Epidemiology and symptomatology of depression in Sri Lanka: a cross-sectional population-based survey in Colombo District.
BACKGROUND
It is important to understand the nature of depression in non-Western and lower-income countries, but little such research exists. This study aimed to examine the characteristic features of depression in Sri Lanka, and to identify environmental risk factors.


METHODS
Depression diagnoses, symptoms and impairment were measured using the Composite International Diagnostic Interview, in a population-based sample of 6014 twins and non-twins in the Colombo region of Sri Lanka (the CoTASS sample). Socio-demographic factors and environments were assessed via questionnaires.


RESULTS
Lifetime-ever depression was reported in 6.6% of participants, rising to 11.2% if the functional impairment criterion was excluded. The symptom profile of depression and its socio-demographic associations were very comparable to those in Western and more economically developed countries, whether functional impairment was included in the definition or not. Standard of living was independently associated with depression, especially among men at the more deprived end of the distribution. Specific associations were found with both financial wellbeing and material characteristics of the home environment.


CONCLUSIONS
The observational associations identified are cross-sectional, so do not necessarily imply causal links.


CONCLUSIONS
Aside from a lower prevalence, depression is very similar in this predominantly urban Sri Lankan sample to higher-income, Western countries, and may be under-identified due to a relatively low cultural appropriateness of the assessment of impairment. Under Sri Lanka's cultural and environmental context, certain aspects of the material environment are associated with depression among certain segments of society, perhaps because of their particular link to social status and social networks.
Ball
Harriet A
HA
MRC Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, De Crespigny Park, London, SE5 8AF, UK. harriet.ball@kcl.ac.uk
Siribaddana
Sisira H
SH
Kovas
Yulia
Y
Glozier
Nick
N
McGuffin
Peter
P
Sumathipala
Athula
A
Hotopf
Matthew
M
D000328:Adult; D000367:Age Factors; D000368:Aged; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology* / Q000235:genetics / Q000523:psychology; D003906:Developing Countries; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004200:Diseases in Twins / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology* / Q000235:genetics / Q000523:psychology; D005260:Female; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D012923:Social Class; D012931:Social Environment; D012944:Social Support; D012945:Social Values; D012959:Socioeconomic Factors; D013188:Sri Lanka; D014505:Urban Population / Q000706:statistics & numerical data*; D055815:Young Adult