Individual and area-level factors associated with depression in indonesia: a multilevel analysis using the 2018 national basic health research

Background: Depression has become the leading cause of disease burden in low- and middle-income countries. However, evidence on the determinants of depression in those countries has been limited. This study aims to identify the factors in individual and area levels associated with depression using existing nationally representative data in Indonesia. Methods: Multilevel mixed-effects logistic regression models were performed on various national-scale Indonesian cross-sectional surveys and Indonesian Population Census to estimate those associations. We included adults aged 18 + who participated in the National Basic Health Research 2018 in this study. Depression was measured using the Mini International Neuropsychiatric Interview (MINI). Individual level variables include demographic characteristics, socioeconomic status, history of diseases, health behaviours, healthcare accessibility, and familial history of psychosis. District-level variables include the availability of health providers and professionals, regional gross domestic product, and the happiness index. Results: We found that individual-level factors, i.e., education, occupation, marital status, economic status, comorbidities, health behaviours, and difficulty with healthcare access were associated with the risk of depression. Happiness index as district-level factor, is related to the odds of depression. District-level factors, including the availability of general practitioners and mental health professionals and the density of healthcare providers, had no significant association with depression. The measured variables provided modest explanatory value overall. Conclusion: Individual-level factors are associated with depression among adults in Indonesia. Among the district level factors, only happiness index is related to depression. These results strengthen previous studies which stated determinants at the individual level are an important factor in depression. Therefore, effective prevention programs in mental health need to target both individuals and families.