chow et al., 2004; Heath, Brown, Kobylarz,
& Castano, 2005; Kivela, Pahkala, & Laippala, 1988;
Wada et al., 2004) to assess the prevalence and risk
factors of depression among the geriatric population
while only a few similar studies have been done in the
developing world (Al-Shammari & Al-Subaie, 1999;
Thongtang et al., 2002). In all these studies there was
considerable variation in the prevalence and risk
factors of geriatric depression. Depending on the
country of origin and the study settings prevalences
have been reported to range from as low as 0.9%
to as high as 42% among elderly Caucasians
(Djernes, 2006). Similarly, studies from India
report figures of geriatric depression ranging from
6% to 50% (Patel & Prince, 2001). In Pakistan several
studies have been conducted to assess depression in the
general population (Mirza & Jenkins, 2004), but to our
knowledge no such study has been carried out in the
elderly.
Therefore, as this important issue still remained
unexplored in Pakistan, a need was felt to assess the
magnitude of this problem and to determine the
factors that might precipitate depression in a geriatric
population of Pakistan, and hence identify areas for
intervention and further research.
Methods
Sample and settings
We designed a cross-sectional study which was
carried out using questionnaire based interviews.
*Corresponding author. Email: waris.qidwai@aku.edu
ISSN 13607863 print/ISSN 13646915 online
2008 Taylor & Francis
DOI: 10.1080/13607860802121068
http://www.informaworld.com
It was conducted in the waiting areas of the Community
Health Centre (CHC) of Aga Khan University Hospital
(AKUH) in Karachi. Karachi is the largest city of
Pakistan with a population of more than 13 million
(City District Government Karachi) comprising of
a mixture of all the major ethnic groups found in
Pakistan (Punjabi, Sindhi, Mohajir, Baluchi, Pathan,
Memon, Kashmiri and Afghani). Health care services in
Karachi are provided by many private and state owned
hospitals. Catering to 500,000 out patients annually
AKUH is one of the largest private tertiary hospitals in
the country, providing high quality health services to
people from all over Karachi and Pakistan. Although it
is a relatively expensive hospital, the CHC, which is
a primary health care facility within its premises,
provides out patient family medicine and specialist
services at very subsidized rates which are comparable
with other cheap facilities in the city. Hence people from
all socioeconomic classes come here to seek treatment.
We obtained a probability sample by approaching
all people (patients and attendants) aged 65 and above
in the waiting areas. People unable to comprehend the
questions asked by the interviewers were excluded.
This comprised of people who could not understand
Urdu or those with severe cognitive impairment. This
was continued for 2 weeks (during the second half of
July 2006) until we had approached 425 eligible
candidates. With a rejection rate of 5.5%, we managed
to complete 402 interviews. The commonest reason
for refusal was lack of time. The interviews were
conducted by senior medical students who were trained
to administer the questionnaire by experienced
researchers and psychiatrists.
Written informed consent was taken after explain-
ing the study objectives. The subjects were free to
withdraw at any time without giving any reason.
Confidentiality of all subjects was ensured.
Questionnaire
The questionnaire was designed after an extensive
literature search (Abolfotouh, Daffallah, Khan,
Khattab, & Abdulmoneim 2001; Borglin, Jakobsson,
Edberg, & Hallberg, 2005; Cole & Dendukuri, 2003;
Djernes, 2006). A pre-test was carried out on 30
subjects. No major changes were required, and the
results of the pre-test were discarded.
The questionnaire was divided into five parts.
The first part dealt with the demographic profile of
the subjects (age, sex, marital status, etc). The second
part assessed common health issues (fatigue, incon-
tinence, immobility, hearing loss etc.). A three-point
anchored scale (mild, moderate and severe) allowed the
subjects to self-report each health complaint according
to its severity. Present chronic diseases and their status
were also taken into account.
The third part evaluated socio-economic risk
factors (financial problems, living conditions, major
losses, etc) while the fourth part was concerned with
the spiritual needs (presence, nature, fulfillment,
changes with age, etc) of the geriatric population.
The last part of the questionnaire assessed depression
using the 15-Item Geriatric Depression Scale (GDS-15)
(Sheikh & Yesavage, 1986).
Although there are several tools to assess depres-
sion in the Urdu speaking populations (Naqvi & Khan,
2005), none of them have been designed to target the
elderly. Depression in the elderly presents differently, it
manifests less with somatic symptoms and more with
affective ones (Bolla-Wilson & Bleecker, 1989; Zemore
& Eames, 1979). Therefore, we chose the GDS-15. This
scale was developed in 1986 by Sheikh and Yesavage as
a research and clinical tool specifically for the elderly
population (Sheikh & Yesavage, 1986). Over the years
it has been translated and validated by several
researchers (Wancata, Alexandrowicz, Marquart,
Weiss, & Friedrich, 2006). Due to the lack of
validation studies in our population, there are no
cut-off values for identifying depression using the
GDS-15. We used a cut-off value of 5 to identify
depression as studies in other populations have shown
this value to be highly sensitive and specific
(Abas et al., 1998; Hoyl et al., 1999).
We translated this scale to Urdu and to see if the
original wordings were preserved it was re-translated
back to English by three different people. The three
translators were randomly selected by the non-medical
people who were blinded to the study. No validation
studies have been conducted on the Urdu version
of the GDS-15 and this may be a limitation of
this study. The rest of the questionnaire was also
designed in Urdu.
Statistical analysis
Data were double entered on Epi-Info version 6 and
SPSS version 13 was used for statistical analysis and
data management.
Descriptive statistics included means (SD) for
continuous variables and proportions for categorical
variables. The Chi-square Test and Univariate Logistic
Regression were used to identify the factors associated
with depression amongst the elderly and to calculate
the crude odds ratio (OR) and 95% confidence
intervals (CI) of the associating independent variables.
To assess the independent effect of individual factors,
potential confounders were controlled by means of
Multiple Logistic Regression Analysis and the adjusted
ORs (AOR) with their 95% CI were calculated.
Variables which were biologically meaningful or had
a p-value 0.25 upon univariate analysis were selected
for multivariate analysis (Hosmer & Lemeshow, 2000).
Results
Four hundred and two (402) subjects above or equal to
the age of 65 were surveyed with a response rate
of 94.5%. There were 280 (69.7%) males and
350 H.A. Ganatra et al.
122 (30.3%) females. Age ranged from 65 to 90 years,
with majority (64.7%) lying between ages of 65 and 70
(mean age 70.6 years). Of the total participants 76.4%
were currently married and 75.6% were unemployed.
Most subjects had received 11 or more years of
education (36.8%) while 15.4% had received secondary
level education (grade 610), 20.1% had received
primary education (grade 15) and 27.6% were
illiterate. The subjects were from all common ethnic
backgrounds found in Pakistan.
The prevalence of depression amongst the elderly
was found to be 22.9% (n 92). Depression was found
to be present in 27.8% of the females (34 out of 122)
and in 20.7% of the males (58 out of 280).
The results of univariate analysis are presented in
Table 1. Depression in the elderly was significantly
associated with being unmarried, not being employed,
hearing impairment, dizziness, pain, mobility impair-
ment, stress, dyspnea, fatigue, insomnia, visual impair-
ment, higher number of health problems, chronic
illnesses, number of daily medicines, major losses in
life, dissatisfaction with health services, financial
problems and inadequately fulfilled spiritual needs
( p 0.05).
The final multiple logistic regression analysis
model (Table 2) showed that after adjusting for
confounders, financial problems ( p-value 0.002),
increasing number of daily medicines
( p-value 0.03) and greater number of health
problems ( p-value 0.002) were independent risk
factors of geriatric depression. Mild urinary incon-
tinence ( p-value 0.08) and inadequately fulfilled
spiritual needs ( p-value 0.067) were found to be
marginally associated with depression in the elderly.
Discussion
We found a 22.9% prevalence of depression among
the elderly in our study. Since this study was the first
of its kind in Pakistan there was no local data
available for comparison purposes. However, it was
lower than the mean prevalence of 34% in the
general population of the country as reported by
a systematic review (Mirza & Jenkins, 2004). Several
studies have been conducted in developing countries
to assess the prevalence of depression in the geriatric
population. Studies in community samples have
reported it to range from 6% to 50% in India
(Patel & Prince, 2001) and 12.78% in Thailand
(Thongtang et al., 2002). The prevalence of depres-
sion amongst the elderly presenting to primary health
care centres in Saudi Arabia has been reported to be
39% (Al-Shammari & Al-Subaie, 1999). A systematic
review by Djernes (2006) reported the prevalence of
depression among elderly Caucasians in developed
countries to range from 0.9 to 42%. Furthermore, it
was found that the prevalence of depression in
community dwellers (0.925%) was generally lower
than those living in nursing homes (1442%).
The above figures indicate that the prevalence of
geriatric depression varies significantly depending on
the country and settings. Our prevalence of 22.9% was
derived from a population comprising of both; patients
presenting to a primary health care centre and
attendants, who had no acute illness. Therefore, in
our opinion if a population-based study was carried
out in a pure community setting in Pakistan the
prevalence might be lower, but this can only be
confirmed by further research.
Numerous risk factors of geriatric depression have
been identified previously (Al-Shammari & Al-Subaie,
1999; Chow et al., 2004; Cole & Dendukuri, 2003;
Garcia Serrano & Tobias Ferrer, 2001; Heun & Hein,
2005; Thongtang et al., 2002). Some of them are low
education levels, low vision, swallowing difficulties,
financial inadequacy, life dissatisfaction, poor self-
perceived health, bereavement, sleep disturbance,
memory impairment, prior depression, female gender,
poor family relationships, physical illness, medication
use, dependence in activities of daily living, unemploy-
ment, divorced or widowed status, living alone and
fecal/urinary incontinence. As shown in Table 1, most
of these risk factors were also associated with
depression among the elderly in our sample.
On multivariate analysis, we found that depression
is precipitated by various physical and social factors.
Physical factors included increasing health problems,
greater medicine use and urinary incontinence, whereas
social factors included financial difficulties and unful-
filled spiritual needs.
The total number of health problems is the most
important physical factor responsible for geriatric
depression. Chronic diseases in the elderly have been
shown to be the most consistent risk factor of
depression (Cole & Dendukuri, 2003; Djernes, 2006).
In old age, the number of health problems accumu-
late. They add up with the persisting chronic
ailments to become quite cumbersome, one problem
leading to another till a progressively worsening
vicious cycle is formed. Health problems are known
to become much more of a burden in the geriatric
population (Borglin et al., 2005) and the cumulative
effect of multiple diseases leads to a lower quality of
life (Sharma, 2003). Our study has also demonstrated
that elderly with 10 or more health problems are
several times more likely to be depressed. This
increasing number of health problems invariably
leads to a greater use of medicines which is another
major problem in the elderly. A high number of
daily medicines may remind them of how sick they
are and cause reinforcement of the sick role. It is
also quite bothersome to swallow so many pills each
day. According to our findings, elderly people using
three or more medicines were at least twice as likely
to be depressed as compared to those who were
not taking any medication. Similar findings have
also been reported by other researchers
(Al-Shammari & Al-Subaie, 1999; Garcia Serrano
& Tobias Ferrer, 2001).
Aging & Mental Health 351
Table 1. Univariate analysis of factors associated with depression among an elderly population of Karachi, Pakistan.
Depression n (%)
Variables Depressed Non-depressed Crude OR
a
95% CI
b
Gender ( p-value 0.118)
Male 58 (63) 222 (71.6) 1.00
Female 34 (37) 88 (28.4) 1.48 (0.912.41)
Marital status ( p-value 0.021)
Married 62 (67.4) 245 (79) 1.00
Unmarried 30 (32.6) 65 (21) 1.82 (1.093.05)
Education ( p-value 0.205)
11 or more years 30 (32.6) 118 (29) 1.00
610 years 20 (21.7) 42 (13.5) 1.87 (0.963.65)
15 years 15 (16.3) 66 (21.3) 0.89 (0.451.78)
Illiterate 27 (29.3) 84 (27.1) 1.26 (0.7012.28)
Satisfaction with health services ( p-value 0.002)
Yes 27 (29.3) 156 (50.5) 1.00
No 59 (64.1) 136 (44.0) 2.49 (1.494.14)
Dont know 6 (6.5) 17 (5.5) 2.04 (0.745.64)
Employment ( p-value 0.042)
Employed 17 (18.5) 81 (26.1) 1.00
Retired 41 (44.6) 154 (49.7) 1.27 (0.682.37)
Housewife 34 (37) 75 (24.2) 2.16 (1.124.19)
Living alone ( p-value 0.075)
No 85 (92.4) 300 (96.8) 1.00
Yes 7 (7.6) 10 (3.2) 2.47 (0.916.69)
Number of daily medications ( p-value 0.001)
None 9 (9.8) 77 (24.8) 1.00
12 drugs 21 (22.8) 92 (29.7) 1.95 (0.854.51)
34 drugs 31 (33.7) 79 (25.5) 3.36 (1.507.52)
More 31 (33.7) 62 (20) 4.28 (1.899.66)
Hearing impairment ( p-value 0.008)
None 48 (52.2) 185 (59.7) 1.00
Mild 32 (34.8) 112 (36.1) 1.10 (0.661.83)
Severe 12 (13) 13 (4.2) 3.56 (1.538.29)
Memory decline ( p-value 0.848)
None 46 (50) 163 (52.6) 1.00
Mild 41 (44.6) 128 (41.3) 1.14 (0.701.84)
Severe 5 (5.4) 19 (6.1) 0.93 (0.332.63)
Urinary Incontinence ( p-value 0.153)
None 57 (62) 212 (68.4) 1.00
Mild 25 (27.2) 56 (18.1) 1.66 (0.952.89)
Severe 10 (10.9) 42 (13.5) 0.89 (0.421.87)
Dizziness ( p-value50.001)
None 40 (43.5) 203 (65.5) 1.00
Mild 35 (38) 89 (28.7) 2.00 (1.193.35)
Severe 17 (18.5) 18 (5.8) 4.79 (2.2810.09)
Pain ( p-value 0.003)
None 16 (17.4) 103 (33.2) 1.00
Mild 40 (43.5) 131 (42.3) 1.97 (1.043.20)
Severe 36 (39.1) 76 (24.5) 3.05 (1.585.90)
Mobility impairment ( p-value 0.012)
None 41 (44.6) 190 (61.3) 1.00
Mild 39 (42.4) 85 (27.4) 2.13 (1.283.56)
Severe 12 (13) 35 (11.3) 1.59 (0.763.32)
Dyspnea and Fatigue ( p-value 0.023)
None 30 (18.9) 129 (81.1) 1.00
Mild 41 (22) 145 (78) 1.22 (0.322.06)
Severe 21 (36.8) 36 (63.2) 2.51 (1.294.90)
Sleep problems ( p-value 0.001)
None 50 (54.3) 212 (68.4) 1.00
Mild 20 (21.7) 68 (21.9) 1.25 (0.692.24)
Severe 22 (23.9) 30 (9.7) 3.11 (1.665.84)
(continued )
352 H.A. Ganatra et al.
Studies throughout the world have validated the
link between financial difficulties and geriatric depres-
sion (Al-Shammari & Al-Subaie, 1999; Chow et al.,
2004; Thongtang et al., 2002). Financial difficulties
pose an even greater problem in a developing third-
world country like ours. Most elderly in our sample
were financially supported either by their children
(51.2%) and/or through their previous investments
(45.3%). Unlike the developed western countries, there
is no significant government support for the elderly in
Pakistan. Only 15.9% of the subjects were receiving
pensions from the government and even these were of
very meager amounts. Although a causal link is clearly
a possibility, the direction of causality is by no means
clear. Living with financial difficulties puts the elderly
at a great social disadvantage and causes mental stress
and worries which then contribute towards depression.
However, it is also possible that a depressed individual
perceives himself to have a multitude of problems
which would also include financial problems. Since
the financial problems stated in our study were self
reported we were unable to determine the direction of
causality. Objective assessment of the socio-economic
status of our participants would have made
this possible.
Urinary incontinence in old age is another matter
of concern worldwide (Damian, Valderrama-Gama,
Rodriguez-Artalejo, & Martin-Moreno, 2004;
Jumadilova, Zyczynski, Paul, & Narayanan, 2005).
It imposes severe restrictions on the social life of the
elderly as they are unable to go to public places to
work or socialize for longer periods with family or
friend. Due to the restraints placed on their daily lives
elderly patients with urinary incontinence have worse
perceived health which has a substantial negative
impact on the quality of life (Ko, Lin, Salmon, &
Bron, 2005) and this in turn may precipitate depres-
sion. Urinary incontinence poses greater problems
among our population which comprises mostly of
practicing Muslims. According to our findings, 98% of
the elderly reported the practice of religion as the main
spiritual need. However, elderly with urinary incon-
tinence are unable to do so appropriately due to the
Islamic religious requirement of being clean. To be
hindered from practicing religion due to any reason
poses a great psychological burden upon the elderly, as
Table 1. Continued.
Depression n (%)
Variables Depressed Non-depressed Crude OR
a
95% CI
b
Visual impairment ( p-value 0.023)
None 47 (51.1) 206 (66.5) 1.00
Mild 36 (39.1) 79 (25.5) 2.00 (1.213.31)
Severe 8 (9.8) 25 (8.1) 1.58 (0.693.60)
Stress ( p-value50.001)
None 34 (37) 210 (67.7) 1.00
Mild 28 (30.4) 73 (23.5) 2.37 (1.344.18)
Severe 30 (32.6) 27 (8.7) 6.86 (3.6412.93)
No. of health problems ( p-value50.001)
13 6 (6.5) 73 (23.5) 1.00
46 22 (23.9) 102 (32.9) 2.62 (1.016.80)
79 19 (20.7) 71 (22.9) 3.26 (1.238.63)
1012 30 (32.6) 52 (16.8) 7.02 (2.7318.08)
13 15 (16.3) 12 (3.9) 15.21 (4.9346.92)
Chronic diseases ( p-value 0.039)
No 16 (17.4) 87 (28.1) 1.00
Yes 76 (82.6) 223 (71.9) 1.85 (1.023.35)
No. of recreational activities ( p-value 0.053)
46 25 (17.4) 119 (82.6) 1.00
13 64 (25.4) 188 (74.6) 1.62 (0.972.72)
None 3 (50) 3 (50) 4.76 (0.9124.97)
Major loss ( p-value 0.011)
No 57 (62) 235 (75.8) 1.00
Yes 35 (38) 75 (24.2) 1.92 (1.173.15)
Financial problems ( p-value50.001)
No 58 (63) 259 (83.5) 1.00
Yes 34 (37) 51 (16.5) 2.98 (1.775.00)
Spiritual needs adequately fulfilled? ( p-value 0.009)
Yes 46 (55.4) 200 (70.9) 1.00
No 37 (44.6) 82 (29.1) 1.96 (1.193.25)
Notes:
a
OR Odds Ratio.
b
CI Confidence Interval.
Aging & Mental Health 353
our study has shown inadequately fulfilled spiritual
needs to be associated with depression with marginal
significance. The majority of our respondents (72.3%)
reported that their spiritual needs have increased with
age; hence it is a cause of concern that these increasing
needs are not being met. It has been shown that
religious involvement is usually associated with better
mental health (Moreira-Almeida, Neto, & Koenig,
2006). The reasons as to why these needs are not being
fulfilled can be a topic for further research.
It must be noted that there are a few limitations to
this study. First of all, as the participants were derived
from a convenient site, it is difficult to determine
the representativeness of our sample to the general
population. The sample obtained was not a homo-
genous one and comprised of both patients and
non-patients; it was also not possible to provide
information about those sections of the community
that were not represented by this sample and about
those who refused to participate in this study.
Nevertheless, we believe that this sample was adequate
for an initial study and gives us a rough idea about the
burden and precipitators of geriatric depression in our
country. Our findings highlight the need for popula-
tion studies to determine the precise prevalence of
geriatric depression and to further investigate its
causative factors in our society.
Secondly, we did not make any objective assess-
ment of the self-reported problems and reliability of
such data is always questionable. The authors are of
the opinion that as this study was the first of its kind
in our population, there were many variables to look
into and the objective measurement of all of these
variables would have been extremely tedious and
tiresome for both the interviewers and the elderly
participants. This would have adversely affected
quality of the data and therefore, the results.
However, now that we have identified specific factors
associated with depression in the elderly, we strongly
recommend further objective studies to be carried
out to fully explore the relationship of each factor
with geriatric depression.
Another major limitation could be the Urdu
translation of the GDS-15 that we used in our study.
As no validation study has ever been carried out on
this version, the results may prove to be misleading.
Although it is not possible to claim with surety that the
Urdu version of this scale would have the same
sensitivity and specificity as the original version, we
believe that it should be similar. The reason for this
assumption is the fact that GDS-15 has been translated
and validated in many different populations and
languages and we found no reason as to why it
would be unsuitable for our population. We also found
that the wording and meaning of the questions were
preserved after re-translating it back to English.
However, this claim can never be concrete unless
validation studies are carried out on the Urdu version
of GDS-15.
Another important area that needs to be researched
is the association of family systems with geriatric
depression. The joint family systems in our part of the
world offer greater social and financial support to the
elderly (Itrat, Taqui, Qazi, & Qidwai, 2007) and in our
opinion this might lead to a lower prevalence of
geriatric depression. This is supported by an Indian
study, which showed better prognosis of depression
among elderly living in joint family systems (Jhingan,
Sagar, & Pandey, 2001).
Conclusions
Even though the prevalence of geriatric depression
reported by our study is less than that of most other
countries, it is still a high percentage and efforts should
be made to reduce this figure. There are currently 6.16
million people in Pakistan aged 65 or above (World
Population Prospects: The 2006 Revision) and our
study indicates that at least one in five of them may be
suffering from depression. We have managed to
identify several easily modifiable risk factors of
depression among the elderly. Therefore, through the
combined efforts of health care professionals and the
government a reduction in geriatric depression is
possible. As there are no specialized geriatric clinics
in Pakistan, most elderly end up being treated by
family physicians. These physicians need to be aware
of the burden of geriatric depression and its risk
factors. Further population-based studies should be
carried out to accurately estimate the burden of
Table 2. Multivariate analysis of factors associated with
depression among an elderly population of Karachi,
Pakistan.
Variable Adjusted OR
a
95.0% CI
b
Number of daily medications ( p-value 0.032)
None 1.00
12 drugs 1.83 (0.734.57)
34 drugs 2.49 (1.026.08)
More than 4 drugs 3.70 (1.499.22)
Urinary incontinence ( p-value 0.067)
None 1.00
Mild 1.11 (0.562.18)
Severe 0.38 (0.160.91)
Total number of health problems ( p-value 0.002)
13 1.00
46 2.66 (0.997.20)
79 2.45 (0.876.94)
1012 4.84 (1.7313.55)
13 10.83 (3.0138.92)
Financial problems ( p-value 0.001)
No 1.00
Yes 2.96 (1.595.48)
Adequately fulfilled spiritual needs ( p-value 0.08)
Yes 1.00
No 1.67 (0.942.98)
Notes:
a
OR Odds Ratio.
b
CI Confidence Interval.
354 H.A. Ganatra et al.
geriatric depression throughout Pakistan and to
explore further risk factors that can be addressed.
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