Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Archana Dambal

"Journal of clinical and diagnostic research is a welcome change in publishing practices. It aims to reach out to the grass-root level researchers who do not lack in experience, clinical material and ideas, but lack in their knowledge in English language and statistics. The journal achieves it's aim by supporting in these exact domains.
It also gives due credit to all research designs like descriptive and qualitative studies while many journals ignore these important study designs. The rigorous review process does not allow any compromise in quality
It is indexed in many indexing agencies and the articles are available under creative commons licence free of cost
The frequency of publication supports many aspiring authors from India and other countries.
It's wide scope welcomes articles across various specialities in medicine. In an era when there is an unscientific insistence on speciality specific research by regulatory bodies in medical education, JCDR supports collaborative research across specialities. I wish the publisher all the best in his future endeavors."



Dr. Archana Dambal
Department of General Medicine,
Belgaum Institute of Medical Sciences,Belgaum, Karnataka,INDIA,
On 30 Nov 2018




Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2010 | Month : December | Volume : 4 | Issue : 6 | Page : 3484 - 3492

A Cross-Sectional Descriptive Population-Based Study To Estimate The Prevalence Of Depression In An Urban Slum In Chennai City And The Associated Risk Factors

MUTHUKUMAR K* AND BHARATWAJ R S**

*MBBS., MD, Assistant Professor, Karpaga Vinayaga Institute of Medical Sciences and Research Centre, GST Road, Chinna Kolambakkam, Palayanoor Post, Madurantagam Taluk, PIN: 603 308, Tamil Nadu, India; **MBBS., MD, Assistant Professor, Department of Community Medicine, Shri Lakshmi Narayana Institute of Medical Sciences, Pondicherry, India, PIN: 605 502

Correspondence Address :
Dr.K.Muthukumar MD.,
Assistant Professor,
Department of Community Medicine,
Karpaga Vinayaga Institute of Medical Sciences and Research Centre,
GST Road, Chinna Kolambakkam,
Palayanoor PO, Madurantagam TK,
PIN: 603 308
Tamilnadu, India
Email: gnafamily@live.com
Phone: +91-44-9841143909

Abstract

Introduction
Depression has been under diagnosed and under reported in primary care settings. Various illnesses and biopsychosocial factors have been implicated as the contributing factors for depression. The overall rate of depression has increased in recent decades; depression is now being seen at younger ages and with greater frequency worldwide.

Very few studies have been done in the past to estimate the magnitude of the problem of depression in the community in India, particularly so in the urban slums.

Method
A cross sectional descriptive study was done. An urban slum in ward 131 of Chennai city was selected by using a simple random table, from among the 155 wards in the Chennai Corporation.
700 individuals who were aged between 15 and 65 years, from the urban slum of ward 131, were chosen by simple random sampling and were screened by a General Health Questionnaire (GHQ-12), followed by assessment by using Beck’s Depression Inventory scale (BDI).
Statistical analysis was done by the authors by using the SPSS 12 Version.

Results
The prevalence of depression in the study population was 22.8%, which included mild depression (20.7%) and moderate depression (2.1%). Female gender, illiteracy, being single after marriage in the form of being separated or divorced, widow or widower and the loss of one or both the parents before attaining 16 years of age were found to be the factors which were significantly associated with depression.

Conclusion
A large proportion of people in the urban slum had depression and many psychosocial factors were found to be associated with it. Health care personnel must be trained to identify the vulnerable groups and appropriate treatment should be administered at the primary care setting itself. In India, due to the scarcity of mental health services and resources, the policy makers can consider encouraging community participation in the form of the creation of self help groups with the support of the grass root level health workers.

Keywords

Chennai, Depression, GHQ (General Health Questionnaire) and BDI (Beck’s Depression inventory scale)

How to cite this article :

MUTHUKUMAR K AND BHARATWAJ R S. A CROSS-SECTIONAL DESCRIPTIVE POPULATION-BASED STUDY TO ESTIMATE THE PREVALENCE OF DEPRESSION IN AN URBAN SLUM IN CHENNAI CITY AND THE ASSOCIATED RISK FACTORS. Journal of Clinical and Diagnostic Research [serial online] 2010 December [cited: 2019 Sep 22 ]; 4:3484-3492. Available from
http://jcdr.net/back_issues.asp?issn=0973-709x&year=2010&month=December&volume=4&issue=6&page=3484-3492&id=987

Introduction
“Health is a state of complete physical, mental and social well being and not merely an absence of disease or infirmity”(1)
Mental, behavioural, and social health problems are an increasing part(2) of the health problems world over. Yet, these have received scant attention outside the wealthier, industrialized nations. The World Health Organization (WHO) declared Mental Health: “STOP EXCLUSION: DARE TO CARE” as the theme of the World Health Day, on 7th April 2001 in recognition of the burden that mental and brain disorders pose on people and the families which are affected by them.
At present(3), major and minor mental disorders are among the leading morbidity and mortality producing conditions in both the developing and the developed countries. The global burden of disease for neuropsychiatric disorders, as measured by the loss of DALY’S (Disability Adjusted Life Year), was estimated(4) to be 6.8% worldwide. The overall DALY’S for neuropsychiatric disorders is estimated(5) to increase to 15% by the year 2020 and this is proportionately larger than that of the CVS diseases.
Though the burden of illness resulting from psychiatric and behavioural disorders is enormous, it is grossly under-represented(6) by the conventional public health statistics, which tend to focus on mortality rather than morbidity and dysfunction. Deaths are traditionally ascribed to their proximate causes, rather than to the underlying disease states or behaviours that lead to the final crisis; thus, a death may be attributed to liver failure, when the underlying cause for the liver failure may be alcoholism due to depression and in depression, relapse is common and care over a long term is essential.
The number of persons with major and minor disorders is likely to increase(7) substantially in the decades to come, for two reasons;
(a) The number of people living in the age group which is at a risk for certain mental disorders is increasing due to the change in the demographics.
(b). The overall incidence in the rate of depression has increased in recent years. Depression is now being seen at younger ages and with greater frequency worldwide.

Depressed patients suffer as much disability and distress, if not more, as patients with chronic medical disorders such as systemic hypertension, diabetes mellitus, coronary artery disease and arthritis(8). Though clear guidelines for the management of depression are available, which include antidepressants and psychological interventions like cognitive therapy and social support, the majority of people suffering from depression do not receive adequate treatment(8).

Depression is the principal or secondary reason for seeking care in as many as one-fifth to one-third of the patients who attend primary health care clinics in low income countries according to the findings that have been reported from research studies from North America and Europe(9).

In addition to this, primary care providers fail to diagnose and treat as many as 35% to 50% of the patients with depressive disorders.(10) Therefore, the depression produces far more morbidity in the community. Suicide is an important consequence of depression(11). Every year, 10-20-million people attempt suicide and one million of them(12) – including many who are young – do kill themselves, thus increasing the premature mortality.

Though the National Mental Health Programme was launched by the Government of India in 1982, there are an estimated 70 million mentally ill people in India and 10% alone receive active psychiatric assistance or help, with only 4000 qualified Psychiatrists, 2000 Psychiatric Social Workers and 400 Psychiatric nurses (13) attending to them. In a country which has crossed a population of one billion, only 121 districts in 30 states and union territories are covered under the District Mental Health Programme(14)

In view of the above scenario, the present study was conducted to estimate the prevalence of depression in an urban slum of Chennai city by using the time tested case finding instruments for depression in primary care settings(15), namely the General Health Questionnaire and Beck’s Depression Inventory scale.

Material and Methods

The authors conducted the study after informing the purpose of the study to each of the study participants and after obtaining an informed written consent from the study participants. In the case of illiterates, the authors got their thumb impression, so as to ensure that they are willing to participate in the study, as the study was addressing some of the sensitive personal issues of the participants.
STUDY DESIGN: A cross sectional descriptive study was chosen, as it measures the proportion of people who have depression at a specified point or period. The results of this study will be valuable for administrative purposes, for example, for determining the workload of the personnel in a health programme and they will also be useful in ‘Community diagnosis’, i.e. to identify the communities that need special programmes or action to prevent the illness.
STUDY AREA: From among the 155 wards in Chennai Corporation, Ward 131 was selected by a simple random technique with the help of a random number table, and the urban slum in ward 131 was chosen as the study area. Ward 131, Kodambakkam, which is in the Zone IX Saidapet of Chennai Corporation, is situated at 13.0481 N latitude and 80.2214 E longitude. It is one of the westerly located neighbourhoods of Chennai city.

According to the Family register in ward 131, there were 7342 families in the ward 131 with the population of 45044. The total population in the urban slum in ward 131 was 13626, among which there were 7792 persons aged more than 15 years.

STUDY POPULATION:
INCLUSION CRITERIA
• All those aged(16) between 15 and 65 years in the urban slum of ward 131
• Those who were able to provide informed consent

EXCLUSION CRITERIA
• Those who were not willing to participate in the study
• Those who were aged less than 15 years and more than 65 years.


CALCULATION OF SAMPLE SIZE;
The following formula(17) was used for calculating the sample size for estimating the population proportion with specified relative precision,

Sample size (n) = ( Z1-α ) 2 P (1- P ) / ε 2,
Where Z1-α is confidence level at 95% (standard value of 1.96), ‘P’ is estimated prevalence of depressed in the previous study and ‘ε’ is the allowable error (Relative precision).
The sample size here, was calculated on the basis of 20% prevalence of depression18 and a relative precision of 15%, with a 95% confidence interval.

N = 3.84(20 x 80) / 3 x 3

N =683

This sample size was rounded off to 700.

SAMPLING METHOD;
All the people between 15 - 65 years in ward 131 were enlisted in the sampling frame. Among them, 700 were selected by simple random sampling. The purpose of the study was explained to the study participants and a valid consent was obtained from everyone who participated in the study. Confidentiality and empathy were suitably applied as and when sensitive and emotional issues were addressed.
The Multi Purpose Health worker (MPHW), the grass root level health worker who is the first level contact between the individual in the community and the Health care delivery system, attached to the Health post, ward 131, informed the study participants that the researcher, a qualified medical Doctor was going to make it to their home for conducting the study

STUDY TOOLS;
1. Basic questionnaire.
2. General Health Questionnaire(19) (GHQ)
3. Beck’s Depression Inventory scale(20) (BDI)
A semi-structured baseline questionnaire in Tamil, (the local language of the participants) comprising of questions on the age, sex, educational, occupational, income and marital status of the participants, whether their parents were alive or not, if not whether the death of the parent occurred before or after the study participant attained sixteen years, current medical illnesses and medications if any and questions related to personal habits such as smoking, alcohol and substance abuse, was constructed. The participants were asked to fill the baseline questionnaire and for the illiterates(21), the Author (1) read the contents and the obtained data were documented. The two psychological rating scales, the 12-item General Health Questionnaire (GHQ) and the 13 item Beck Depression Inventory (BDI) scale were used. The 12-item General Health Questionnaire was given to the participants and the 13 item Beck Depression Inventory (BDI) scale was given to those who had been found to have psychiatric morbidity, as screened by the (GHQ). People who could read were given the Tamil version of the self-rating scales and were asked to encircle the responses that they currently experienced. The Author (1) read the scales to the illiterates and the responses selected by them were documented in the proforma.

Piloting was done in the study area, involving 30 participants, to assess the feasibility of the study, which revealed 7 persons to be suffering from depression (23.3%) and among the seven, 5 were found to have mild and 2 had moderate depression.
All the 700 participants were given the baseline questionnaire, following which the 12-item General Health Questionnaire (GHQ) was administered to all the study participants. Scores above 3 were considered to be significant to detect psychiatric morbidity, if present. Since this instrument was highly sensitive as a first line screening device in the community, all those who had a GHQ score of more than 3, were given the second instrument, the 13 item Beck Depression Inventory Scale, which was used to diagnose and grade the depression, if present. This was applied as per the standard psychiatric norms and procedures.

STATISTICAL ANALYSIS was done by the authors by using the SPSS 12 Version.

Results

Of the 700 study participants, 49.9% (349) were females and 50.1% (351) were males. The age of the study population ranged from 18 years to 60 years and the mean age was 42.4 years. The greatest proportion of the population belonged to the 41-50 years age group.(Table/Fig 1)


(Table/Fig 1): Distribution of study population by age categories

PSYCHIATRIC MORBIDITY BY USING GHQ
The General Health Questionnaire was given to all the participants to assess them for the presence of psychiatric morbidity and if they were found to be having underlying psychiatric morbidity, the participants were then given the BDI scale.

Of the 700 study participants, 170 (24.2%) had psychiatric morbidity as per the GHQ and it was noted that the prevalence of the psychiatric morbidity was maximum between 41 – 50 years of age - 30.4% (n = 76) and minimum between 18 - 30 years of age -16.1% (n = 19).

93.6% (n = 160) of the people with psychiatric morbidity were found to have mild and moderate depression, according to the BDI. The overall prevalence of depression in the community was 22.8% (Mild depression being 20.7% and Moderate depression was 2.1 %.) No cases of severe depression were identified in the study. (Table/Fig 2). For further calculations, the moderate and mild depression categories were combined.

(Table/Fig 2): Number of people with depression identified with BDI scale


From (Table/Fig 3), it is evident that the prevalence of depression is significantly higher among women overall and almost twice that of the men in all the age categories, which was statistically significant, except in the 18-30 age years group.

(Table/Fig 3): Male to female comparison of depressed individuals


Depression was found to be present in 60.5% of the people whose fathers had died before they reached the age of 16 years, while the prevalence was only 24.4% among the people whose fathers had died after they reached the age of 16 years. In those whose fathers were still alive, the prevalence of depression was 18.6%. Statistical analysis revealed a highly significant association between the loss of the father and presence of depression, with a much higher prevalence in people who had lost their father before they had attained 16 yrs of age. (Table/Fig 4)

Depression was found to be present in 59.6% of the people whose mothers had died before they reached the age of 16 years, while the prevalence was only 31.1% among the people whose mothers had died after they reached the age of 16 years.
(Table/Fig 4): Relationship between loss of father and depression

P<0.001

In those whose mothers were still alive, the prevalence of depression was 18.5% (Table/Fig 5)

(Table/Fig 5): Relationship between loss of mother and depression
P<0.001

The prevalence of depression in the married group was 20.2%. It was maximum in the group of being single after marriage (separated, divorced, widow or widower) (51.6%) and was found to be the least in the unmarried group (16.9%). The χ2 analysis revealed a highly statistically significant positive association between being single after marriage and depression (Table/Fig 6).

(Table/Fig 6): Marital Status and Depression
p<0.001

In illiterates, 29.3% were found to be depressed, while the %s of depression were 21.3% in those who had education up to the high school level and 12.9% in those who had studied up to the higher secondary school or the college level. There was a statistically significant association between literacy status and the prevalence of depression. (Table/Fig 7)

Depression was present in 43.9% people with co morbid Diabetes Mellitus and Hypertension, while it was seen only in 20.7% people without these two illnesses.
(Table/Fig 7): Prevalence of Depression and Literacy status
P<0.01

There was a statistically significant difference in the prevalence of depression between people with these two co morbid illnesses and those without these two co morbid illnesses. (Table/Fig 8)

(Table/Fig 8): Prevalence of depression with / without co morbidity
P<0.001
In our study, there was no statistically significant association between depression and smoking and consuming alcohol.

Discussion

This study was conducted in the urban slum of ward 131 to estimate the cross sectional prevalence of depression in an urban slum at a community level.

The prevalence of depression in this study has been found to be on par with most of the studies which were conducted in India and outside India(18),(22),(23) &(24)

The overall prevalence of depression in the community was 22.85% (Mild depression being 20.71% and Moderate depression was 2.14 %.) No cases of severe depression were identified in the study. (Table/Fig 2)

The prevalence of depression in women was almost twice of that seen in men in all the age categories, which was statistically significant, except in the 18-30 years age group. This finding supports the previous findings that more women suffer with depression than men (25) &(26)

Loss of a parent or both the parents in childhood or before attaining 16 years of age, has been consistently implicated as a predisposing factor for depression by various studies across the world (27), (28) &(29) In our study also, the loss of fathers before the respondents reached the age of 16 years, had emerged as a statistically significant factor which was associated with depression, when compared with the loss of a parent after 16 years and the ‘Father alive status’.

Similarly, loss of mothers before the age of 16 years also emerged as a statistically significant factor which was associated with depression, when compared with the loss of mothers after 16 years and the ‘Mother alive’ status.

When looking at the current marital status and depression, the population of single after marriage due to being separated or divorced, widows or widowers had a depression rate of 51.5% and a highly statistically significant association (p < 0.0001) was found between depression and being single after marriage. The lower prevalence of depression in the unmarried group and a higher prevalence in the group which was being single after marriage is consistent with the cross-cultural literatures which endorsed that marriage confers protection or prevents most of the mental illnesses viz. depression, stress and personality disorders(30),(31) & (32). One of these studies revealed a lower rate depression in married individuals(30), while another reported higher rates of depression in divorced individuals than the married(31) and a 3rd one revealed lesser depression rates in those who were never married than in those who were being single after marriage(32) Though depression as a cause of being single after marriage was not studied, we can say that the likelihood of depression among those who were being together with their spouse was lesser than in those who were single after marriage in our study population.

A higher prevalence of depression among the illiterate participants and the lowest in the most educated group was observed in our study. A better level of education in this community was found to be associated with a lower prevalence of depression. A better employment and economic status due to higher education might perhaps contribute to the difference in the depression rates.

A statistically significant association was present between the presence of diabetes and/or hypertension and depression, in our study. This association again is consistent with studies which were conducted, which revealed in India and outside India(33), (34) & (35), that there is a significant association between depression and co morbid conditions like diabetes and hypertension.

Studies in the past have implicated a poor socio economic status with depression. In our study, the highest level income group was Rs.1500 (Around 30 US Dollars per month) and above and it is unclear whether this is the true representation of their economic status, as the participants in the study did not file income tax forms, in which they were expected to reveal all their possible sources of income, perhaps due to ignorance or illiteracy. It is also doubtful whether these economical or occupational categories really classify the people in a way in which research could really benefit from it.

LIMITATIONS
• Persons aged more than 65 years could have been included after ruling out a cognitive deficit, if any.
• Biological correlates of depression like markers could have been studied to corroborate the diagnosis of depression.

Conclusion

Firstly, those participants in the study who were found to be suffering from depression were advised to attend the Psychiatry Out-patient’s Block for appropriate treatment and the Multipurpose Health Worker was requested to follow them up, periodically.

There is huge case load of more than 20% unidentified depression cases in the community in our study. This, accompanied by the lack of an adequate health care system to detect and manage the same, brings forth the need for the following possible remedial actions.

• Active steps should be taken to train and sensitize the medical and paramedical personnel about identifying and managing depression in the primary care settings itself.
• Vulnerable groups like women, those who had lost their parents before attaining 16 years of age and those who are remaining single, must be identified and appropriate preventive measures or treatment should be given at the earliest suitable opportunity.
• Suitable IEC (Information, Education and Communication) activities must be formulated to sensitize the vulnerable population for seeking immediate mental health care, as and when the symptoms arise. Once the awareness increases, culturally appropriate treatment and technology must be made available to combat the morbidity which is caused due to depression.
• Policy makers can consider community participation with the involvement of Non-Governmental organizations, Self Help Groups or Public Private Partnerships, while planning to combat the common mental disorders like depression, as the mental health services are poorly developed in India.
• Co morbid physical illnesses along with depression, which are an emerging trend, must be taken into account while planning preventive and curative mental and physical health services.
As the cross sectional studies do not allow one to make causal assumptions, further researches should be conducted, for instance, to study the depression in females, while higher rates are reported across the world and it is essential to conduct researches on women’s health that encompasses the holistic nature of health, viz., incorporating psychological, reproductive and social view points.

Acknowledgement

We sincerely thank Prof.Dr.R.Sathianathan MD, HOD & Professor of Psychiatry, Madras Medical College and Prof.Dr.M.Thirunavukkarasu MD, HOD &Professor of Psychiatry, Government Stanley Medical College for their support and expert guidance in this study. We remain grateful to Dr.S.Vivekanandhan MD and Prof.Dr.B.W.C.Sathiasekaran MD, HOD & Professor of Community Medicine, Sri Ramachandra Medical University who had been the constant source of encouragement and guidance throughout the study. We extend our sincere thanks to Mr.R.S.Mukund for his constant motivation in the final presentation of this study.

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