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 Table of Contents  
Year : 2018  |  Volume : 25  |  Issue : 4  |  Page : 204-212

Depression among ambulatory adult patients in a primary care clinic in southeastern Nigeria

1 Department of Family Medicine, Federal Medical Centre, Umuahia, Abia State, Nigeria
2 Department of Psychiatry, Federal Medical Centre, Umuahia, Abia State, Nigeria
3 Department of Public Health, Federal University of Technology, Owerri, Imo State, Nigeria

Date of Web Publication21-Dec-2018

Correspondence Address:
Dr. Gabriel Uche Pascal Iloh
Department of Family Medicine, Federal Medical Centre, Umuahia, Abia State
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/npmj.npmj_107_18

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Background: Depression is a global health problem that occupies eminent position in clinical and community mental health. As the global prevalence of depression increases, the sociomedical challenges associated with it increase, especially in resource-constrained environment. Aim: The study was aimed at describing depression among ambulatory adult patients in a primary care clinic in Southeastern Nigeria. Patients and Methods: A cross-sectional descriptive hospital-based study was carried out on 400 adult patients in a primary care clinic of Federal Medical Centre, Umuahia. Data on relevant epidemiological variables were collected using pre-tested, structured interviewer-administered questionnaire. Patient Health Questionnaire-9 was used to assess for depression. Data were analysed using the Statistical Package for the Social Sciences software version 21. Test of associations was done using Chi-test and logistic regression, and P < 0.05 was considered statistically significant. Results: The age of the study participants ranged from 18 to 78 years with mean age of 38 ± 9.2 years, and there were 40.5% males. The prevalence of depression was 48.5% with the most common type being mild depression (32.3%). Occurrences of symptoms were most frequent and severe in the home environment (59.8%) and during the night (62.9%). Hypertension (35.5%) and alcohol use (57.5%) were the most common medical condition and substance used, respectively. Depression was significantly associated with elderly age (P = 0.005), females (P = 0.017), physical inactivity (P = 0.039) and psychosocial stressors (P = 0.042). The most significant predictor of depression was elderly age (adjusted odds ratio = 2.50; 95% confidence interval [1.40–3.78]; P = 0.001). Older persons were three and half times more likely to have depression when compared to their counterparts who were younger. Conclusion: This study has demonstrated high prevalence of depression and some epidemiological factors in the occurrence of depression among the study participants. Depression occurred predominantly among the elderly, females, physically inactive, hypertensive and those who had psychosocial stressors. Occurrences of symptoms were most frequent at home and nighttime. The most commonly used substance was alcohol.

Keywords: Adult patients depression, Nigeria, prevalence, primary care

How to cite this article:
Iloh GU, Aguocha GU, Amadi AN, Chukwuonye ME. Depression among ambulatory adult patients in a primary care clinic in southeastern Nigeria. Niger Postgrad Med J 2018;25:204-12

How to cite this URL:
Iloh GU, Aguocha GU, Amadi AN, Chukwuonye ME. Depression among ambulatory adult patients in a primary care clinic in southeastern Nigeria. Niger Postgrad Med J [serial online] 2018 [cited 2021 Jun 19];25:204-12. Available from: https://www.npmj.org/text.asp?2018/25/4/204/248205

  Introduction Top

Depression is a global health problem that causes significant dysfunction to the society and increases utilisation of health resources, especially when it is undiagnosed and inappropriately treated.[1],[2],[3] It is characterised by clusters of clinical manifestations such as persistent low mood, anhedonia, anergia, weight changes, poor or increased appetite, insomnia or hypersomnia, psychomotor retardation or agitation, feeling of worthlessness or excessive guilt, poor concentration and suicidal ideation.[4],[5],[6] Other symptoms commonly reported in depression include crying spells, feeling isolated, lack of motivation, increased perception of pain, increased anxiety and irritability.[7] Most of these symptoms must be present on a continuous period (every day or most days, most of the time) and may affect varying levels of family, social and occupational daily life functioning for at least 2 weeks.[4],[5] In operational terms, depression has been defined by various working groups for clinical and epidemiological diagnosis using specific set of criteria by Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5)[4] and International Classification of Diseases (10).[5] The diagnostic criteria varied in specific number of symptom counts for the diagnosis of depression but generally include core symptoms of depressed mood, anhedonia and aggregates of other symptoms.[4],[5] Various tools have been used to study depressive disorders in clinical and epidemiological studies.[4],[5] These tools include Patient Health Questionnaires (PHQ),[8] Hamilton Depression Rating Scale (HAM-D),[9] Zung Depression Scale (ZDS),[10] Beck Depression Inventory-II (BDI),[11] Centre for Epidemiological Studies Depression Scale (CES-D),[12] amongst others.[13] The validity and reliability of various depression rating scales in general and specific global populations have been reported with all the tools demonstrating good psychometric properties.[13]

The aetiology of depression is polyfactorial,[14] and its epidemiological risk factors include biological, psychological, socioeconomic and demographic, personal and pre-morbid characteristics.[14],[15],[16],[17],[18] However, depression results from a complex interaction of psychosocial, environmental and biogenetic factors with people who have gone through adverse life events such as bereavement, loss of financial or material resources, unemployment, family dysfunction and psychological trauma are at higher risk.[1],[15] There is strong evidence for a genetic component to depression, and specific genetic factors such as serotonin transporter gene and candidate genes that increase susceptibility to depression have been described.[18] More so, depression has been documented in biomedical literatures to occur disproportionately higher in persons with chronic medical conditions[19] such as hypertension,[20] diabetes mellitus,[21] stroke,[22] coronary heart disease,[23] chronic obstructive pulmonary disease,[24] HIV/AIDS,[25] heart failure[26] and cancers,[27] as well as with factors that increase the risk for these medical conditions.

Globally, the prevalence of depression is rising at an alarming rate,[1],[28] and global map of depression rates around the world shows the social and public health burden of depression with depression constituting the second leading cause of disability with 4% of the population diagnosed worldwide.[3] It is estimated that by the year 2020, if the current epidemiological transition continues, the burden of depression will increase to 5.7% of total global burden of diseases and will constitute the second leading cause of disability and second to ischaemic heart disease.[2] In 2004, the World Health Organization (WHO) ranked unipolar depression as the third leading cause of global burden of disease and projected it will move into first place by 2030.[29] In 2017, depression was estimated to affect more than 300 million people (5% of the global population) of all ages and a leading cause of disability worldwide affecting more women than men and at its most severe forms can lead to suicide.[1] In the United States of America (USA) between 2009 and 2012, more than 1 of 20 Americans, 12 years of age and older reported moderate or severe depressive symptoms in the past 2 weeks.[30] In 2015, an estimated 16.1 million (6.7% of all adults) adults aged 18 years and older in the USA had at least one major depressive episode in the previous 1 year.[31] Among the Indian population, the lifetime prevalence of depression was 5.25% among individuals aged 18 years and above with the current lifetime prevalence of 2.68%, suggesting that 1 of 20 adult individuals have suffered from depression in the past with half of them suffering at present.[32] The WHO also reported that about 36% of the Indian population suffers from major depression at some time or the other in their lives.[33] In a regional large-scale urban cross-sectional study, the prevalence of 15.1% was reported in the adult population in Chennai, South India.[34] In the Nigerian survey of mental health, the reported lifetime incidence of major depression in adults aged 18 years and more was 3.1% with 1-year estimate of 1.1%.[35] Hospital-based studies in Nigeria reported the prevalence of 59.6% in Ilesa, Western Nigeria,[36] 44.5% in Ilorin, Northcentral Nigeria,[37] 47.8% in Ado Ekiti[38] and 45.7% in Port Harcourt, South-South Nigeria.[39]

Depression is found in all societies and cultures throughout the world and affects different occupational groups and the individual ability to live a meaningful and gainful life.[1],[3],[40] Depression has also been reported in different occupational groups such as medical doctors,[41] resident physicians,[42] undergraduate medical students,[43] public servants[44] and unemployed population.[45]

As a global problem, burden of depression varies considerably depending on where a person lives, but an increase of more than 18% has been reported between 2005 and 2015 with the WHO leading 1-year global campaign on depression.[1] This was highlighted by the World Health Day 2017 with the theme ‘Depression- let’s talk[1] and World Family Doctors Day 2017 with the theme - Curbing depression'.[46] In 10 October 2012, during the World Mental Health Day, the WHO and World Federation of Mental Health described depression as a global health crisis.[47] The goal of the campaign on depression is that there are more people with depression everywhere in the world and those with depressive illness should seek and get help.[1],[48],[49]

In a resource-poor Nigerian environment, the family and societal ecology are changing rapidly,[50],[51] an alteration that is favourable to the emergence of depression. With the rising prevalence of socioeconomic deprivation and national economic recession, Nigerians are likely to experience more severe health challenges of depression if the tide is not arrested.[51] Of great concern in Nigeria is that although depression has effective treatments which are available, many individuals with depression do not have access to adequate treatment and experiencing one episode of depression places an individual at risk for experiencing another episode and further increases the chances of having more depressive episodes in the future. This primary care study was, therefore, conducted to provide data that would help in the identification of specific groups of at-risk patients in whom depressive disorder may be anticipated as well as providing valuable information that can be used to guide mental health promotion and mental health first aid particularly for depression. This study was, therefore, undertaken to describe depression among ambulatory adult patients in a primary care clinic in Southeastern Nigeria.

  Patients and Methods Top

Ethical certification was obtained from health research and ethics committee of Federal Medical Centre (FMC), Umuahia, with reference number FMC/QEH/G.596/Vol. 10/251 dated 30th May 2017. Informed consent was also obtained from the respondents included in the study.

This was a cross-sectional descriptive study carried out on 400 adult patients from 31 May 2017 to 30 June 2017 at the Department of Family Medicine, Federal Medical Centre (FMC), Umuahia, a tertiary hospital in Abia state, Southeastern Nigeria.

Umuahia is the capital of Abia state, Nigeria. Abia State is endowed with abundant mineral and agricultural resources with supply of professional, skilled, semiskilled and unskilled workforce. Economic and social activities are low compared to industrial and commercial cities such as Onitsha, Port Harcourt and Lagos in Nigeria.

The study was conducted at the Department of Family Medicine of FMC, Umuahia, Nigeria. The Department of Family Medicine of the hospital serves as a primary care clinic within the setting of the tertiary hospital. Patients who need primary care are managed and followed up in the clinic while those who need other specialists care are referred to the respective core specialist clinics for further management.

Adult patients aged ≥18 years who gave informed consent were recruited for the study and those who were not competent to respond to the questionnaire such as critically ill patients, the deaf and dumb were excluded from the study.

Sample size estimation was determined using the formula[52] for estimating minimum sample size for descriptive studies n=Z2 pq/d2 where n=Desired sample size when population is more than 10,000; Z=Standard normal deviate set at 1.96 which corresponds to 95% confidence limit; p=prevalence of depression in a Nigerian family practice population in Ado-Ekiti Nigeria[38] (P=47.8%); q=1.0 – p (q=0.52), d=Desired level of precision was set at 0.05. This gave a minimum sample estimate of 384 patients. However, selected sample of 400 adult patients was used to improve the precision of the study. The eligible patients for the study were consecutively recruited for the study based on the inclusion criteria until the sample size of 400 was achieved.

The instrument for data collection consisted of sections on sociodemographic variables, family history of psychiatric disorder, personal history of psychiatric illness and selected epidemiological variables such as time of the day with most frequent and severe symptoms, place of most frequent and severe symptoms, use of substances, physical activity profile, experience of psychosocial adverse events and comorbid medical conditions.

The generic nine-item module PHQ was used for the assessment of depression.[8] It consisted of the nine DSM-IV criteria for depression and assessed symptoms of depression over the past 2 weeks among the respondents. Each of the nine items was scored: not at all = 0, several days = 1, more than half the days = 2 and nearly every day = 3. The total score was graded thus: 0–4 = no depression, 5–9 = mild depression, 10–14 = moderate depression, 15–19 = moderately severe and >19 = severe depression. The PHQ-9 is standardised and has comparable sensitivity and specificity with other depression scales[8],[53] and had also been used in Nigerian primary care practice population.[37],[38]

Pre-testing of the study instrument was done at the Family Medicine Clinic of the hospital. Five patients were haphazardly selected and used for the pre-testing of the study tool which lasted for 1 day. The pre-testing was done to assess the applicability of the questionnaire and standard tools. All the patients used for the pre-testing of the questionnaire instrument gave valid and reliable responses confirming the clarity and applicability of the questionnaire tools, and questions were interpreted with the same meaning as intended.

Operationally, adult patients were classified based on their ages into young adults who were aged 18–39 years, middle-aged adults (40–59 years) and elderly or older persons (60 years and more). The time of exposure was divided into two: daytime was defined inclusively as the time from 6.00 am to 6.00 pm Nigerian time while nighttime refers exclusively to the time from 6.00 pm to 6.00 am Nigerian time. Physical activity was assessed by inquiring how many times the respondents engaged in physical activities in the previous 7 days. Those who engaged in activities that cause a moderate or large increase in breathing or heart rate for ≥30 min for ≥3 days/week were considered physically active while the level of activity below this was considered physical inactivity. Personal history of psychiatric disorder or chronic medical condition referred to previous and/or current management of psychiatric disorder or chronic medical condition by a health professional, respectively. Family history of psychiatric disorder meant previous information on any psychiatric disorder in the first-, second- and third-generation family members who were dead or alive made by a health professional.

The data generated were analysed using the Statistical Package for the Social Sciences software version 21 (IBM SPSS, New York, USA). Categorical variables were described by frequencies. Bivariate analysis involving Chi-square test was used to test for significance of association between categorical variables. Logistic regression was employed where appropriate. In all cases, P < 0.05 and confidence limits which did not embrace unity[1] were considered statistically significant. Odds ratio which is an indicator of degree of association of depression with a predictor independent variable was estimated at 95% confidence limit.

  Results Top

The age of the study participants ranged from 18 to 78 years with mean age of 38 ± 9.2 years. There were 162 (40.5%) male and 238 (59.5%) female with male-to-female ratio of 1:1.5. Other demographic characteristics of the study participants are shown in [Table 1].
Table 1: Sociodemographic characteristics of the study participants (n=400)

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Of the 400 study participants, 194 of them had depression, giving a prevalence of 48.5% with the most common type being mild depression (32.3%) [Table 2].
Table 2: Prevalence and type of depression among the study participants

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[Table 3] shows distribution of the study participants based on personal history of psychiatric disorder, family history of psychiatric disorder and personal history of chronic medical conditions. Of the 400 participants, 38 (9.5%), 17 (4.4%) and 142 (35.5%) had personal history of psychiatric disorder, family history of psychiatric disorder and personal history of chronic medical conditions, respectively. The most common chronic medical condition was hypertension.
Table 3: Frequency distribution of the clinical characteristics of the study participants

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[Table 4] shows the distribution of the study participants based on physical activity profile, substance use and psychosocial stressors. Of the 400 participants, 255 (63.8%), 230 (57.5%) and 289 (72.3%) were physically active, used alcohol and experienced psychosocial stressors, respectively. The most common psychosocial stressor was dwindling of financial resources.
Table 4: Frequency distribution of the study participants based on physical activity, substance use and psychosocial stressors

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One hundred and sixteen (59.8%) of the depressed participants had most frequent and severe symptoms at home environment while 122 (62.9%) of the depressed participants had most severe and frequent symptoms during the nighttime (6 pm–6 am exclusive) [Table 5].
Table 5: Frequency distribution of the participants with depression by place and time of the most frequent and severe symptoms (n=194)

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Bivariate Chi-square analysis of the demographic variables, histories of psychiatric disorder and hypertension, alcohol use, physical activity, psychosocial stressors as related to depression showed that age (≥60 years) (χ2 = 7.18; P = 0.005), sex (female) (χ2 = 12.21; P = 0.017), physical activity (inactive) (χ2 = 11.05; P = 0.039) and presence of psychosocial stressors (χ2 = 7.35; P = 0.042) were statistically significant while other variables were not statistically significant [Table 6].
Table 6: Association between characteristics of the respondents and depression

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Binary logistic regression of statistically significant variables at Chi-square analysis showed that the most significant predictor of depression was elderly age (AOR= 2.50; 95% CI (1.40-3.78); P=0.001). Older persons were three and half times more likely to have depression when compared to their counterparts who were younger [Table 7].
Table 7: Logistic regression analysis of the significant variables

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  Discussion Top

The study has shown that 48.5% of the study participants had depression with 32.3% being mild, 14.4% moderate, 1.3% moderately severe and 0.5% severe. The pattern of depression in this study is in congruence with the global epidemiological pattern of depression described in primary care settings[6],[36],[37],[38],[39] while the prevalence of 48.5% is lower than the prevalence of 59.6% reported among primary care patients in Ilesa, Western Nigeria[36] but higher than 44.5% reported in Ilorin, Northcentral Nigeria,[37] 47.8% in Ado Ekiti, Western Nigeria,[38] 45.7% in Port Harcourt, South-South, Nigeria[39] and 15.1% in Chennai, South, India.[34] The high prevalence reported in this study could be a reflection of the epidemiological profiles of the study population in addition to the degree and pattern of clustering of risk factors for depression in various families and communities in Nigeria which is characterised by social vices such as terrorist attacks, armed robbery, kidnappings, herdsmen invasion, individual and communal land disputes; state and national economic recessions marked by poor and irregular salaries and pensions and absence of social welfare services.[50],[51],[54] More so, there is widespread and increasing personal poverty in Nigeria,[54] and the WHO has recognised poverty as a risk factor for rising burden of depression worldwide.[1] Accordingly, personal and family incomes are among the social determinants of health because income determines individual and family overall standard of living and quality of life which affect mental health.[1] As a mental ill-health, depression is a whole-body illness involving the mood, body and mind and affects the way the victim eats, sleeps, feels about self and thinks about things. It is, therefore, pertinent for the patients to understand that depression is not a sign of weakness or failure but an expression of emotional disturbance.[1],[46],[47],[48],[49] This is very relevant especially in Nigeria where depressive illness is considered to be caused by spiritual attacks from enemies, and remedy is usually believed to be spiritual.[55] The unfortunate issue in depression is that most persons with the illness experience feel uncomfortable revealing their feelings to health professionals, family members, friends or significant others, but the good news is that depression is a treatable medical condition, especially when it is detected early and for the person living with depression, talking to someone they trust is often the first step towards recovery and treatment.[1],[32],[48],[49]

This study has shown that older patients had more depressive episodes compared to other age groups and are the most significant predictor of depression among the study participants. This finding is in consonance with reports that depression can develop at any time in a person's life but it occurs disproportionately higher among older persons, particularly in resource-poor environment where there is poverty of social, economic and medical resources for the older persons.[37] Although the factors responsible for higher occurrence of depression among the older persons are variable, this could be ascribed to the fact that older persons are likely to experience adverse life socioenvironmental events such as loss of spouse and family members, retirement from work, loneliness, reduced ability to do things that were possible when younger and chronic medical conditions such as hypertension, diabetes, heart diseases, osteoarthritis and cancers.[56] More so, ageing is associated with biological waning of hormones due to menopause and andropause,[57] molecular ageing of the brain,[58] age-related degenerative changes and higher vascular lesion load.[59] In addition, elderly persons in Nigeria are likely to be retired and tired from primary and secondary occupations with irregular or no pensions.[37],[56] Physicians should, therefore, be aware of these subtleties in other to tailor preventive interventions to accommodate the needs of older persons with depression.

One hundred and twenty-five (64.4%) females had depression when compared with 69 males (35.6%). This finding is in tandem with global gender epidemiological pattern for depression.[1],[3] Research studies in Nigeria[35],[36],[37],[38],[39],[40] and other parts of the world[30],[31],[34] have reported preponderance of females as victims of depressive mental disorder. The higher burden of depression in females could be due to joint effects of biological vulnerabilities and socioenvironmental provoking experiences.[60] Accordingly, females have greater tendency to depression due to drastic hormonal changes in female sex hormones at puberty, menstrual cycle, post-partum period and menopause.[60] The state of the female hormonal imbalance promotes hormonal deregulation in depression through the regulation of the central nervous system, alteration of the production of serotonin, a neurotransmitter highly associated with depression and control of specific receptors and other metabolic intermediates. More so, socioenvironmental risk factors of depression are overrepresented among the female folks particularly in Nigeria where females carry the burden of domestic and household chores in addition to other work/social engagements while the married ones have additional burden of raising and caring for the children. There is, therefore, need for primary prevention targeted at jointly manipulating putative socioenvironmental risk factors that predispose the female gender to depression.

Depressive symptoms occurred predominantly during the nighttime (6 pm–6 am inclusive). Phenomenally, depressive disorder is characterised by mood swings with variable degrees of symptoms severity in the morning, afternoon and night but night worsening of symptoms predominated in this study. Appropriately, mood swings as a physiological variable are regulated by a circadian clock interacting with sleep homeostat and most patients with depression have shifts in timing and duration of sleep and other activities which affect the mood state.[61] The worsening of depressive symptoms at night could be attributed to circadian pacemaker interacting with sleep homeostat to determine nocturnal sleep architecture with subjective wakefulness and nighttime vigilance. In addition, the higher frequency of depressive symptoms during the night in this study also corresponded with the period of minimum outdoor activities and social interactions in the study area which could have influence on mood dysregulation characteristics of depression.

One hundred and sixteen (59.8%) of the respondents had higher frequency of depressive symptoms in the home environment. This finding could be attributed to relationship between social rhythms and mood characterised by social disability with limited social interactions and most times social withdrawal.[62] More so, depressive symptoms in this study have worst episode at night when the victim is most likely to be in the home environment. Furthermore, home environment in family provoked and aggravated depressive illness could constitute a fertile ground for family-related environmental factors that prompt the depressive episode, especially in the presence of poor family cohesion, restricted expression of emotions and high family domestic violence, abuses or conflicts.

Thirty-one (16.0%) of the depressed participants had personal history of depression. This finding could be an indication that some patients with depression are very somatically oriented and poorly psychologically oriented that the diagnosis of depression is missed during clinical encounter in general practice. Of great concern in Nigeria is that patients with clinical diagnosis of depression or other mental health disorders may not accept a mental health diagnosis.[36],[37],[38] However, in those with previous episodes of depressive illness, initial depressive episodes can create changes in the neurochemistry that makes it more likely that future episode will occur even a small dose of psychosocial and environmental stressors can trigger recurrent depressive episodes. It is, therefore, pertinent for clinicians not to become adversarial at this point, but raising the psychological components of the depressive ill-health will allow the patient to discuss psychological matters at the clinical encounter.

Twelve (6.2%) of the study participants admitted to positive family history of mental illness. This low family history of mental ill-health could be attributed to underdiagnosis of mental disorder in Nigeria, especially in general practice.[37],[39] In addition, denials of family history of mental illness and pattern of depression among the family members of the study participants with greater percentage of them having mild-to-moderate depression which might not be easily noticed are contributory. More so, the respondents did not have adequate information on the mental health histories of their vertical or horizontal first-, second- or third-degree relatives. Although in its natural history, depression has waxing and waning course and full recovery is usual, positive family history of mental depression or other mental health disorders is associated with severe forms of depression with poorer prognostic outcomes.

Ninety-nine (51.0%) of the participants with depression consume alcoholic beverages. Admittedly, the physiological and biochemical effects of any level of alcohol consumption are well known, but depressogenic effect of alcohol use is capable of altering patient's mood and potentially affect the management of depression in a patient whose management modalities require high levels of discipline, acceptance and commitment therapy.[63] In as much as individual lifestyle is a matter of choice and this choice has substantial effects on depression, there is a need to counsel depressed patients on alcohol use. This will ensure that the choice made is an informed choice. Of great interest in Nigeria is that individuals with depression try substances such as alcohol as a method to escape from the symptoms of depression but alcohol makes the prognosis worse. Physicians should, therefore, be aware of this disposition to alcohol use to tailor lifestyle interventions to accommodate the needs of patients with depression amidst other diverse care resources for depression.

This study has shown that 119 (61.3%) of the patients who had depression were physically inactive. Researchers[64] have documented the physical and mental health benefits of physical activities, especially in patients with depressive illness. Although physical activity profile varies socioenvironmentally, physical inactivity in depressed patients could be due to the fact that some patients with depression have limited domestic, work and social activities of daily living. The finding of this study makes for a strong call to action for proactive interventions for depressive mental ill-health by adopting strategies to ensure that depressed patients who were physically inactive should become physically active while those who are physically active should not go back to physical inactivity. More so, physical activity is one of the non-pharmacological modalities for the management of depression, and there is a physical activity for everyone with depression.

Two hundred and eighty (72.3%) of the respondents had experienced psychosocial stressors with the most common being dwindling financial resources and 146 (75.3%) of them had depression. This finding could be a proxy indicator of effect of local and national economic depression on the financial capacity and capability of the individuals as well as their psychological well-being. In Nigeria, the hostile socioeconomic climate of poverty created by the national economic recession has been documented to constitute a fertile environment for the genesis of depression, especially in those who are predisposed to depression.[37],[51] Accordingly, depressive disorder does not emerge from one psychosocial factor or event but interactions of multiple socioenvironmental and psychological factors which emanate from dysfunction of social structure, function, organisation and system thus fuelling the global call to curbs the impact of depression through addressing, particularly social determinants of depression.[1],[29],[46]

This study has shown that the most common chronic medical condition associated with depression was hypertension. Although co-morbid hypertension in depression appears like a trait rather than a depressive state as the relationship between blood pressure and depression is still inconsistent with variable reports of association.[20],[65] The high prevalence of hypertension in depressed patients in this study could be a reflection that hypertension is the most common non-communicable disease in Nigeria. However, the association between depression and blood pressure is reportedly bidirectional as depression can develop as a product of psychological adjustment to hypertensive medical condition, and pathobiological changes in hypertension can precipitate depression.[65] In addition, certain antihypertensive medications have been documented to predispose to depressive illness. The relationship between depression and blood pressure among Nigerian Africans requires further investigations for causal pathway to be clarified and determined.

Study limitations

The limitations of this study are recognised by the researchers. First and foremost, the study was hospital based. Hence, the results of this study may not be general conclusions regarding respondents in the community. Second, the sampled population was drawn from hospital attendees in the Family Medicine Clinic of the Hospital. Thus, extrapolation of the results of this study to the entire patients in the hospital should be done with caution because the findings may not be a true representation of what may be obtained in the other clinics of the hospital. Finally, this study was not an all-inclusive study on epidemiology of depression but on some selected epidemiological variables. Despite these limitations, the study provides valuable data on prevalence and some epidemiological factors in the occurrence of depression for consultative and comparative purposes.

  Conclusion Top

This study demonstrated the prevalence and some epidemiological factors in the occurrence of depression among the study participants. Depression occurred predominantly among the elderly, females, physically inactive, hypertensive and those who had psychosocial stressors. Occurrences of symptoms were most frequent at home and nighttime. The most commonly used substance was alcohol.

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Conflicts of interest

There are no conflicts of interest.

  References Top

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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]

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