Estimating the prevalence of depression using wastewater-based epidemiology: A case study in Qinghai Province, West China

Abstract

Wastewater-based epidemiology (WBE) is considered a cost-effective alternative approach capable of determining the consumption and prevalence of drug use in communities, however, the application of WBE for estimating the prevalence of depression has seldom been reported. In this study, the prevalence of antidepressants was estimated in five cities in Qinghai Province, west China to examine the feasibility of using WBE to estimate the depression prevalence. Residual concentrations of the drugs varied from different wastewater treatment plants (WWTPs) in five cities. Venlafaxine (0.06–720 ng/L), O-desmethylvenlafaxine (1.31–1659 ng/L), paroxetine (<LOD-69.9 ng/L), sertraline (0.20–3.36 ng/L), and nortriptyline (<LOD-50.8 ng/L) were in the top concentrations quartile in the influent samples of 17 WWTPs. Back-calculation estimated venlafaxine (538 mg/1000 inh/d) as the most consumed antidepressant in Qinghai Province, followed by paroxetine (159 mg/1000 inh/d), sertraline (150 mg/1000 inh/d) and amitriptyline (97.2 mg/1000 inh/d). The prevalence of depression was 17.8 % based on antidepressant usage (2.50 %), which was consistent with the data conducted by traditional survey (16.7 %). Risk assessment showed that fluoxetine, citalopram and venlafaxine in effluents might cause ecological risks to aquatic environment. This study provided a promising way for monitoring antidepressant usage and depression prevalence through WBE, which would improve the understanding of depression disease and provide guidance for public health care.