Unveiling the Hidden Burden: Prevalence of Depression among the Destitute in Kerala, India.

Abstract

Background: In developing countries like India, literature on the destitute primarily addresses their economic and livelihood vulnerabilities, often overlooking their mental health. Depression, which contributes to the global burden of disease, is a chronic and prevalent mental health condition. Most destitute populations, identified by the Multidimensional Poverty Index, are concentrated in low-income and lower-middle-income countries, with India hosting the largest destitute population.

Methods: This paper examines the prevalence of depression among Kerala's destitute population. Data were collected from 440 respondents via stratified sampling, drawn from the Destitute Free Kerala project, a state government initiative aimed at eradicating destitution, with participants selected from three geographically representative districts: Alappuzha, Kottayam, and Idukki. The 20-item Center for Epidemiologic Studies Depression Scale (CES-D) and a study-specific questionnaire were used. Analysis employed univariate and multivariate logistic regression.

Results: The mean CES-D score was 21.80 (SD 5.55) with a median of 21.0, indicating a high prevalence of depression within the studied population. Variables significantly associated with depression included sudden health shocks (AOR = 3.44, 95% CI [2.10, 5.64], P < 0.001), chronic health problems (AOR = 3.70, 95% CI [2.22, 6.17], P < 0.001), education level (AOR = 0.67, 95% CI [0.44, 1.01], P = 0.056 for high school and above compared to primary education or below), and marital status (AOR = 3.65, 95% CI [1.64, 8.13], P = 0.001 for married compared to unmarried individuals).

Conclusion: Findings underscore the need for robust mental health components in policies and interventions targeting this vulnerable, highly deprived population.