Prevalence and biopsychosocial determinants of depression among community-dwelling older persons with low perceived social support

Depression among older persons leads to profound and debilitating outcomes. However, there is a lack of understanding regarding the biopsychosocial determinants of depression among community-dwelling older persons with low social support. Bridging this knowledge gap can enhance the prevention and management of this condition within a specific subgroup of older persons. This study aimed to identify determinants of depression among community-dwelling older persons with low social support in Malaysia. This study conducted a cross-sectional analysis using secondary data from the National Health and Morbidity Survey (NHMS) 2018: Elderly Health, a nationally representative survey of community health in Malaysia. The dataset includes detailed information on 926 community-dwelling older persons aged 60 and above with low social support, covering 14 modules on sociodemographics and various health conditions. For this study, relevant variables were extracted to examine factors associated with depression within this population. Depression served as the dependent variable, while various biological (functional limitations, dementia, having chronic diseases, physical activity, vision disability, hearing disability), psychological (control in life, autonomy in life, satisfaction in life, self-realisation, psychological abuse, physical abuse), and social factors(age, gender, ethnicity, educational level, individual monthly income, employment status, marital status and living companion), guided by established biopsychosocial models of depression, were considered independent variables. To assess factors associated with depression, chi-square and simple logistic regression were performed. Multiple logistic regression was applied to identify determinants. Analysis was performed using the complex sampling module in the International Business Machines Statistical Package for the Social Sciences (IBM SPSS) software version 29. The weighted overall prevalence of depression among community-dwelling older persons aged 60 and above with low social support was 22.5% (95% CI: 17.3 - 28.7). A breakdown by age categories found increasing prevalent with increasing age, with 34.1% found depressed among those aged 80 and above. The determinants of depression were being single, as compared to those married (aOR 2.010, 95% CI: 1.063 – 3.803, p: 0.031), having dementia, as opposed to the absence of the disease (aOR 3.717, 95% CI: 1.544 – 8.888, p: 0.003), and having a visual disability, as compared to normal visions (aOR 3.462, 95% CI: 1.504 – 7.972, p: 0.004). It was also found that for every one-unit increase in control in life score, the odds of developing depression were decreased by 32.6% (aOR: 0.674, 95% CI: 0.599– 0.759, p < 0.001) and one unit increase in self-realisation score decreased the odds of developing depression by 24.7% (aOR: 0.753, 95% CI: 0.671 – 0.846, p < 0.001). In conclusion, a staggering one-fifth of older persons with low social support suffered from depression, with the determinants spanning biological, psychological, and social factors. To tackle this issue, depression screening among older persons should assess these determinants comprehensively. Management strategies should prioritise evaluating social support and providing aids for older persons with the risk factors to navigate and perform various functions within the home environment, with collaborative referrals to relevant providers for tailored care.

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