Prevalence and correlates of depressive symptoms among adults living in the Amazon, Brazil: A population-based study

Abstract

Background: Depression is an affective disorder and one of the main contributors to the burden of disease worldwide. Our purpose is to estimate the prevalence of depressive symptoms and associated factors in the population of the Manaus Metropolitan Region. Methods: We conducted a population-based, cross-sectional study with a probabilistic three-phase sampling in 2015, based on a previously calculated sample size. Adults living in Manaus and seven inner cities of the metropolitan region were surveyed for depressive symptoms using the Patient Health Questionnaire (PHQ-9) and a cutoff score of >= 9. We performed a Poisson regression with robust variance using a hierarchical approach to calculate the prevalence ratio (PR) of depression and 95% confidence intervals (CIs). Results: Among 4001 participants (response rate 76%), the prevalence of current depressive symptoms was 7% (95% CI: 6-8%). Depressive symptoms were more frequent in inhabitants of Manaus than in those from the countryside (PR = 6.13, 95% CI: 2.91-12.91); in women than in men (PR = 2.55, 95% CI: 1.96-3.33); in indigenous than in white people (PR = 2.56, 95% CI: 1.24-5.30); and in those with hypertension (PR = 1.47, 95% CI: 1.13-1.92), cardiac disease (PR = 1.62, 95% CI: 1.12-2.33), and poor health status (fair: PR = 5.10, 95% CI: 2.50-10.37; bad: PR = 10.27, 95% CI: 4.92-21.44 very bad: PR = 21.14, CI 95%: 10.16-43.99). High school education (PR = 0.55, 95% CI: 0.32-0.95) and middle class economic status (PR = 0.33, 95% CI: 0.12-0.89) were protective factors. Limitations: Limitations include the lack of measurement of physical activity, religious beliefs, leisure time, and use of alcohol and other drugs since these factors can affect depression and health status. Conclusion: Seven out of every 100 adults from the Manaus Metropolitan Region have depressive symptoms. This rate is higher in women, individuals living in Manaus, indigenous people, people with hypertension or chronic cardiac disease, and those with a poor health status.