{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T07:51:51Z","timestamp":1793433111878,"version":"4.5.0"},"reference-count":43,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2024,12,6]],"date-time":"2024-12-06T00:00:00Z","timestamp":1733443200000},"content-version":"unspecified","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005915","name":"Tata Trusts","doi-asserted-by":"publisher","award":["NA"],"award-info":[{"award-number":["NA"]}],"id":[{"id":"10.13039\/501100005915","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Pratiksha Trust","award":["NA"],"award-info":[{"award-number":["NA"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2024,10,17]]},"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Depression is a growing public health concern in India but its prevalence is uneven across the country, possibly influenced by several sociodemographic factors. We aimed to assess the rural-urban disparity in the prevalence of depression and their associated sociodemographic and lifestyle-related factors.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Participants were middle-aged and older adults (\u226545 years) from two parallel, prospective cohorts from rural (CBR-SANSCOG, n=4493) and urban (CBR-TLSA, n=972) southern India. We used cross-sectional data from the baseline clinical and biochemical assessments of the above two cohorts. The Geriatric Depression Scale (GDS-30) was used to screen for depression (cut-off \u226510). Logistic regression was used to assess the relationship between place of residence (rural vs urban) and prevalence of depression, adjusting for age, sex, education, income, marital status, Body Mass Index (BMI), alcohol use, tobacco use and number of comorbidities. The Fairlie decomposition analysis was used to decompose the rural-urban disparity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We found that the prevalence of depression was significantly higher in rural than in urban participants (14.49% vs 8.23%, p&lt;0.001). The fully adjusted binary logistic regression model showed that rural-dwelling individuals were 1.57 times more likely to have depression than urban residents (AOR: 1.57, 95%\u2009CI: 1.03, 2.39). In the decomposition analysis, the variables included in this model (age, sex, education, income, marital status, BMI, alcohol use, tobacco use and number of comorbidities) explained 35.21% of the rural-urban disparity in the prevalence of depression, with sex and marital status being the significant contributors.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Participants in our rural cohort had significantly higher odds for depression as compared to their urban counterparts, with sociodemographic factors playing a key role in this disparity. This underscores the need for scaling up mental health services in the rural communities of India including training primary healthcare providers to promptly identify and manage depression.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjph-2023-000760","type":"journal-article","created":{"date-parts":[[2024,12,7]],"date-time":"2024-12-07T12:05:12Z","timestamp":1733573112000},"page":"e000760","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Decomposing rural-urban differences in depression prevalence: a cross-sectional analysis of two community-based southern Indian cohorts"],"prefix":"10.1136","volume":"2","author":[{"given":"Pooja","family":"Rai","sequence":"first","affiliation":[{"name":"Centre for Brain Research, Indian Institute of Science, Bangalore, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pravin","family":"Sahadevan","sequence":"additional","affiliation":[{"name":"Centre for Brain Research, Indian Institute of Science, Bangalore, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas G","family":"Issac","sequence":"additional","affiliation":[{"name":"Centre for Brain Research, Indian Institute of Science, Bangalore, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0877-7936","authenticated-orcid":false,"given":"Jonas S","family":"Sundarakumar","sequence":"additional","affiliation":[{"name":"Centre for Brain Research, Indian Institute of Science, Bangalore, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,12,7]]},"reference":[{"key":"2025083109511719000_2.2.e000760.1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2015.1357"},{"key":"2025083109511719000_2.2.e000760.2","unstructured":"CSDH . Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the commission on social determinants of health. Geneva, 2008."},{"key":"2025083109511719000_2.2.e000760.3","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1007\/s40615-016-0335-8","article-title":"Racial\/Ethnic Disparities in Diabetes Quality of Care: the Role of Healthcare Access and Socioeconomic Status","volume":"5","author":"Canedo","year":"2018","journal-title":"J Racial Ethn Health Disparities"},{"key":"2025083109511719000_2.2.e000760.4","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph192114571","article-title":"Disparities in Prevalence and Barriers to Hypertension Control: A Systematic Review","volume":"19","author":"Elnaem","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"2025083109511719000_2.2.e000760.5","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1097\/CRD.0000000000000507","article-title":"Healthcare Disparities in Cardiovascular Medicine","volume":"32","author":"Fishkin","year":"2024","journal-title":"Cardiol Rev"},{"key":"2025083109511719000_2.2.e000760.6","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2022-067429","article-title":"Health inequalities in infectious diseases: a systematic overview of reviews","volume":"13","author":"Ayorinde","year":"2023","journal-title":"BMJ Open"},{"key":"2025083109511719000_2.2.e000760.7","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.ss6609a1"},{"key":"2025083109511719000_2.2.e000760.8","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2007.07040704"},{"key":"2025083109511719000_2.2.e000760.9","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.201500453"},{"key":"2025083109511719000_2.2.e000760.10","doi-asserted-by":"publisher","DOI":"10.1007\/s10880-017-9510-2"},{"key":"2025083109511719000_2.2.e000760.11","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1001\/jamapsychiatry.2015.10","article-title":"Urban vs Rural Residence and the Prevalence of Depression and Mood Disorder Among African American Women and Non-Hispanic White Women","volume":"72","author":"Weaver","year":"2015","journal-title":"JAMA Psychiatry"},{"key":"2025083109511719000_2.2.e000760.12","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1007\/s40615-015-0188-6","article-title":"Racial and Ethnic Disparity in Major Depressive Disorder","volume":"3","author":"Shao","year":"2016","journal-title":"J Racial Ethn Health Disparities"},{"key":"2025083109511719000_2.2.e000760.13","doi-asserted-by":"crossref","DOI":"10.3390\/brainsci8120207","article-title":"Exploring Causes of Depression and Anxiety Health Disparities (HD) by Examining Differences between 1:1 Matched Individuals","volume":"8","author":"Coman","year":"2018","journal-title":"Brain Sci"},{"key":"2025083109511719000_2.2.e000760.14","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/S2215-0366(19)30475-4","article-title":"The burden of mental disorders across the states of India: the Global Burden of Disease Study 1990\u20132017","volume":"7","author":"Sagar","year":"2020","journal-title":"Lancet Psychiatry"},{"key":"2025083109511719000_2.2.e000760.15","article-title":"Depression and Associated Factors Among Older Adults in a North Indian State: A Cross-Sectional Study","volume":"15","author":"Debnath","year":"2023","journal-title":"Cureus"},{"key":"2025083109511719000_2.2.e000760.16","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1038\/s41582-021-00565-x","article-title":"Changing demography and the challenge of dementia in India","volume":"17","author":"Ravindranath","year":"2021","journal-title":"Nat Rev Neurol"},{"key":"2025083109511719000_2.2.e000760.17","doi-asserted-by":"crossref","DOI":"10.1016\/j.dialog.2023.100114","article-title":"Urban-rural and gender differential in depressive symptoms among elderly in India","volume":"2","author":"Kumar","year":"2023","journal-title":"Dialogues Health"},{"key":"2025083109511719000_2.2.e000760.18","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1016\/S2215-0366(22)00186-9","article-title":"Sub-national patterns and correlates of depression among adults aged 45 years and older: findings from wave 1 of the Longitudinal Ageing Study in India","volume":"9","author":"Perianayagam","year":"2022","journal-title":"Lancet Psychiatry"},{"key":"2025083109511719000_2.2.e000760.19","unstructured":"Chadramouli C . Rural urban distribution of population. In: Registrar General & Census Commissioner I, Affairs MOH, editors. 2011."},{"key":"2025083109511719000_2.2.e000760.20","doi-asserted-by":"publisher","DOI":"10.1002\/gps.930100505"},{"key":"2025083109511719000_2.2.e000760.21","doi-asserted-by":"crossref","first-page":"2450","DOI":"10.1002\/alz.12722","article-title":"Srinivaspura Aging, Neuro Senescence and COGnition (SANSCOG) study: Study protocol","volume":"19","author":"Ravindranath","year":"2023","journal-title":"Alz Dement"},{"key":"2025083109511719000_2.2.e000760.22","doi-asserted-by":"crossref","DOI":"10.1002\/alz.076251","article-title":"Recruitment and Retention Strategies Adopted in TATA Longitudinal Study of Aging Study: A prospective Cohort Study on Aging in Urban India","volume":"19","author":"Hs","year":"2023","journal-title":"Alzheimers Dement"},{"key":"2025083109511719000_2.2.e000760.23","article-title":"Rural-urban and gender differences in metabolic syndrome in the aging population from southern India: Two parallel, prospective cohort studies","volume":"47","author":"Sundarakumar","year":"2022","journal-title":"E Clin Med"},{"key":"2025083109511719000_2.2.e000760.24","doi-asserted-by":"publisher","DOI":"10.1016\/0022-3956(82)90033-4"},{"key":"2025083109511719000_2.2.e000760.25","doi-asserted-by":"crossref","first-page":"104002","DOI":"10.1016\/j.archger.2019.104002","article-title":"Diagnostic accuracy of various forms of geriatric depression scale for screening of depression among older adults: Systematic review and meta-analysis","volume":"87","author":"Krishnamoorthy","year":"2020","journal-title":"Arch Gerontol Geriatr"},{"key":"2025083109511719000_2.2.e000760.26","doi-asserted-by":"crossref","first-page":"328","DOI":"10.4103\/ijcm.IJCM_367_18","article-title":"Association of Nutritional Status with Depression and Cognitive Function of Older Women Residing in Old-age Homes of Kolkata, India","volume":"44","author":"Maity","year":"2019","journal-title":"Indian J Community Med"},{"key":"2025083109511719000_2.2.e000760.27","doi-asserted-by":"crossref","DOI":"10.1002\/hsr2.901","article-title":"Depression and anxiety during the first and second waves of the COVID-19 pandemic in two large, prospective, aging cohorts in rural and urban India","volume":"5","author":"Sundarakumar","year":"2022","journal-title":"Health Sci Rep"},{"key":"2025083109511719000_2.2.e000760.28","unstructured":"World Health Organization, Regional Office for the Western P . The Asia-Pacific Perspective: Redefining Obesity and Its Treatment; Sydney Health Communications Australia; 2000."},{"key":"2025083109511719000_2.2.e000760.29","doi-asserted-by":"crossref","unstructured":"Rubin DB . Multiple Imputation for Nonresponse in Surveys. New York: John Wiley & Sons, Inc, 1987.","DOI":"10.1002\/9780470316696"},{"key":"2025083109511719000_2.2.e000760.30","doi-asserted-by":"crossref","first-page":"305","DOI":"10.3233\/JEM-2005-0259","article-title":"An extension of the Blinder-Oaxaca decomposition technique to logit and probit models","volume":"30","author":"Fairlie","year":"2005","journal-title":"JEM"},{"key":"2025083109511719000_2.2.e000760.31","unstructured":"Fairlie JB . Stata module to generate nonlinear decomposition of binary outcome differentials. 2006."},{"key":"2025083109511719000_2.2.e000760.32","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1016\/j.amepre.2018.11.008","article-title":"Urban-Rural Differences in Older Adult Depression: A Systematic Review and Meta-analysis of Comparative Studies","volume":"56","author":"Purtle","year":"2019","journal-title":"Am J Prev Med"},{"key":"2025083109511719000_2.2.e000760.33","doi-asserted-by":"publisher","DOI":"10.1002\/gps.1175"},{"key":"2025083109511719000_2.2.e000760.34","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2020-048090","article-title":"Depressive symptoms in adults in rural and urban regions of Canada: a cross-sectional analysis of the Canadian Longitudinal Study on Aging","volume":"11","author":"St John","year":"2021","journal-title":"BMJ Open"},{"key":"2025083109511719000_2.2.e000760.35","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1080\/13607863.2018.1450839","article-title":"Urbanicity of residence and depression among adults 50 years and older in Ghana and South Africa: an analysis of the WHO Study on Global AGEing and Adult Health (SAGE)","volume":"23","author":"Adjaye-Gbewonyo","year":"2019","journal-title":"Aging Ment Health"},{"key":"2025083109511719000_2.2.e000760.36","doi-asserted-by":"crossref","DOI":"10.1186\/s12888-023-04911-9","article-title":"Life course rural\/urban place of residence, depressive symptoms and cognitive impairment among older adults: findings from the Longitudinal Aging Study in India","volume":"23","author":"Muhammad","year":"2023","journal-title":"BMC Psychiatry"},{"key":"2025083109511719000_2.2.e000760.37","doi-asserted-by":"crossref","first-page":"3","DOI":"10.4103\/0019-557X.152845","article-title":"Prevalence of depression and associated risk factors among the elderly in urban and rural field practice areas of a tertiary care institution in Ludhiana","volume":"59","author":"Sengupta","year":"2015","journal-title":"Indian J Public Health"},{"key":"2025083109511719000_2.2.e000760.38","doi-asserted-by":"crossref","first-page":"2460","DOI":"10.1002\/alz.12726","article-title":"Approaches to engage an aging, rural cohort in southern India during the COVID-19 crisis and the psychological impact of COVID-19 in this cohort","volume":"19","author":"Sundarakumar","year":"2023","journal-title":"Alzheimers Dement"},{"key":"2025083109511719000_2.2.e000760.39","doi-asserted-by":"publisher","DOI":"10.1177\/0898264315591003"},{"key":"2025083109511719000_2.2.e000760.40","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph18062818","article-title":"Rural-Urban Differences in the Factors Affecting Depressive Symptoms among Older Adults of Two Regions in Myanmar","volume":"18","author":"Sasaki","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"2025083109511719000_2.2.e000760.41","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2023.1099260","article-title":"Association between specific social activities and depressive symptoms among older adults: A study of urban-rural differences in China","volume":"11","author":"Han","year":"2023","journal-title":"Front Public Health"},{"key":"2025083109511719000_2.2.e000760.42","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1093\/geronb\/gbac195","article-title":"Living Alone and Depressive Symptoms Among Older Japanese: Do Urbanization and Time Period Matter?","volume":"78","author":"Kobayashi","year":"2023","journal-title":"J Gerontol B Psychol Sci Soc Sci"},{"key":"2025083109511719000_2.2.e000760.43","doi-asserted-by":"crossref","first-page":"102463","DOI":"10.1016\/j.ajp.2020.102463","article-title":"Prevalence of Common mental disorders in older adults: Results from the National Mental Health Survey of India","volume":"55","author":"Sinha","year":"2021","journal-title":"Asian J Psychiatr"}],"container-title":["BMJ Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjph-2023-000760","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T16:51:32Z","timestamp":1756659092000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjpublichealth.bmj.com\/lookup\/doi\/10.1136\/bmjph-2023-000760"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12]]},"references-count":43,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,12,7]]},"published-print":{"date-parts":[[2024,12]]}},"alternative-id":["10.1136\/bmjph-2023-000760"],"URL":"https:\/\/doi.org\/10.1136\/bmjph-2023-000760","relation":{},"ISSN":["2753-4294"],"issn-type":[{"value":"2753-4294","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12]]}}}