Epidemiology of depression in Azerbaijani urban female population. Cross-cultural comparison of depression incidence/prevalence indicators

Introduction

The aim is to determine the prevalence and incidence of depression for an Azerbaijani female sample and explore the impact of cultural factors on depression.

Objectives

To determine: the optimal cut-off point of ZDRS; the point prevalence and 3 month incidence of depression; risk factors for depression. To compare the depression prevalence in the two language groups of the Azerbaijani population (Azerbaijani-speaking and Russian-speaking) for determining possible impact of cultural factors on depression.

Methods

The first screening with ZDRS (Az) and ZDRS (Ru) were carried out with 1500 research participants, who filled out the questionnaires at their homes. All the screened subjects who score 40 and more on ZDRS were examined by MINI. True-positive and false-positive results were defined. Ten percent of the screened subjects, who score less than 40 on ZDRS were randomly chosen for clinical interviews to define true-negative and false-negative results. According to the analysis the optimal cut-off point of ZDRS in the Azerbaijani female population was found with the definition of its sensitivity, specificity, positive predictive value and negative predictive value. Based on the optimal cut-off point of ZDRS, point prevalence and incidence of depression was determined in Azerbaijan. The follow-up screening was conducted to determine the 3 month incidence of depression.

Results

The determined prevalence and incidence of depression will be reported with the optimal cut-off point of ZDRS.

Conclusions

The results of the current study suggested that the ZDRS was a valid tool for use in screening patients with depression disorders but need a modification.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

[Suicide Rates and Suicide Prevention in Women of Turkish Origin in Berlin]

Suicidality in female Turkish immigrants is higher as compared to that of native-born women of the same age. The analysis of the national mortality registry in Germany reported a 2-fold suicide risk in the target group compared to German women of the same age. A population-based multi-modal intervention project was conducted. Suicidal crisis were analysed in focus groups and guided the development of the intervention module. The intervention consisted of a public awareness campaign, a telephone hotline, and the training of key persons. All parts of the intervention were subsequently evaluated. Suicide attempts of the target group that were presented at all emergency units in Berlin were registered. In a population-based interview survey the aim was to elicit central sociodemographic and psychosocial variables that may influence distress and help-seeking behaviour in women of Turkish origin.

Translation and adaptation of the Zung Self- Rating Depression Scale for application in the bilingual Azerbaijani population

BACKGROUND

A self-reported Zung Self-Rating Depression Scale (ZSDS) is recognized as a reliable and valid measure for assessment of depressive symptoms, applicable cross-culturally. The aim of the study was to adapt ZSDS for application in the bilingual Azerbaijani population.

METHODS

ZSDS was translated into Azerbaijani and Russian. Two pilot studies on small samples (n=30 and n=45) were conducted to improve the scale's acceptability. A readability study was conducted on a bigger sample of depressed subjects (n=55) and healthy controls (n=120). Chronbach's alpha for the total scale, item-test correlations, alpha if item deleted, and sensitivity and specificity at various cut-off levels were calculated.

RESULTS

The drop-out rate was 83.3% at the first pilot study due to problems of comprehension of item 5 and culturally unacceptable wording of item 6. After rewording of the items drop-out reduced to 20%. On the reliability study Chronbach's alpha for the total scale was 0.8727, and item-test correlations for the most individual items were satisfactory. An optimal cut-off point was 45 points with sensitivity=90.91%, specificity=80.83%.

CONCLUSIONS

Adaptation of the Zung Self-Reported Depression Scale improved cultural acceptability of the scale in the context of the Azerbaijani study population.

Cross-Cultural Challenges in the Diagnosis of Depression

For a long time it was assumed that depressive disorders were a classic western problem specific to industrial states. However, the World Bank discovered in a study as early as 1993 that depression in Third World countries was already fifth on the list of illnesses which comprise the largest contribution to the Global Burden of Disease. Affective and behavioural disorders as well as somatic complaints represent the three central categories of symptoms in depression. In western cultures an affective disorder is seen as the main characteristic of a depression, whereas in other cultures different symptoms can be in the foreground. The increase in supraregional communication and cooperation as well as the worldwide increase in immigrant populations demand that cultural aspects are considered in the diagnosis and treatment of depression. Physicians need to consider the cultural background of their patients in order to achieve an optimal therapy. If the sociocultural aspects, which cannot always be fully appreciated, of a culturally sensitive diagnosis are not taken into consideration, this can lead to an artificial prevalence of the disorder by making false diagnoses. In order to minimize these mistakes, the guideline for judging cultural influencing factors should be used to complete the diagnosis.

Not only the development of culturally adequate therapy concepts and institutions, but also the expansion of knowledge about the psychopathology and epidemiolgy of psychic disorders, e. g. of depression in immigrant groups and the examination of their use of treatment facilities, are the goals of cross-cultural psychiatry and psychotherapy.