A Modified Questionnaire to Find Out the Association of Depression with Increased Mortality, Among Urban Decedents, Dying Due to Various Causes

Introduction: Depression and Type A behaviour are important risk factors of death due to cardiovascular disease (CVD) and diabetes. Depression also predisposes deaths due to suicides. In the present study, we examine the association of endogenous depression with causes of deaths and accuracy of the questionnaire for diagnosis, among urban decedents in a lower middle income country. Methods: We studied the randomly selected record1s of death of 2222 (1385 men and 837 women) decedents, aged 25-64 years, out of 3034 death records overall from the records at Municipal Corporation, Moradabad, India. All the families of these decedents could be contacted individually to find out the causes of death, by scientist/doctor administered, informed consented, verbal autopsy questionnaire, completed with the help of the spouse and local treating doctor practising in the appropriate health care region. Clinical data and causes of death were assessed by a questionnaire based on available hospital record and verbal autopsy questionnaire, suggested by WHO and International College of Nutrition (ICN). Decedents were classified into mild to moderate and severe depression based on available records and verbal autopsy questionnaire validated for this study by Agnieszka. The association of depression with causes of death was calculated by Mantel-Haesnzel Chi square test. Results: Several of the decedents had mild to moderate depression (n=153, 6.88%) (men 6.64 %, n=92; and women 7.28 %, n=61). The prevalence of severely depressed victims was similar among men (1.08%, n=15) women 1.67% (n=14) with a total of 1.3%(n=29). The total prevalence of depression was 8.19% (n=182). There was an overall increase in diabetes mellitus, hypertension, and CAD among decedents with depression and the trend was significant. The prevalence of depression showed a significant rising trend among decedents dying due to circulatory and suicidal causes of death, both among men and women. Multivariate logistic regression analysis after adjustment of age and body mass index revealed that hypertension and CAD and diabetes mellitus were strongly associated whereas depression and sedentary behaviour were weakly associated with risk of deaths due to CVDs. Social class 3 and 4 were not associated with risk of deaths due to CVDs and diabetes. Depression was an important risk factor of deaths due to CVDs and suicides. Conclusions: The prevalence of depression was substantial among decedents dying due to various causes of death as revealed by the Agnieszka's questionnaire. Depression may be accurately diagnosed as contributing risk factor among decedents dying due to circulatory diseases and suicides.Larger studies would be necessary to demonstrate the accuracy of the questionnaire in the diagnosis of depression and its association of with causes of death among decedents.