title: Cross-sectional study of depression and help-seeking in Uttarakhand, North India.
abstract: OBJECTIVE
  This study sought to use a population-based cross-sectional survey to describe depression prevalence, healthcare seeking and associations with socioeconomic determinants in a district in North India.
  
  
  METHODS
  This study was conducted in Sahaspur and Raipur, administrative blocks of Dehradun district, Uttarakhand, in July 2014.
  
  
  METHODS
  A population-based sample of 960 people over the age of 18 years was selected in 30 randomised clusters after being stratified by rural:urban census ratios.
  
  
  METHODS
  The survey used a validated screening tool, Patient Health Questionnaire, to identify people with depression, and collected information regarding socioeconomic variables and help-seeking behaviours. Depression prevalence and health seeking behaviours were calculated, and multivariable logistic regression was used to assess associations between risk factors and depression.
  
  
  RESULTS
  Prevalence of depression was 6% (58/960), with a further 3.9% (37/960) describing a depressive episode of over 2 weeks in the past 12 months. Statistically significant adjusted OR for depression of more than 2 were found for people who were illiterate, classified as Scheduled Caste/Tribe or Other Backward Castes, living in temporary material housing and who had recently taken a loan. While over three quarters of people with depression (79%) had attended a private or government general medical practitioner in the past 3 months, none had received talking therapy (100% treatment gap) and two people (3.3%) had been prescribed antidepressants.
  
  
  CONCLUSIONS
  There are clear associations between social, educational and economic disadvantage and depression in this population. Strategies that address the social determinants of depression, such as education, social exclusion, financial protection and affordable housing for all are indicated. To address the large treatment gap in Uttarakhand, we must ensure access to primary and secondary mental health providers who can recognise and appropriately manage depression.
authors.affiliation: Department of Community Health and Development, Emmanuel Hospital Association, New Delhi, India Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden.
authors.forename: Kaaren
authors.initials: K
authors.lastname: Mathias
authors.affiliation: Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden.
authors.forename: Isabel
authors.initials: I
authors.lastname: Goicolea
authors.affiliation: Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Michelle
authors.initials: M
authors.lastname: Kermode
authors.affiliation: Agnes Kunze Society, Dehradun, Uttarakhand, India.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Singh
authors.affiliation: Centre for Mental Health, Public Health Foundation of India, New Delhi, India.
authors.forename: Rahul
authors.initials: R
authors.lastname: Shidhaye
authors.affiliation: Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden.
authors.forename: Miguel San
authors.initials: MS
authors.lastname: Sebastian
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology*; D005260:Female; D000066505:Help-Seeking Behavior; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D055815:Young Adult
keywords: EPIDEMIOLOGY; MENTAL HEALTH; PUBLIC HEALTH