Risk factors for depressive disorders among patients attending outpatient clinics of Assiut University Hospitals

Abstract

Background Depression is a common mental health problem observed frequently in general medical setting. Aim The aim of this study was to identify possible demographic and clinical risk factors for depressive disorders among patients attending outpatient clinics of Assiut University Hospitals. Methods A cross-sectional study was conducted during a 1-year period from 1 June 2006 to 31 May 2007; 2304 patients aged 15 years and above were screened for depression using the Beck Depression Inventory. Patients who scored 4 or more were further evaluated through a psychiatric sheet especially prepared for the present work. Psychiatric diagnosis of patients was based on the Diagnostic and Statistical Manual of Mental Disorders, 4th ed.-text revision criteria. Medical/surgical diagnoses were confirmed by appropriate investigations, and information about the possible risk factors were obtained. Patients were also screened using the suicidality sheet and scored using the Sheehan Disability Scale. Results Depression was found in 202 patients, representing 8.8% of the entire sample. Depression was significantly higher among female patients, highly educated and literate individuals, nonworking male patients and among divorced/widowed/separated individuals. Patients with malignancy, disfiguring conditions, autoimmune conditions, renal diseases, and hepatic diseases were at a higher risk of developing depressive disorders. Patients with two or more medical/surgical conditions were at a high risk of developing depressive disorders (25.9 and 17.1%, respectively). Depressive disorders were significantly high among patients on dialysis (42.9%), radiotherapy (40%), chemotherapy (38.5%), steroids (28.9%), interferon (25%), and digoxin (21.9%). Depressive disorders were more prevalent among patients with a duration of medical illness of 24 months or more. The degree of impairment is significantly higher among patients with moderate and severe depression, particularly in patients having severe depression with psychotic features. Suicidality is significantly higher among patients with severe depression, particularly among patients having severe depression with psychotic features. Conclusion Patients attending outpatient clinics might be at a high risk for depressive disorders, especially those with certain medical conditions, with more than two medical diseases, and receiving specific treatment modalities. These patients need close psychiatric attention for early detection of depressive disorders and proper management.