The cross-sectional association of stressful life events with depression severity among patients with hypertension and diabetes in Malawi

Abstract

Depressive disorders are a leading cause of global morbidity and remain disproportionately high in low- and middle-income settings. Stressful life events (SLEs) are known risk factors for depressive episodes and worsened depressive severity, yet are under-researched in comparison to other depression risk factors. As depression is often comorbid with hypertension, diabetes, and other noncommunicable diseases (NCDs), research into this relationship among patients with NCDs is particularly relevant to increasing opportunities for integrated depression and NCD care. This study aims to estimate the cross-sectional association between SLEs in the three months preceding baseline interviews and baseline depressive severity among patients with at least mild depressive symptoms who are seeking NCD care at 10 NCD clinics across Malawi. SLEs were measured by the Life Events Survey and depressive severity (mild vs. moderate to severe) was measured by the Patient Health Questionnaire-9. The study population (n = 708) was predominately currently employed, grand multiparous (5–8 children) women with a primary education level. Two thirds (63%) had mild depression while 26%, 8%, and 3% had moderate, moderately severe, and severe depression, respectively. Nearly all participants (94%) reported at least one recent SLE, with the most common reported SLEs being financial stress (48%), relationship changes (45%), death of a family member or friend (41%), or serious illness of a family member or friend (39%). Divorce/separation, estrangement from a family member, losing source of income, and major new health problems were significant predictors of greater (moderate or severe) depressive severity compared to mild severity. Having a major new health problem or experiencing divorce/separation resulted in particularly high risk of more severe depression. After adjustment, each additional SLE was associated with a 9% increased risk of moderate or worse depressive severity compared to mild depressive severity (RR: 1.09; (95% CI: 1.05, 1.13), p<0.0001). Among patients with NCDs with at least mild depressive symptoms, SLEs in the prior 3 months were associated with greater depressive severity. While many SLEs may not be preventable, this research suggests that assessment of SLEs and teaching of positive coping strategies when experiencing SLEs may play an important role in integrated NCD and depression treatment models.

The relationship between serum resolvin D1, NLRP3, cytokine levels, and adolescents with first-episode medication-naïve major depressive disorder

“…Previous studies on adolescent depression have primarily focused on serotonin and hypothalamic–pituitary–adrenal (HPA) axis dysregulation hypotheses [ 7 , 8 ]. In recent decades, mounting evidence suggests that inflammation may play a significant role in depression, as evidenced by a higher prevalence of depression in patients with immune diseases, multiple sclerosis, and diabetes [ 9 , 10 ]. Anti-inflammatory treatments, such as infliximab and minocycline, have also show significant antidepressant effects [ 11 ].…”

The relationship between serum Resolvin D1, NLRP3, cytokine levels, and adolescents with first-episode medication-naïve major depressive disorder

“…Previous studies on adolescent depression have primarily focused on serotonin and hypothalamic-pituitary-adrenal (HPA) axis dysregulation hypotheses (7,8). However, in recent decades, growing evidence has shown that in ammation may play an important role in depression, with a higher prevalence of depression in patients with immune diseases, multiple sclerosis, and diabetes (9,10). Studies have also shown that anti-in ammatory treatments, such as in iximab and minocycline, also show signi cant antidepressant effects (11).…”