Detection and prevalence of depression among adult type 2 diabetes mellitus patients attending non-communicable diseases clinics in Lilongwe, Malawi

Abstract

<jats:title>Abstract</jats:title> <jats:p>Background Depression is associated with chronic physical illnesses and negatively affects health outcomes. However, it often goes undiagnosed and untreated. We investigated the prevalence of depression among adult type 2 diabetes mellitus (T2DM) patients attending non-communicable diseases (NCD) clinics in Lilongwe, Malawi, and estimated the level of routine detection by NCD clinicians. This study set out to determine the prevalence of major depression and its detection among adult type 2 diabetes mellitus (T2DM) patients attending NCD clinics in Lilongwe, Malawi. Methods In a cross-sectional study design, 323 T2DM patients aged ≥ 18 years were screened for depression with the Patient Health Questionnare-9 (PHQ-9) followed by diagnostic assessment with the Structured Clinical Interview for DSM-IV (SCID). We analysed the association between presence of major depression and sociodemographic factors using logistic regression. Results Three quarters of the participants (76%) were females. The participants’ ages ranged from 21–79 years. Of the 323 participants, 58 (18%) met criteria for DSM-IV major depression. None of the cases of major depression had been identified by the NCD clinicians. Major depression was found not to be significantly associated with any of the sociodemographic factors. Conclusions We found that depression is common among NCD clinic attendees with T2DM in Malawi,, and poorly detected by NCD clinicians. Given the high prevalence and challenges in clinical identification, integration of depression screening with a standardized validated tool should be a high priority so as to link patients to appropriate services.</jats:p>

Prevalence and correlates of major depressive disorders among patients with cancer at Kamuzu Central Hospital in Malawi

“…Our study had also reported that among those with major depressive disorder, most clients (52%) had moderate depressive symptoms indicated by higher PHQ scores. This was worrisome as it showed most patients were unattended to in time while symptoms were advancing and this could impact negatively on their general health status [8].The current study had also reported higher proportions of sub-threshold depressive disorder of 43% which was twice higher than that reported among type 2 diabetes in Malawi as well as among patients with cancer elsewhere [20,24]. This group of patients in our study presented with clinically signi cant depressive symptoms without meeting the criteria for major depressive disorder at cut-off value of 9 on PHQ-9 score.…”

“…This might be the true estimate considering that we used active screening approach other than self-reports. However, we expected the prevalence to be even higher than reported considering previous estimates [19,20]. The lower-than-expected estimate could be explained by excluded cases of physical and emotional distress which would have had scored high on PHQ-9 score and increase the prevalence of major depressive disorder.…”

“…The lower-than-expected estimate could be explained by excluded cases of physical and emotional distress which would have had scored high on PHQ-9 score and increase the prevalence of major depressive disorder. That would also explain why our estimate was lower than the 18% reported among patients living with type 2 diabetes mellitus [20] and lower than 19%-30% range reported among general patients attending outpatient services at one primary care facility [19].…”

“…The prevalence of depression among the general patients attending to the outpatient department at a primary health care in Matawale was 30.3% in the study, yet none was detected by attending clinicians during routine care [19]. Another study reported prevalence of 18% for major depression among diabetic patients in Lilongwe and again none had been identi ed by the clinicians [20]. In that study, major depression was not signi cantly associated with any of the socio-demographic factors.…”

“…The third study used self-reports among cancer patients at Kamuzu and Queen Elizabeth Central hospitals and depression was estimated at 9% [5]. The latter ndings could be an underestimation considering that previous studies had reported zero detection of depression by attending clinicians [19,20].…”