Late-life depression in sub-Saharan Africa: a stratified meta-analysis of prevalence by diagnostic method and study setting

BACKGROUND: Depression among older adults in Sub-Saharan Africa (SSA) is an increasing public health concern. This is the first meta-analysis to report stratified prevalence estimates based on assessment method (diagnostic vs. screening) and study setting (community vs. condition-specific). DATA SOURCES: PubMed, Embase, Web of Science and CINAHL were systematically searched through July 2024. METHODS: Studies assessing depression in adults aged ≥60 years in SSA using validated screening tools or structured diagnostic criteria were included. Random-effects meta-analyses were stratified into four groups: (i) community-based studies using diagnostic interviews, (ii) community-based studies using screening tools, (iii) condition-specific studies using diagnostic interviews, and (iv) condition-specific studies using screening tools. Moderator analyses, heterogeneity assessments and publication bias evaluations were conducted. RESULTS: Forty-six studies with 34 130 participants were included. Pooled prevalence varied by method and setting. Among community-based studies using diagnostic interviews, prevalence was 13% (95% CI: 8%-21%). Those using screening tools reported 30% (95% CI: 24%-38%). In condition-specific settings, diagnostic interview studies showed a 26% prevalence (95% CI: 17%-38%), while screening-based studies showed the highest prevalence at 38% (95% CI: 29%-49%). CONCLUSION: Depression is common among older adults in SSA, especially in clinical populations and when assessed using screening tools. These findings highlight the need for localised mental health policies, especially where diagnostic resources are limited.