Socio-demographic and clinical profile of depressive disorder among adolescents (14-19yrs) attending a rural primary health-care set-up in Eastern India Dr. Aniruddha Basu, M.D. , Senior Resident, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore. Dr. Sirshendu Chaudhuri, D.P.H. , Junior Resident, Department of Community Medicine, Christian Medical College Vellore, Ex-Superintendent Singot Rural Hospital, Mathrun Subdivision, Bardhmann, West Bengal Dr. Rajarshi Neogi, M.D. , RMO-cum-Clinical Tutor Calcutta Medical College, Kolkata, West Bengal, India

Introduction Adolescents (10-19 yrs) constitute 21.4% of India’s population. Census data, 2011. For them one of the leading cause of DALY is unipolar depression. Gore et al., 2007. Adolescent depression is different from adult depression. Text book of Child and adolescent psychiatry. Adolescent depression leads to serious consequences. Haarasilta et al.,2004. Need to study adolescent depression and its correlates.

Literature Review Author, yr Study Methodology prevalence Mishra et al.,2000 N=1097,school-girls,12-18yrs 13.76% Nair et al., 2004 N=1014, school-based, (13-19yrs), Kerala 3% Srinath et al., 2005 N=1578, community based, (4-16yrs), CBCL, Bangalore 0.1% Pillai et al.,2008 N=2048, community based, (10-19yrs), DAWBA, Goa 0.5% Bansal et al.,2009 N=125, school based, 9th Std, BDI, Pune 18.4% Patel et al.,2013 N=3,649,community based, (16-24yrs), Goa 7.87% Khaikar et al.,2013 N=3671, hospital-based, (4-16yrs), Wardha 3.73% Characteristics of depression varies across different cultural , social and economic settings

Aims and Objectives To find the point prevalence of a depressive episode among adolescents in a rural primary health centre set-up in eastern India. To find the socio-demographic and clinical profile of depressed adolescents.

Methodology Study design: Cross-sectional Place of study : Singot rural hospital, Mathrun sub-division, district of Barddhaman located in the state of West Bengal. Duration: Month of March, 2013. Sample size: 144 consecutive adolescent patients. Data collection: Done by a qualified psychiatrist.

Methodology Inclusion Criteria: Age 14-19yrs Exclusion criteria Presence of any serious medical/ surgical condition Patients having difficulty in speaking, hearing or impaired comprehension(as per judgment of attending physicians). Patients denying consent.

Methodology Instruments Statistical Analysis Socio-demographic sheet Semi-structured clinical profile sheet Patient Health Questionnaire 9 (PHQ-9) ( Bengali validated version) World Health Organization-Alcohol Smoking and Substance Involvement Screening Test (ASSIST) Statistical Analysis

Results Initial selection(n=148) Final selection after valid informed consent (n=144) Denied consent(n=4) PHQ<10(n=133,92.4%) PHQ>10(n=11, 7.6%))

Results Socio-demographic profile: Variable Non-depressed (n=133) Total (n=144) p gender female 75(56.4) 5(45.5) 80(55.5) 0.5 male 58(43.6) 6(54.5) 64(44.6) Age (yrs) 16.61 ±1.9 17.45 ± 1.39 16.67 ± 1.88 0.08 Education(yr) 7.7±3.7 9.9± 2.5 7.9 ±3.7 0.06 Occupation student 66(49.5) 8(72.7) 74(71.4%) 0.3 Working 15(10.5) 2(18.2) 17(11.8%) Non-working 19(14.3) 19(13.2%) House-wife 33(24.8) 1(9.1%) 34(23.6%)

Results Socio-demographic profile: Variable Non-depressed (n=133) Total (n=144) p religion Hindu 87(65.4) 7(63.6) 94(65.3) 1.0 Muslim 46(34.6) 4(36.4) 50(34.7) Economy < Poverty Line 73(54.9) 6(54.5) 79(59.3) 0.61 >Poverty Line 60(45.1) 5(45.5) 60(41.7) Family Nuclear 95(71.4) 9(81.8) 104(72.2) 0.37 Joint 38(28.6) 2(18.2) 40(27.8)

Results Clinical Profile: Variable Non-depressed (n=133) Depressed Total (n=144) Co-morbidity absent 129(97.0) 7(63.6) 136(94.4) 0.001 present 4(3.0) 4(36.4) 8(5.6) Family history Absent 102(76.7) 109(75.7) 0.5 Present 31(23.3) 4(36.6) 35(24.3) Death in family 120(90.2) 10(90.9) 130(90.3) 1.0 13(9.8) 1(7.6) 14(9.7)

Results Profile of females: Variable Non-depressed (n=75) Depressed Total (n=80) p Age at Menarche (yrs) 12.7±1.2 12.8±1.5 0.9 Menstrual complaints absent 51(68) 4(80) 55(69) 1.0 present 24(32) 1(20) 25(31) marriage unmarried 42(56) 2(40) 44(40) 0.7 married 33(44) 3(60) 36(60)

Results Profile of married females: Variable Non-Depressed (n=33) Total (n=80) p Age at marriage 15.8±1.2 16.0±1.0 0.81 Abortion absent 27(81.8) 1(33.3) 28(77.8) 0.12 Present 6(18.2) 2(66.7) 8(22.8) child Absent 19(57.6) 3(100) 22(61.1) 0.27 14(42.4) 0(0) 14(38.9) pregnancy Non-pregnant 20(60.6) 23(63.9) 0.29 pregnant 13(39.4) 13(36.1)

Results Clinical factors among males: Type of substance used ever: Variable Non-depressed (n=58) Depressed (n=6) Total (n=64) p Substance Use Never used 20(34.5) 3(50) 23(35.9) 0.7 Use ever 38(64.5) 41(64.1)

Discussion Depression screening done among adolescents in a remote area in West Bengal where prior data is lacking. Study found point prevalence of depressive disorder (7.6%). High rate of substance use(particularly tobacco) found. Statistically significant association with co-morbidities. Socio-demographic profile of female demands urgent attention. Some trend-level association needs to be explored further.

Limitations Only screening instruments used for diagnosis. Other psycho-social factors not considered. No corroboration of facts done from informants/investigations. Multivariate model could have been used. Representativeness of the sample. Genuineness of reported age could not be considered. Low awareness/stigma regarding mental illness.

Conclusion Studies for characterization of risk factors for depression High prevalence of depression among adolescents(7.6%) High prevalence of substance use(64%) Co-morbidities potentially associated with depression Alarming socio-demographic profile of female adolescents Studies for characterization of risk factors for depression Large population based epidemiological studies. Focused Interventions for ‘at risk group’ .

Acknowlegment We thank all staff and superintendent of Singot rural hospital in Bardhamann district of West Bengal. Funding: No funding was received. Conflict of interest: Nil Ethical Clearance: Taken from Calcutta Medical College and Hospital, Kolkata, India