ImportanceDepression 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.ObjectiveTo 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 ParticipantsThis 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 MeasuresMajor 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.ResultsAmong 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 RelevanceThe 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.

中文翻译：

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印度成人抑郁症的诊断、治疗和缓解


重要性抑郁症是全球和世界上人口最多的国家印度心理健康负担的主要贡献者。缺乏关于印度成人抑郁症健康保险的国家级证据。目的估计印度中老年人抑郁症患者使用医疗保健服务、诊断为抑郁症、接受治疗和缓解的比例。设计、设置和参与者这项横断面研究使用了 2017-2018 年印度纵向老龄化研究的个人层面调查数据，该研究代表了印度的所有 36 个邦和联邦直辖区。数据收集时间为 2017 年 4 月 1 日至 2018 年 12 月 31 日。样本包括 45 岁或以上的成年人，他们有关于抑郁症、医疗保健服务使用、抑郁症诊断和治疗以及社会人口学特征的数据。家庭的回复率为 96%，个人的回复率为 87%。数据分析时间为 2024 年 1 月 15 日至 2024 年 7 月 23 日。主要结局和措施使用综合国际诊断访谈简短症状量表评估过去 12 个月内的重度抑郁发作。我们使用抽样权重估计了自我报告的卫生服务使用情况、抑郁症诊断和抑郁症治疗，并按农村与城市居民对数据进行了分层。如果参与者接受治疗且症状少于 3 种，则认为他们处于缓解状态。结果在 65 121 名参与者中，中位年龄为 57 岁 （IQR，50-65 岁）;男性占 53.3%，女性占 46.7%。在居住地方面，32.1% 的参与者居住在城市地区，67.9% 的参与者居住在农村地区。抑郁的加权患病率为 8.6% （95% CI，8.3%-8.9%）。在所有抑郁症参与者中，63.7% （95% CI， 62.0%-65.3%） 在过去一年中使用过任何卫生服务，3.1% （95% CI，2.6%-3.7%） 被诊断出患有抑郁症;1.6% （95% CI， 1.2%-2.0%） 接受了某种形式的治疗 （51% 的确诊患者） 和 1.0% （95% CI， 0.7%-1.3%） 处于缓解期 （62% 的接受治疗者）。农村地区的抑郁症患病率 （9.8% [95% CI， 9.4%-10.1%]）高于城市地区 （6.2% [95% CI， 5.8%-6.7%]），尽管农村地区的卫生服务使用、诊断和治疗 （分别为 61.2% [95% CI， 59.2%-63.1%]、2.6% [95% CI， 2.1%-3.3%] 和 1.1% [95% CI， 0.8%-1.6%]）低于城市地区 （71.8% [95% CI， 分别为 68.5%-74.9%]、4.6% [95% CI，3.5%-6.2%] 和 3.0% [95% CI，2.1%-4.4%]。在印度 2960 万 （95% CI，28.6-3060 万） 患有抑郁症的中老年人中，有 2910 万 （95% CI，28.2-3010 万）未得到治疗，其中 2240 万 （95% CI，21.6-2330 万）生活在农村地区。结论和相关性这项横断面研究的结果表明，尽管近三分之二的印度中老年人患有抑郁症使用卫生服务，但 97% 的成年人未得到诊断，大约一半被诊断的成年人未得到治疗。在印度，需要提高认识和系统性的努力来筛查和治疗抑郁症患者。