Prevalence of Depression and Associated Factors Among the Patients With Diabetes and Hypertension in Rwanda

Purpose:

Chronic non-communicable diseases are frequently becoming linked with development of depressive symptoms and disorders with major health consequences associated with this co morbidity (Gunn, Ayton, Densley et al. 2012; Al-Amer, Sobeh, Zayed and Al-domi, 2011).   Global trends have shown that the co-morbidity of depression and chronic NCDs has been associated with major health consequences including high rate of mortality and morbidity, disability, reduced quality of life and  increased health costs and non- adherence to treatment  (Markowitz, Gonzalez , Wilkinson & Safren , 2011; Moussavi , Chatterji , Verdes , Tandon  et a. 2007). It is in this context that the World Health Organization has recommended the regular screening of depression among chronically ill patients (NICE, 2009). 

The current study explored the prevalence of depression among diabetic and hypertensive patients in three selected district hospitals in Rwanda. We also explored Socio- demographic factors associated with the co morbidity of depression and chronic non communicable diseases (represented by diabetes and hypertension) in the current study. 

Methods:

This is a part of a larger study which aimed to adapt the Collaborative Care Model to manage the co morbidity of depression and chronic non communicable disease to Rwandan context. This part present the quantitative data. A descriptive cross-sectional design approach was used to explore prevalence of depression among 339 diabetic and hypertensive patients. The systematic random sampling technique was used to choose the sample. We used the Patient Health Questionnaire-9 (PHQ-9) to screen depression. Data was collected over a period of six weeks. Data was analysed using Stata13.0. Frequencies were calculated for categorical data. Bivariate logistic association was used to calculate the association between socio demographic data and depression.

 

Results:

The sample size was 385 and 339 have participated in the study making the response rate 88%. The findings revealed that all participants 100 %( n=339) had diabetes; however a small number of participants 6.2% (n=21) also had hypertension. The majority of participants was over 60 years 34% (n=116).  More than a half of participants 56% (n=190) have been diagnosed with diabetes and/or hypertension between 1 and 5 years. The majority of participants 56.9% (n=193) were married. The high number of participants 78.5% (n=266) were not employed and the majority of participants were living with their family members 87.6% (n=297). Also the majority of participants 34.8 (n=198) never schooled.

The prevalence of depression was calculated using the PQH-9 table of score. The results have shown that a vast majority of participants 83.8% (=284) had depression. Among them 17.9% (n=61) had moderately severe to severe depression and the big number of participants had minimal to moderate depression 81.9% (n=223). Only 16.2 (n=55) did not have depression.

It was found that only a statistically significant association was found between age and depression (p=0.01). Similarly, a significant association was found between gender and depression (p=0.02).However there were no significant associations found between depression and other demographic factors. These are p-values found between depression and relationship status (p=0.49); employment status (p=0.17), who lived with the respondents (p=0.28); educational level (p=0.49); duration of diabetes/hypertension (p=0.57) and types of medication used (p=0.37).  

Conclusion:

A very high prevalence rate 83% (n=284) of depression among diabetic and hypertensive patients was found in our study. Age and gender were associated with depression. Based on the findings from this study, we recommend for routine screening in Rwanda for depression in patients with diabetes and hypertension as well as other non-communicable diseases especially for those attending district hospitals to reduce the number of the depressed or the misrecognized depressed patients and consequently offer them a better quality of life.