Burden of depression and its associated factors among older people living in Gondar town, Ethiopia: a community based cross-sectional study

Abstract

Objectives

Depression is one of the main causes of disability worldwide and makes a major contribution to the global disease burden, especially in developing countries. It is also one of the most prevalent psychiatric disorders in the older people and a significant risk factor for both disability and death. Despite the fact that little research has been done on it among those who live in sub-Saharan Africa, especially Ethiopia, the aim of this study was to fill the above-mentioned gap among older people.

Method

A community-based cross-sectional study was conducted from April to June 2023. A total of 607 older people were included using the multistage sampling technique. An interview-administered questionnaire was used to assess depression using the Geriatric Depression Scale item 15 with a cut-off ≥5. For statistical analysis, the binary logistic regression model was employed.

Results

The mean age of the study participants was 72.45 (SD ±9.08) years. The prevalence of depression was found to be 45%. Age 80 years and above, 70–79 years, widowed, retired, known chronic disease, and poor social support were associated factors with depression.

Conclusion

Compared to other studies conducted in different regions of Ethiopia, the prevalence of depression in this study was found to be high, at 45%. The results of this study may be taken as providing health professionals, health policymakers, and other pertinent stakeholders’ early warning signs and guidance on how to take efficient control measures and conduct periodic monitoring among older people.

Keywords:

• Depression
• older people
• Ethiopia

Introduction

Global life expectancy has increased over the past few decades due to two main factors: a decline in death and fertility rates and an improvement in quality of life (Bujang et al., 2012; Osman, 2015). In 2019, there were one billion people over the age of 60 in the world; by 2030, there will be 1.4 billion; and by 2050, there will be 2.1 billion (Zenebe et al., 2021). Eighty percent of all older people will reside in low- and middle-income countries by the year 2050 (Rudnicka et al., 2020; World Health Organization, 2018). There were 6.1 million old people (5.3%) in Ethiopia in 2020; by 2030, this number is expected to rise to 6.1%, and by 2050, it is expected to reach 10.4% (Juergens, 2019).

Increased geriatric mental health issues are correlated with an aging population (Blazer & Hybels, 2005). The physical and psychological changes that come with aging often present a number of difficulties for older people as a whole (Blazer & Hybels, 2005). Older populations, in particular, are predicted to experience an increase in the prevalence of mental health issues (Flood & Buckwalter, 2009). Depression is one of the main causes of disability worldwide and a significant contributor to the global disease burden (James et al., 2018). It is also one of the most common psychiatric disorders in the older population (Moss et al., 2012) and a significant risk factor for mortality and disability (Blazer et al., 2001).

There is a wide range of estimates regarding the prevalence of depression in older people (Charney et al., 2003; Demyttenaere et al., 2004; Gallo & Lebowitz, 1999). Depending on cultural context, the World Health Organization (WHO) estimated that the prevalence of depression among older people ranged from 10% to 20% in 2015, affecting nearly 300 million people (Mitchell & Subramaniam, 2005; Raviola et al., 2012; Steel et al., 2014; World Health Organization, 2017). Among these with mental issues, 40% were diagnosed to have a depressive disorder (Patel & Saxena, 2014). People with depressive disorder have a 40% greater chance of premature death than those without the illness (World Health Organization, 2017). It is a common mental disorder among older people and is characterized by unhappiness, loss of interest, feelings of guilt or low self-respect, disturbed sleep or appetite, fatigue, and poor concentration (EL-Gilany et al., 2018). This in older people often goes untreated, as people think that it is a normal part of the aging process and a natural reaction to chronic diseases, loss, and social conversion (Nair et al., 2013).

Depression is the most hideous disease that affects older people, and it has become a serious public health issue that attracts worldwide attention (Roh et al., 2015). While being older does not always mean being depressed and hopeless, some older people have difficulties with which they may find it difficult to deal, leading to feelings of distress, worry, hopelessness, and isolation (Mirkena et al., 2018). The clinical picture of depression in old age is sometimes hidden by memory problems with discomfort and anxiety symptoms; nevertheless, these problems are actually subsequent to depression (Blazer, 2003; Hasin et al., 2005; Yu et al., 2020).

Numerous community-based studies found that older people experienced depression-related complications, particularly in low-income countries (Andreasen et al., 2014; Ferrari et al., 2013; Padayachey et al., 2017; Saxena et al., 2013; World Health Organization, 2009). It contributes to the functional limitations brought on by physical illness, interferes in the way of treatment and rehabilitation, and makes a person’s physical functioning even worse (Nicholson, 2011; Souci et al., 2006). Because of its considerable contribution to the increase in direct annual livelihood costs, it also has an economic effect on older people (Luppa et al., 2008). Therefore, it is considered medically urgent to improve later-life mental health in order to prevent an increase in suicides in an aging society (Zenebe et al., 2021).

Psychological, social, and biological mechanisms are assumed to determine the etiology of depression and concomitant psychiatric conditions, even if the actual origins of depression are still unknown (Lemma et al., 2010). Social scientists, postulating the psychosocial theory, posited that depression could be caused by a lack of interpersonal and communication skills, social support, and coping mechanisms (Gonzalez et al., 1990). Old biological theories state that depression is caused by a lack of monoamines in the brain. However, recent theories underscore the role of brain-derived neurotropic factor (BDNF) in the pathogenesis of depression (Dwivedi, 2009). In general, depression in older people is the result of a complex interaction of social, psychological, and biological factors (Suwanmanee et al., 2012; Sidik et al., 2004).

Different factors, including genetic predisposition, chronic diseases and disabilities, pain, frustration with limitations in activities of daily living (ADL), personality traits (dependent, anxious, or avoidant), unfavorable life events (separation, divorce, bereavement, poverty, social isolation), and inadequate social support, can raise an individual’s risk of developing depression in their later years (Akbaş et al., 2020; Djernes, 2006; Hayward et al., 2012; Roberts et al., 1997; Velázquez-Brizuela et al., 2014; Yaka et al., 2014). Many studies have shown a relationship between depression and a number of socioeconomic factors, including older age, a lack of education, and manual labor (Park et al., 2015). Thus, older people suffering from depression often have a combination of psychological, physical, and social needs (Pasco et al., 2011).

Evidence of depression disorders in older people is generally weaker than for other health services in low-income countries, particularly in Ethiopia, and no research has been done to show the prevalence and contributing factors of depression among the older people in Gondar town. Therefore, the aim of this study was to assess the prevalence of depression and identify the associated factors.

Methods and materials

Study design and participants

A community-based cross-sectional study was carried out in February and March of 2023 in Gondar town, northwest Ethiopia. The study was conducted in Gondar town, Amhara regional state, Northwest Ethiopia. The city is located in the central Gondar zone of Amhara regional state, 748 kilometers northwest of Addis Ababa, Ethiopia’s capital, and about 180 kilometers from Bahir Dar, Amhara regional state’s capital. Gondar is among the most ancient and largely populated cities in the country. It has an altitude of 12˚360 N 37˚280E and a longitude of 12.60˚ N 37.467˚E, with an elevation of 2133 meters above sea level. Gondar town has 25 kebeles (the smallest administrative units in Ethiopia). According to the Gondar Statistics Agency’s 2021/22 projection from 2007 population census data, the total population of Gondar town was estimated at 390,000; more than half of the population were women, and 6879 were older people (2021/2022). Older people in Ethiopia play a key role in contributing to the social and economic fabric of the family. They are wise and seasoned members of any society; their knowledge, insight, and experience can help in the advancement of development, making them an invaluable resource for the country. The town has one comprehensive specialized hospital and eight health centers; they are providing health services to the population.

Population and sample size

The source population was the entire population of community-dwelling older people aged 60 and above living in Gondar town. During the study period, the study population consisted of older people aged 60 and up living in selected kebeles (the smallest administrative units in Ethiopia). Older people aged 60 years and older who were permanent residents (≥6 months) in the selected kebeles were included.

Sample size and sampling procedure

The sample size was determined by using the single population proportion formula with a prevalence (P) of 45% from the study done in Womberma (Mulat et al., 2021), a 95% confidence interval, and a 5% margin of error. The minimum sample size (n) required for the study was calculated by using a design effect of 1.5 and a 10% non-response rate. With this, the total sample size was found to be 627. The multi-stage sampling technique was used to select participants with the assumption of a homogenous population. The town had six sub-cities, each composed of different kebeles (the smallest administrative units in Ethiopia). Three sub-cities were selected by the lottery method and clustered into 25. Thirty percent of this cluster and their households were also selected by the lottery method, and finally, by proportional allocation to each cluster, individuals were selected by a computer-generated simple random sampling method. Every household in the selected cluster was visited to interview participants.

Operational definition

Older people

Those participants who are older than or equal to 60 years old were considered older people (World Health Organization, 2015).

Depression

It was measured by the Geriatric Depression Scale, short form (GDS-15). It is a suitable instrument to diagnose depression in the community-dwelling older people using a cut-off point greater than or equal to five (Dias et al., 2017).

Physical activity level

Older people perform any kind of moderate-intensity exercise (such as walking, cycling, sports or planned exercise, and strength exercise) done for at least 150 min per week (World Health Organization, 2010).

Perceived social support

Social support has been described as support access to an individual through social ties with other individuals, groups, and the larger community. Perceived social support was operationalized as follows by using the Oslo-3 scale and individual score: 3–8 as poor, moderate 9–11, and strong 12–14 (Lin et al., 1979).

Substance use

It was assessed if the participant used substances like alcohol, cigarettes, and/or hashish in the preceding 3 months.

Study variables

Dependent variable

Depression

(Yes = 1, No = 0)

Independent variables

Sociodemographic characteristics such as sex, age, marital status, religion, education, income status, and employment status. Clinical, psychological, substance use, and lifestyle-related factors: known history of medical conditions (hypertension, diabetic mellitus, heart disease, epilepsy, HIV/AIDS) Social support, consumption of psychoactive substances like alcohol and cigarettes, and lifestyle-related factors like physical disability and physical activity level.

Data collection methods and tools

After obtaining permission from the ethical review committee at the University of Gondar College of Medicine and Health Science, a house-to-house visit was done. A face-to-face interview was taken with study participants using a predesigned, pretested structured schedule with the following domains: socio-demographic characteristics like gender, age, religion, educational status, marital status, employment status, and income status. Clinical, perceived psychosocial support, substance use, and lifestyle characteristics of the study participants, like physical disability, known chronic disease, perceived social support, cigarette smoke, alcohol use, and physical activity level. The other detailed contents of the questionnaire were developed from previous literature, and the questionnaire was modified based on all the variables that directly meet the objective of the study. It was prepared in an English version and translated to the Amharic language back to English to ensure consistency by language experts. Data collection was done by four trained health extension workers and two physiotherapist supervisors. To ensure the quality of the data, all data collectors and supervisors received one-day training by the principal investigator on the purpose of the study, details of the data collection instrument, interviewing techniques, the importance of privacy, and ensuring the confidentiality of the respondents prior to the actual data collection. The supervisor checked for the completeness and consistency of the data. The data collection tools were pre-tested on 5% of the total sample size before the actual data collection period to check for the accuracy of responses, language clarity, and appropriateness of the tools. For the actual study, the necessary change was made after the pretest.

Statistical analysis

The collected data was entered into Epidata and exported, coded, and analyzed using Statistical Package for the Social Sciences (SPSS) Version 26. An analysis of binary logistic regression was used to identify the factors that would predict the outcome variable. For both bivariable and multivariable logistic regression analyses, a cut-off p value of 0.05 was considered a significant level. Prior to determining the final independent predictor variables for depression, the bivariable logistic regression analysis was done, and variables that were determined to be statistically significant were included in the multiple logistic regression analysis. Variables with a p value of < 0.05 at the 95% confidence interval (CI) and their odds ratio (OR) were used to interpret the findings of the final model.

Results

A total of 607 study participants were involved, with a response rate of 95%. Among the total respondent population, more than half of the study participants were male. The mean age of the participants was 72.45 (SD ±9.08) years. The majority of the participants (75.9%) were followers of Orthodox Christianity; more than half of the study participants (51.2%) were married; 269 (44.3%) of the study participants had secondary education status; 224 (40.2%) of the study participants were self-employed; 190 (31.3%) of the study participants had ≥ 3500 ETB in monthly income (see Table 1).

Table 1. Frequency distribution of socio-demographic variables among community dweller older people living in Gondar town, Northwest, Ethiopia, 2023 (n = 607).

	Overall		Male		Female
Variables	N	%	n	%	n	%
Age in years
60–69	237	39	133	21.9	104	17.1
70–79	178	29.3	76	12.5	102	16.8
80 and older	192	31.6	78	12.9	14	18.8
Religions
Orthodox Christian	459	75.6	217	35.7	242	39..9
Muslim	97	16	47	7.7	50	8.8
Protestant	37	6.1	16	2.6	21	3.5
Jewish	14	2.3	7	1.2	7	1.2
Educational status
Tertiary or higher	227	37.4	116	19.1	111	18.3
Secondary	269	44.3	143	23.6	126	20.8
Illiterate or primary	111	18.3	28	4.6	83	13.7
Marital status
Married	311	51.2	157	25.9	154	25.4
Single	84	13.8	46	7.6	38	6.3
Divorce	94	15.5	46	7.6	48	7.9
Widowed	118	19.4	38	6.3	80	13.2
Employment status
Salaried	124	20.4	61	10.0	63	10.4
Self employed	224	40.2	114	18.8	130	21.4
Retired with pension	197	32.5	90	14.8	107	17.6
Currently not working	24	4.0	12	2.0	12	2.0
Never work for money	18	3.0	10.0	1.60	18.0	3.0
Monthly individual income
Highest (≥79.53$)	190	31.3	101	16.6	89	14.7
Average (=52.98$)	108	17.8	62	10.2	46	7.6
lowest (≤23.32$)	309	50.9	124	20.4	185	30.5

Clinical, perceived psychosocial support, substance use and life style characteristics of the study participants

The majority of the study participants (87.3%) had no physical disability; more than one-third of the study participants had known chronic disease, of which 90 (14.8%) were hypertensive. The majority of the study participants, 339 (55.8%), had strong social support. Five hundred seventy-three (94.4%) of them had never smoked cigarettes, and more than two-thirds of the study participants, 465 (76.6%), were not alcoholics. Three hundred seventy-nine (62.4%) of the respondents were physically active (see Table 2).

Table 2. Clinical, perceived social support, psychoactive substance use and life style of older people at Gondar town, North West, Ethiopia, 2023 (n = 607).

	Overall		Male		Female
Variables	N	%	n	%	n	%
Physical disability
No	529	87.3	269	44.4	260	42.9
Yes	77	12.7	18	3.0	59	9.7
Known chronic disease
No	383	63.1	184	30.3	199	32.0
Yes	224	36.9	103	17.3	121	19.9
Perceived social support
Strong	339	55.8	168	27.7	171	28.2
Intermediate	179	29.5	82	13.5	97	16.5
Poor	89	14.7	37	6.1	52	8.6
Ever smoke cigarette
No	573	94.4	265	43.7	308	50.7
Yes	34	5.6	22	3.6	12	2.0
Ever used alcohol
No	465	76.6	218	38.9	247	40.7
Yes	142	23.4	69	11.4	73	12.0
Physical activity level (in minutes per week)
No	379	62.4	193	31.8	186	30.6
Yes	228	37.6	94	15.5	134	22.1

Factor associated with depression among the elders

The overall prevalence of depression among older people was found to be 45% (95% CI: 41.2–49.2%). In this study, age, marital status, employment status, having known chronic disease, and poor social support were factors significantly associated with depression among the older people. Older people whose age was eighty years and above were sex times (AOR: 6.62, 95% CI: 4.03–10.89), 70–79 years were (AOR: 3.65, 95% CI: 2.21–6.02) more likely to develop depression compared to 60–69 years old. Widowed older people were 2.08 times (AOR = 2.08, 95% CI: 1.19–3.62) more likely to develop depression compared to married ones. Older people whose retired employment status is 2.50 times higher (AOR = 2.50, 95% CI: 1.42–4.40) are more likely to develop depression compared to salaried.

Older people who had known chronic disease were two times (AOR = 2.26, 95% CI: 1.48–3.34) more likely to develop depression than their counterparts. And those who perceived poor social support were also six times more likely to have depression compared to those who had strong social support (AOR = 6.10, 95% CI: 3.21–11.58) (see Table 3).

Table 3. Simple and multiple logistic regression analysis of depressive disorder among older people living in Gondar town, Northwest, Ethiopia, 2023 (n = 607).

Depression			OR(95%CI)
Variables	Yes	No	COR(95%CI)	AOR(95%CI)	p value
Gender
Male	117	170	1	1
Female	157	163	1.40(1.01–1.93)	1.02(0.68–1.54	0.91
Age in years
60–69	54	183	1	1
70–79	94	84	3.79(2.48–5.78)	3.65(2.21–6.02)	0.001**
80 and above	126	66	6.47(4.22–9.89)	6.62(4.03–10.87)	0.001**
Educational status
Tertiary or above	103	124	1	1
Secondary	103	166	0.74(0.52–1.06)	1.64(0.91–2.95)	0.09
Illiterate or primary	68	43	1.90 (1.19–3.02)	0.64(0.41–1.01)	0.05
Marital status
Married	127	184	1	1
single	35	49	1.03(0.63–1.68)	1.42(0.77–2.61)	0.25
Divorce	36	58	0.89(0.56–1.44)	0.88(0.49–1.57)	0.67
Widowed	76	42	2.62(1.68–4.08)	2.08(1.19–3.62)	0.001*
Employment status
Salaried	46	78	1	1
Self-employed	57	140	0.69(0.42–1.12	0.62(0.34–1.10)	0.10
Retired with pension	157	87	3.06(1.95–4.79)	2.50(1.42–4.40)	0.01*
Currently not working	7	17	0.69(0.26–1.81)	0.46(0.15–1.40)	0.17
Never work for money	7	11	1.07(0.39–2.97)	0.91(0.27–2.98)	0.87
Monthly individual income
Highest (≥79.53$)	73	117	1	1
Average(=52.98$)	48	60	1.28(0.79–2.07)	0.94(0.51–1.74)	0.86
lowest (≤23.32$)	153	156	1.57(1.08–2.27)	0.85(0.51–1.42)	0.54
Physical disability
No	228	301	1	1
Yes	46	31	1.95(1.20–3.18)	0.79(0.40–1.58)	0.51
Known chronic disease
No	147	236	1	1
Yes	127	97	2.10(1.50–2.93)	2.26(1.48–3.34)	0.001**
Perceive social support
Strong	134	205	1	1
Intermediate	70	109	0.98(0.67–1.42)	0.87(0.56–1.36)	0.56
poor	70	19	5.63(3.24–9.78)	6.10(3.21–11.58)	0.001**
Physical activity level (in minute per week)
≥150	158	221	1	1
≤150	116	112	1.44(1.04–2.01)	1.03(0.66–1.59)	0.89

COR = Crude odd ratio, AOR = Adjusted odd ratio 1 = Reference categories, *p value < 0.05, **p value <0.001.

Discussion

The results showed that 45% (95% CI: 41.2–49.2%) of the older people had depression, which was consistent with research from studies conducted in Sudan (47.5%), Egypt (44.4%), Ambo (41.8%), and Womberma Ethiopia (45%) (Awunor et al., 2018; Assil & Zeidan, 2013; Mulat et al., 2021; Mirkena et al., 2018; Mohamed & Abd-Elhamed, 2011), respectively. However, more extensive research was conducted in Thailand (18%), Saudi Arabia (39%), China (10.5%), and Harar (28.5%) (Al-shammari & Al-subaie, 1999; Charoensakulchai et al., 2019; Girma et al., 2016; Mandolikar et al., 2017), respectively. This variation may be the result of different tools; for example, in China, the study used the GDS-30 to screen for socioeconomic variation and depression. It may have resulted from a different study population in Harar, where the majority of participants were less than 75 years old, because being younger is less prone to depression compared with being older.

Furthermore, this result was greater than research conducted in China (32.8%) (Zou et al., 2018) and Sri Lanka (13.9%) among older aged 60 to 74 (Rajapakshe et al., 2019). This discrepancy might arise from the fact that study participants in Sri Lanka ranged in age from 60 to 74.Older people who were older than 74 years old had a higher more likely to developing depression in comparison to those who were younger, as supported by both our findings and other studies (Awunor et al., 2018). The variation in China could be found in that the depression measurement tool was categorized as a score of 6 or above in China, indicating depression, potentially leading to an underestimation of the prevalence of depression

However, the results of this finding were lower compared to other studies: Urban India (75.5%) (Buvneshkumar et al., 2018), Vietnam (66.9%) (Dao et al., 2018), Nepal (66.9%) (Chalise, 2014), India (52.9%) (Paul et al., 2019), and Brazil (49.76) (Leal et al., 2014). This difference could be explained by the fact that most of the participants in our study were married in India and Nepal. Because in both studies, married people were less likely to experience depression than divorced or widowed people. Variations in depression measurement tools and study population may be in urban India. In Brazil, this could be because a larger proportion of study participants were female and had longer stays in institutions. Because women of the female gender were more likely to have depression (Mulat et al., 2021). In Vietnam considering that the Zung self-rating depression scale was used to screen for depression, the discrepancy may have resulted from different instruments used (Dao et al., 2018).

In this study, we found that retirement, older age, widowed marital status, having known chronic diseases, and poor social support were statistically associated with depression among the older people. Age 80 and older were 6.62 times more likely to develop depression compared with age 60–69 (AOR = 6.62, 95% CI: 4.03–10.87), and age 70–79 years were 3.65 times more likely to develop depression compared to age 60–69 years (AOR = 3.65, 95% CI: 2.21–6.02). This result is supported by studies found in Womberma, Ethiopia, Brazil, Vietnam, Sri Lanka, and India (Borges et al., 2013; Mulat et al., 2021; Paul et al., 2019; Rajapakshe et al., 2019), respectively. It is widely recognized that as people get older, they encounter a variety of issues, such as socioeconomic, psychological, nutritional, and physical problems. These health problems lead to various disabilities, and studies indicate that about a third of the older have psychiatric disorders (Alam et al., 2011). In addition, decreased confidence, financial hardship, and dependence on others exacerbate the suffering of aging (Koenig et al., 2014).

The widowed marital status of the older people was 2.08 times more likely to develop depression compared with married people (AOR = 2.08, 95% CI: 1.19–3.62). This result is supported by other studies, systematic reviews, and meta-analyses in Sri Lanka and South Africa (Peltzer & Phaswana-Mafuya, 2013; Rajapakshe et al., 2019; Zenebe et al., 2021) respectively. This phenomenon may be explained by the experience of perceived social support loss and loneliness (Rajapakshe et al., 2019).

Older people who had retired were 2.5 times more likely to develop depression compared with salaried people (AOR = 2.50, 95% CI: 1.42–4.40). This is consistent with research done in Korea, Ambo, Ethiopia, Sudan, and Khartoum (Assil & Zeidan, 2013; Mirkena et al., 2018; Park & Kang, 2016). This could be a result of retired people not having enough opportunities to socialize and exchange thoughts and emotions. Older people may experience feelings of loneliness and a lack of assistance. Moreover, these emotions may play a role in the onset of depression. Older people who had known chronic diseases were 2.26 times more likely to develop depression compared with their counterparts (AOR = 2.26, 95% CI: 48–3.34).

This result was in line with studies with Womberma from Ethiopia, China, and Sri Lanka (Mulat et al., 2021; Mandolikar et al., 2017; Rajapakshe et al., 2019). According to the WHO, the presence of chronic illness is one of the associated factors for developing depression (World Health Organization, 2017). In addition, this finding was also supported by a systematic review and meta-analysis conducted in 2003 (Cole & Dendukuri, 2003). This could be attributed to the fact that physical illness could increase the development of emotional problems or depression.

Furthermore, older individuals with low social support were 6.1 times more likely to experience depression than those with high support (AOR = 6.10, 95% CI: 3.21–11.58). This study was consistent with studies in Womberma; a systematic review and meta-analysis were done in 2021 in Sri Lanka and India (Mulat et al., 2021; Paul et al., 2019; Rajapakshe et al., 2019; Zenebe et al., 2021). This is supported by another systematic review done in 2018 that indicated that poor social support increases depression among older people, whereas high social support results in reduced mortality, improved health, and a greater quality of life (Mohd et al., 2019). Therefore, social support is a potential resource available to all individuals that could be enhanced and bring overall benefit to the elderly. Even though the prevalence of depression in Gondar is relatively high, comparable to that of other studies done in Ethiopia, the existing policies, strategies, programs, and interventions targeting older people with depression are not sufficient to promote the health of the older population in Ethiopia.

Conclusion

Compared to other studies conducted in different regions of Ethiopia, the prevalence of depression among the older people in this study was found to be high, at 45% (95% CI: 41.2–49.2%). Older people having depression was found to be influenced by a number of circumstances, including older age, being widowed, marital status, retirement, known chronic diseases, and poor social support. The results of this study may be taken as providing health professionals, health policymakers, and other pertinent stakeholder’s early warning signs and guidance on how to take efficient control measures and conduct periodic assessments to identify depression risk factors in older people.

Author’s contributions

MDT conceived the idea of the study, data mining analysis and wrote the main part of the paper. GJB and TK designed the figure and participated in the writing of the section. DMM, FSZ and KC have reviewed and edited Table 3. KC, AKK and STC assist in the data mining analysis and wrote the Supplement. All authors read and approved the final manuscript.

Availability of data and material

The datasets used and/or analyzed during the current study are not publicly available due to confidentiality issues but available from the corresponding author on reasonable request at [email protected].

Ethics approval and consent to participate

Ethical clearance was obtained from the University of Gondar, College of Medicine and Health Science Institutional Review Board (IRB) Committee, with protocol number 1545/2022. All methods were performed in accordance with the National Health Research Ethics Review Guidelines. Permission to conduct the study was obtained from Gondar sub-cities and selected kebele bureaus. The purposes and importance of the study were explained to the participants in the study, and written informed consent was obtained from each participant for literate participants and from a parent and/or legal guardian for illiterate participants. Confidentiality was maintained at all levels of the study. The investigator was notifying the participants on behalf of the data collectors that they are legally liable for any problems that occur in the study participants’ privacy. Participants’ involvement in the study was on a voluntary basis; participants who are unwilling to participate in the study and those who wish to quit their participation at any stage were informed to do so without any restrictions.

Acknowledgements

We would like to acknowledge the sub-cities and selected kebele bureau’s their willingness to collect data, respondents, data collectors, and their voluntary participation and provision of their time for this study.

Disclosure statement

The authors declare that they have no competing interest.

Additional information

Funding

This work was financially support by university of Gondar. The funder has no role in the design of the study, data collection, and analysis, interpretation of data and in writing the manuscript.