Unveiling the Hidden Burden: Prevalence of Depression among the Destitute in Kerala, India

In developing countries like India, literature on the destitute primarily addresses their economic and livelihood vulnerabilities, often overlooking their mental health. Depression, which contributes to the global burden of disease, is a chronic and prevalent mental health condition. Most destitute populations, identified by the Multidimensional Poverty Index, are concentrated in low-income and lower-middle-income countries, with India hosting the largest destitute population.

This paper examines the prevalence of depression among Kerala's destitute population. Data were collected from 440 respondents via stratified sampling, drawn from the Destitute Free Kerala project, a state government initiative aimed at eradicating destitution, with participants selected from three geographically representative districts: Alappuzha, Kottayam, and Idukki. The 20-item Center for Epidemiologic Studies Depression Scale (CES-D) and a study-specific questionnaire were used. Analysis employed univariate and multivariate logistic regression.

The mean CES-D score was 21.80 (SD 5.55) with a median of 21.0, indicating a high prevalence of depression within the studied population. Variables significantly associated with depression included sudden health shocks (AOR = 3.44, 95% CI [2.10, 5.64], P < 0.001), chronic health problems (AOR = 3.70, 95% CI [2.22, 6.17], P < 0.001), education level (AOR = 0.67, 95% CI [0.44, 1.01], P = 0.056 for high school and above compared to primary education or below), and marital status (AOR = 3.65, 95% CI [1.64, 8.13], P = 0.001 for married compared to unmarried individuals).

Findings underscore the need for robust mental health components in policies and interventions targeting this vulnerable, highly deprived population.