Factors Associated with Depression among Older Adults with Diabetes and/or Hypertension Attending Rural Health Centre IVs in Southwestern Uganda: A Convergent Mixed-Methods Cross-Sectional Study

Abstract

Background: Depression frequently co-occurs with diabetes and hypertension, but determinants among older adults receiving chronic-disease care in rural Ugandan primary-care settings remain poorly characterised. This article examined clinical, lifestyle and psychosocial factors associated with depression among older patients attending two Health Centre IV facilities in Rwampara District. Methods: A convergent mixed-methods cross-sectional study enrolled 244 adults aged 60 years or older with documented Diabetes mellitus, hypertension, or both, and eight health workers. Patients were recruited consecutively at Bugamba and Kinoni HC IVs. Depression was measured with the Patient Health Questionnaire-9 and defined as a score of 10 or above. Binary logistic regression produced crude and adjusted odds ratios (AORs) with 95% confidence intervals (CIs). Key-informant interviews and structured facility observations were analysed thematically and used to explain the quantitative associations. Results: Overall, 137 of 244 patients (56.15%; 95% CI: 49.81–62.29) screened positive for depression. In the adjusted analysis, patients living with both diabetes and hypertension had greater odds of depression than those with diabetes alone (AOR=2.38, 95% CI: 1.03–5.49; p=.043). Another chronic illness was associated with nearly sixfold higher odds (AOR=5.89, 95% CI: 3.14–11.06; p<.001), and fair rather than good sleep quality was associated with higher odds (AOR=2.26, 95% CI: 1.20–4.28; p=.012). Satisfaction with family support was protective (AOR=0.43, 95% CI: 0.21–0.90; p=.025). Health workers linked depression to cumulative treatment demands, fear of complications, disrupted sleep and inadequate practical or emotional support. Neither facility had a PHQ-9 or other depression-screening tool or a visible mental-health referral pathway during four observation sessions. Conclusion: Depression among older adults in rural NCD clinics was associated primarily with multi-morbidity, sleep difficulties and weak family support. Routine case-finding should therefore prioritise patients with multiple conditions and combine brief depression screening with sleep assessment, family-engagement strategies and functional referral pathways.