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Background: Depression is the leading cause of disability across all age groups worldwide. This, often chronic, condition impacts adversely on morbidity, mortality, and quality of life and leads to increased health expenditure. Older adults with depression are particularly vulnerable. There is evidence that social engagement in the elderly is associated with lower prevalence of depression in high-income countries but this association is not well established in low- and middle-income countries. Our aims are to investigate the association between social engagement and depression in adults aged 50 and over in China and India, and to address the possible factors affecting the association.

Methods: This study used data from World Health Organization’s Study on Adult health and AGEing (WHO-SAGE) wave 1. WHO-SAGE is multi-country longitudinal SAGE survey that aims to gather information on the health and wellbeing of adult populations in low- and middle- income countries. The study population (n=19159) consisted of two samples; China (n=12641) and India (n=6518) of participants aged 50 or more. The dependent variable, depression, was measured using a standardized WHO symptom based algorithm. Information on social engagement, was captured from self-reported responses in the WHO_SAGE questionnaire; a binary independent variable was created for social engagement.

Results: Depression prevalence differed between China and India. China had a two percent prevalence compared to 19 percent prevalence in India. Women had higher prevalence compared with men (2.4 compared to 1.5 in China and 21 compared to 18 in India). Social engagement was associated with low prevalence of depression in China but there was no significant association in India. The association between social engagement and depression in China was not significantly different in the presence of covariates such as socio-demographic characteristics, self-rated health, comorbidities and pain.

Conclusion: Social engagement is independently associated with lower odds of depression odds among adults aged 50 or more in China. Strategies aimed at promoting social engagement in older adults in China can not only lead to decreased prevalence of depression, but they can indirectly impact on mortality, health-care expenditure and quality of life of older adults.