Depression & Its Associated Factors: A Comparative Study of Rural and Urban Adult Out-Patients in Northwestern Nigeria

Abstract

Background: Depression has a substantial direct and indirect impact on physical illness among the general outpatients. This impact includes amplifying physical symptoms and worsening functional impairment, thereby increasing morbidity and mortality, decreasing patients’ adherence to treatment, increasing the cost of treatment, and reducing the health-related quality of life. Aim: This study aimed to determine and compare the prevalence and factors associated with depression amongst rural and urban general outpatients. Study Design: It was a descriptive comparative cross-sectional study. Place and Duration of Study: The study was conducted in two general out-patients clinics located in urban and rural Kano, respectively, viz. Aminu Kano Teaching Hospital (AKTH) and Kumbotso Comprehensive Community Healthcare Clinic (KCCHC). Methodology: A minimum sample size was calculated to be 50 per each group (Rural vs Urban) and 10 was added per each group to allow for attrition or non-response. A simple random sampling was employed to select 60 participants with depression. Patient Health Questionnaire 9(PHQ-9) was used to screen for depression, and was confirmed using Mini International Neuropsychiatric Inventory (MINI-5) among the participants. They were also assessed for social support using the Oslo-3-item Social Support Scale (OSS-3). Results: A higher prevalence of depression was found among urban patients (53.6%) than their rural counterparts (33%). In the urban area, depression was associated with chronic medical illness, a family history of mental illness, lower social support and lower social status.  In rural areas, depression was associated with being single; increased frequency of consultation visits, fewer years in formal education and having more than one physical illness. Conclusion: Depression was more prevalent among urban outpatients than their rural counterparts. There is a need to incorporate regular screening of depression in the study areas, most notably among patients who are at high risk (Urban > rural) of depression based on the factors that were identified to be associated with depression in the study.