Depressive disorder at the household level: prevalence and correlates of depressive symptoms among household members

ABSTRACT

Background

Globally, an estimated five percent of adults have major depressive disorder. However, little is known about the relationship between these individuals’ depressive symptoms and their household members’ mental health and well-being.

Objectives

We aimed to investigate the prevalence and predictors of depressive symptoms among adult household members of patients living with major depressive disorder in Neno District, Malawi.

Methods

As part of a cluster randomized controlled trial providing depression care to adults with major depressive disorder, we conducted surveys with patients’ household members (n = 236) and inquired about their overall health, depressive symptoms, disability, and social support. We calculated prevalence rates of depressive disorder and conducted multivariable linear regression and multivariable logistic regression analyses to assess correlates of depressive symptom severity and predictors of having depressive disorder (PHQ-9), respectively, among household members.

Results

We observed that roughly one in five household members (19%) screened positive for a depressive disorder (PHQ-9 > 9). More than half of household members endorsed six or more of the nine symptoms, with 68% reporting feeling ‘down, depressed, or hopeless’ in the prior two weeks. Elevated depression symptom severity was associated with greater disability (β = 0.17, p < 0.001), less social support (β = −0.04, p = 0.016), and lower self-reported overall health (β = 0.54, p = 0.001). Having depressive disorder was also associated with greater disability (adjusted Odds Ratio [aOR] = 1.12, p = 0.001) and less social support (aOR = 0.97, p = 0.024).

Conclusions

In the Malawian context, we find that depressive disorder and depression symptoms are shared attributes among household members. This has implications for both screening and treatment, and it suggests that mental health should be approached from the vantage point of the broader social ecology of the household and family unit.

Trial Registration

ClinicalTrials.gov (NCT04777006) - March 2, 2021.

KEYWORDS:

• Depression
• depressive disorder
• social ecology
• epidemiology
• social determinants

Responsible Editor Jennifer Stewart Williams

Responsible Editor Jennifer Stewart Williams

Acknowledgments

We would like to thank the clinicians, data collectors, and other staff at Partners In Health/APZU who spend their days making Integrated Chronic Care a reality throughout Neno District. Zikomo.

Author contributions

KM, OM, and RM contributed to the study conception and design. KM, OM, and MK performed data collection. R M, KM, and TeR performed data preparation and analysis. RM, KM, and TeR wrote the first draft of the manuscript. All authors reviewed, commented, and provided feedback on all versions of the manuscripts. All authors read and approved the final manuscript.

Consent for participation and publication

We obtained written informed consent from all participants to participate in the study. Patients signed informed consent regarding publishing their data. The research was carried out in accordance with the RAND Human Subjects Protection Committee guidelines.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethics

The study has received ethics approval from the RAND Human Subjects Protection Committee as well as the National Health Science Research Committee of Malawi (20/11/2626). The research was carried out in accordance with the RAND Human Subjects Protection Committee guidelines.

Paper context

Among household members of adults living with major depressive disorder, we find a high prevalence of depressive symptoms and moderate-to-severe depressive disorders. The findings shed new light on the social ecology of major depressive disorder, including the correspondence of elevated depressive symptoms among co-habiting household members. The findings indicate that mental health screening and treatment should extend beyond the individual perspective – to consider screenings among household members and interventions that account for household dynamics.

Data availability statement

Deidentified data and code are available upon request (email: [email protected]).

Additional information

Funding

This work was supported by the NIMH under Grant [R01 MH117760]. More details can be found on ClinicalTrials.gov [NCT04777006]. The funder had no role in study design, implementation of activities, data analysis and interpretation, writing, or the decision to submit the paper.