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

Abstract

BackgroundIn 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.MethodsWe 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.ResultsThe 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.ConclusionsDepression 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.

Depressive disorder in patients attending the outpatient department of a tertiary care hospital in Colombo

“…The only study published was from the Northern Province of Sri Lanka in 16 primary health care facilities [11]. The findings of this study may not be generalisable to other parts of the country, given that the study had been done out in a rural area in the aftermath of an armed conflict.…”

“…A study conducted in 12 Divisional Hospitals and 4 Primary Medical Care Units in the Northern Province reported overall prevalence of depression of 17.8% and major depression 4.5% [11]. Several other studies have looked at the prevalence of depression in different populations in Sri Lanka.…”

Prevalence and correlates of depression among older urban community‐dwelling adults in Sri Lanka

“…Perceptions of ill health and pain, quality of life, and functional status are consequences of depression, which itself was comparable to or exceeded the effects of other chronic diseases . Certain sociodemographic and health‐related factors, comparable to those identified in the Western world, have been associated with depression in Sri Lanka . Among them, gender, ethnicity, level of education, restricted instrumental activities of daily living, hearing difficulty, physical disability, perceived income inadequacy, and living alone were associated with elder depression …”

“…Lifestyle changes in this period can predispose them to psychological imbalances and, therefore, conditions such as depression. Evidence from some studies has demonstrated that there are higher prevalence of depression among young elders, compared to younger age groups and older elders . These studies also found that most young elders who retained physical capacity had positive mental well‐being.…”

“…A 2‐week period of ‘feeling sad, empty or depressed’ or ‘loss of interest in most things’ was reported in 13.4% of men and 17.9% of women . A recent cross‐sectional study was conducted in primary health care units in Northern Province, Sri Lanka, using the nine‐item Public Health Questionnaire; it found that the prevalence of mild depression was 13.3%, moderate depression 3.3%, and moderately severe to severe depression less than 1% . However, the study populations in these studies were not confined to the elderly.…”