Abstract
BackgroundDepression is a serious public health issue that has clinical, social and economic implications. Adult patients attending a primary healthcare (PHC) facility were screened in order to estimate the prevalence of depressive features and identify potential risk factors for screening positive.MethodsThis was an analytical cross-sectional study conducted at a clinic in Pretoria, South Africa. A self-administered questionnaire, which included the Patient Health Questionnaire-9 (PHQ-9) screening tool, was completed by patients attending the clinic. A PHQ-9 score of less than five was deemed as a negative screen for depressive features; with a score of five or more being considered a positive screen. A multivariate logistic regression model was developed to identify factors associated with a positive screen for depressive features.ResultsA total of 199 patients participated and the proportion screened positive for depressive features using the PHQ-9 tool was 46.23% (n = 92). Employed participants had significantly lower odds (odds ratio [OR] = 0.48; 95% confidence interval [CI]: 0.25 – 0.94) of screening positive, whilst the participants with significantly higher odds were those with co-morbidities (OR = 2.12; 95% CI: 1.08 – 4.17) and a history of stressful life events (OR = 3.21; 95% CI: 1.64 – 6.28).ConclusionDepression appears to be a significant problem in PHC settings in South Africa. Screening for depressive features at primary level, targeting those with chronic medical conditions, history of recent stressful life events and other known risk factors may improve detection rates, lead to earlier diagnosis and improved health outcomes.
Highlights
South Africa is experiencing a health transition with a quadruple burden of communicable, non-communicable, perinatal and maternal, and injury-related disorders.[1,2] Mental disorders contribute to the non-communicable disease burden
Major depressive disorder (MDD) is a mental disorder characterised by changes in affect, mood, neurovegetative function, cognition and psychomotor activity.[4]
The lifetime prevalence of major depression in South Africa has been reported at 9.7% in 2009 and the 12-months prevalence at 4.9% which is comparable with other countries.[6]
Summary
South Africa is experiencing a health transition with a quadruple burden of communicable, non-communicable, perinatal and maternal, and injury-related disorders.[1,2] Mental disorders contribute to the non-communicable disease burden. Target 4 of Goal 3 of the Sustainable Developmental Goals (SDGs), focuses on mental health and it states ‘by 2030 reduce by one-third premature mortality from NCDs through prevention and treatment, and promote mental health and wellbeing’.3. The lifetime prevalence of major depression in South Africa has been reported at 9.7% in 2009 and the 12-months prevalence at 4.9% which is comparable with other countries.[6] Acccording to South African Stress and Health (SASH), the prevalence of MDD in SA was 9.8% across all ages with highest prevalence of 14.6% in Free State,[7] whereas Cholera et al,[8] showed a prevalence of 11.8% amongst the human immunodeficiency virus (HIV) population group using the Mini International Neuropsychiatric Interview (MINI)-defined current major depressive episode (MDE). Adult patients attending a primary healthcare (PHC) facility were screened in order to estimate the prevalence of depressive features and identify potential risk factors for screening positive
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