Background: Depression is a substantial global health concern. Physical injury increases the risk for depression. There is limited information on this topic from LMICs, where the prevalence of depression is increasing and burden of injuries is high.

OBJECTIVE:  Assess the association between physical injuries and depression, using community-based, nationally-representative data from 6 LMICs (China, Ghana, Mexico, India, Russia, and South Africa)

Methods: Data from the Study on Global Ageing and Adult Health (SAGE) survey performed between 2007 and 2010 were analyzed (http://www.who.int/healthinfo/sage/en/). The sample consisted of adults aged >18 years. Ethical approval was obtained from WHO Ethical Review Committee and from local ethical boards. Variables were depression, injury, and control variables (socio-demographic). Statistical analysis was performed with Stata 14.1. by using a multivariable logistic regression analysis to assess the association between physical injury variables (exposures) and depression (outcome). A sensitivity analysis and a country-wide analysis were also performed to assess inter-country heterogeneity and results variability.

RESULTS: 42,489 individuals were evaluated; the average age of sampled subjects was 43.8 (14.4); where 50.1% were females. The overall prevalence of depression was 4.1%. Overall, the prevalence of physical injuries with and without disability were, respectively, 1.4% and 6.5% for any injury, 0.4% and 2.0% for injuries due to road traffic accidents, and 1.0% and 4.7% for injuries due to other causes. The prevalence of males, lower levels of wealth and education, rural setting, and alcohol consumption were significantly higher among those who suffered injuries.  The prevalence of depression was higher among those who suffered injuries in the overall sample and also country-wide. The results for the multivariable logistic regression analyses showed that compared to having no injury, any injury without disability (OR=1.72; 95%CI=1.18-2.50) and with disability (OR=3.81; 95%CI=2.16-6.73), were both associated with significantly higher odds for depression.

CONCLUSIONS: In all countries, any injury was associated with higher odds, for depression although the results were not significant in all countries. A moderate level of between-country heterogeneity was observed (I²=63.1%).