In studies from both high income countries and low- and middle-income countries (LMICs), depression was found to be associated with significant functional impairment, decreased quality of life, increased use of health services, higher degree of morbidity, elevated risk for mortality and a compromised overall health status. Depression accounted for 4.5% of the worldwide total burden of disease in 2007 and is also responsible for the greatest proportion of burden attributable to non- fatal health outcomes, accounting for almost 12% of total years lived with disability worldwide. Overall, depressive disorders are the leading cause of disability globally and major depressive disorder is the second leading cause of the global burden of disease. Although the prevalence of depression varies between populations, every year an estimated 5.8% of the adult population develops a depressive episode and the lifetime risk for severe depression is estimated to be 12–16%. These findings support current initiatives to scale-up mental health services at the PHC level and indicate that social support is an important target for intervention.Ī diagnosis of depression requires the experience of depressed mood, loss of interest and enjoyment, and/or reduced energy leading to diminished activity for at least 2 weeks, as well as functional impairment or subjective distress. In this study, PHC clinicians identified cases of depression with high symptom burden, suicidality and functional impairment. Diagnosed cases were found to have higher functional impairment compared to community controls (RR = 1.91 95% CI 1.74, 2.09). In the multivariable model, greater functional impairment was associated with higher depressive symptoms (RR = 1.04 95% CI 1.02, 1.05) and lower social support (RR = 0.96 95% CI 0.95, 0.98). PHC diagnosed cases were found to have higher depressive symptom severity and suicidality, but lower social support compared to non-diagnosed controls (P < 0.05). No significant difference in functional impairment was found between diagnosed cases and non-diagnosed controls.
Multivariable negative binomial regression models were fitted to examine the association of demographic, social, economic and clinical characteristics with functional impairment. The 12-item version of the WHO Disability Assessment Schedule (WHODAS-2.0) was used to assess functional impairment. PHC diagnosed cases were also compared to a community representative sample of adult healthy controls (n = 197 “community controls”). Of these, 92 were diagnosed to have depression (“PHC diagnosed cases”) and the remaining 39 people were PHQ positive but considered not to have depression (“non-diagnosed controls”). Those who scored five or above on the PHQ-9 (n = 131) were assessed by PHC workers. A total of 2038 adult consecutive PHC attendees were screened for depressive symptoms using the 9-item Patient Health Questionnaire (PHQ-9). As part of the Programme for Improving Mental health carE (PRIME), PHC clinicians were trained to diagnose depression using an adapted version of the World Health Organization (WHO) mental health Gap Action Programme (mhGAP).
MethodsĪ comparative cross-sectional study was conducted. The aim of this study was to identify factors associated with functional impairment among people diagnosed with depression in PHC in Ethiopia as part of implementation of a task-shared model of mental healthcare. There have been few studies examining the functioning of clinically-diagnosed people with depression in primary healthcare (PHC) in low- and middle-income countries (LMICs).
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