Depression among pet owners and non-pet owners: a comparative cross-sectional study in Dhaka, Bangladesh

Introduction

Pet animals can play enormous roles in the lives of humans by providing company, support, and entertainment. There is evidence that the companionship of a household pet can improve human psychological health through the development of strong emotional bonds (Wells, 2009). It has been observed that interaction with animals strengthens the human consciousness in terms of behavior, attitude, responsibility, and social support (Serpell, 1999). A survey of Americans aged 65 years and older revealed that in some groups, levels of depression were lower among pet owners than in non-pet owners, but the overall picture was complex (Garrity, Stallones, Marx, & Johnson, 1989). Another study demonstrated that the presence of a resident dog for over two years reduced depression among the older residents of a nursing home (Crowley-Robinson, Fenwick, & Blackshaw, 1996). Furthermore, a meta-analysis suggested that animal-assisted activities significantly reduces the symptoms of depression (standard deviation, SD = 0.61, 95% confidence interval, CI = 0.03–1.19) (Souter & Miller, 2007). However, several research studies have also found that pet owners were in no better health than non-pet owners, or in some instances were even in worse health (Herzog, 2011).

Depression is a challenging public health problem, and often first manifests in teenagers or those in their early 20s or 30s (National Institute of Mental Health, 2015). The World Health Organization has long predicted that depression would become a leading contributor to disease burden in terms of disability-adjusted life years (DALY) calculated for all ages (WHO, 2001). Currently, there are more than 300 million sufferers of depression worldwide; nearly half of these people live in South-East Asia and the Western Pacific Region (WHO, 2017a). In Bangladesh, 4.1% of the population has a depressive disorder, responsible for 7.1% of the country's entire DALY (WHO, 2017b).

Establishing a human–animal bond is just one of many well-known methods for managing depression. However, no study to date has examined this in Dhaka, Bangladesh. The principle aim of this study was to scrutinize the association between housing a pet animal and human depression in Dhaka. In particular, we compared depression in pet owners with that in non-pet owners, and analyzed other confounding associations with depression status.

Methods

Ethical approval

Before data was collected, formal approval was granted by the Institutional Review Committee of North South University, Dhaka, Bangladesh. Participants in the online survey responded anonymously and indicated their informed consent in the first section of the e-questionnaire; they were informed that completion of the questionnaire would denote the consent to participate in the study. Written informed consent was obtained before face-to-face interviews. Despite the methodology describing the minimum age as 13, all respondents (18 years and older) were adults in Bangladesh, therefore, parental/guardian’s consent was not sought.

Questionnaire

The questionnaire was divided into two sections: sociodemographic questions and assessment of depression. Copies of the online and offline questionnaires are found in the Extended data.

Section 1: This section comprised a brief set of sociodemographic questions asking for the participant's current residence, age, gender, marital status (married, unmarried, divorced, or widowed), height, weight, monthly household income, employment status (job holder, business owner, homemaker, other,), educational status (primary or less, secondary, higher secondary, college degree and higher), and religion (Islam, Hinduism, Buddhism, Christianity).

This section also asked a few lifestyle-related questions on smoking and alcohol drinking habits (yes, no, or occasionally) and physical disability that leaves them unable to work (yes or no). Finally, this section asked whether or not participants owned a pet; those indicating at least one pet were further asked what type of pet they owned, the purpose of owing the pet, and for how long had they owned that pet.

Section 2: Depression was measured using the Patient Health Questionnaire 9 (PHQ-9) depression scale. PHQ-9 is scored from the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire (PRIME-MD PHQ). It consists of nine questions aimed at detecting the symptoms of depression and a question to assess functional impairment. The authors of a validation study concluded that PHQ-9 is a reliable and accurate measure of depression severity and significance from a clinical and research perspective (Kroenke, Spitzer, & Williams, 2001).

The responses to each question on the questionnaire are scored on a scale from 0 to 3 to give a total score ranging from 0 to 27. The responses to the questions indicate the occurrence of depressive symptoms over the previous two weeks with or without household pets. Responses were coded as 0 = not at all; 1 = several days; 2 = more than half the days; 3 = nearly every day. The total score represents the status of depression: <9 = absence of depression, ≥10 = presence of depression (Manea, Gilbody, & McMillan, 2012).

Data analysis

The dataset template was designed using IBM SPSS (Statistical Package for the Social Sciences) version 21, and analysis was performed using STATA 15 (Software for Statistics and Data Science). Cross tabulation was used to compare characteristics between the groups. A chi-square test was used with a significance level set at alpha <0.05 to determine the percentages and p-values for the categorical variables. An independent sample t-test was used to compare the means of all continuous variables between the groups.

A binary logistic regression was performed to estimate the odds ratio with a 95% confidence interval to determine the odds that a participant would meet the criteria for depression status based on current pet ownership, controlling for age, gender, marital status, BMI status, monthly household income, occupation, education, religion, use of tobacco and alcohol, physical disability, and difficulty in working.

For analysis, some variables were categorized as dichotomous due to the small sample size. These variables were age group (>30 years, <30 years), marital status (married, unmarried), monthly household income (>60000 BDT, ≥60000 BDT), education (>12 years, others), religion (Muslim, others), tobacco use (yes, no), alcohol consumption (yes, no), difficulty in working, taking care of things or getting along with people with respect to PHQ-9 responses (yes, no).

Results

A total of 290 participants enrolled in this study. Of these, 10 were omitted for giving incomplete answers, therefore, the final number of respondents was 280, comprising 140 pet owners and 140 non-pet owners, thus maintaining the 1:1 ratio of group sizes. Table 1 shows the mean and standard deviation age and PHQ-9 scores for the pet owners and non-pet owners taking part in this study.

Table 2 depicts the background characteristics, behavioral factors, disability status, and depression classification by pet ownership group. There were more female participants than male participants among pet owners (68.6% vs 31.4%), whereas there were more males than females for the non-pet owners (52.1% vs 47.8%). Marital status, age, religion, education level, tobacco and alcohol consumption, and monthly household income did not differ significantly between groups (p ≥ 0.05). Job holders constituted 34.3% of pet owners and 61.4% of non-pet owners in terms of occupation. “Other occupation” was reported by 45.7% of pet owners and 29.3% of the non-owning group. According to the data on religion, 93.6% of pet owners and 90.0% of the non-pet owners are Muslim, whereas in both groups, a small proportion (pet owners = 6.4%, non-pet owners = 10.0%) were of other religious denominations. A similar educational status was recorded for both groups, and more than 80% of the participants had >12 years of schooling.

The tobacco consumption rate among pet owners was 22.9%, and among non-pet owners, it was 29.3%. In total, 13.6% of the pet owners consume alcohol, whereas 10.0% of the non-pet owners drink alcohol. Only 5.7% of the pet owners reported having a physical disability, whereas for non-pet owners, the proportion was 7.1%.

There was a statistically significant difference in BMI status between the groups. The underweight rate was three times higher among pet owners (15.0%) than in non-pet owners (5.0%). The proportion of overweight pet owners was 22.9%, and 30.7% for non-pet owners. Regarding PHQ-9 responses, 41.4% of pet owners and 55.7% of non-pet owners reported difficulty working, taking care of things, or getting along with people. Moreover, 7.9% of the pet owners were obese compared to 12.1% of non-pet owners.

A detailed breakdown of pet ownership showed that 66.4% were cat owners, whereas 6.4%, 3.6%, and 1.4% owned dogs, birds, and rabbits, respectively. Other participants had more than one type of pet (Figure 1).

Figure 1. Pet ownership vs pet preferences.

In terms of priorities for choosing a pet, 89.3% of owners keep pets primarily for companionship (Figure 2). A total of 70.7% (n = 99) of the pet owners had owned their pet for <75 months, whereas the rest 29.3% (n = 41) had owned their pet for longer.

Figure 2. Purpose of having pets.

Table 3 outlines the results of the bivariate logistic regression with a 95% confidence interval. Of the 13 predictor variables, six were statistically significant: gender (AOR: 3.38, CI: 1.50–7.62), marital status (AOR: 2.10, CI: 1.05–4.16), tobacco use (AOR: 2.72, CI: 1.04–7.09), physical disability (AOR: 5.27, CI: 1.50–18.53) and difficulty in working, taking care of things or getting along with people with respect to PHQ-9 responses (AOR: 5.94, CI: 3.16–11.16). Although not significant in this analysis, pet owners were 41% (AOR: 0.59, CI: 0.31–1.14) less depressed than the control group.

Discussion

This survey explored the association of pet ownership with depression. It was hypothesized that pet owners are less likely to be depressed than non-pet owners. We found that after adjusting for related confounders that pet owners were 41% less likely to be depressed than non-pet owners, although the result was not statistically significant. There is evidence supporting the association between pet ownership and lower level of depression. Garrity et al. (1989) found a positive impact of pet ownership on depression, emotional health, and physical health. Pet owners were found to be less depressed and had suffered fewer recent illnesses than the control group. Having a strong attachment with a pet was significantly (p = 0.0133) associated with less depression among older people (65+ years of age). McConnell et al. (2011) observed that pet ownership (specifically dogs) brings wellbeing to people who have social needs to fulfill and that these people were found to be less depressed.

However, in another study, pet ownership and attachment were not associated with depression and levels of loneliness in individuals living alone (Antonacopoulos & Pychyl, 2010). Our study did not include a separate analysis to determine the singular associations based on the type of pet, as more than half of the participants owned cats (n = 93; 66.4%). Cline found no association between dog ownership and depression, but dog ownership was associated with greater wellbeing in married women and single adults (Cline, 2010). Similarly, in another study, pet owners were found to have higher levels of satisfaction in life than non-pet owners, although they did not differ in happiness or positive or negative emotions compared to the other group. The length of time a primary pet is kept might be one reason for this opposing outcome as the average time was 5.5 years (SD = 3.88 years, range = 3 months–17 years) (Bao & Schreer, 2016).

In this study, male participants have significantly higher (3.38 times) chances of being depressed than females. Similarly, Tower and Nokota (2006) found a lower level of depressive symptoms among unmarried women who lived with a pet than unmarried women who did not live with a pet. Consistent with our study, male participants have more depression than female participants, although no combined associations with depression were observed among sex, marital status, and pet ownership.

Limitations

We acknowledge that this study had some limitations. The sample size was minimal. There is a possibility of recall bias among the participants while reporting information. In this cross-sectional study, the identified factors are regarded as associated factors, that is, either the causes or the results of depression. However, using a validated screening e-questionnaire was considered a cost-effective approach to exploring the general situation, and was therefore used in this study. The study population was from a township in an urban area of Dhaka, so the results may not be generally applicable to other urban or rural areas.

Conclusion

This study outlined the relationship between owning a household pet and managing depression. This study observed that pet owners were 41% less depressed than non-pet owners. Participants’ gender, marital status, tobacco consumption, physical disability, and difficulty in working were significantly associated with depression. Further research is needed to investigate through a qualitative approach.

Data availability