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- Alem, Atalay, et al.
(author)
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Clinical course and outcome of schizophrenia in a predominantly treatment-naive cohort in rural Ethiopia
- 2009
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In: Schizophrenia Bulletin. - : Oxford University Press (OUP). - 0586-7614 .- 1745-1701. ; 35:3, s. 646-654
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Journal article (peer-reviewed)abstract
- The established view that schizophrenia may have a favorable outcome in developing countries has been recently challenged; however, systematic studies are scarce. In this report, we describe the clinical outcome of schizophrenia among a predominantly treatment-naive cohort in a rural community setting in Ethiopia. The cohort was identified in a 2-stage sampling design using key informants and measurement-based assessment. Follow-up assessments were conducted monthly for a mean duration of 3.4 years (range 1-6 years). After screening 68 378 adults, ages 15-49 years, 321 cases with schizophrenia (82.7% men and 89.6% treatment naive) were identified. During follow-up, about a third (30.8%) of cases were continuously ill while most of the remaining cohort experienced an episodic course. Only 5.7% of the cases enjoyed a near-continuous complete remission. In the final year of follow-up, over half of the cases (54%) were in psychotic episode, while 17.6% were in partial remission and 27.4% were in complete remission for at least the month preceding the follow-up assessment. Living in a household with 3 or more adults, later age of onset, and taking antipsychotic medication for at least 50% of the follow-up period predicted complete remission. Although outcome in this setting appears better than in developed countries, the very low proportion of participants in complete remission supports the recent observation that the outcome of schizophrenia in developing countries may be heterogeneous rather than uniformly favorable. Improving access to treatment may be the logical next step to improve outcome of schizophrenia in this setting.
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- Fekadu, Abebaw, et al.
(author)
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Utility of the concept of minor depressive disorder : evidence from a large rural community sample in a developing country setting
- 2007
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In: Journal of Affective Disorders. - : Elsevier BV. - 0165-0327 .- 1573-2517. ; 104:1-3, s. 111-118
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Journal article (peer-reviewed)abstract
- BACKGROUND: Evidence on the utility of the minor depressive disorder diagnostic construct in rural communities and developing countries is scarce. AIM: To assess the utility and validity of definitive minor depressive disorder in Ethiopia by determining its impact and sociodemographic correlates. METHODS: Assessment of 68,378 adults, aged 15-49 years, living in a largely rural district in Ethiopia using the Composite International Diagnostic Interview. RESULTS: The lifetime prevalence of minor depressive disorder was 2.2% (95% CI=2.1%, 2.3%). Age, marital status, education and unemployment independently predicted minor depressive disorder. Over 80% of cases used health services, 55.1% experienced persistent thoughts of death and 14.6% attempted suicide. LIMITATION: Findings are based on lifetime estimates. CONCLUSIONS: Minor depressive disorder is an important public health problem in rural Ethiopia, as shown by the associated high health service use and risk behaviour. Sociodemographic correlates suggest aetiological continuity with major depression. Thus our findings extend the clinical and public health utility of this diagnostic construct to rural community and developing country settings.
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| 5. |
- Fekadu, Abebaw, et al.
(author)
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Validity of the concept of minor depression in a developing country setting
- 2008
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In: Journal of Nervous and Mental Disease. - 0022-3018 .- 1539-736X. ; 196:1, s. 22-28
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Journal article (peer-reviewed)abstract
- Evidence for validity of the diagnostic construct of minor depressive disorder comes primarily from reports on subthreshold depressive states rather than minor depressive disorder per se. We report on the prevalence, impact, and sociodemographic correlates of minor depressive disorder in a developing country setting as further validation of this diagnostic construct. Diagnostic assessment of 1714 adults of an island population in Ethiopia was carried out using the Composite International Diagnostic Interview. The lifetime prevalence of minor depressive disorder was 20.5% (95% confidence interval 18.6, 22.5%). One-third of cases had sought help and expressed suicidal ideation. Being divorced/widowed, middle-aged, and having somatic pain were independently associated with having minor depressive disorder. Only being divorced/widowed was a shared risk factor for both minor depressive disorder and bereavement. Minor depressive disorder seems to be a useful and valid diagnostic construct with particular clinical significance in this and, possibly, similar developing country settings.
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