title: Gender, depression and physical impairment: an epidemiologic perspective from Aleppo, Syria.
abstract: OBJECTIVE
  Examine the association of physical impairment with gender, depression, and socio-demographics in the community in Aleppo, Syria.
  
  
  METHODS
  We conducted a cross-sectional, population-based study in Aleppo on adults aged 18-65 (N = 2,038). We used a computerized interviewer-administered structured questionnaire. Physical impairment was measured via an adapted 12-item World Health Organization, Health State Description Individual Questionnaire which includes both physical and emotional items. We used physical impairment items score to classify individuals into low, middle, and high physical impairment category. Self-report of physician-diagnosed depression and chronic diseases active in the past year and their current treatment status were obtained.
  
  
  RESULTS
  Sample mean age (SD) was 35.3 (12.1) years, 55% were female, and 4.5% had depression. Female gender, low socioeconomic status (SES), and depression were associated with high physical impairment. Women had more impairment (OR = 3.35, 95% CI: 2.15-5.21) with little change after controlling for depression and chronic diseases, but significantly decreased after controlling for socio-demographics (OR = 1.51, 95% CI: 0.84-2.73). The association with low (vs. high) SES was prominent (OR = 2.48, 95% CI: 1.32-4.67) after controlling for all variables. Depression's association (OR = 4.85, 95% CI: 1.93-12.15) lost significance after controlling for chronic diseases (OR = 2.81, 95% CI: 0.96-8.25), but further adjustment for socio-demographics had little effect.
  
  
  CONCLUSIONS
  Women and individuals of low SES appear more vulnerable to physical impairment in the community in Aleppo. Depression's association with physical impairment may be mediated through co-existing chronic diseases. Public health planning regarding physical impairment in Syria should encompass these as putative risk factors.
authors.affiliation: American Lake Division, VA Puget Sound Health Care System, 9600 Veterans Drive, A-116, Tacoma, WA, 98493, USA. nael.kilzieh@va.gov
authors.forename: Nael
authors.initials: N
authors.lastname: Kilzieh
authors.forename: Samer
authors.initials: S
authors.lastname: Rastam
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Ward
authors.forename: Wasim
authors.initials: W
authors.lastname: Maziak
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000453:epidemiology; D015897:Comorbidity; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology*; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000145:classification / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D012923:Social Class; D011795:Surveys and Questionnaires; D013593:Syria / Q000453:epidemiology