Depression and Multimorbidity among Older Indians Residing in Front-Runner, Achiever and Aspirant States: Insight from Longitudinal Ageing Study in India (LASI) – Wave I

Introduction: Multimorbidity is gaining prominence as a global public health challenge, with demographic and epidemiologic transitions. Epidemiologically, a bidirectional link exists between depression and multimorbidity, and it is influenced by biological, psychosocial and care-related factors. Variations are expected in the different States with differential performances in the National Institution for Transforming India (NITI) Aayog Annual Health Index. The objective is to study the association of depression with multimorbidity among the older Indian population living in front-runner, achiever, and aspirant States. Methods: wave (2017-18). A total of 66,606 Indian participants aged ≥45 years were included in the analysis. Based on their NITI Aayog Annual Health Index score, the States and UTs are classified into front-runner (top one-third), achiever (middle one-third) and aspirant (lowest one-third). For this study, the Health Index Round IV 2019-2020 was used for categorization of the states. Depression was the outcome variable, classified according to the Composite International Diagnostic Interview-Short Form (CIDISF). Multivariable logistic regression analysis was conducted to calculate adjusted odds of association between depression and multimorbidity. The association between multimorbidity and depression was stratified according to the categorization of States into front-runners, achievers, and aspirants. Results: Among those with at least two comorbidities, depression was reported in 8.74%. Among those with at least four multimorbidities, depression was reported in 15.56%. Depression was found to most commonly occur along with hypertension (35.8%) and musculoskeletal disorders (21.67%), and least commonly along with cancer (1.09%) and chronic renal failure (1.31%). There was a strong association between depression and multimorbidity, which was highest in achiever states (OR (95% CI): 2.05 (1.74-2.42)), followed by aspirant (OR (95% CI): 1.85 (1.66-2.06)) and front runner (OR (95% CI): 1.75 (1.53-1.99)) states. Conclusions: Strong association between depression and multimorbidity across all three State categories indicates a need for inclusion of mental health care components in the composite annual health index. Incorporation of routine and high-risk screening for depression among patients with multimorbidity into the Ayushman Bharat Comprehensive Primary Health Care (CPHC) package needs to be tested with health technology assessment studies as a potential future policy change.