Prevalence of unrecognized depression and associated factors among patients attending medical outpatient department in Adare Hospital, Hawassa, Ethiopia

Chronic exposure to aflatoxin B1 increases hippocampal microglial pyroptosis and vulnerability to stress in mice

BACKGROUND

Chronic aflatoxin B1 (AFB1) exposure may increase the risk of multiple neuropsychiatric disorders. Stress is considered one of the main contributors to major depressive disorder. Whether and how chronic AFB1 exposure affects vulnerability to stress is unclear.

METHODS

Mice were exposed for three weeks to AFB1 (100 µg/kg/d) and/or chronic mild stress (CMS). The vulnerability behaviors in response to stress were assessed in the forced swimming test (FST), sucrose preference test (SPT), and tail suspension test (TST). Microglial pyroptosis was investigated using immunofluorescence, enzyme-linked immunosorbent assays, and western blot assay in the hippocampus of mice. Hippocampal neurogenesis and the effects of AFB1-treated microglia on proliferation and differentiation of neural stem/precursor cells (NSPCs) were assessed via immunofluorescence in the hippocampus of mice.

RESULTS

Mice exposed to CMS in the presence of AFB1 exhibited markedly greater vulnerability to stress than mice treated with CMS or AFB1 alone, as indicated by reduced sucrose preference and longer immobility time in the forced swimming test. Chronic aflatoxin B1 exposure resulted in changes in the microglial morphology and increase in TUNEL⁺ microglia and GSDMD⁺ microglia in the hippocampal dentate gyrus. When mice were exposed to both CMS and AFB1, pyroptosis-related molecules (such as NLRP3, caspase-1, GSDMD-N, and interleukin-1β) were significantly upregulated in the hippocampus. These molecules were also significantly enhanced by AFB1 in primary microglial cultures. AFB1-treated mice showed decrease in the numbers of BrdU⁺, BrdU-DCX⁺, and BrdU-NeuN⁺ cells in the hippocampal dentate gyrus, as well as the percentages of BrdU⁺ cells that were NeuN⁺ in the presence or absence of CMS when compared with vehicle-treated mice. The combination of AFB1 and CMS exacerbated these effects to an even greater extent. The number of DCX⁺ cells correlated negatively with the percentage of ameboid microglia, TUNEL⁺ microglia and GSDMD⁺ microglia in the hippocampal dentate gyrus. AFB1-treated microglia suppressed the proliferation and neuronal differentiation of NSPCs in vitro.

CONCLUSION

Chronic AFB1 exposure induces microglial pyroptosis, promoting an adverse neurogenic microenvironment that impairs hippocampal neurogenesis, which may render mice more vulnerable to stress.

Prevalence of and factors associated with depression among adult patients living with HIV/AIDs undergoing ART unit in Banadir hospital, Mogadishu Somalia

BACKGROUND

Depression is the most common psychiatric disorder in HIV/AIDs patients, and its prevalence is three times higher in HIV/AIDs patients. Globally, over 35 million people were living with HIV/AIDs, 24.7 million were in Sub-Saharan Africa. The study aims to estimate the prevalence and determine factors associated with depression among HIV/AIDs adult patients in the ART unit at Banadir Hospital Mogadishu, Somalia.

METHOD

A hospital-based cross-sectional study was conducted between 1 May and 1 July 2022. Samples were recruited from the HIV/AIDs adult patients attending in ART unit at Banadir Hospital, Mogadishu, Somalia. A validated research tool, including sociodemographic, behavioral, clinical, and psycho-social characteristics, three items social support scale, an 11-item HIV stigma scale, and patient health questions-9 (PHQ-9) were used. The interview was conducted privet room in the ART unit. Logistic regression was used to determine factors associated with depression at the significance level a = 0.050.

RESULT

The overall prevalence of depression among HIV/AIDs patients was 33.5% (95%CI = 28.1-39.0). In the multivariable logistic regression, three factors were associated with depression; the odds of depression were 3.415 times (95%CI=1.465-7.960) greater for those with poor social support than those with moderate-strong social support. Those with moderate and poor treatment adherence had 14.307 times (95%CI=5.361-38.182) greater odds of depression than those with good treatment adherence. Those who use substances had 3.422 times (95%CI=1.727-6.781) greater odds of having depression than those who did not.

CONCLUSION

People living with HIV in Mogadishu, Somalia, suffer from depression. The implementation to reduce depression should be focused on empowering social support, developing an appropriate approach to increase treatment adherence, and reducing or eliminating substance use.

Magnitude and Severity of Depression and Associated Factors Among Hypertensive Patients Attending Follow-up Treatment at Public Hospitals of Hadiya Zone, Ethiopia

Introduction

Co-morbid depression in hypertension leads to non-adherence to anti-hypertensive treatment.

Objective

To assess the magnitude and severity of depression and associated factors among hypertensive patients attending follow-up treatment at public hospitals of Hadiya zone, Ethiopia, 2022.

Methods

Hospital-based cross-sectional study was conducted from January 1, to January 31, 2022. The total sample size was 315 and used a systematic random sampling technique. Data were collected through a face-to-face interview. Data were entered using Epi-data Version 4.6 and exported to SPSS Version 25 for analysis. The goodness-of-fit test was done. Binary logistic regression was done, and variables with a p-value of < .25 in the bivariable analysis were taken into the multivariable analysis. Statistically significant was declared at a p-value of < .05 with an adjusted odds ratio and 95% confidence interval.

Result

The magnitude of depression among hypertensive patients was 37.1% (95% CI 31.7-43.9). Regarding the severity, 56.1% had no depression, 6.7% had mild, 17.3% had moderate, 14.7% had moderately severe, and 5.1% had severe depression. Body mass index: 19.12-24.9 kg/m2 [AOR 0.06, 95% CI: 0.02-0.23], body mass index: 25-29.9 kg/m2 [AOR 0.08, 95% CI: 0.02-0.35], absence of family history hypertension [AOR 0.39, 95% CI: 0.18-0.85], presence of co-morbidity [AOR 2.43, 95% CI: 1.34-4.42), low perceived stress scale [AOR 0.07, 95% CI: 0.01-0.56], low medication adherence [AOR 2.70, 95% CI: 1.17-6.24], and moderate medication adherence [AOR 0.29, 95% CI: 0.09-0.88] were significantly associated.

Conclusion

About four in 10 hypertensive patients attending follow-up treatment were depressed. The mean score of severity of depression was mild. Body mass index, family history of hypertension, co-morbidity, perceived stress scale, and medication adherence were significantly associated with depression. Therefore, maintaining body mass index, screening and treating co-morbid illness, accommodating stress, and educating about medication adherence might minimize the risk of depression.

Prevalence of unrecognized depression and associated factors among medical outpatient department attendees; a cross sectional study

OBJECTIVES

To determine the prevalence and associated factors of unrecognized depression among patients who visit non-psychiatric outpatient departments in the University of Gondar specialized teaching hospital. North West Ethiopia.

METHODS

An institution-based cross-sectional study was conducted among Medical outpatient departments in the University of Gondar specialized referral hospital from March to April 2019. We collected data through face-to-face interviews. We recruited 314 participants for face-to-face interviews using the systematic random sampling technique. The patient health questionnaire (PHQ-9) was used to measure depression. Coded variables were entered into Epi Info version 7 and exported to SPSS version 20 for analysis. Descriptive statistics and multivariable logistic regression analysis were used. Adjusted odds ratios (AOR) with a 95% confidence interval were used to calculate significance.

RESULTS

A total of 314 participants were interviewed with a response rate of 100%. The prevalence of depression was 15.9% with (95% CI (12.1-20.1)). In the multivariate logistic regression revealed that, able to read and write (AOR = 0.24, 95% CI (0.67-0.84)), secondary education (AOR = 0.34, 95% CI (0.12-0.91)), education in college and university level (AOR = 0.32, 95% CI (0.13-0.78)), poor social support (AOR = 7.78, 95% CI (2.74-22.09)), current cigarette smokers(AOR = 12.65, 95% CI (1.79-89.14)) were associated with depression.

CONCLUSION

The prevalence of depression among outpatient attendees was high. We recommend an early depression screening be carried out by health professionals.

Depressive symptoms in primary health care attendees in Sebeta Town, Ethiopia: Prevalence, associated factors, and detection by health workers

Depression often goes unrecognized in the primary health care setting. When depression occurs in clinical settings, it increases the risk of mortality from co-morbid medical conditions. Besides, 70% of patients with depression have somatic complaints, resulting in unnecessary investigations and mismanagement. This study was intended to investigate the prevalence and associated factors of depressive symptoms in primary health care centers and the detection rate in Sebeta Town, Ethiopia. An institution-based cross-sectional study was conducted among 384 visitors of adult outpatient department of four primary health centers in Sebeta Town, Ethiopia from October 1 to November 3, 2020. Depressive symptoms were assessed using PHQ-9 at cut-off score of 5. Data were entered using EPI data version 3.1 and exported to SPSS version 20 for data analysis. Descriptive statistics and binary logistic regression analysis were conducted. The prevalence of depressive symptoms was 27.9% (95% CI: 23.4-32.6). Detection rate of depressive symptoms by PHC providers was 0.93% (95% CI: 0.0-5.1). The factors positively associated with depressive symptoms were being unmarried (adjusted odds ratio (AOR): 3.40, 95% CI: 1.56-7.40, p < 0.01), perceived worsening of illness (AOR: 3.67, 95% CI: 1.73-7.77, p < 0.01), having family history of depression (AOR: 3.78, 95% CI: 1.40-10.23, p < 0.01), current alcohol consumption (AOR: 2.73, 95% CI: 1.22-6.10, p < 0.05), and current khat consumption (AOR: 5.43, 95% CI: 2.55-11.56, p < 0.01). Moderate social support (AOR: 0.16, 95% CI: 0.06-0.41, p < 0.01) and strong social support (AOR: 0.23, 95% CI: 0.09-0.63, p < 0.01) compared to poor social support, and the age group 25-31 (AOR: 0.36, 95% CI: 0.14-0.92, p < 0.05), compared to the age group 18-24, were negatively associated. Prevalence of depressive symptoms was found to be high, while the detection rate was very low. Provision of depression care services integrated into routine health care at PHC level was recommended.

Prevalence, severity, and associations of depression in people with epilepsy in Guinea: A single-center study

BACKGROUND AND OBJECTIVE

Depression has long been recognized as a comorbidity of epilepsy in high-income countries, ranging from 17 to 49% of people with epilepsy (PWE). Of the limited studies from sub-Saharan Africa (SSA), where most people have uncontrolled seizures, an even higher prevalence of depression is reported among PWE at times exceeding 80%. We sought to assess the prevalence and severity of depression and its associated factors among PWE in Guinea, a sub-Saharan West African country where most PWE have poorly controlled seizures.

METHODS

People with epilepsy from the community, age 16 years old and above, were consecutively recruited into a convenience cohort at the Ignace Deen Hospital in the capital city, Conakry, in summer 2018 as part of a larger study characterizing PWE in Guinea. Each participant was evaluated by a team of Guinean physicians and a U.S.-based neurologist to confirm the diagnosis of epilepsy. Inperson interviews were performed to measure demographic, clinical, socioeconomic, and related variables. Depression was measured via the Patient Health Questionniare-9 in the language of the participant's preference with a cutoff of 5 or more points being categorized as depressed. Regression analyses were performed to measure the associations between explanatory variables with the outcome of depression.

RESULT

Of 140 PWE (age range: 16-66 years old; 64 female; 64% taking an antiseizure medication including 28% carbamazepine, 16% phenobarbital, and 14% valproic acid; duration of epilepsy: 11 years; 71% with one or more seizures in the past month; 17% never treated with an antiseizure medication; 90% with loss of consciousness during seizures; 10% without formal education; 31% with university level education; 62% using tap water; 48% with a serious seizure-related injury), the point prevalence of depression was 66% (95% confidence interval [CI]: 58%-74%): 43% of PWE had mild depression, 19% moderate, 4% moderate to severe, and 0.1% severe. In a multivariate analysis, the occurrence of a seizure in the past month (odds ratio: 3.03, 95% CI: 2.63-3.48, p = 0.01) was associated with depression, while gender, self-perceived stigma score, serious injuries, and the number of antiseizure medications taken were not statistically significantly associated (p > 0.05). Twenty-five percent of all participants endorsed thoughts of self-harm or suicidality.

CONCLUSION

Two-thirds of PWE in Guinea had depression in this single-institution convenience cohort. The presence of a seizure in the last month was the factor most associated with depression and is modifiable in many PWE. The high prevalance of depression suggests that screening and addressing depressive symptoms should be incorporated into routine epilepsy care in Guinea.

Prevalence and Factors Associated with Depression among HIV/AIDS-Infected Patients Attending ART Clinic at Jimma University Medical Center, Jimma, Southwest Ethiopia

Background

HIV is a chronic life-threatening illness and, like other similar chronic and stigmatizing illnesses, can be stressful to manage. Depression is a common mental health problem that deteriorates the quality of life of people with HIV/AIDS and found to be a strong predictor for noncompliance to antiretroviral therapy treatment. Therefore, epidemiological evidence on the factors associated with depression among patients with HIV/AIDS can contribute towards effective and efficient preventive health care strategies for this population.

Objectives

To assess the prevalence and factors associated with depression among HIV/AIDS-infected patients attending ART clinic at Jimma University Medical Center, Jimma, Southwest Ethiopia, in 2018.

Methods

This study followed an institution-based cross-sectional quantitative study design. A simple random sampling method yielded 303 participants who were interviewed from April to May 2018, using a pretested questionnaire, followed by their card review. The SPSS version 23 was used for bivariate analysis which was used to find out the significance of association. Variables that showed association in bivariate analysis at p value < 0.25 were entered to multivariable logistic regressions to control for confounders, and the significance of association was determined by 95% confidence interval and p value < 0.05.

Results

The point prevalence of depression was 94 (31%). Variables like sex (AOR = 0.510 (95%CI = 0.264‐0.986)), marital status (AOR = 3.610 (95%CI = 1.649‐7.901)), opportunistic infection (AOR = 3.122 (95%CI = 1.700‐5.733)), and medication adherence (AOR = 0.470 (95%CI = 0.266‐0.831)) were significantly associated with depression. Conclusion and Recommendation. From the findings of this study, it is possible to conclude that depression was highly prevalent among people living with HIV/ADS. Sex, marital status, opportunistic infection, and medication adherence were found to be associated with depression and need attention from the health professional working in the ART clinic.

Prevalence of Depression and Associated Factors among Diabetes Patients in East Shewa, Ethiopia: Bayesian Approach

BACKGROUND

Depression is one of the most pressing public health problems and also highly prevalent comorbid condition among diabetes mellitus (DM) patients. Depression may impact lifestyle decisions and ability to poorly perform tasks which are risk factors for DM. For reducing the impact of depression among DM patients in developing countries, it is crucial to identify and assess associated risk factors of depression among DM patients, thereby designing effective management techniques. In line with this, the current study applies the Bayesian framework, which pools prior information and current data, to find factors associated with depression among DM patients.

METHODS

A hospital-based cross-sectional study was conducted at Adama Hospital and Medical College (AHMC) from March to April 2019. Data was entered into the Epi-data 3.1 then exported to the R software 3.4.4. Bayesian logistic regression models were fitted to the data using the Markov chain Monte Carlo (MCMC) algorithm. Estimates of model parameters including adjusted odds ratio (AOR) with 95% credible intervals (CI) were calculated.

RESULTS

A total of 359 adults with DM were included in the analysis. The prevalence of depression among diabetic patients was 9.22% (95% CI: 6.4% to 12.7%). Higher fasting blood sugar level (AOR = -1.012; HPD CI: (1.0020, 1.025)), having diabetic complication (AOR = 0.1876; HPD CI: (0.0214, 0.671)), history of hospital admission (AOR = 0.2865; HPD CI: (0.0711, 0.7318)), low medication adherence (AOR = 29.29; HPD CI: (3.383, 92.26)), and taking both insulin and oral antidiabetic medication (AOR = 24.46; HPD CI: (15.20, 49.37) were significantly and strongly associated with depression among DM patients.

CONCLUSIONS

Prevalence of depression among diabetes patients in the catchment area of Adama Hospital, Ethiopia, was found to be very low. Higher fasting blood sugar level, diabetic complication, history of hospital admission, low medication adherence, and taking both insulin and oral antidiabetic medication were found to be strong predictors of prevalence of depression among DM patients. Based on the findings, we recommend that integrating screening and treating of depression, early detection and management of diabetic complication, and giving counseling to improve medication adherence is an effective approach for lowering the impact of depression on DM patients.

Prevalence of Depression among Students of a Dental Tertiary Care Center in Kerala

Introduction:

According to the World Health Organization, more than 300 million people were estimated to suffer from depression in 2017. Many studies have observed that medical personnel have a higher level of depression, but studies among dentists are scarce. Early diagnosis will help in controlling the morbidity and mortality due to depression. Hence, this study was undertaken to estimate the prevalence of depression among students of Government Dental College (GDC), Thiruvananthapuram, the capital city of the state of Kerala, India.

Materials and Methods:

A cross-sectional study was conducted at GDC, Thiruvananthapuram, for a period of 3 months from September to December 2017, using the Patient Health Questionnaire-9 (PHQ-9) and a pro forma comprising 37 questions. Students having PHQ scores >9 were considered to have depression. The questionnaire was administered on 364 students comprising undergraduate students, paradental students, house surgeons, and postgraduates. Separate sessions were arranged for each group and four reminders were given.

Results:

The prevalence of depression was estimated as 26.9% (95% confidence interval: 22.4–31.8). Being married, having high and average level of course satisfaction, and having close friends were found to act as independent protective factors, whereas female gender and breakups in relationships were found to be independent risk factors.

Conclusion:

It is high time we provide supportive programs and implement preventive measures to help professional students, especially those who are at higher risk of mental ill-health. Further studies need to be conducted to explore the academic reasons for depression.

Depression among epileptic patients and its association with drug therapy in sub-Saharan Africa: A systematic review and meta-analysis

Background

Despite the high prevalence of epilepsy in sub-Saharan Africa and the established relationship between depression and epilepsy, the extent of comorbid epilepsy and depression in the region is still poorly understood. The objective of this systematic review and meta-analysis is to address this gap in the literature by determining the pooled prevalence of depression among epileptic patients in sub-Saharan Africa.

Methods

A systematic desk review and electronic web-based search of PubMed, Google Scholar, EMBASE, PsycINFO and the World Health Organization’s Hinari portal (which includes the SCOPUS, African Index Medicus, and African Journals Online databases) conducted from December 2, 2017 to February 30, 2018, identified peer-reviewed, original research articles and doctoral dissertations using pre-defined quality and inclusion criteria. Relevant data were extracted and descriptive summaries of the studies presented in tabular form. The I² statistic was used to assess heterogeneity across studies. Funnel plot asymmetry and Egger’s tests were used to check for publication bias and the methodological quality of the included studies were assessed using the scale developed by Hoy and colleagues. The pooled prevalence of comorbidity at a 95% confidence interval (CI) was determined by applying a trim and fill analysis in a random-effects model.

Results

Our search identified 167 studies, of which 14 original research articles and two doctoral dissertations reporting on case-control and cross-sectional studies were eligible for inclusion in the final analysis. The pooled estimate of prevalence of depression among patients with epilepsy was 32.71% (95% CI: 25.50–39.91%). Regional sub-group analysis found that the pooled prevalence in East Africa was 34.52% (95% CI: 23.53–45.51%) and 29.69% (95% CI: 22.7–36.68%) in Southern and West Africa. The odds of depression among epileptic patients receiving polytherapy were 2.65 higher than in those receiving monotherapy (95% CI: 1.49–4.71, I² = 79.1%, p < 0.05).

Conclusion

Our findings indicate high comorbidity in sub-Saharan Africa and suggest that it may be more prevalent there than elsewhere. Comorbidity is statistically associated with polytherapy in the studies reviewed. Given the high levels of comorbidity in the region, more attention should be paid to incorporating depression screening and treatment into existing epilepsy programs and to revising treatment guidelines on comorbid depression to reduce polytherapy.

The Prevalence of Depression among Diabetic Patients in Ethiopia: A Systematic Review and Meta-Analysis, 2018

BACKGROUND

Diabetes mellitus is a chronic metabolic disorder characterized by hyperglycemia. Depression is one of the major important public health problems that is often comorbid with diabetes. Despite the huge effect of comorbid depression and diabetes, the overall pooled prevalence of depression among diabetic patients in the country level remains unknown. Therefore, the objective of this systematic review and meta-analysis is to estimate the pooled prevalence of depression among patients with diabetes mellitus in Ethiopia.

METHOD

Data extraction was designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were accessed through electronic web-based search from PubMed, Cochrane Library, Google Scholar, Embase, and PsycINFO. All statistical analyses were done using STATA version 11 software using random effects model. The pooled prevalence was presented in forest plots.

RESULTS

A total of 9 studies with 2944 participants were included in this meta-analysis and the overall pooled estimated prevalence of depression among diabetic patients in Ethiopia was 39.73% (95% CI (28.02%, 51.45%)). According to subgroup analysis the estimated prevalence of depression in Addis Ababa was 52.9% (95% CI: 36.93%, 68.88%) and in Oromia region was 45.49% (95% CI: 41.94, 49.03%).

CONCLUSION

The analysis revealed that the overall prevalence of comorbid depression among diabetic patients in Ethiopia was high. Therefore, Ministry of Health should design multisectorial approach and context specific interventions that address this comorbid depression in this specific group as well as general population.