Prevalence and risk factors of anxiety and depression among non-communicable diseases clinic attendees in rural Rwanda: a cross-sectional study

Abstract

Objectives: This study aimed to estimate the prevalence of depression and anxiety and associated risk factors among non-communicable diseases (NCD) clinic attendees in rural Rwanda.

Design: Cross-sectional.

Setting: 44 health centres in three rural districts in Rwanda.

Participants: Adults aged 18 years and older with a clinical diagnosis of diabetes, hypertension and/or asthma, who were attending a follow-up appointment during the study period (n=595).

Outcome measures: Primary outcome measures were depression (measured by Patient Health Questionnaire-9) and anxiety (measured by Generalised Anxiety Disorder-7). Explanatory measures included sociodemographic and behavioural risk factors associated with depression and anxiety.

Results: Of 595 participants, 265 (44.5%) had depression (95% CI: 40.5% to 48.6%) and 202 (33.9%) had anxiety (95% CI: 30.1% to 37.9%). Comorbidity of depression and anxiety was found in 137 participants (23%). Participants with no formal education had significantly higher odds of reporting depression and anxiety compared with those with primary and secondary/higher education (adjusted OR (aOR)=2.08; 95% CI=1.27 to 3.33, p=0.004, aOR=5.00; 95% CI=1.12 to 25.00, p=0.035, respectively). In addition, participants who were unemployed were more likely to report depression and anxiety (aOR=3.03; 95% CI=1.62 to 5.67, p<0.001). Similarly, participants who had trauma in the past were more likely to report depression and anxiety than those who did not experience traumatic events in the past (aOR=1.67; 95% CI=1.09 to 2.56, p=0.019).

Conclusions: The overall prevalence of depression and anxiety was found to be significantly high among the study participants. The risk factors that were associated with depression and anxiety included level of education, district of residence, employment status and past trauma exposure. The findings emphasise the need for integrating mental health screening into NCD care, district-specific interventions, employment support services and trauma-focused care.

Keywords: Anxiety disorders; Depression & mood disorders; Diabetes Mellitus, Type 2; Hypertension; Prevalence; Risk Factors.

Figure 1. Prevalence of depression, anxiety and comorbidity of anxiety and depression among study participants (n=595). The bar graph displays the percentage prevalence of depression (green bar: 44.5%, 95% CI=40.5% to 48.6%), anxiety (red bar: 33.9%, 95% CI=30.1% to 37.9%) and co-occurrence of both anxiety and depression (orange bar: 22.5%).

Figure 2. Prevalence of depression and anxiety among patients with different types of NCDs (n=595). The green bar shows the percentage prevalence of depression while the red bars show the percentage prevalence of anxiety. Of 30 participants with diabetes, 15 had depression (51.3%) while 12 (41%) had anxiety. Of 446 participants with hypertension, 198 (44.4%) had depression while 157 (35.2%) had anxiety. Regarding asthma, 29 of 71 (41.5%) of the participants had depression while 18 (25.6%) had anxiety. Lastly, of 48 participants with NCD comorbidities, 21 (44.6%) had depression while 19 (39.3%) had anxiety. NCDs, non-communicable diseases.