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Validity of the concept of minor depression in a developing country setting
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
Department of Psychological Medicine, School of Medicine, Cardiff University, Cardiff, UK.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
Department of Community Health, Addis Ababa University, Addis Ababa, Ethiopia.
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2008 (English)In: Journal of Nervous and Mental Disease, ISSN 0022-3018, E-ISSN 1539-736X, Vol. 196, no 1, 22-28 p.Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
2008. Vol. 196, no 1, 22-28 p.
Keyword [en]
Depression, prevalence, risk factor, developing country, Ethiopia
National Category
Psychiatry
Research subject
Psychiatry
Identifiers
URN: urn:nbn:se:umu:diva-37804DOI: 10.1097/NMD.0b013e31815fa4d4PubMedID: 18195638OAI: oai:DiVA.org:umu-37804DiVA: diva2:370085
Available from: 2010-11-15 Created: 2010-11-15 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Studies on affective disorders in rural Ethiopia
Open this publication in new window or tab >>Studies on affective disorders in rural Ethiopia
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background

Affective disorders are poorly defined and studied in sub-Saharan Africa despite their substantial public health impact.

Objectives

Overall objective: To describe the epidemiology of selected affective disorders in rural Ethiopia.

Specific objectives

1. To describe the validity and utility of the concept of minor depressive disorder (mD).

2. To describe the manifestation, prevalence and the short-term clinical and functional course and outcome of bipolar disorder.

Subjects and methods

Population: Zay community residents (age ≥16), and residents of Butajira (ages 15-49), in Southern Ethiopia.

Study design: Population-based cross-sectional and longitudinal studies

Case identification: For the identification of cases with bipolar disorder, a two stage process was employed. An initial screen used key informants and interview with the Composite International Diagnostic Interview (CIDI) to identify cases with probable bipolar disorder. A second confirmatory diagnostic assessment stage employed the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). For the identification of cases with mD, data from the CIDI was used.

Follow-up: 312 cases with bipolar disorder from Butajira were followed up for a mean of 2.5 years (ranging 1-4 years) through monthly clinical assessments and annual symptom and functional ratings.

Results

The CIDI was administered to 1714 adults among the Zay and to 68, 378 adults among the Butajira residents. The prevalence of mD among the Zay and Butajira was 20.5% and 2.2% respectively. Up to 80% of cases with mD had used services for their symptoms, while a third to a half of cases had thought about self harm. Up to a sixth of cases had attempted suicide. Age, marital status, education and somatic symptoms were independently associated with mD.

The prevalence of bipolar disorder among the Zay was 1.8%. During a 2.5-year follow-up of 312 cases with bipolar disorder from Butajira, 65.9% relapsed (47.8% manic, 44.3% depressive and 7.7% mixed episodes) while 31.1% experienced persistent illness. Female gender predicted depressive relapse whereas male gender predicted manic relapse. Only being on psychotropic medication predicted remission (OR=3.42; 95% CI=1.82, 6.45). Disability was much worse among bipolar patients than in the general population and was predicted by symptom se3verity.

Conclusions

This is the largest study on mD and bipolar disorder in Africa. mD appears to have potential clinical utility in this setting given its association with service use and risk. The identified risk factors for mD also suggest potential aetiological continuity with major depression. The relatively high prevalence of bipolar disorder among the Zay may be related to genetic predisposition perhaps mediated through a founder effect, but other factors need exploring. In relation to the outcome of bipolar disorder, this study indicates that, contrary to previous assumptions, the course of bipolar disorder is characterised by both manic and depressive relapses in a relatively proportionate fashion. Bipolar disorder also leads to significant levels of disability. This is the only prospective outcome study of bipolar disorder in Africa where cases were monitored systematically at short assessment intervals. Therefore, findings are likely to be more robust than previous reports.

Place, publisher, year, edition, pages
Umeå: Umeå University, 2010. 79 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1381
Keyword
bipolar disorder, depressive disorder, affective disorder, mood disorder, prevalence, outcome, cross-sectional study, prospective study, longitudinal study, isolated population, Ethiopia, Africa, developing countries
National Category
Psychiatry
Research subject
Psychiatry
Identifiers
urn:nbn:se:umu:diva-37813 (URN)978-91-7459-103-3 (ISBN)
Public defence
2010-12-08, Sal A, våning 0, Psykiatriska kliniken, Umeå, 14:05 (English)
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Available from: 2010-11-18 Created: 2010-11-15 Last updated: 2010-11-18Bibliographically approved

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