Distribution and association of road traffic accident with depression among Indian population aged 45 years and above: nested multilevel modelling analysis of nationally representative cross-sectional survey.

Introduction: The prevalence of important public health problems like road traffic accidents (RTA) and depression are surging. This study was aimed to estimate distribution and determine the association between RTA and depression among Indian population aged 45 years and above: overall and stratified into age group, gender and across states/union territories as aspirants, achievers, and front runners.

Methods: Using Longitudinal Aging Study in India (LASI) dataset (April 2017-December 2018), we have conducted this study among middle aged (45-59 years) and older adults and elderly (≥ 60 years) Indians. Bivariate analysis was conducted to estimate the prevalence of RTA and depression nationally and across aspirants, achievers, and front runner states. States and union territories were categorised as low, medium, and high as per RTA and depression prevalence, which were further cross tabulated. Spatial distribution maps were created using Microsoft Excel. We have documented the association of RTA with depression. To reduce the confounding effects of demographic and socioeconomic; health related and behavioural covariates; propensity score matching (PSM) was conducted. Nested multilevel regression modelling was analysed using STATA version 17.

Results: Prevalence of RTA was 1.84% (1.74-1.94) nationally, highest among achiever states [2.04% (1.82-2.30)]. Prevalence of depression was 6.08% (5.90-6.26) nationally, highest among aspirant states [7.02% (6.74-7.30)]. The adjusted odds of having RTA was significantly among depressed [aOR (95% CI) 1.76 (1.45-2.15)] than non-depressed participants; which was much higher among females [aOR (95% CI) 1.93 (1.43-2.62)] than in males [aOR (95%CI) 1.67 (1.29-2.16)] and much higher among middle aged [aOR (95%CI) 2.08 (1.63-2.65)]. Odds of RTA was highest across front runners [aOR (95%CI) 1.86 (1.26-2.72)] followed by aspirant states [aOR (95%CI) 1.79 (1.37-2.33)].

Conclusion: This study established the positive association between depression and road traffic accidents among middle aged, older adults and elderly. Therefore, efforts must be taken to address mental health issues in them with proper policy implication more focused on females and middle aged. Front runner's states should get the limelight followed by aspirant states.