The global population is undergoing a continuous shift in its age composition, influenced by rising life spans and declining fertility rates. As people live longer, the number of elderly people in the total population is rapidly increasing. Globally, there were 727 million people aged 65 years or older in 2020. Over the next three decades, the global number of the elderly is projected to more than double, reaching over 1.5 billion in 2050. All regions will see an increase in the size of their elderly population between 2020 and 2050. The share of the global population aged 65 years or over is expected to increase from 9.3% in 2020 to 16% by 2050 (World Health Organization, 2020).

Population aging is a global phenomenon with virtually every country in the world experiencing growth in both the size and the proportion of older persons in the population. In 2019, there were 703 million persons aged 65 years or over in the global population (United Nations Department of Economic and Social Affairs, 2020).

Population aging is a human success story that reflects the advancement of public health, medicine, and economic and social development, and its contribution to the control of disease, prevention of injury, and reduction in the risk of premature death. The extension of human longevity and subsequent decrease in fertility levels inevitably leads to a shift in the population age distribution from younger to older ages. This demographic trend presents both opportunities and challenges for society, particularly in terms of healthcare needs and psychological well-being of the elderly population.

The purpose of the current study was to assess the prevalence of depression, anxiety, and stress in the elderly living in Manchi village, Karnataka, and to identify the factors associated with these psychological issues.

A cross-sectional study was conducted in the Manchi Grama Panchayat, Bantwal Taluk, and Dakshina Kannada districts. The study population was comprised of elderly individuals residing in their families in this region.

The cross-sectional study was conducted from April 2022 to October 2022. The inclusion criteria were: (1) individuals aged 60 years and above, (2) residing with their families in Manchi Grama panchayat, and (3) willing to participate in the study. Exclusion criteria included: (1) individuals with known psychiatric disorders, (2) those taking psychotropic medications, (3) those with severe cognitive impairment, and (4) those unable to communicate.

The required sample size for this study was determined using the following formula: N= 4pq/d². Where p=prevalence proportion, q=1-p, d=desired level of absolute precision, and N=required sample size. Considering the prevalence of depression among the elderly in a previous study (Mandolikaret al., 2017) to be 75.5% (p=0.755), relative precision (d=10% of p=7.5%), and 10% of the non-response rate/sample loss, the calculation was: N=3.84×0.755×0.245/(0.075)² = 126. By adding a 10% non-response rate, the final sample size was 138.

Stratified sampling was used in this study. There were 822 elderly individuals distributed among the seven wards in Manchi Village. As the total sample size was 138, 20 elderly individuals were randomly selected from each ward using a simple random sampling. Twenty elderly individuals were selected from each of the six wards, and eighteen elderly individuals were selected from the seventh ward to reach a sample size of 138.

Elderly individuals aged above 60 years.

Those residing with their families in rural areas of Karnataka.

Those who are physically and mentally capable of responding to the survey or interview.

Elderly individuals living alone or in institutional settings, such as old-age homes.

Those who refused to provide consent for the study.

Before conducting the study, the investigator submitted a synopsis and a request letter for ethical clearance to the Yenepoya Ethics Committee-2. The study was approved with protocol number YEC-1/2022/044 for the period from April 6, 2022, to October 5, 2022.

Three tools were used for data collection.

1)Socio-demographic questionnaire: A self-designed tool for collecting data on sociodemographic variables including age, sex, religion, marital status, educational level, occupation, residence, monthly income, morbidities, and family details.

2)Depression Anxiety Stress Scale (DASS-42): This scale assesses symptoms of depression, anxiety, and stress in adults using a 42-item questionnaire (Lovibond and Lovibond, 1995). Each item was rated on a 4-point Likert scale ranging from 0 (did not apply to me) to 3 (applied to me very much). The DASS-42 measures the severity of a range of symptoms that are common to depression, anxiety, and stress.

3)UCLA Loneliness Scale (Version 3): This scale was used to assess loneliness among older adults (Russell, 1996). The UCLA-LS consists of 20 statements (11 negative and 9 positive), to which responses are given on a 4-point Likert-type scale ranging from 1 (never) to 4 (often). Statement scores range from 20 to 80, with higher scores indicating higher levels of loneliness (Panayiotouet al., 2023).

Data were entered in Microsoft Excel, and SPSS software was used for statistical analysis. Categorical variables were presented as frequencies and percentages. The chi-squared test was used to determine the association between different variables. Statistical significance was set at p<0.05.

Out of the 138 questionnaires handed out, every patient consented to participate in the interviews. Slightly more than half of the participants (63%) were women, a majority (50%) were married, and nearly half (44.9%) were between the ages of 60 and 64. Most participants were part of nuclear families (57.2%), lacked formal education (73.2%), and were financially independent (88.4%). A large proportion (94.2%) suffered from chronic illnesses, with diabetes (40.5%) and a combination of diabetes and hypertension (31.8%) being the most prevalent conditions (Table 1).

The study findings indicate that the majority of the elderly participants (63.8%) had a normal mental health status. However, a considerable proportion (36.2%) exhibited symptoms of depression (Table 2).

Table 3 presents the distribution of participants based on their level of depression. The majority of the participants (63.8%) had normal mental health, with depression scores ranging from 0 to 9. Mild depression (scores between 10 and 13) was observed in 14.4% of the participants, while 10.1% experienced moderate depression (scores between 14 and 20). Additionally, 10.1% of the participants were classified as having severe depression, with scores of 21 and above.

Table 4 presents the distribution of participants based on their level of anxiety. Only 14.4% of participants had normal levels of anxiety (scores ranging from 0 to 7). Mild anxiety (scores between 8 and 9) was the most prevalent, affecting 43.4% of the participants. Additionally, 20.2% of the participants experienced moderate anxiety (scores between 10 and 14), while 21.7% reported severe anxiety, with scores of 15 and above.

Table 5 presents the distribution of participants based on their level of stress. The results indicate that 28.3% of the participants had normal stress levels, with scores ranging from 0 to 14. Mild stress (scores between 15 and 18) was the most prevalent, affecting 46.4% of the participants. Additionally, 13.0% of the participants experienced moderate stress (scores between 19 and 25), while 12.3% reported severe stress, with scores of 26 and above.

Table 6 shows that the only significant association with depression among the elderly was the type of family (p=0.022), where those from nuclear families had higher depression levels compared to those from joint families. Other factors such as age, gender, marital status, education, financial dependence, and the presence of chronic disease did not show statistically significant associations with depression.

Table 7 presents the gender differences in loneliness among elderly participants. The mean loneliness score for males is 26.40±5.75, while for females, it is slightly higher at 27.41±5.6. However, the t-value (1.005) and p-value (0.317) indicate that this difference is not statistically significant.

The 60-64 age group reports the highest levels of depression (33.3%) and anxiety (42.3%), while the 71-80 group experiences the most stress (25.2%). Males show higher anxiety (73.7%) and stress (60.6%) levels, whereas females have higher depression rates (60%). However, no significant differences are found (p=0.73). Widowed individuals report the highest depression (58%) and stress (33.3%), but no considerable associations are observed (p=0.92). Nuclear families have higher depression (90%) and stress (71.7%) rates, yet no significant differences are noted (p=0.89) (Table 8).

This cross-sectional study conducted among elderly residents of Manchi village in rural Karnataka reveals important insights into the mental health status of the elderly. Our findings indicate that a substantial proportion of elderly individuals experience psychological distress, with varying degrees of depression, anxiety, and stress.

In our study, it was found that 63.8% of the study participants did not have any kind of depression, while 36.2% had some level of depression. The prevalence of depression in our study is higher than that reported by Sahni et al., (2020) from North India, who found that depression was present in 40.7% of the elderly. A lesser prevalence was also found in a study done by Bincy et al., (2021) in Tamil Nadu wherein they found that the prevalence of depression was 67.5%. The substantial variation in the prevalence of depression across different studies can be attributed to various factors including socio-cultural differences, economic conditions, study settings, and the assessment tools used.

Our study revealed that 10.1% of participants had moderate levels of depression, 10.1% had severe depression, and 14.4% had mild depression. These findings differ from other studies which have reported mild to moderate depression to be around 33.2%. The variations in the severity of depression among elderly populations across different studies highlight the complex nature of this mental health issue and the influence of various factors on its manifestation.

With regard to anxiety, the majority of participants (43.4%) had mild anxiety, 21.7% had severe anxiety, and 20.2% had moderate anxiety. These findings are lower than those reported by Thagunna et al., (2020), who reported severe anxiety in 85.5% of the elderly, and 20.2% of the total participants reported a moderate level of anxiety. The different prevalence rates of anxiety could be due to variations in socio-economic factors, cultural contexts, and support systems available to the elderly in different regions.

In terms of stress levels, 46.4% of participants had mild stress, 12.3% had severe stress, and 13% had moderate stress. Similar findings were reported by Varghese et al., (2020), who found that 46.7% of the elders had moderate stress, followed by 30% with high levels of stress. Stress has been a major mental health problem affecting a large portion of the population globally, with prevalence rates ranging from 10% to 55%.

A significant finding of our study was the association between depression and family type, with higher depression levels observed in nuclear families compared to joint families. This aligns with traditional Indian values where joint families are believed to provide better emotional and social support to the elderly. The lack of this support system in nuclear families may contribute to feelings of isolation and subsequently, depression among the elderly. However, no statistically significant associations were found between depression and other demographic variables such as age, gender, marital status, education, financial dependence, or the presence of chronic diseases.

Gender differences were observed in the prevalence of different psychological issues. Depression was more common among females (60%) compared to males (40%), although this difference was not statistically significant. A different pattern was seen with anxiety and stress, where males showed higher prevalence rates (73.7% for anxiety and 60.6% for stress) compared to females. These gender differences could be attributed to various factors including societal roles, coping mechanisms, and physiological differences.

Marital status also appeared to influence psychological well-being, with widowed individuals reporting the highest rates of depression (58%) and stress (33.3%). This could be attributed to the loss of a life partner and the subsequent changes in lifestyle and social interactions. However, these associations were not statistically significant.

Loneliness, another important aspect of psychological well-being among the elderly, showed a slightly higher mean score among females (27.41) compared to males (26.40), although this difference was not statistically significant. Loneliness is a complex emotion that can be influenced by various factors including social connections, family support, and individual personality traits.

These findings highlight the complex interplay of various demographic, social, and health factors in influencing the psychological well-being of the elderly population. The high prevalence of depression, anxiety, and stress in this study population emphasizes the need for targeted interventions to address these mental health issues among the elderly, particularly in rural settings.

The study reveals a concerning prevalence of depression, anxiety, stress, and loneliness among the elderly living in families in rural Karnataka. A significant portion of the participants (36.2%) experience varying degrees of depression, while anxiety (85.6%) and stress (71.7%) are also prevalent, indicating critical mental health challenges within this demographic. The findings highlight the impact of various socio-demographic factors, including age, gender, marital status, and family structure, on mental health outcomes.

Given the high rates of chronic diseases and low literacy levels, there is an urgent need for targeted mental health interventions and educational programs that address both physical and psychological well-being. Community-based initiatives that promote social interaction and support can help mitigate feelings of isolation and improve the overall mental health of the elderly.

We gratefully acknowledge the local Grama Panchayat for granting permission to conduct this study. We extend our sincere appreciation to all the participants for their valuable contributions. We also thank Yenepoya (Deemed to be University) for its support throughout the course of this research.