Multidimensional determinants of depression and non-depression in older adults: evidence from national data.
Abstract
Background
The global demographic transition indicates a rapid shift toward an aging population structure. Good mental health in advanced ages is critical for a healthy aging. Problems such as depression reduce life expectancy and impose a societal burden. This study aims to examine, through a multidimensional approach, the sociodemographic, economic, health-related, functional, and psychosocial factors affecting depression levels among individuals aged 65 and over in Türkiye.
Method
In this study, microdata from the Türkiye Older Adult Profile Survey conducted by Turkish Statistical Institute (TurkStat) in 2023 was utilized. The analysis included a total of 10,348 individuals aged 65 and over who personally responded to perception-related questions. The dependent variable, depression level, was categorized as "not depressed," "mild," and "severe" according to Geriatric Depression Scale scores. In the analysis of the data, a generalized ordered logit model and marginal effects were employed due to the violation of the parallel lines assumption.
Findings
Depression was common among older adults, with 46.71% exhibiting mild depressive symptoms. Specifically, 34.26% were mildly depressed and 12.45% were severely depressed, while 53.29% were classified as non-depressed. According to the analysis results, female gender, living alone, low-income level, and experiencing financial hardship significantly increase the risk of depression. In terms of health status, poor self-rated general health, sensory impairments (vision/hearing difficulties), history of falls, and the need for home care are the main factors increasing the likelihood of depression. An increase in functional independence (KATZ index) and maintaining a physically active lifestyle exhibit protective effects. Additionally, strong neighbor support, a higher number of support people, and a sense of autonomy in decision-making processes significantly reduce the level of depression.
Conclusion
Geriatric depression in Türkiye is a multidimensional phenomenon with complex socioeconomic and environmental determinants, in addition to biological factors. In particular, older women, individuals living alone, and economically disadvantaged groups are at high risk. The findings indicate that, to support healthy aging, clinical interventions alone are insufficient; strengthening social support networks, enhancing urban accessibility, and urgently developing inclusive public health policies that promote older adults'autonomy are required.