Abstract
Background: Depression is disorder of enormous public health importance as it affects about 350 million people worldwide, by adversely impacting on their quality of life. Well-designed large scale community based research on the prevalence and socio demographic risk factors of depression in different regions of India is indispensable to formulate public health preventive programs and policy decisions. The present study was an effort to provide much needed information on the prevalence and correlates of depression in Sikkim, a North Eastern state of India where such data is scare.
Methodology: A cross-sectional study was done among adults in the urban metropolitan area of Tadong, in the capital city of Gangtok, Sikkim from May 2013 to August 2014. Systematic randomized sampling design was chosen with every tenth house selected for the study. Total number of subjects were 400 included in this study. Socio-demographic variables like age, gender, marital and socio-economic status were collected. Clinical variables that were collected include past history of psychiatric illness, substance abuse, family history of psychiatric illness and comorbid chronic pain symptoms. Depressive episode was diagnosed clinically using ICD -10 criteria. Severity of depression was assessed using Hamilton rating scale (17 items) for depression. Statistical analysis using Chi square test for determining the association between categorical variables was performed using SPSS software.
Results: A prevalence rate of 17.25% (n=69) with female to male gender ratio of 1.29:1 was found. This study estimated the prevalence of geriatric depression to be 18.75 (n=6). A significant association of depression with age (p=0.012) was found, with decreasing age associated with increasing prevalence of depression. A non- significant association was observed between depression and gender (p=0.322), marital status (p= 0.101) socio-economic status (p=0.063). Among the clinical variables assessed the results revealed a significant association of depression with family history of psychiatric illness (p=0.003) and chronic pain symptoms (p=0.010) and a non-significant association of depression with past history of psychiatric illness (p=0.006) and substance abuse (p=0.18).
Conclusion: We concluded that regular screening programs and medical camps in the community should include psychiatric services or psychiatric screening instruments to identify patients with depression, especially patients with chronic somatic pain.
Keywords: Depression, Socioeconomic status, Psychiatric comrbidities, Chronic pain.
References
- Hagop S. Akiskal M.D. Mood disorders. Sadock, Benjamin J.; Sadock, Virginia A.; Ruiz, Pedro. Title: Kaplan & Sadock's Comprehensive Textbook of Psychiatry, 9th Edition.
- Bijl R V, de Graaf R, Hiripi E, Kessler R C, Kohn R et al (2003). The prevalence of treated and untreated mental disorders in five countries. Health affairs 22 (3):122-133.
- sikkim.gov.in electoral roll call.
- Dudala SR, Reddy KAK, Prabhu GR. Prasad's socio-economic status classification- An update for 2014. Int J Res Health Sci [Internet]. 2014 Jul 31;2(3):875-8.
- National Crime Records Bureau , Ministry of Home Affairs , Accidental Death & Suicides in India 2013
- Hamilton M. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol 1967;6(4):278–96.
- Zimmerman M, Martinez JH, Young D, Chelminski I, Dalrymple K.J Affect Disord. 2013 Sep 5;150(2):384-8.
- Galbaud du Fort G, Newman SC, Bland RC Psychiatric comorbidity and treatment seeking. Sources of selection bias in the study of clinical populations. Journal of Nervous and Mental Disease (1993)181: 467-474.
- Jacobi F, Rosi S, Carlo Faravelli, Renee Goodwin, Saena Arbabzadeh- Bouchez andJean-Pierre Le pine Edited by E. J. L. Griez, C. Faravelli, D. J. Nutt andJ. Zohar. & 2005 JohnWiley & Sons Ltd. Mood Disorders: Clinical Management and Research Issues. ISBN 0 470 09426 5.
- Dube, K.C. A study of prevalence and biosocial variables in mental illness in a rural and urban community in Utter Pradesh, India. Acta Psychiatrica Scandinavica, (1970) 46, 327-332.
- Verghese, A., Beig, A., Senseman, L.A., Sunder Rao, P.S.S. & Benjamin, V. A social and psychiatric study of a representative group of families in Vellore town. Indian Journal of Medical Research, (1973) 61, 608-620.
- Sethi, B.B., Gupta, S.C, Mahendru, R.K. Kumari, P. Mental health and urban life - a study of 850 families. British Journal of Psychiatry, (1974) 124/243-246.
- Thacore, V.R., Gupta, S.C. & Suraiya, M. Psychiatric morbidity in a north Indian community. British Journal of Psychiatry, (1975) 126, 364-369
- Shah, V., Goswami, U.A., Maniar, R.C., Hajariwala, D.C. Sinha, B.K. Prevalence of psychiatric disorders in Ahmedabad- an epidemiological study. Indian Journal of Psychiatry, (1980) ;22: 384-389.
- Chhabra V, Kar N. Geriatric patients in a psychiatric ward: A 10 year profile. Indian J Psychiatry 2002;44:S47.
- Venkoba Rao A, Madhavan T. A geropsychiatric morbidity survey in a semiurban are near Madurai. Indian J Psychiatry 1982;24:258.
- Venkoba Rao Mental health and ageing in India. Indian J Psychiatry 1981;23:1.
- Jhirwal OP, Gupta LN, Singhal AK, Verma KK. Psychiatric problems of service utilizers in a newly created geriatric clinic of tertiary Hospital setting. Indian J Psychiatry 2004;46:S49.
- Szadoczky E, Papp Z,VitraiJ, Rihmer Z, FurediJ. The prevalence of major depressive and bipolar disorders in Hungary. Results from a national epidemiologic survey. J Affect Disord (1998) 50: 153-162.
- Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Ehleman S,Wittchen HU, Kendler KS Lifetime and 12-month prevalence of DSM-III- R psychiatric disorders in the United States: Results from the National Comorbidity Survey. Arch Gen Psychiatry (1994)51: 8-19.
- Poongothai S, Pradeepa R, Ganesan A, Mohan V. Prevalence of Depression in a large urban South Indian Population- The Cheenai Urban Rural Epidemiology Study (CURES-70). Plos one 2009;4:E7185.
- Gautam Amin , Sandeep Shah and G.K. Vankar . Prevalence and recognition of Depression in Primary care. Indian J Psychiatry, 1998, 40(4), 364-369.
- Berkman LF, Berkman CS, Kasl S, Freeman DH Jr, Leo L, Ostfeld AM, Cornoni-HuntleyJ, BrodyJA Depressive symptoms in relation to physical health and functioning in the elderly. AmJEpidemiol (1986)124(3): 372-388.
- Lorant V, Deliege D, Eaton W, et al. Socioeconomic inequalities in depression: a meta-analysis. Am J Epidemiol 2003;157:98–112.
- Andrade L, Caraveo-Anduaga JJ, Berglund P, et al. Crossnational comparisons of the prevalences and correlates of mental disorders. Bull World Health Organ 2000;78:413–26.
- Vuorilehto, M., Melartin T., Isometsa E. Depressive disorders in primary care: recurrent, chronic, and co-morbid. Psychological Medicine, (2005) 35, 673-82.
- Manwell, B., Czabala J. C., Ignaczak M., Mundt M. P. Correlates of depression among heavy drinkers in Polish primary care clinics. International Journal of Psychiatry in Medicine, (2004) 34, 165-78.
- Melartin, T. K., Rytsala H. J., Leskela U. S., Lestela-Mielonen P. S., Sokero T. P., Isometsa E. T. Current comorbidity of psychiatric disorders among DSM-IV major depressive disorder patients in psychiatric care in the Vantaa Depression Study. Journal of Clinical Psychiatry, (2002)63, 126-34.
- Schuckit M. A. Drug and Alcohol Abuse: a clinical guide to diagnosis and treatment , 6th edn. New York: Springer; 2006.
- Bridge JA, Brent DA, Johnson BA, Connolly J Familial aggregation of psychiatric disorders in a community sample of adolescents. JAmerAcad Child Adolesc Psychiatry (1997) 36(5): 628-636.
- Kendler KS, Walters EE, Kessler RC The prediction of length of major depressive episodes: Results from an epidemiological sample of female twins. Psychol Med (1997) 27(1): 107-117.
- Klein DN, Lewinsohn PM, Seeley JR, Rohde P Family study of major depressive disorder in a community sample of adolescents. Arch Gen Psychiatry (2001) 58: 13-20.
- France RD, Houpt JL, Skott A, Krishman KR, Varia IM. Depression as a psychopathological disorder in chronic low back pain patients. J Psycho.som Res . 1986;30:127-133.
- Blumer D, Heilbronn M. Second-year follow-up study on systematic treatment of chronic pain with antidepressants. Henry Ford Hosp Med J.1981;29:67-68.
Corresponding Author
Dr Bhanu Pratap Singh
Senior Resident, Department of Psychiatry, Medical College, Pali, and
Govt Bangar Hospital, Surajpole, Pali, Rajasthan, India