STUDY OF DEPRESSIVE DISORDER IN FEMALE

ABSTRACT

Depressive disorder is common psychiatric disorder with lifetime prevalence of about 15%, perhaps as high as 25% for woman that is two fold of onset of major depressive disorder and about 40-50% have onset between 20 to 50 years of age. Major depressive disorder occurs most often in person that have no close interpersonal relationship or who divorced or separated. This study shows out of 484 female who attended psychiatric Department of CMS Teaching hospital, Bharatpur Chitwan, 147 (30.37%) were diagnosed as depressive disorder. Among them 14 (2.89%) were categorized as mild depression, 60 (12.40%) were moderate and 73 (15.08%) were severe depression. Depressive disorder is more those whose husband works as police /Army, politician and live outside the country, which could be current bad and insecurity political situation in Nepal.

INTRODUCTION

Major depression is the most common psychiatric problem seen in primary care. Prevalence figures for major depression vary substantially between surveys (Smith & Weisman, 1992). Ten years prospective study in Zurich estimated the lifetime prevalence of major depression, as about 16 percent. They are consistently increased women across different culture. The reasons for increased rates among women are uncertain. Depression is more common among the unemployed; divorced, all medical illness and their treatment can act as non-specific stress, which may lead to mood disorder in predisposed subject. The point prevalence of depressive symptoms is in between 13-20% (Boyd & Wiseman, 1982). Major depression is common disorder with lifetime prevalence of about 15%, perhaps as high as 25% for woman that is two fold of onset of major depressive disorder and about 40-50% have onset between 20 to 50years of age. In general major depressive disorder occur most often in person that have no close interpersonal relationship or who divorced or separated.

Freud (1957-1939) conceptualized two different types of depression as endogenous, which is biologically determined, and another exogenous, which is precipitated by loss. ( Kerepelin, 1921) suggested that depression is common with cyclothymic personality. (Krestchmar,1936) associated with pyknic body built Hippocrates (450-350 BC) used the term mania and melancholia for mental disturbances. He believed that the smaller excess of body humors produce melancholic, choleric, phlegmatic and sanguine personalities. There is difference between depressive symptoms and depressive disorder. Depressive symptoms can be transient but depressive disorder is associated depressive symptoms at least 2 weeks period. This study shows out of 484 female who attended psychiatric Department of CMS Teaching hospital, Bharatpur Chitwan, 147 (30.37%) were diagnosed as depressive disorder. Among them 14 (2.89%) were categorized as mild depression, 60 (12.40%) were moderate and 73 (15.08%) were severe depression. Depressive disorder is more those whose husband works as police /Army, politician and live outside the country, which could be current bad and insecurity political situation in Nepal. A ten-year perspective study in Zurich, (Angst, 1992) estimated the life time prevalence of major depression is about 16 percent, rates of depressive disorder seen to be higher in industrialized countries. They are consistently increased in woman across different cultures

 

MATERIAL AND METHOD

Objectives:

1)         To study depression in female.

2)         To detect severity of depression

Tools :

1)         Self designed Semi structured Perfoma

    It is prepared to obtain the socio-demographic characteristics of the patient. Which contains name, age, sex, caste, address, education, marital status, occupation, religion and other information. 

2)         I.C.D. - 10 Diagnostic Research Criteria  (WHO, 1992)

3)         Hamilton's Depression Rating Scale, (Hamilton, 1967) this scale was developed by Maxwell Hamilton in 1967.  This scale is designed to measure the severity of illness of patient already classified as suffering from depressive illness.

RESULT

Table 1

DISTRIBUTION ON THE BASIS OF AGE GROUP

AGE
	N		%
0-10	10		2.07
11-20	109		22.52
21-30	82		16.94
31-40	76		15.70
41-50	138		28.51
5-60	59		12.19
61-70	10		2.07
TOTAL	484		100

Table 1 Data shows highest numbers of patient were age group 41-50 (N-138, 28.51%) followed by age group11-20 (N-109, 22.52%).

Table –2

DISTRIBUTION ON THE BASIS OF MARIETAL STATUS

MARIETAL STATUS N % MARRIED 349 72.11 UNMARRIED 118 24.38 WIDOW 16 3.31 TOTAL 484 100

Data shows highest numbers of patient were married (N-349, 72.11%).

 

Table-3

DISTURIBUTION ON THE BASIS OF OCCUPATION

OCCUPATION	N	%
FARMER	105	71.43%
HOUSEWIFE	32	21.77%
SERVICE	7	4.76%
UNEMPLOYED	3	2.04%
TOTAL	484	100

Data shows distribution on the basis of occupation, most of cases were farmer (N-105, 71.43 %).

Table- 4

DISTRIBUTION ON THE BASIS OF FAMILY HISTORY

OF MENTAL ILLNESS

FAMILY HISTORY OF MENTAL ILLNESS	N	%
POSITIVE	86	17.77
NEGATIVE	398	82.23
TOTAL	484	100

Data shows most of the patients were family history of mental disorder negative (N-398, 82.23%)

Table-5

DISTRIBUTION ON THE BASIS OF STRESS FACTOR

STRESS FACTOR	N	%
POSITIVE	424	87.60
NEGATIVE	59	12.40
TOTAL	484	100

Data shows most of the patients were stress factor positive (N-424, 87.60%).

Table -6

DIAGNOSIS OF DEPRESSION BY USING ICD-10 DIAGNOSTIC RESEARCH CRITERIA (ICD-10 DCR)

DEPRESSON	N	%
MILD DEPRESSON	14	2.89
MODERATE DEPRESSON	60	12.40
SEVERE   DEPRESSON	73	15.08
TOTAL   DEPRESSON	147	30.37

Data shows, diagnosis of depression by using ICD 10 diagnostic criteria for research (ICD-10, DCR). Highest were found severe depression (N-73, 15.08%), followed by moderate (N-60, 12.40%) and mild depression was (N-14, 2.89%)

 

 

 

 

Table-7

DISTRIBUTION ON THE BASIS OF MARIETAL STATUS AND DEPRESSION

MARIETAL STATUS N DEPRESSION % MARRIED 349 106 30.37 UNMARRIED 118 29 24.58 WIDOW 16 12 75

Data shows highest numbers of patient with depression were widow   ( N= 29,75%) followed by married   ( N=  106,30.37%).

 

Table-8

DISTRIBUTION ON THE BASIS OF SINGLE EPISODE AND RECURRENT DEPRESSION

DEPRESSION N % SINGLE EPISODE 112 76.19 RECURRENT 35 23.80 TOTAL 147 100

Data shows highest numbers of patient with depression were single episode.

 

Table-9

 DISTRIBUTION ON THE BASIS OF JOB OF THE HUSBAND

 

 

JOB OF THE HUSBAND		N	%
1	POLICE/ARMY	29	27.36
2	HUSBAND OUTSIDE THE COUNTRY	51	48.11
3	HUSBAND LIVING SAME PLACE	5	4.72
4	POLITICIAN	20	18.87
5	OTHER	6	5.67
6	TOTAL	106	100

Data shows maximum numbers of patient were found depressed those whose husbands were police /army (N -29, 27.36%), husband works outside country (N-51, 48.11% )and politician (N-20, 18.87%).

 

DISCUSSION:

Depressive disorder is common psychiatric disorder with lifetime prevalence of about 15%, perhaps as high as 25% for woman and about 40-50% have onset between 20 to 50years of age. Ten years prospective study in Zurich estimated the lifetime prevalence of major depression, as about 16 percent. They are consistently increased women across different culture. Major depressive disorder occurs most often in person that have no close interpersonal relationship or who divorced or separated. The objective of this study is to identify depressive disorder and severity of depressive disorder in female. The ICD-10 diagnostic criteria for research (ICD-10, DCR) was used for diagnose depression. The Hamilton’s Depression Rating Scale (HDRS) was used for grading for depression.

The samples were collected from 1/11/2003 to 31/4/2004. Total number of female who attended psychiatric department of CMSTH Bharatpur, Nepal was taken as cases. Total number of cases was 484, among them 147 female were found depressed. The rapport was established with the patient to get enough information. The semi structured Performa was filled with adequate information The Performa composed of Name, Age, Sex, Marital Status, Address, Religion, Caste, Education, Occupation, and Type of family, Socioeconomic Status, Family Income and Total number of family members. Question related with complaints of the patient was taken which include chief complaints, History of present illness, past history, family history and premorbid personality. The examination of the patient was done detail manner, which include General examination, systemic examination and mental state examination. The cases are diagnosed by using ICD-10DCR  and Hamilton’s depression rating scale (HDRS) was used for grading for depression and categorized as;

            Mild depression.

            Moderate depression.

         Severe depression.

This study shows out of 484 female who attended psychiatric Department of CMS Teaching hospital, Bharatpur Chitwan, 147 (30.37%) were diagnosed as depressive disorder. Among them 14 (2.89%) were categorized as mild depression, 60 (12.40%) were moderate and 73 (15.08%) were severe depression. Depressive disorder is more those whose husband works on police /Army, politician and live outside the country, which could be current bad and insecurity political situation in Nepal.

REFRENCES

 Angst. J. (1992) How recurrent and predictable is depressive illness. In long term treatment of depression (edition S. Montgomery and F Rouillon), PP 1-3 Wiley, Chichester.

Boyd, J.H., and wissmen, M.M. (1982) Epidemiology in handbook of affective disorder (ed ES Paykel) Churchill livingstone, Edinburgh.

Freud, S. (1957) Mourning & Melancholia. The standard edition of the copulate psycho social work. Vol. 14, pp 243-258. Hugarth, press London.

Hamiltan M.(1960)  A Rating scale for depression, J. neurol Neurosurg. Psychiatry 28, 56

Kraepelin, E. (1921) Manic Depressive Insanity and Paranoia (ed. G.M. Robortson) DeinburghL: E.&.S. Living Stone.

Krestchmer, E. (1936) Physique and character (2^nd Eds.) Trans., W.J.H., Sportt and K.P. Trench. Trubener, New York. 

 WHO (1992) International Classification of disease and related heath problems, Tenth revision: Clinical description and diagnostic guideline; Geneva: World Health Organization.

                                                                                                                                                                

Dr C.P SEDAIN

             LECTURER, DEPARTMENT OF PSYCHIATRY

. CMS,TH BHARATPUR