Prevalence of depression and its associated factors among patients attending primary care settings in the post-conflict Northern Province in Sri Lanka: a cross-sectional study

BMC Psychiatry

Sharika Lasanthi Peiris¹  Kolitha Wickramage¹  Upul Senarath² 

[1] International Organization for Migration Sri Lanka, No. 62, Green Path, Ananda Coomaraswamy Mawatha, Colombo 03, Sri Lanka;Department of Community Medicine, Faculty of Medicine, University of Colombo, 25 Kynsey Road, Colombo 08, Sri Lanka

关键词: PHQ-9;    Patient Health Questionnaire;    Post-conflict;    Primary care;    Mental health;    Depression;   

Others  :  1123690
DOI  :  10.1186/1471-244X-14-85

 received in 2013-11-14, accepted in 2014-03-12,  发布年份 2014

【 摘 要 】

Background

In Sri Lanka, civilians in the Northern Province were affected by a long-term armed conflict that ended in 2009. This study aims to describe the prevalence of depression and its associated factors among adult patients attending primary care settings in the Northern Province in Sri Lanka.

Methods

We report data from a cross-sectional patient morbidity registry established in 16 primary care facilities (12 Divisional Hospitals and 4 Primary Medical Care Units) in four districts of the Northern Province. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depression among all patients aged ≥18 years, between March and May 2013. A sample of 12,841 patient records was included in the analysis. A total score of ≥10 in the PHQ-9 was considered as major depression. Factors associated with major depression were tested using multivariable logistic regression analysis.

Results

The prevalence of major depression was 4.5% (95% CI: 4.1-4.9) and mild depression was 13.3% (95% CI: 12.7-13.9). The major depression was significantly higher in females than males (5.1% vs. 3.6%) and among unpaid family workers (6.0%) than any other category who earned an income (varied between 1.2% and 3.2%). The prevalence was rising significantly with advancing age, and ranged from 0.3% in the youngest to 11.6% in the elderly.

Multivariable regression analysis revealed that the females have a higher risk for major depression than males (OR = 1.4; 95% CI: 1.1-1.7). Older patients were more likely to be depressed than younger patients, OR (95% CI) were 4.9 (1.9-12.5), 5.6 (2.2-14.0), 5.7 (2.3-14.2) and 4.7 (1.8-11.9) for the age groups 25–34, 35–49, 50–64, and ≥65 years respectively, in contrast to 18–24 year group. Disability in walking (OR = 7.5; 95% CI: 5.8-9.8), cognition (OR = 4.5; 95% CI: 3.6-5.6), self-care (OR = 2.6; 95% CI: 1.7-4.0), seeing (OR = 2.3; 95% CI: 1.8-3.0), and hearing (OR = 2.0; 95% CI: 1.5-2.5) showed significant associations with depression.

Conclusions

Depression is a common issue at primary care settings in a post-conflict population, and the elders, women and persons with disability are at a greater risk. Strengthening capacity of primary care facilities and community mental health services is necessary for early detection and management.

【 授权许可】

   
2014 Senarath et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Patel V, Flisher AJ, Hetrick S, McGorry P: Mental health of young people: a global public-health challenge. Lancet 2007, 369(9569):1302-1313.
• [2]World Health Organization: World health report 2001: mental health: new understanding, new hope. Geneva: World Health Organization; 2001.
• [3]Cipriani A, Barbui C, Geddes JR: Suicide, depression, and antidepressants: patients and clinicians need to balance benefits and harms. BMJ [Br Med J] 2005, 330(7488):373.
• [4]Ustun TB, Ayuso-Mateos JL, Chatterji S, Mathers C, Murray CJ: Global burden of depressive disorders in the year 2000. Br J Psychiatry 2004, 184:386-392.
• [5]Katon W, Schulberg H: Epidemiology of depression in primary care. Gen Hosp Psychiatry 1992, 14(4):237-247.
• [6]Utsun TB, Sartorius N: Form and frequency of mental disorders across centres. In Mental illness in general health care: an international study. West Sussex: John Wiley & Sons Ltd.; 1995.
• [7]Berardi D, Leggieri G, Ceroni GB, Rucci P, Pezzoli A, Paltrinieri E, Grazian N, Ferrari G: Depression in primary care. A nationwide epidemiological survey. Fam Pract 2002, 19(4):397-400.
• [8]Wittchen HU, Pittrow D: Prevalence, recognition and management of depression in primary care in Germany: the Depression 2000 study. Hum Psychopharmacol Clin Exp 2002, 17(S1):S1-S11.
• [9]Wulsin LR, Vaillant GE, Wells VE: A systematic review of the mortality of depression. Psychosom Med 1999, 61(1):6-17.
• [10]Global depression statistics [http://www.biomedcentral.com/presscenter/pressreleases/20110722 webcite]
• [11]Poongothai S, Pradeepa R, Ganesan A, Mohan V: Prevalence of depression in a large urban South Indian population: The Chennai Urban Rural Epidemiology study (CURES:70). PLoS One 2009, 4(9):e7185.
• [12]Gadit AAM, Mugford G: Prevalence of depression among households in three capital cities of Pakistan: need to revise the mental health policy. PLoS One 2007, 2(2):e209.
• [13]Asghar S, Hussain A, Ali SMK, Khan AKA, Magnusson A: Prevalence of depression and diabetes: a population-based study from rural Bangladesh. Diabet Med 2007, 24(8):872-877.
• [14]Siriwardhana C, Sumathipala A, Siribaddana S, Samaraweera S, Abeysinghe N, Prince M, Hotopf M: Reducing the scarcity in mental health research from low and middle income countries: a success story from Sri Lanka. Int Rev Psychiatry 2011, 23(1):77-83.
• [15]Institute of Research and Development (IRD), Ministry of Health (MOH): National Mental Health Survey Report. Colombo: IRD, MOH; 2007.
• [16]Summerfield D: War and mental health: a brief overview. BMJ 2000, 321(7255):232-235.
• [17]Mollica RF, Wyshak G, Lavelle J: The psychosocial impact of war trauma and torture on Southeast Asian refugees. Am J Psychiatry 1987, 144(12):1567-1572.
• [18]De Jong JTVM, Komproe IH, Van Ommeren M: Common mental disorders in postconflict settings. Lancet 2003, 361(9375):2128-2130.
• [19]Murthy RS, Lakshminarayana R: Mental health consequences of war: a brief review of research findings. World Psychiatry 2006, 5(1):25.
• [20]Roberts B, Damundu EY, Lomoro O, Sondorp E: Post-conflict mental health needs: a cross-sectional survey of trauma, depression and associated factors in Juba, Southern Sudan. BMC Psychiatry 2009, 9:7. BioMed Central Full Text
• [21]Husain F, Anderson M, Lopes Cardozo B, Becknell K, Blanton C, Araki D, Kottegoda Vithana E: Prevalence of war-related mental health conditions and association with displacement status in postwar Jaffna District, Sri Lanka. JAMA 306(5):522.
• [22]Siriwardhana C, Adikari A, Pannala G, Siribaddana S, Abas M, Sumathipala A, Stewart R: Prolonged internal displacement and common mental disorders in Sri Lanka: the COMRAID study. PLoS One 2013, 8(5):e64742.
• [23]Elbert T, Schauer M, Schauer E, Huschka B, Hirth M, Neuner F: Trauma-related impairment in children–a survey in Sri Lankan provinces affected by armed conflict. Child Abuse Negl 2009, 33(4):238-246.
• [24]Somasundaram D, Sivayokan S: Rebuilding community resilience in a post-war context: developing insight and recommendations - a qualitative study in Northern Sri Lanka. Int J Ment Health Syst C7 - 3 7(1):1-25.
• [25]Ministry of Health: Health Facility Survey 2011: District Profiles. Colombo: Ministry of Health; 2011.
• [26]Kroenke K, Spitzer RL: The PHQ-9: a new depression diagnostic and severity measure. Psychiatr Ann 2002, 32(9):1-7.
• [27]Patient health questionnaire (PHQ) [http://www.phqscreeners.com/overview.aspx# webcite]
• [28]Arroll B, Goodyear-Smith F, Crengle S, Gunn J, Kerse N, Fishman T, Falloon K, Hatcher S: Validation of PHQ-2 and PHQ-9 to screen for major depression in the primary care population. Ann Fam Med 2010, 8(4):348-353.
• [29]Institute of Research and Development (IRD), Ministry of Health (MOH): National Mental Health Survey. Colombo: IRD, MOH; 2012.
• [30]Li C, Ford ES, Strine TW, Mokdad AH: Prevalence of Depression Among U.S. Adults With Diabetes: Findings from the 2006 Behavioral Risk Factor Surveillance System. Diabet Care 2008, 31(1):105-107.
• [31]Mont D: Measuring disability prevalence. In SP Discussion Paper. New York: The World Bank, Disability & Development Team HDNSP; 2007.
• [32]Department of Census and Statistics Sri Lanka: Sri Lanka Census of Population and Housing. Colombo: Department of Census and Statistics Sri Lanka; 2012.
• [33]Kroenke K, Spitzer RL, Williams JB: The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001, 16(9):606-613.
• [34]Cassano P, Fava M: Depression and public health: an overview. J Psychosom Res 2002, 53(4):849-857.
• [35]Jacka FN, Mykletun A, Berk M: Moving towards a population health approach to the primary prevention of common mental disorders. BMC Med 2012, 10(1):149. BioMed Central Full Text
• [36]Djernes JK: Prevalence and predictors of depression in populations of elderly: a review. Acta Psychiatrica Scandinavica 2006, 113(5):372-387.
• [37]Rosemann T, Backenstrass M, Joest K, Rosemann A, Szecsenyi J, Laux G: Predictors of depression in a sample of 1,021 primary care patients with osteoarthritis. Arthritis Care Res 2007, 57(3):415-422.
• [38]United States Surgeon General: Older adults and mental health. Mental Health: A Report of the Surgeon General, 1999 1999.
• [39]Cole MG, Dendukuri N: Risk factors for depression among elderly community subjects: a systematic review and meta-analysis. Am J Psychiatry 2003, 160(6):1147-1156.
• [40]Han B, Gfroerer JC, Colpe LJ, Barker PR, Colliver JD: Serious psychological distress and mental health service use among community-dwelling older US Adults. Psychiatric Serv 2011, 62(3):291-298.
• [41]Chang-Quan H, Xue-Mei Z, Bi-Rong D, Zhen-Chan L, Ji-Rong Y, Qing-Xiu L: Health status and risk for depression among the elderly: a meta-analysis of published literature. Age Ageing 2010, 39(1):23-30.
• [42]Katon WJ, Lin EHB, Von Korff M, Ciechanowski P, Ludman EJ, Young B, Peterson D, Rutter CM, McGregor M, McCulloch D: Collaborative care for patients with depression and chronic illnesses. N Engl J Med 2010, 363(27):2611-2620.
• [43]Frederick JT, Steinman LE, Prohaska T, Satariano WA, Bruce M, Bryant L, Ciechanowski P, DeVellis B, Leith K, Leyden KM: Community-based treatment of late life depression: an expert panel informed literature review. Am J Prev Med 2007, 33(3):222-249.
• [44]Steinman LE, Frederick JT, Prohaska T, Satariano WA, Dornberg-Lee S, Fisher R, Graub PB, Leith K, Presby K, Sharkey J: Recommendations for treating depression in community-based older adults. Am J Prev Med 2007, 33(3):175-181.
• [45]Penninx BW, Leveille S, Ferrucci L, van Eijk JT, Guralnik JM: Exploring the effect of depression on physical disability: longitudinal evidence from the established populations for epidemiologic studies of the elderly. Am J Pub Health 1999, 89(9):1346-1352.
• [46]Von Korff M, Ormel J, Katon W, Lin EB: Disability and depression among high utilizers of health care: a longitudinal analysis. Arch Gen Psychiatry 1992, 49(2):91-00.
• [47]Steel Z, Chey T, Silove D, Marnane C, Bryant RA, van Ommeren M: Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. JAMA 2009, 302(5):537-549.
• [48]Somasundaram D: Collective trauma in the Vanni- a qualitative inquiry into the mental health of the internally displaced due to the civil war in Sri Lanka. Int J Ment Health Syst 2010, 4:22. BioMed Central Full Text
• [49]Kohn R, Saxena S, Levav I, Saraceno B: The treatment gap in mental health care. Bull World Health Org 2004, 82(11):858-866.
• [50]Samarasekara N, Davies MLM, Siribaddana S: The stigma of mental illness in Sri Lanka: the perspectives of community mental health workers. Stigma Research and Action 2012, 2(2):93-99.