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The cross-sectional association of stressful life events with depression severity among patients with hypertension and diabetes in Malawi

Depressive disorders are a leading cause of global morbidity and remain disproportionately high in low- and middle-income settings. Stressful life events (SLEs) are known risk factors for depressive episodes and worsened depressive severity, yet are under-researched in comparison to other depression...

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Autores principales: Landrum, Kelsey R., Pence, Brian W., Gaynes, Bradley N., Dussault, Josée M., Hosseinipour, Mina C., Kulisewa, Kazione, Malava, Jullita Kenela, Masiye, Jones, Akello, Harriet, Udedi, Michael, Zimba, Chifundo C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9803137/
https://www.ncbi.nlm.nih.gov/pubmed/36584142
http://dx.doi.org/10.1371/journal.pone.0279619
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author Landrum, Kelsey R.
Pence, Brian W.
Gaynes, Bradley N.
Dussault, Josée M.
Hosseinipour, Mina C.
Kulisewa, Kazione
Malava, Jullita Kenela
Masiye, Jones
Akello, Harriet
Udedi, Michael
Zimba, Chifundo C.
author_facet Landrum, Kelsey R.
Pence, Brian W.
Gaynes, Bradley N.
Dussault, Josée M.
Hosseinipour, Mina C.
Kulisewa, Kazione
Malava, Jullita Kenela
Masiye, Jones
Akello, Harriet
Udedi, Michael
Zimba, Chifundo C.
author_sort Landrum, Kelsey R.
collection PubMed
description Depressive disorders are a leading cause of global morbidity and remain disproportionately high in low- and middle-income settings. Stressful life events (SLEs) are known risk factors for depressive episodes and worsened depressive severity, yet are under-researched in comparison to other depression risk factors. As depression is often comorbid with hypertension, diabetes, and other noncommunicable diseases (NCDs), research into this relationship among patients with NCDs is particularly relevant to increasing opportunities for integrated depression and NCD care. This study aims to estimate the cross-sectional association between SLEs in the three months preceding baseline interviews and baseline depressive severity among patients with at least mild depressive symptoms who are seeking NCD care at 10 NCD clinics across Malawi. SLEs were measured by the Life Events Survey and depressive severity (mild vs. moderate to severe) was measured by the Patient Health Questionnaire-9. The study population (n = 708) was predominately currently employed, grand multiparous (5–8 children) women with a primary education level. Two thirds (63%) had mild depression while 26%, 8%, and 3% had moderate, moderately severe, and severe depression, respectively. Nearly all participants (94%) reported at least one recent SLE, with the most common reported SLEs being financial stress (48%), relationship changes (45%), death of a family member or friend (41%), or serious illness of a family member or friend (39%). Divorce/separation, estrangement from a family member, losing source of income, and major new health problems were significant predictors of greater (moderate or severe) depressive severity compared to mild severity. Having a major new health problem or experiencing divorce/separation resulted in particularly high risk of more severe depression. After adjustment, each additional SLE was associated with a 9% increased risk of moderate or worse depressive severity compared to mild depressive severity (RR: 1.09; (95% CI: 1.05, 1.13), p<0.0001). Among patients with NCDs with at least mild depressive symptoms, SLEs in the prior 3 months were associated with greater depressive severity. While many SLEs may not be preventable, this research suggests that assessment of SLEs and teaching of positive coping strategies when experiencing SLEs may play an important role in integrated NCD and depression treatment models.
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spelling pubmed-98031372022-12-31 The cross-sectional association of stressful life events with depression severity among patients with hypertension and diabetes in Malawi Landrum, Kelsey R. Pence, Brian W. Gaynes, Bradley N. Dussault, Josée M. Hosseinipour, Mina C. Kulisewa, Kazione Malava, Jullita Kenela Masiye, Jones Akello, Harriet Udedi, Michael Zimba, Chifundo C. PLoS One Research Article Depressive disorders are a leading cause of global morbidity and remain disproportionately high in low- and middle-income settings. Stressful life events (SLEs) are known risk factors for depressive episodes and worsened depressive severity, yet are under-researched in comparison to other depression risk factors. As depression is often comorbid with hypertension, diabetes, and other noncommunicable diseases (NCDs), research into this relationship among patients with NCDs is particularly relevant to increasing opportunities for integrated depression and NCD care. This study aims to estimate the cross-sectional association between SLEs in the three months preceding baseline interviews and baseline depressive severity among patients with at least mild depressive symptoms who are seeking NCD care at 10 NCD clinics across Malawi. SLEs were measured by the Life Events Survey and depressive severity (mild vs. moderate to severe) was measured by the Patient Health Questionnaire-9. The study population (n = 708) was predominately currently employed, grand multiparous (5–8 children) women with a primary education level. Two thirds (63%) had mild depression while 26%, 8%, and 3% had moderate, moderately severe, and severe depression, respectively. Nearly all participants (94%) reported at least one recent SLE, with the most common reported SLEs being financial stress (48%), relationship changes (45%), death of a family member or friend (41%), or serious illness of a family member or friend (39%). Divorce/separation, estrangement from a family member, losing source of income, and major new health problems were significant predictors of greater (moderate or severe) depressive severity compared to mild severity. Having a major new health problem or experiencing divorce/separation resulted in particularly high risk of more severe depression. After adjustment, each additional SLE was associated with a 9% increased risk of moderate or worse depressive severity compared to mild depressive severity (RR: 1.09; (95% CI: 1.05, 1.13), p<0.0001). Among patients with NCDs with at least mild depressive symptoms, SLEs in the prior 3 months were associated with greater depressive severity. While many SLEs may not be preventable, this research suggests that assessment of SLEs and teaching of positive coping strategies when experiencing SLEs may play an important role in integrated NCD and depression treatment models. Public Library of Science 2022-12-30 /pmc/articles/PMC9803137/ /pubmed/36584142 http://dx.doi.org/10.1371/journal.pone.0279619 Text en © 2022 Landrum et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Landrum, Kelsey R.
Pence, Brian W.
Gaynes, Bradley N.
Dussault, Josée M.
Hosseinipour, Mina C.
Kulisewa, Kazione
Malava, Jullita Kenela
Masiye, Jones
Akello, Harriet
Udedi, Michael
Zimba, Chifundo C.
The cross-sectional association of stressful life events with depression severity among patients with hypertension and diabetes in Malawi
title The cross-sectional association of stressful life events with depression severity among patients with hypertension and diabetes in Malawi
title_full The cross-sectional association of stressful life events with depression severity among patients with hypertension and diabetes in Malawi
title_fullStr The cross-sectional association of stressful life events with depression severity among patients with hypertension and diabetes in Malawi
title_full_unstemmed The cross-sectional association of stressful life events with depression severity among patients with hypertension and diabetes in Malawi
title_short The cross-sectional association of stressful life events with depression severity among patients with hypertension and diabetes in Malawi
title_sort cross-sectional association of stressful life events with depression severity among patients with hypertension and diabetes in malawi
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9803137/
https://www.ncbi.nlm.nih.gov/pubmed/36584142
http://dx.doi.org/10.1371/journal.pone.0279619
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