Screening of Depression Among Medical Outpatients Visiting the University Teaching Hospital of Kigali, Rwanda

Abstract

Jean Pierre Gafaranga,1,2 Leopold Bitunguhari,3,4 Charles Mudenge,1,5 Felix Manirakiza,6,7 Brian Kelly,8 Paul Gatabazi9– 11 1Department of Psychiatry and Behavioral Sciences, School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda; 2Department of Mental Health, University Teaching Hospital of Kigali, Kigali, Rwanda; 3Department of Internal Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda; 4Department of Internal Medicine, School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda; 5Department of Psychiatry, Ndera Neuropsychiatric Teaching Hospital, Kigali, Rwanda; 6Department of Clinical Biology, School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda; 7Department of Pathology, University Teaching Hospital of Kigali, Kigali, Rwanda; 8School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; 9School of Economics and Business, College of Business and Economics, University of Johannesburg, Johannesburg, South Africa; 10Department of Mathematics and Applied Mathematics, University of Johannesburg, Johannesburg, South Africa; 11Department of Statistics, University of South Africa, Pretoria, South AfricaCorrespondence: Jean Pierre Gafaranga, Department of Psychiatry and Behavioral Sciences, School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda, Tel [phone], Email [email protected]; [email protected]: Depression is a significant global public health concern, affecting individuals across different age groups and cultural backgrounds. However, screening for depression remains an essential but often neglected aspect of healthcare, particularly in outpatient settings. This study aimed to assess the prevalence of depression among outpatients visiting the internal medicine department of the University Teaching Hospital of Kigali in Rwanda and evaluate the feasibility of implementing a depression screening program in this setting.Methods: An institution-based cross-sectional study design was employed, involving 300 adult medical outpatients through convenience sampling, aged 18 years and above, who visited the internal medicine department between October 7 to November 6, 2019. The Patient Health Questionnaire-9 (PHQ-9) was used as the screening tool to assess depressive symptoms. Additionally, socio-demographic and clinical data were collected to explore potential risk factors associated with depression using a binary logistic regression model.Results: A high prevalence of depression was identified among internal medicine outpatients, with 45.7% of participants screened positive for depression, with moderate, moderately severe, and severe depression accounting for 21%, 17%, and 8%, respectively. The following factors were significantly associated with positive screening for depression: lack of formal education (OR=4.463, p=0.011, 95% CI= [1.410; 14.127]), secondary education (OR=3.402, p=0.003, 95% CI= [1.517; 7.630]), low-income (OR=2.392, p=0.049, 95% CI= [1.003; 5.706]) and headache as a chief complaint (OR=3.611, p=0.001, CI= [1.718; 7.591]).Conclusion: This study highlights the high prevalence of depression among medical outpatients. Due to the stigma associated with mental health, patients frequently seek help for physical symptoms such as headaches and other bodily complaints rather than mental health concerns. Introducing routine depression screening in medical departments could potentially facilitate early identification, and intervention, and lead to improved patient care. Future research should focus on evaluating such screening programs’ effectiveness and long-term outcomes in resource-limited settings like Rwanda.Keywords: depression, screening, medical outpatients, internal medicine department

Keywords

• depression
• screening
• medical outpatients
• internal medicine department