title: Chronic respiratory disease and high altitude are associated with depressive symptoms in four diverse settings.
abstract: Depression is a prevalent comorbidity of chronic respiratory disease (CRD), and may indicate worse clinical outcomes. The relationship between depression and living with chronic hypoxia due to CRD or residence at altitude has received little attention in resource-poor settings.
  
  
  
  To investigate the association between CRD conditions and depressive symptoms in four settings in Peru.
  
  
  
  We collected data on CRD and depressive symptoms in adults aged ⩾35 years. Depressive symptoms were measured according to the Center for Epidemiologic Studies Depression scale. Multivariable ordinal logistic regression was used to assess the adjusted odds of being in a higher category of depressive symptoms as a function of CRD.
  
  
  
  We analyzed data from 2953 participants (mean age 55.3 years, 49% male). The prevalence of major depressive symptoms was 19%, with significant variation according to setting. Participants with at least one CRD (OR 1.34, 95%CI 1.06-1.69) and those living at altitude (OR 1.64, 95%CI 1.10-2.43) had an increased adjusted odds of being in a higher category of depressive symptoms.
  
  
  
  We found a high prevalence of depressive symptoms, and a positive association between depressive symptoms with CRD and with living at altitude, both of which cause chronic hypoxia.
authors: Division of Pulmonary and Critical Care, School of Medicine, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
authors: S
authors: S
authors: Zaeh
authors: Division of Pulmonary and Critical Care, School of Medicine, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
authors: C H
authors: CH
authors: Miele
authors: Division of Pulmonary and Critical Care, School of Medicine, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
authors: N
authors: N
authors: Putcha
authors: Program in Global Disease Epidemiology and Control, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
authors: R H
authors: RH
authors: Gilman
authors: CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Department of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors: J J
authors: JJ
authors: Miranda
authors: CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors: A
authors: A
authors: Bernabe-Ortiz
authors: Division of Pulmonary and Critical Care, School of Medicine, School of Medicine, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
authors: R A
authors: RA
authors: Wise
authors: Division of Pulmonary and Critical Care, School of Medicine, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA; School of Medicine, Program in Global Disease Epidemiology and Control, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
authors: W
authors: W
authors: Checkley
mesh_terms: D000328:Adult; D000368:Aged; D000531:Altitude; D015992:Body Mass Index; D002908:Chronic Disease; D015897:Comorbidity; D003863:Depression / Q000150:complications / Q000453:epidemiology; D003865:Major Depressive Disorder / Q000150:complications / Q000453:epidemiology*; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010568:Peru / Q000453:epidemiology; D015995:Prevalence; D012140:Respiratory Tract Diseases / Q000150:complications / Q000453:epidemiology*; D012307:Risk Factors