title: Depression and disability in people with podoconiosis: a comparative cross-sectional study in rural Northern Ethiopia.
abstract: BACKGROUND
  Little is known about depressive symptoms in podoconiosis despite the independent contribution of depression to worse health outcomes and disability in people with other chronic disorders.
  
  
  METHODS
  Two-hundred and seventy-one individuals with podoconiosis and 268 healthy neighbours (individuals from the nearest household in any direction) were investigated for depressive symptoms using a validated Amharic version of the Patient Health Questionnaire (PHQ-9). The WHO Disability Assessment Schedule II (WHODAS II) tool was used to measure disability. Logistic regression and zero inflated negative binomial regression were used to identify factors associated with elevated depressive symptoms, and disability, respectively.
  
  
  RESULTS
  Among study participants with podoconiosis, 12.6% (34/269) had high levels of depressive symptoms (scoring 5 or more points on the PHQ-9, on two assessments two weeks apart) compared to 0.7% (2/268) of healthy neighbours (p<0.001). Having podoconiosis and being older were significantly associated with increased odds of a high PHQ-9 score (adjusted odds ratios [AOR] 11.42; 95% CI: 2.44-53.44 and AOR 1.04; 95% CI: 1.00-1.08, respectively). Significant predictors of a higher disability score were having podoconiosis (WHODAS II multiplier value: 1.48; 95% CI: 1.39-1.58) and having a high PHQ-9 score (1.07; 95% CI: 1.06-1.08).
  
  
  CONCLUSIONS
  We recommend integrating evidence-based treatments for depression into podoconiosis interventions.
authors.affiliation: Brighton & Sussex Medical School, Brighton, UK J.Bartlett1@uni.bsms.ac.uk.
authors.forename: Joanna
authors.initials: J
authors.lastname: Bartlett
authors.affiliation: Brighton & Sussex Medical School, Brighton, UK School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Kebede
authors.initials: K
authors.lastname: Deribe
authors.affiliation: International Orthodox Christian Charities, Debre Markos, Ethiopia.
authors.forename: Abreham
authors.initials: A
authors.lastname: Tamiru
authors.affiliation: International Orthodox Christian Charities, Addis Ababa, Ethiopia.
authors.forename: Tsige
authors.initials: T
authors.lastname: Amberbir
authors.affiliation: Aklilu Lemma Institute of Pathology, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Girmay
authors.initials: G
authors.lastname: Medhin
authors.affiliation: University of Brighton, Brighton, UK.
authors.forename: Muzaffar
authors.initials: M
authors.lastname: Malik
authors.affiliation: Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Hanlon
authors.affiliation: Brighton & Sussex Medical School, Brighton, UK.
authors.forename: Gail
authors.initials: G
authors.lastname: Davey
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology / Q000523:psychology*; D006233:Persons with Disabilities / Q000523:psychology*; D004604:Elephantiasis / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology*; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D012424:Rural Population / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Depression; Ethiopia; Mental health; Neglected tropical disease; Podoconiosis