Johnson Pradeep R, Ekstrand Maria L, Selvam Sumithra, Heylen Elsa, Mony Prem K, Srinivasan Krishnamachari
Department of Psychiatry, St John's Medical College, Sarjapur Road, Bangalore, Karnataka 560034, India.
Division of Mental Health and Neurosciences, St. John's Research Institute, St John's Medical College, Sarjapur Road, Bangalore, Karnataka 560034, India.
J Affect Disord Rep. 2021 Jan;3. doi: 10.1016/j.jadr.2020.100071. Epub 2021 Jan 2.
Depression and chronic medical disorders are strongly linked. There are limited studies addressing the correlates of the severity of depression in patients with co-morbid disorders in primary care settings. This study aimed to identify the socio-demographic and disease-specific risk factors associated with the severity of depression at baseline among patients participating in a randomized controlled trial (HOPE study).
Participants were part of a randomized controlled trial in 49 primary care health centers in rural India. We included adults (≥ 30 years) with at least mild Depression or Anxiety Disorder and at least one Cardiovascular disorder or Type 2 Diabetes mellitus. They were assessed for the severity of depression using the PHQ-9, severity of anxiety, social support, number of co-morbid chronic medical illnesses, anthropometric measurements, HbA1c, and lipid profile.
Proportionately there were more women in the moderate category of depression than men. Ordinal logistic regression showed co-morbid anxiety and a lower level of education significantly increased the odds of more severe depression, while more social support was significantly negatively associated with depression severity in women. In men, anxiety was positively associated with greater depression severity; while reporting more social support was negatively associated with depression.
This is a cross-sectional study and thus, no causal conclusions are possible.
Anxiety and poor social support in both genders and lower educational levels in women were associated with increased severity of depression. Early identification of risk factors and appropriate treatment at a primary care setting may help in reducing the morbidity and mortality associated with depression.
抑郁症与慢性疾病密切相关。在初级保健机构中，针对共病患者抑郁症严重程度的相关因素进行研究的较少。本研究旨在确定参与一项随机对照试验（HOPE研究）的患者在基线时与抑郁症严重程度相关的社会人口学和疾病特异性风险因素。
参与者来自印度农村49个初级保健健康中心的一项随机对照试验。我们纳入了年龄≥30岁、至少患有轻度抑郁症或焦虑症且至少患有一种心血管疾病或2型糖尿病的成年人。使用PHQ-9评估他们的抑郁严重程度、焦虑严重程度、社会支持、共病慢性疾病的数量、人体测量指标、糖化血红蛋白和血脂谱。
在中度抑郁类别中，女性比例高于男性。有序逻辑回归显示，共病焦虑和较低的教育水平显著增加了更严重抑郁症的几率，而更多的社会支持与女性抑郁症严重程度显著负相关。在男性中，焦虑与更高的抑郁症严重程度呈正相关；而报告更多的社会支持与抑郁症呈负相关。
这是一项横断面研究，因此无法得出因果结论。
男女的焦虑和社会支持不足以及女性较低的教育水平与抑郁症严重程度增加有关。在初级保健机构早期识别风险因素并进行适当治疗可能有助于降低与抑郁症相关的发病率和死亡率。
