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. 2023 Apr 1;33(2):69-78.
doi: 10.1097/YPG.0000000000000333. Epub 2022 Dec 20.

Study protocol of DIVERGE, the first genetic epidemiological study of major depressive disorder in Pakistan

Maria Valkovskaya  1 , Arsalan Hassan  2 , Eirini Zartaloudi  3 , Fahad Hussain  4 , Muhammad Umar  4 , Bakht Khizar  4 , Inzemam Khattak  4 , Shamshad Ahmed Gill  5 , Shams-Ud-Din Ahmad Khan  6 , Imtiaz Ahmad Dogar  7 , Ali Burhan Mustafa  8 , Moin Ahmed Ansari  9 , Syed Qalb I Hyder  9 , Muhammad Ali  9 , Nilofar Ilyas  9 , Parveen Channar  9 , Nazish Mughal  9 , Sumera Channa  9 , Khalid Mufti  10 , Ali Ahsan Mufti  10 , Mian Iftikhar Hussain  11 , Sadia Shafiq  12 , Muhammad Tariq  12 , Muhammad Kamran Khan  13 , Shahzad Tahir Chaudhry  14 , Abdul Rashid Choudhary  15 , Mian Nizam Ali  16 , Gohar Ali  17 , Ashfaq Hussain  18 , Muhammad Rehman  17 , Noman Ahmad  19 , Saeed Farooq  20   21 , Farooq Naeem  22   23 , Tanveer Nasr  4 , Glyn Lewis  1 , James A Knowles  24 , Muhammad Ayub  1 , Karoline Kuchenbaecker  1   25
Affiliations

Study protocol of DIVERGE, the first genetic epidemiological study of major depressive disorder in Pakistan

Maria Valkovskaya et al. Psychiatr Genet. .

Abstract

Introduction: Globally, 80% of the burdenof major depressive disorder (MDD) pertains to low- and middle-income countries. Research into genetic and environmental risk factors has the potential to uncover disease mechanisms that may contribute to better diagnosis and treatment of mental illness, yet has so far been largely limited to participants with European ancestry from high-income countries. The DIVERGE study was established to help overcome this gap and investigate genetic and environmental risk factors for MDD in Pakistan.

Methods: DIVERGE aims to enrol 9000 cases and 4000 controls in hospitals across the country. Here, we provide the rationale for DIVERGE, describe the study protocol and characterise the sample using data from the first 500 cases. Exploratory data analysis is performed to describe demographics, socioeconomic status, environmental risk factors, family history of mental illness and psychopathology.

Results and discussion: Many participants had severe depression with 74% of patients who experienced multiple depressive episodes. It was a common practice to seek help for mental health struggles from faith healers and religious leaders. Socioeconomic variables reflected the local context with a large proportion of women not having access to any education and the majority of participants reporting no savings.

Conclusion: DIVERGE is a carefully designed case-control study of MDD in Pakistan that captures diverse risk factors. As the largest genetic study in Pakistan, DIVERGE helps address the severe underrepresentation of people from South Asian countries in genetic as well as psychiatric research.

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Figures

Fig. 1
Fig. 1
Overview of the content of the DIVERGE interview. DIVERGE, Depression: Interplay between Varying EnviRonments and GEnes.
Fig. 2
Fig. 2
Level of education by sex for 500 participants with MDD. MDD, major depressive disorder.
Fig. 3
Fig. 3
Clinical characteristics of the first 500 MDD patients recruited for DIVERGE. The pie charts reflect depression severity. The darker shades represent the severe form of symptoms. The percentage of participants and an actual count (in brackets) are reported for each variable. DIVERGE, Depression: Interplay between Varying EnviRonments and GEnes; MDD, major depressive disorder.
Fig. 4
Fig. 4
Forms of treatment and help for depression amongst 251 patients who reported any other help received for their current psychiatric diagnosis, apart from medications.
See this image and copyright information in PMC

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