Depression in the Peruvian population and its associated factors: analysis of a national health survey

Highlights

• Peruvian adults population' prevalence of moderate and severe depressive symptoms was 3.9% and 2.5%, respectively (2018).

• Women were more likely to have clinically relevant depressive symptoms, with a ratio of 2:1 compared to men.

• Being over 45 years old or 65 or older, living in the Andean region increased the probability of severe depressive symptoms.

• Having high blood pressure, diabetes mellitus, or some disability increased the probability of severe depressive symptoms.

Abstract

Background

: To date, the factors associated with the presence of depression or depressive symptoms in the Peruvian population have not been described. This study aimed to determine the prevalence of clinically relevant depressive symptoms in the Peruvian population and its associated factors.

Methods

: A cross-sectional analytical study of secondary data from 2018 Demographic and Family Health Survey was conducted. The survey database includes 31,996 participants over 18 years of age. The dependent variable of the analysis was the presence of depression during the 14 days before the survey measured by the Patient Health Questionnaire (PHQ-9). Factors associated with the presence of depression were estimated with a proportional odds logistic regression model.

Results

: The overall prevalence of clinically relevant depressive symptoms was 6.4% (moderate and severe symptomatology in 3.9% [95% CI: 3.6–4.3] and 2.5% [95% CI: 2.2–2.7], respectively). Being a woman, belonging to the age groups of 45 to 64 years or 65 or older, living in the Andean region, and having high blood pressure or diabetes mellitus or some disability increased the probability of having clinically relevant depressive symptoms.

Limitations

: The use of the PHQ-9 tool to assess depressive symptomatology limits the evaluation to a period of two weeks before the survey, requiring further study for diagnosis confirmation.

Conclusion

: Six out of 100 Peruvians presented moderate to severe clinically relevant depressive symptoms in 2018. Strategies for depression should contemplate population subgroups , such as women and patients with chronic diseases and disabilities.

Introduction

Major depressive disorder (MDD) is one of the public health problems with the most significant impact on the population, being among the leading causes of disease burden (GBD 2017 Disease and Injury Incidence and Prevalence Collaborators, 2018). Globally, more than 300 million people suffer from depression (4.4% of the world's population) (World Health Organization 2017), with an increase of 18.4% having been reported in the number of people with depression between 2005 and 2015 (Vos et al., 2016). In 2018, depression rose to be the most significant contributor to disability worldwide (7.5% of all years lived with disabilities [YLD]) (World Health Organization 2017, Vos et al., 2016) after having been in third place in 2017 (GBD 2017 Disease and Injury Incidence and Prevalence Collaborators, 2018). Moreover, depression is the main factor associated with suicide, a health problem that causes around 800,000 deaths per year (World Health Organization 2017).

In Peru, neuropsychiatric diseases occupy first place in the burden of disease (Ministerio de Salud 2018). Among mental health problems, MDD has the highest burden of disease with 224,535 disability-adjusted life years (DALYs) (3.9% of the total), which is equivalent to 7.5 years lost per 1,000 inhabitants (Ministerio de Salud, 2018). Given this scenario, the Ministry of Health of Peru has proposed the inclusion of mental health as a research priority in the country over the period from 2019 to 2023. This proposal includes promoting and supporting studies aimed at assessing the state of mental health in the Peruvian population as well as the factors associated with various mental health problems, including depression (Ministerio de Salud, 2019).

The biomedical literature has described several factors associated with the development of MDD, including sex and socioeconomic factors (Lorant et al., 2007, Cole and Dendukuri, 2003). However, studies are required at a local level because each area can have specific sociodemographic factors that have an impact on the prevalence of mental illness (Ferrari et al., 2013, Weissman et al., 1996). Demographic Health Surveys (DHS) are useful to study the state of diseases in the population.

Since 1986, the National Institute of Statistics and Informatics (INEI by its acronym in Spanish) in Peru has carried out the Demographic and Family Health Survey (ENDES by its acronym in Spanish), allowing the study of various health problems in the Peruvian population (Instituto Nacional de Estadística e Informática, 2019; Instituto Nacional de Estadística e Informática, 2019). ENDES has been collecting data to assess the mental health status of the Peruvian population since 2014, and while depression is reported to be at the top of disease load, the factors associated with the presence of depression or depressive symptoms in the Peruvian population have not been described. Some symptoms scales such as the PHQ-9 questionnaire are used for screening and severity assessment of depressive symptoms (Calderón et al., 2012, Villarreal-Zegarra et al., 2019). ENDES survey measures PHQ-9 questionnaire to evaluate the presence of clinically relevant depressive symptoms in the Peruvian population.

The aim of this study was to determine the prevalence of clinically relevant depressive symptoms in the Peruvian population and its associated factors. The results will help to develop health strategies to reduce the mental health burden in our country.