Background Consistent evidence has linked depression to social factors among older people in rich countries; however, little is known for low- or middle-income countries (LMIC) and virtually no research exists that is comparable across LMIC. Understanding the relationship between key socioeconomic factors and depressive symptoms among older people in resource-poor contexts is essential for developing mental health policies.

Methods To investigate social determinants of depressive symptoms among older adults in LMIC, we conducted a cross-sectional analysis of adults age 50+ from 51 countries that participated in the World Health Survey in 2002–2003. Using multivariable ordinal logistic regression models, we examined the association between socioeconomic predictors and the severity of depressive symptoms.

Results Similar to patterns from rich countries, more severe depressive symptoms were reported among older, female, less-educated, poorer, and urban-dwelling individuals. Living arrangement also emerged as an important predictor that exhibited substantial heterogeneity across countries. In Southeast Asian countries, the odds of reporting more severe depressive symptoms was 2.6 (95% CI 1.5 to 4.7) times higher for individuals living alone compared to in intergenerational households. In African countries, individuals living in skipped-generation households (only older people and dependent children) reported significantly worse symptoms. Further analyses will incorporate country-level predictors (eg, availability of pensions, HIV/AIDS mortality) to explain some between-country variation.

Conclusions In addition to established socioeconomic determinants, living alone or in skipped generation households is associated with an increased risk of depressive symptoms among older people.