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.
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Interpersonal psychotherapy in a group format was selected specifically because it was considered the most culturally appropriate intervention for this population, based on results of previous qualitative research and on discussions with representatives of the local population.
“Interpersonal psychotherapy in a group format was selected specifically because it was considered the most culturally appropriate intervention for this population, based on results of our previous qualitative research (Bolton et al , 2004) and on discussions with representatives of the local population.”
From Group interpersonal psychotherapy for depression in rural Uganda: 6-month outcomes: Randomised controlled trial (2006) · cites this paper as Bolton et al, 2004
Cites
Cross-national epidemiology of major depression and bipolar disorder
Weissman, M. M. (1996) · JAMA: The Journal of the American Medical Association · doi:10.1001/jama.1996.03540040037030 · Cited by 2,302 · see citing works
BOLTON, P. (2001) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-200104000-00005 · Cited by 239 · cited 2× · see citing works
“Symptom occurrence and duration were assessed using an approach described elsewhere [19].”
MethodSelf-citationAn alternative approach to cross-cultural function assessment
Bolton, P., & Tang, A. M. (2002) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-002-0580-5 · Cited by 224 · see citing works
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van Ginneken, N., Tharyan, P., Lewin, S., Rao, G. N., Meera, S., Pian, J., Chandrashekar, S., & Patel, V. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009149.pub2 · Cited by 575 · see citing works
Kohrt, B. A., Rasmussen, A., Kaiser, B. N., Haroz, E. E., Maharjan, S. M., Mutamba, B. B., de Jong, J. T., & Hinton, D. E. (2014) · International Journal of Epidemiology · doi:10.1093/ije/dyt227 · Cited by 355 · see citing works
Kohrt, B. A., Jordans, M. J., Tol, W. A., Luitel, N. P., Maharjan, S. M., & Upadhaya, N. (2011) · BMC Psychiatry · doi:10.1186/1471-244x-11-127 · Cited by 213 · see citing works
Bass, J., Neugebauer, R., Clougherty, K. F., Verdeli, H., Wickramaratne, P., Ndogoni, L., Speelman, L., Weissman, M., & Bolton, P. (2006) · British Journal of Psychiatry · doi:10.1192/bjp.188.6.567 · Cited by 214 · see citing works
Self-citationDo not forget culture when studying mental health
Bass, J. K., Bolton, P. A., & Murray, L. K. (2007) · The Lancet · doi:10.1016/s0140-6736(07)61426-3 · Cited by 131 · see citing works
Self-citationAssessing local instrument reliability and validity: a field-based example from northern Uganda
Betancourt, T. S., Bass, J., Borisova, I., Neugebauer, R., Speelman, L., Onyango, G., & Bolton, P. (2009) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-008-0475-1 · Cited by 124 · see citing works
Self-citationBass, J. K., Ryder, R. W., Lammers, M., Mukaba, T. N., & Bolton, P. A. (2008) · Tropical Medicine & International Health · doi:10.1111/j.1365-3156.2008.02160.x · Cited by 105 · see citing works
Self-citationHaroz, E. E., Bass, J. K., Lee, C., Murray, L. K., Robinson, C., & Bolton, P. (2014) · BMC Psychology · doi:10.1186/s40359-014-0031-6 · Cited by 71 · see citing works
Self-citationSexual relationship power and depression among HIV-infected women in Rural Uganda
Hatcher, A. M., Tsai, A. C., Kumbakumba, E., Dworkin, S. L., Hunt, P. W., Martin, J. N., Clark, G., Bangsberg, D. R., & Weiser, S. D. (2012) · PLoS ONE · doi:10.1371/journal.pone.0049821 · Cited by 67 · see citing works
Kaiser, B. N., Kohrt, B. A., Wagenaar, B. H., Kramer, M. R., McLean, K. E., Hagaman, A. K., Khoury, N. M., & Keys, H. M. (2015) · International Journal of Culture and Mental Health · doi:10.1080/17542863.2015.1015580 · Cited by 14 · see citing works
Bah, A. J., Wurie, H. R., Samai, M., Horn, R., & Ager, A. (2025) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2024.100852 · Cited by 7 · see citing works
- Authors
- Bolton, P., Wilk, C., & Ndogoni, L.
- Affiliations
- Boston University (US)
- University of Maryland, Baltimore (US)
- World Vision International (GB)
- Corresponding author
- Wilk, ChristopherM.
- ORCID
- Bolton, Paul
- Venue
- Social Psychiatry and Psychiatric Epidemiology
- Published
- 2004-06
- Volume
- 39
- Issue
- 6
- Pages
- 442-7
- ISSN
- 0933-7954 (ISSN-L)
- 1433-9285
- OpenAlex
- W1990149441
- Cited by
- 219
- References
- 3
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 5 · 2023: 6 · 2022: 11 · 2021: 19 · 2020: 5 · 2019: 15 · 2018: 6 · 2017: 10 · 2016: 19 · 2015: 10 · 2014: 20 · 2013: 13 · 2012: 13
- FWCI
- 9.27
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Social Psychiatry and Psychiatric Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- University of Nairobi Research Archive (University of Nairobi) (submittedVersion)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Keywords
- major depressive disorder, depression prevalence, rural Uganda, HIV, functional disability, symptom criteria, DSM-IV diagnostic criteria, Hopkins Symptom Checklist, risk factors, age, educational attainment, gender differences
- MeSH terms
- Acquired Immunodeficiency Syndrome, Adult, Depressive Disorder, Major, Major Depressive Disorder, Female, Humans, Male, Surveys and Questionnaires, Rural Population, Uganda, Reproducibility of Results, HIV Infections, Comorbidity, Prevalence
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