Assessment of depression prevalence in rural Uganda using symptom and function criteria

Abstract. Background: We sought to assess the prevalence of major depression in a region of sub-Saharan Africa severely affected by HIV, using symptom and functional criteria as measured with locally validated instruments. Method: Six hundred homes in the Masaka and Rakai districts of southwest Uganda were selected by weighted systematic random sampling. A locally validated version of the depression section of the Hopkins Symptom Check List (DHSCL) and a community-generated index of functional impairment were used to interview 587 respondents. Results: Of respondents,21% were diagnosed with depression using three of the five DSM-IV criteria (including function impairment) compared with 24.4 % using symptom criteria alone. Increased age and lower educational levels are associated with a greater risk for depression; however, a gender effect was not detected. Conclusions: Most community-based assessments of depression in sub-Saharan Africa based on the DSM-IV have used symptom criteria only.We found that expanding criteria to more closely match the complete DSM-IV is feasible, thereby making more accurate assessments of prevalence possible. This approach suggests that major depression and associated functional impairment are a substantial problem in this population.