1. 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

2. 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.

3. 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

4. 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.

5. 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.

6. 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.

7. 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

8. 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%))

9. 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%)

10. 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)

11. 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)

12. 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)

13. 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)

14. 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)

15. 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.

16. 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.

17. 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’ .

18. 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