title: Spatial distribution of individuals with symptoms of depression in a periurban area in Lima: an example from Peru.
abstract: OBJECTIVE
  To map the geographical distribution and spatial clustering of depressive symptoms cases in an area of Lima, Peru.
  
  
  METHODS
  Presence of depressive symptoms suggesting a major depressive episode was assessed using a short version of the Center for Epidemiologic Studies Depression Scale. Data were obtained from a census conducted in 2010. One participant per selected household (aged 18 years and above, living more than 6 months in the area) was included. Residence latitude, longitude, and elevation were captured using a GPS device. The prevalence of depressive symptoms was estimated, and relative risks (RRs) were calculated to identify areas of significantly higher and lower geographical concentrations of depressive symptoms.
  
  
  RESULTS
  Data from 7946 participants, 28.3% male, mean age 39.4 (SD, 13.9) years, were analyzed. The prevalence of depressive symptoms was 17.0% (95% confidence interval = 16.2%-17.8%). Three clusters with high prevalence of depressive symptoms (primary cluster: RR = 1.82; P = .003 and secondary: RR = 2.83; P = .004 and RR = 5.92; P = .01), and two clusters with significantly low prevalence (primary: RR = 0.23; P = .016 and secondary: RR = 0; P = .035), were identified. Further adjustment by potential confounders confirmed the high prevalence clusters but also identified newer ones.
  
  
  CONCLUSIONS
  Screening strategies for depression, in combination with mapping techniques, may be useful tools to target interventions in resource-limited areas.
authors.affiliation: CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Mental Health Working Group, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Paulo
authors.initials: P
authors.lastname: Ruiz-Grosso
authors.affiliation: CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru. Electronic address: Jaime.Miranda@upch.pe.
authors.forename: J Jaime
authors.initials: JJ
authors.lastname: Miranda
authors.affiliation: CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; International Health Department, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Área de Investigación y Desarrollo, Asociación Benéfica PRISMA, Lima, Peru.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Gilman
authors.affiliation: GIS and Health Informatics Laboratory, Department of Geography, Simon Fraser University, Burnaby, British Columbia, Canada.
authors.forename: Blake Byron
authors.initials: BB
authors.lastname: Walker
authors.affiliation: CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Carrasco-Escobar
authors.affiliation: CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Marco
authors.initials: M
authors.lastname: Varela-Gaona
authors.affiliation: CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Francisco
authors.initials: F
authors.lastname: Diez-Canseco
authors.affiliation: CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Pediatrics, Instituto Nacional de Salud del Niño, Lima, Peru; Department of Pediatrics, School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru.
authors.forename: Luis
authors.initials: L
authors.lastname: Huicho
authors.affiliation: CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; International Health Department, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Área de Investigación y Desarrollo, Asociación Benéfica PRISMA, Lima, Peru; Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD.
authors.forename: William
authors.initials: W
authors.lastname: Checkley
authors.affiliation: CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Antonio
authors.initials: A
authors.lastname: Bernabe-Ortiz
mesh_terms: D000328:Adult; D000531:Altitude; D003863:Depression / Q000453:epidemiology*; D003865:Major Depressive Disorder / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010568:Peru / Q000453:epidemiology; D015995:Prevalence; D012111:Residence Characteristics; D012307:Risk Factors; D012959:Socioeconomic Factors; D062206:Spatial Analysis
keywords: Depression; Hotspot; Mental health; Peru; Spatial clustering