European Journal of Cardiovascular Medicine

Population ageing has become an important public health transition, and mental health in later life now requires the same attention as chronic physical morbidity. Depression in older adults is not only a mood disorder; it is linked with functional decline, poor adherence to treatment, reduced social participation, cognitive difficulties and diminished quality of life [1]. The clinical expression of depression in late life is often subtle. Many elderly individuals present with sleep disturbance, fatigue, body pain, irritability, loss of interest or social withdrawal rather than direct reporting of sadness. These features increase the chance of under-recognition in community and primary care settings [1,14].

The burden of geriatric depression differs across populations because of variations in screening tools, social context, family structure, comorbidity patterns and access to health care. A global meta-analysis reported a substantial pooled burden of depression among older adults, confirming that depressive morbidity in later life is a consistent international concern [3]. In India, a systematic review and meta-analysis of community-based studies estimated that approximately one-third of elderly individuals had depression, with higher estimates in females, rural populations and studies using screening scales such as the Geriatric Depression Scale [4]. These observations highlight the need for local community data, especially from semi-urban and rural Indian settings where older adults face social dependency, health care barriers and changing family support systems.

Perceived stress is another relevant psychological construct in ageing. It reflects the extent to which individuals appraise situations in their life as unpredictable, uncontrollable or overwhelming [8]. In older adults, stress arises from chronic illness, bereavement, financial dependence, reduced mobility, social isolation and role loss. The Perceived Stress Scale has been validated for use among older adults and is useful for understanding subjective stress experiences in community samples [7,8]. Longitudinal evidence shows that higher perceived stress increases the risk of subsequent depression among community-dwelling older adults, indicating that stress assessment has preventive value in geriatric mental health care [9].

Social and clinical vulnerabilities amplify mental health risk in the elderly. Widowhood and living alone are associated with higher depressive symptoms among older adults in India [10]. Similarly, multimorbidity and chronic physical illness increase the probability of depression through pain, disability, treatment burden and reduced independence [11]. Community-based screening can therefore identify high-risk groups before depressive symptoms become severe or disabling.

The present study was conducted with the objective of estimating the prevalence of depression and perceived stress among elderly individuals in a community setting in the Sangareddy population. The study also aimed to assess the association of depression with age, sex, living arrangement, marital status, chronic illness and perceived stress level.

Study design and setting: This was a community-based cross-sectional observational study conducted among elderly individuals from the Sangareddy population, Telangana, India. The study was carried out from November 2025 to March 2026. The community setting included elderly residents living with family members as well as those living alone within the selected field area. Study population: The study population consisted of elderly individuals aged 60 years and above who were permanent residents of the selected community area. A total of 100 eligible elderly participants were included. Participants were approached at the household level, and data were collected after explaining the study purpose in a simple and understandable manner. Eligibility criteria: Individuals aged 60 years and above who were willing to participate and able to respond to the interview were included. Elderly individuals with severe hearing impairment preventing interview, severe cognitive impairment, acute medical illness requiring urgent care, or unwillingness to participate were excluded. Repeat inclusion from the same participant was avoided. Study tools: A structured proforma was used to collect socio-demographic and clinical details, including age, sex, marital status, living arrangement, educational status and history of chronic illness. Depression was assessed using the Geriatric Depression Scale, a widely used screening instrument for older adults [5,6]. Perceived stress was assessed using the Perceived Stress Scale, which measures the subjective appraisal of stress and has been validated in older adult community samples [7,8]. Operational definitions: Depression was classified as no depression, mild depression, moderate depression and severe depression according to standard Geriatric Depression Scale scoring categories. Perceived stress was classified as low, moderate and high based on standard Perceived Stress Scale categories. Moderate-to-high perceived stress was considered clinically relevant for community-level interpretation. Data collection procedure: Data were collected through face-to-face interviews by using the structured questionnaire. Each interview was conducted in a private and respectful environment to reduce reporting hesitation. Responses were checked for completeness at the time of collection. Participants with marked depressive symptoms or high perceived stress were advised to seek further evaluation from a qualified health professional. Statistical analysis: Data were entered into a spreadsheet and analysed using descriptive and inferential statistics. Continuous variables were expressed as mean and standard deviation, while categorical variables were presented as frequency and percentage. The chi-square test was used to assess associations between depression and selected variables. A p-value of <0.05 was considered statistically significant. Ethical considerations: The study followed ethical principles of voluntary participation, confidentiality and respect for elderly participants. Written informed consent was obtained before enrolment. Personal identifiers were not used during analysis. The study was observational and did not interfere with routine health care or personal treatment decisions.

A total of 100 elderly individuals from the community were included in the study. The mean age of the study population was 70.4 ± 7.1 years. Most participants belonged to the 60-69 years age group, followed by 70-79 years. Females constituted 52.0% of the sample. More than half of the participants were married, while 38.0% were widowed. Nearly two-thirds had at least one chronic medical illness. The baseline socio-demographic characteristics are shown in Table 1.

Table 1. Socio-demographic characteristics of the study population

Depressive symptoms were observed in 46.0% of the elderly participants. Mild depression was the most common category, noted in 28.0% of participants, followed by moderate depression in 14.0% and severe depression in 4.0%. No depression was observed in 54.0% of the study population. The distribution of depression severity is presented in Table 2.

Table 2. Prevalence and severity of depression among elderly individuals

Note: Overall depression present includes mild, moderate and severe depression.

Perceived stress was also common among the elderly participants. Moderate perceived stress was reported by 52.0% of the participants, while high perceived stress was observed in 25.0%. Low perceived stress was noted in 23.0% of the study population. Overall, 77.0% of participants had moderate-to-high perceived stress levels, as shown in Table 3.

Table 3. Distribution of perceived stress among elderly individuals

Depression was more frequent among participants aged 80 years and above, those living alone, widowed participants and those with chronic illness. Depression was observed in 70.0% of participants aged 80 years and above compared with 33.3% among those aged 60-69 years. Similarly, depression was higher among participants living alone than among those living with family. The association of depression with selected demographic and clinical variables is shown in Table 4.

Table 4. Association of depression with selected variables

A clear relationship was observed between perceived stress and depression. High perceived stress was present in 7.4% of participants without depression, 32.1% of those with mild depression and 66.7% of those with moderate-to-severe depression. This association was statistically significant, indicating that higher perceived stress was closely linked with increasing depression severity among elderly individuals in the community setting (Table 5).

Table 5. Relationship between depression severity and perceived stress

Overall, the study showed that nearly half of the elderly individuals had depressive symptoms, while more than three-fourths had moderate-to-high perceived stress. Advanced age, living alone, widowed or single status, chronic illness and higher perceived stress were important factors associated with depression in this community-based elderly population.

The present community-based study found that depressive symptoms were present in 46.0% of elderly individuals, while moderate-to-high perceived stress was present in 77.0%. These findings show a considerable psychological burden among older adults in the Sangareddy population. The observed prevalence of depression is higher than the pooled Indian estimate of 34.4% reported by Pilania et al. and is also above several global pooled estimates, although direct comparison is influenced by screening tool, age composition and local social conditions [3,4]. Community studies using screening scales often report wider prevalence ranges because they identify subclinical and mild depressive symptoms in addition to clinically severe depression [2,4].

Mild depression accounted for the largest share of depressive symptoms in the present study. This pattern is consistent with the understanding that late-life depression commonly begins with low-grade symptoms, reduced interest, sleep problems and social withdrawal before progressing to more disabling forms [1,14]. The finding is important because mild depression in elderly individuals still affects daily functioning, health-seeking behaviour and quality of life. It also provides an opportunity for early counselling, family support and primary care follow-up before symptoms become severe.

Depression increased with advancing age and was highest among participants aged 80 years and above. Similar age-related vulnerability has been reported in Indian and international studies, where older age is linked with dependency, bereavement, sensory impairment, reduced mobility and higher chronic disease burden [2,12]. In the present study, chronic illness was significantly associated with depression. This agrees with evidence that multimorbidity increases depressive symptoms through physical limitation, pain, medication burden and loss of independence [11]. Therefore, geriatric care should not separate physical and mental health assessment.

Living alone and widowed/single/separated status were significantly associated with depression. This finding supports evidence from India showing that widowhood and living alone increase depressive vulnerability among older adults [10]. Family support remains a major protective factor in Indian elderly populations, and reduced social contact can intensify emotional distress, perceived helplessness and neglect of health needs. Screening elderly individuals who live alone should therefore be considered a priority during community health visits.

The strong association between perceived stress and depression was one of the central findings of this study. High perceived stress increased progressively from participants without depression to those with moderate-to-severe depression. This graded pattern is consistent with longitudinal evidence showing that higher perceived stress predicts future depression among community-dwelling older adults [9]. Stress-focused interventions, social participation and family-based support have shown value in reducing depressive burden among community-dwelling elderly populations [13]. The present findings support routine use of brief mental health screening tools at community level, especially among elderly individuals with chronic illness, social isolation and high perceived stress.

Limitations

This study was limited by its cross-sectional design, which restricted causal interpretation between perceived stress and depression. The sample size was 100 and was drawn from a single community population, reducing wider representativeness. Depression and stress were assessed using screening tools rather than clinical diagnostic interviews. Self-reported responses were influenced by recall, literacy level and willingness to disclose psychological symptoms.

Depression and perceived stress were common among elderly individuals in the Sangareddy community population. Nearly half of the participants had depressive symptoms, and more than three-fourths had moderate-to-high perceived stress. Depression was significantly associated with advanced age, living alone, widowed or single status, chronic illness and higher perceived stress. These findings support the need for routine community-level screening of older adults, particularly those with social isolation and chronic medical conditions. Early identification, family involvement, primary care referral and stress-reduction support can improve psychological well-being and reduce the hidden burden of geriatric mental health problems in community settings through local health workers, family caregivers and regular primary care contact systems safely.

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