Depression in Ugandan Rural Women Involved in a Money Saving Group: The Role of Spouse’s Unemployment, Extramarital Relationship, and Substance Use

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Abstract

Background

Rural women are highly prevalent to depression, where spouse-related factors, including extramarital affairs and poverty, intensify its likelihood of occurrence. However, women engaged with a Money-Saving Group (MSG) are financially self-dependent, which can reduce the risk of depression suffering. Despite this, there is less study among this cohort, which led us to investigate the prevalence and associated factors of depression among the Ugandan women involved in MSG.

Methods

This was a cross-sectional study in Uganda among rural married or cohabiting women aged 18 to 45 years engaged in MSG. The survey was carried out within a total of 153 participants (33.3 ± 6.7 years) in April 2021. Information related to socio-demographic of the participants, their spouse characteristics, and depression were collected.

Results

About 65.4% of the participants had depressive symptoms (based on the cutoff 10/27 at the PHQ-9). But, 8.15 times (CI: 2.83–23.44, p<0.001) and 16.69 times (CI: 4.85–57.39, p<0.001), higher risk of depression were observed, if the participants’ spouses were using an addictive substance and had been involved in an extramarital relationship, respectively. Similarly, there was an increased likelihood of depression when the participant or spouse was unemployed.

Conclusion

This study observed a higher prevalence of depression, which suggests paying attention to this cohort. Thus, there should be routine screening for depression among married women involved in MSG at lower-level health facilities in rural settings, especially those with spouses engaged in substance use, having an extramarital relationship, and being unemployed.

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Most cited references 57

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The PHQ-9: validity of a brief depression severity measure.

K Kroenke, R L Spitzer, J B Williams (2001)

While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.

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Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis

Brooke Levis, Andrea Benedetti, Brett D. Thombs (2019)

Abstract Objective To determine the accuracy of the Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression. Design Individual participant data meta-analysis. Data sources Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, and Web of Science (January 2000-February 2015). Inclusion criteria Eligible studies compared PHQ-9 scores with major depression diagnoses from validated diagnostic interviews. Primary study data and study level data extracted from primary reports were synthesized. For PHQ-9 cut-off scores 5-15, bivariate random effects meta-analysis was used to estimate pooled sensitivity and specificity, separately, among studies that used semistructured diagnostic interviews, which are designed for administration by clinicians; fully structured interviews, which are designed for lay administration; and the Mini International Neuropsychiatric (MINI) diagnostic interviews, a brief fully structured interview. Sensitivity and specificity were examined among participant subgroups and, separately, using meta-regression, considering all subgroup variables in a single model. Results Data were obtained for 58 of 72 eligible studies (total n=17 357; major depression cases n=2312). Combined sensitivity and specificity was maximized at a cut-off score of 10 or above among studies using a semistructured interview (29 studies, 6725 participants; sensitivity 0.88, 95% confidence interval 0.83 to 0.92; specificity 0.85, 0.82 to 0.88). Across cut-off scores 5-15, sensitivity with semistructured interviews was 5-22% higher than for fully structured interviews (MINI excluded; 14 studies, 7680 participants) and 2-15% higher than for the MINI (15 studies, 2952 participants). Specificity was similar across diagnostic interviews. The PHQ-9 seems to be similarly sensitive but may be less specific for younger patients than for older patients; a cut-off score of 10 or above can be used regardless of age.. Conclusions PHQ-9 sensitivity compared with semistructured diagnostic interviews was greater than in previous conventional meta-analyses that combined reference standards. A cut-off score of 10 or above maximized combined sensitivity and specificity overall and for subgroups. Registration PROSPERO CRD42014010673.

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What factors are associated with recent intimate partner violence? findings from the WHO multi-country study on women's health and domestic violence

Tanya Abramsky, Charlotte H Watts, Claudia Garcia-Moreno … (2011)

Background Intimate partner violence (IPV) against women is a global public health and human rights concern. Despite a growing body of research into risk factors for IPV, methodological differences limit the extent to which comparisons can be made between studies. We used data from ten countries included in the WHO Multi-country Study on Women's Health and Domestic Violence to identify factors that are consistently associated with abuse across sites, in order to inform the design of IPV prevention programs. Methods Standardised population-based household surveys were done between 2000 and 2003. One woman aged 15-49 years was randomly selected from each sampled household. Those who had ever had a male partner were asked about their experiences of physically and sexually violent acts. We performed multivariate logistic regression to identify predictors of physical and/or sexual partner violence within the past 12 months. Results Despite wide variations in the prevalence of IPV, many factors affected IPV risk similarly across sites. Secondary education, high SES, and formal marriage offered protection, while alcohol abuse, cohabitation, young age, attitudes supportive of wife beating, having outside sexual partners, experiencing childhood abuse, growing up with domestic violence, and experiencing or perpetrating other forms of violence in adulthood, increased the risk of IPV. The strength of the association was greatest when both the woman and her partner had the risk factor. Conclusions IPV prevention programs should increase focus on transforming gender norms and attitudes, addressing childhood abuse, and reducing harmful drinking. Development initiatives to improve access to education for girls and boys may also have an important role in violence prevention.

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Author and article information

Journal

Journal ID (nlm-ta): Int J Womens Health

Journal ID (iso-abbrev): Int J Womens Health

Journal ID (publisher-id): ijwh

Journal ID (pmc): intjwh

Title: International Journal of Women's Health

Publisher: Dove

ISSN (Electronic): 1179-1411

Publication date (Electronic): 22 September 2021

Publication date Collection: 2021

Volume: 13

Pages: 869-878

Affiliations

[1 ]Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology , Mbarara, Uganda

[2 ]Faculty of Health Sciences, Lira University , Lira, Uganda

[3 ]Department of Psychiatry, Mbarara Regional Referral Hospital , Mbarara, Uganda

[4 ]College of Health Sciences, Makerere University , Kampala, Uganda

[5 ]CHINTA Research Bangladesh , Savar, Dhaka, 1342, Bangladesh

[6 ]Department of Public Health and Informatics, Jahangirnagar University , Savar, Dhaka, 1342, Bangladesh

Author notes

Correspondence: Mark Mohan Kaggwa Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology , P.O. Box 1410, Mbarara, Uganda Email kmarkmohan@gmail.com

Author information

Mark Mohan Kaggwa http://orcid.org/0000-0002-4733-154X

Rahel Nkola http://orcid.org/0000-0002-4660-0736

Sarah Maria Najjuka http://orcid.org/0000-0003-2020-7941

Firoj al Mamun http://orcid.org/0000-0003-4611-9624

Ismail Hosen http://orcid.org/0000-0001-6406-7325

Mohammed A Mamun http://orcid.org/0000-0002-1728-8966

Scholastic Ashaba http://orcid.org/0000-0002-5822-2488

Article

Publisher ID: 323636

DOI: 10.2147/IJWH.S323636

PMC ID: 8473717

PubMed ID: 34588819

SO-VID: f482a470-685f-49dd-9189-70e261adc15a

License:

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

History

Date received : 07 June 2021

Date accepted : 04 September 2021

Page count

Figures: 0, Tables: 5, References: 58, Pages: 10

Funding

Funded by: any financial support;

The authors declare that the study did not receive any financial support to support the compilation of this report.