Depression Diagnosis, Treatment, and Remission Among Adults in India.

Abstract

Importance: Depression is a leading contributor to mental health burdens globally and in India, the world's most populous country. National-level evidence on health coverage for adults with depression in India is lacking.

Objective: To estimate proportions of middle-aged and older adults with depression in India who used health care services, were diagnosed with depression, received treatment, and were in remission.

Design, setting, and participants: This cross-sectional study used individual-level survey data from the 2017-2018 Longitudinal Ageing Study in India, which represents all 36 states and union territories of India. Data were collected from April 1, 2017, to December 31, 2018. The sample included adults 45 years or older with data on depression, health care service use, depression diagnosis and treatment, and sociodemographic characteristics. The response rates were 96% for households and 87% for individuals. Data were analyzed from January 15, 2024, to July 23, 2024.

Main outcomes and measures: Major depressive episodes in the past 12 months were assessed using the Composite International Diagnostic Interview short-form symptom scale. We estimated self-reported health service use, depression diagnosis, and treatment for depression using sampling weights and stratified the data by rural vs urban residence. Participants were considered in remission if they received treatment and had fewer than 3 symptoms.

Results: Among 65 121 participants, the median age was 57 years (IQR, 50-65 years); 53.3% were men and 46.7% were women. In terms of residence, 32.1% of participants resided in urban areas and 67.9% resided in rural areas. The weighted prevalence of depression was 8.6% (95% CI, 8.3%-8.9%). Of all participants with depression, 63.7% (95% CI, 62.0%-65.3%) had used any health services in the past year and 3.1% (95% CI, 2.6%-3.7%) had been diagnosed with depression; 1.6% (95% CI, 1.2%-2.0%) received some form of treatment (51% of those diagnosed) and 1.0% (95% CI, 0.7%-1.3%) were in remission (62% of those treated). The prevalence of depression was higher in rural areas (9.8% [95% CI, 9.4%-10.1%]) than in urban areas (6.2% [95% CI, 5.8%-6.7%]), although health service use, diagnosis, and treatment were lower in rural areas (61.2% [95% CI, 59.2%-63.1%], 2.6% [95% CI, 2.1%-3.3%], and 1.1% [95% CI, 0.8%-1.6%], respectively) than in urban areas (71.8% [95% CI, 68.5%-74.9%], 4.6% [95% CI, 3.5%-6.2%], and 3.0% [95% CI, 2.1%-4.4%], respectively). Among 29.6 million (95% CI, 28.6-30.6 million) middle-aged and older adults with depression across India, 29.1 million (95% CI, 28.2-30.1 million) were untreated, of whom 22.4 million (95% CI, 21.6-23.3 million) lived in rural areas.

Conclusions and relevance: The findings of this cross-sectional study suggest that despite health service use by nearly two-thirds of middle-aged and older Indian adults with depression, 97% of adults were undiagnosed, and approximately half of adults who were diagnosed were untreated. Greater awareness and systematic efforts to screen and treat persons with depression in India are needed.