Prevalence and determinants of depression in older adults with hypertension: Insights from the Longitudinal Aging Study in India (Preprint)
Authors: Alrahbeni Tahani , Maheshwari Vansh , Satapathy Prakasini , Naser Israa Habeeb , Rustagi Sarvesh , Khatib Mahalaqua Nazli , Gaidhane Shilpa , Zahiruddin Quazi Syed , Gaidhane Abhay M , Mugheed Khalid AL , Padhi Bijaya K 
Published: January 2024

BACKGROUND

Depression, a significant global health issue, acutely impacts the aging population, with a notable effect in countries like India where swift socio-economic changes influence the mental health of older adults. Recent research has focused on the intersection of depression with chronic conditions such as hypertension (HTN) and sleep problems, but there's still a lack of comprehensive studies in the Indian context, particularly among the elderly.

OBJECTIVE

This study aims to explore the prevalence and determinants of depression among older adults with hypertension in India, focusing on the potential mediating role of sleep problems.

METHODS

Utilizing data from the first wave (2017-2018) of the Longitudinal Aging Study in India (LASI), this cross-sectional analysis included 66,606 participants aged 45 and above. The study employed a multistage stratified cluster sampling methodology to ensure diverse geographic representation. Depression was assessed using the Composite International Diagnostic Interview-Short Form (CIDI-SF), and hypertension was determined based on self-reported medical diagnosis or antihypertensive medication usage. Sociodemographic variables, health-related factors, and sleep problems (assessed via the Jenkins Sleep Scale) were considered. Statistical analysis involved descriptive analysis, bivariate analyses, multivariable binary logistic regression, and the Karlson-Holm-Breen (KHB) method for mediation analysis.

RESULTS

The weighted prevalence of HTN was 27.53%, with a depression prevalence of 23.43% among hypertensive patients. Prevalence of depression was notably higher in rural residents, females, underweight individuals, tobacco users, and multimorbid cases. Regression analysis indicated higher odds of depression among females (aOR = 1.32), rural residents (aOR = 1.57), underweight individuals (aOR = 2.17), and multimorbid patients (aOR = 1.56). Mediation analysis revealed that sleep problems partially mediated the relationship between HTN and depression, accounting for 11.19% of the effect. Regional disparities in depression prevalence were evident, with higher rates in states like Uttar Pradesh, Madhya Pradesh, and Bihar, and lower in northeastern states.

CONCLUSIONS

With nearly one in five of hypertensive patients having depression, the findings of our study highlight the need for integrated approaches in healthcare that address both mental and physical health aspects, especially in rural areas, and among women and multimorbid patients. Considering the significant role of sleep problems, integrating sleep management in hypertension care could be crucial in mitigating depression risks. These findings provide valuable insights for healthcare practitioners, policymakers, and stakeholders to develop tailored strategies for addressing the mental health challenges in this vulnerable demographic. The regional variations in depression prevalence also call for region-specific healthcare policies and interventions.