Validity of the Concept of Minor Depression in a Developing Country Setting

Abstract

Evidence for validity of the diagnostic construct of minor depressive disorder comes primarily from reports on subthreshold depressive states rather than minor depressive disorder per se. We report on the prevalence, impact, and sociodemographic correlates of minor depressive disorder in a developing country setting as further validation of this diagnostic construct. Diagnostic assessment of 1714 adults of an island population in Ethiopia was carried out using the Composite International Diagnostic Interview. The lifetime prevalence of minor depressive disorder was 20.5% (95% confidence interval 18.6, 22.5%). One-third of cases had sought help and expressed suicidal ideation. Being divorced/widowed, middle-aged, and having somatic pain were independently associated with having minor depressive disorder. Only being divorced/widowed was a shared risk factor for both minor depressive disorder and bereavement. Minor depressive disorder seems to be a useful and valid diagnostic construct with particular clinical significance in this and, possibly, similar developing country settings.

Recognition of depression by primary care clinicians in rural Ethiopia

“…These provide indirect evidence for the clinical relevance of the depressive symptoms recorded. Although studies from high income countries suggest that those with undetected depression have mild illness and benefit of treatment may be uncertain [41], the extremely low detection rate in the current study and in the few studies from Sub-Saharan African countries mean that a proportion of the missed cases are likely to have more severe illness and to benefit from treatment.…”

“…The questions in the CIDI refer to suicidal ideation, suicide plan and suicide attempt. The CIDI has good face validity, feasibility and reliability [39] and has been used previously in community based studies in Ethiopia [40, 41]. Data collectors were high school graduates with 5 years experience of data collection.…”

Are There Meaningful Differences Between Major Depressive Disorder, Dysthymic Disorder, and Their Subthreshold Variants?

“…The variability present among those labeled with NOS diagnoses may preclude the reliable identification of risk factors, markers for treatment response and prognosis; in short, the diagnostic label does not provide the researcher or the clinician with much useful information. One solution to this problem, in the case of the mood disorders, lies in the creation of an increasing number of diagnoses that would otherwise have been categorized as DDNOS (Angst, 1990; Fekadu et al, 2008; Judd, Rapaport, Paulus, & Brown, 1994; Rapaport & Judd, 1998; Sadek & Bona, 2000). The difficulty with this approach lies in the limited research that has investigated if these proposed mood disorders are distinct entities (as would be assumed by proposing them as separate disorders) or merely subtle variations of existing diagnoses (e.g., less severe versions of MDD or DYS).…”

“…Other proposed diagnostic variations on MDD include recurrent brief depressive disorder (APA, 2000) and subsyndromal symptomatic depression (Judd et al, 1994). The majority of the research on subthreshold forms of depression has attempted to justify a diagnosis based on prevalence and disability (Jaffe, Froom, & Galambos, 1994; Johnson, Weissman, & Klerman, 1992; Judd et al, 1994; Fekadu et al, 2008; Maier et al, 1994; Rapaport & Judd, 1998; Weiller, Boyer, Lepine, LeCrubier, 1994). However, very little research comparing threshold and subthreshold forms of depression has been done.…”

“…In addition to the lack of research examining differences between subthreshold and threshold forms of depression, much of the literature on subthreshold forms of depression has assessed them with questionnaires (Coulehan et al, 1990; Froom et al, 1995; Jaffe et al, 1994; Mino et al, 1994; Tollefson et al, 1993) or with structured diagnostic interviews administered by lay interviewers with minimal training in diagnostic assessment (Broadhead et al, 1990; Fekadu et al, 2008; Hance et al, 1996; Judd et al, 1994; Judd et al, 1997; Weiller et al, 1994). The problem with the use of both methods of assessment lies in the difficulty in differentiating a subthreshold depressive diagnosis from MDD in partial remission, DYS, or adjustment disorder.…”