Determining the Prevalence and Risk Factors for Depressive Symptoms Among Adults in Nepal: Findings from the Dhulikhel Heart Study

Thesis (Master's)--University of Washington, 2016-06

Background: Nepal is currently experiencing a rapid growth in non-communicable diseases (NCDs). Depression has previously been associated with NCDs in South Asia; however, data regarding the prevalence and risk factors for depression is lacking in Nepal. We sought to describe the burden of depressive symptoms within an adult population living in Dhulikhel, Nepal, a suburban town outside of Kathmandu. Methods: We conducted a cross-sectional analysis of baseline data collected from participants enrolled in the Dhulikhel Heart Study (DHS), a population-based, longitudinal cohort study investigating risk factors for cardiovascular disease in Dhulikhel. Baseline questionnaire data consisted of a random sample of 1,073 adults age 18 years and older, which included the Center for Epidemiologic Studies Depression Scale (CESD). A cutoff score of 16 or greater on the CESD has been shown to indicate major depressive symptomatology. Pearson’s chi-squared tests and multiple logistic regression were used to examine associations between the binary CESD depressive symptom score by gender, age, education level, marital status, body mass index, and hypertensive status. Results: Among 1,073 participants, the mean age was 40.3 years (SD: 16.4), and 58.4% were female. The mean CESD score in the sample was 11.7 (SD: 5.3), with 21.3% scoring 16 or greater suggesting major depressive symptomatology. In the adjusted model, increasing age above 60 years old (OR: 1.05, 95% CI: 1.01-1.10, p=0.01) and having no formal education (OR 2.23, 95% CI: 1.21-4.11, p=0.01) were associated with increased risk of depressive symptoms. Persons with a BMI ≥30 (OR: 0.39, 95% CI: 0.18-0.82, p=0.01) and those who were physically active (OR: 0.37, 95% CI: 0.27-0.51, p<0.001) were associated with decreased risk of depressive symptoms. Marital status, gender, ethnicity, religion, tobacco and alcohol use, and hypertension status were not significantly associated with depressive symptoms in the adjusted model. Discussion: Major depressive symptoms are common in Nepal, with an estimated prevalence of 21.3% in this sample. Significant risk factors for increased depressive symptoms included having no formal education, increasing age above 60 years old, and physical inactivity. Being obese was associated with decreased risk of depressive symptoms, which may be due to increased wealth and greater access to food. Gender was attenuated in the adjusted model, likely due to confounding by education, since 42% of women had no formal education.