Gafaranga Jean Pierre, Bitunguhari Leopold, Mudenge Charles, Manirakiza Felix, Kelly Brian, Gatabazi Paul
Department of Psychiatry and Behavioral Sciences, School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda.
Department of Mental Health, University Teaching Hospital of Kigali, Kigali, Rwanda.
Neuropsychiatr Dis Treat. 2024 Apr 8;20:845-854. doi: 10.2147/NDT.S443811. eCollection 2024.
Depression is a significant global public health concern, affecting individuals across different age groups and cultural backgrounds. However, screening for depression remains an essential but often neglected aspect of healthcare, particularly in outpatient settings. This study aimed to assess the prevalence of depression among outpatients visiting the internal medicine department of the University Teaching Hospital of Kigali in Rwanda and evaluate the feasibility of implementing a depression screening program in this setting.
An institution-based cross-sectional study design was employed, involving 300 adult medical outpatients through convenience sampling, aged 18 years and above, who visited the internal medicine department between October 7 to November 6, 2019. The Patient Health Questionnaire-9 (PHQ-9) was used as the screening tool to assess depressive symptoms. Additionally, socio-demographic and clinical data were collected to explore potential risk factors associated with depression using a binary logistic regression model.
A high prevalence of depression was identified among internal medicine outpatients, with 45.7% of participants screened positive for depression, with moderate, moderately severe, and severe depression accounting for 21%, 17%, and 8%, respectively. The following factors were significantly associated with positive screening for depression: lack of formal education (OR=4.463, p=0.011, 95% CI= [1.410; 14.127]), secondary education (OR=3.402, p=0.003, 95% CI= [1.517; 7.630]), low-income (OR=2.392, p=0.049, 95% CI= [1.003; 5.706]) and headache as a chief complaint (OR=3.611, p=0.001, CI= [1.718; 7.591]).
This study highlights the high prevalence of depression among medical outpatients. Due to the stigma associated with mental health, patients frequently seek help for physical symptoms such as headaches and other bodily complaints rather than mental health concerns. Introducing routine depression screening in medical departments could potentially facilitate early identification, and intervention, and lead to improved patient care. Future research should focus on evaluating such screening programs' effectiveness and long-term outcomes in resource-limited settings like Rwanda.
抑郁症是一个重大的全球公共卫生问题，影响着不同年龄组和文化背景的人群。然而，抑郁症筛查仍然是医疗保健中一个重要但常常被忽视的方面，尤其是在门诊环境中。本研究旨在评估卢旺达基加利大学教学医院内科门诊患者中抑郁症的患病率，并评估在该环境中实施抑郁症筛查项目的可行性。
采用基于机构的横断面研究设计，通过便利抽样纳入300名年龄在18岁及以上的成年内科门诊患者，这些患者于2019年10月7日至11月6日期间就诊于内科。使用患者健康问卷-9（PHQ-9）作为筛查工具来评估抑郁症状。此外，收集社会人口统计学和临床数据，使用二元逻辑回归模型探索与抑郁症相关的潜在风险因素。
在内科门诊患者中发现抑郁症的患病率很高，45.7%的参与者抑郁症筛查呈阳性，其中中度、中度严重和重度抑郁症分别占21%、17%和8%。以下因素与抑郁症筛查呈阳性显著相关：未接受正规教育（OR=4.463，p=0.011，95%CI=[1.410；14.127]）、接受中等教育（OR=3.402，p=0.003，95%CI=[1.517；7.630]）、低收入（OR=2.392，p=0.049，95%CI=[1.003；5.706]）以及以头痛为主诉（OR=3.611，p=0.001，CI=[1.718；7.591]）。
本研究突出了内科门诊患者中抑郁症的高患病率。由于与心理健康相关的耻辱感，患者经常因头痛等身体症状和其他身体不适而寻求帮助，而非心理健康问题。在内科引入常规抑郁症筛查可能有助于早期识别和干预，并改善患者护理。未来的研究应侧重于评估此类筛查项目在卢旺达等资源有限环境中的有效性和长期结果。
