Depression and its associated factors: perceived stress, social support, substance use and related sociodemographic risk factors in medical school residents in Nairobi, Kenya.

BACKGROUND: Little data exists regarding depression and its associated factors in medical residents and doctors in Sub-Saharan Africa. Residents are at high risk of developing depression owing to the stressful nature of their medical practice and academic training. Depression in medical residents leads to decreased clinical efficiency, and poor academic performance; it can also lead to substance abuse and suicide. Our primary aim was to measure depression prevalence among medical residents in Kenya's largest national teaching and referral hospital. Secondary aims were to describe how depression was associated with perceived stress, perceived social support, substance use, and educational environment. METHODS: We sampled 338 residents belonging to 8 different specialties using self administered questionnaires in this cross-sectional survey between October 2019 and February 2020. Questionnaires included: sociodemographics, the Centres for Epidemiology Depression Scale - Revised, Perceived Stress Scale, Multidimensional Scale of Perceived Social Support, Alcohol, Smoking and Substance Involvement Screening Test, and Postgraduate Hospital Educational Environment Measure. Bivariate and multivariate linear regression were used to assess for risk factors for depression. RESULTS: Mean participant age was 31.8 years and 53.4% were males. Most residents (70.4%) reported no to mild depressive symptoms, 12.7% had moderate, and 16.9% had severe depressive symptoms. Most residents had high social support (71.8%) and moderate stress (61.6%). The educational environment was rated as more positive than negative by 46.3% of residents. Bivariate analyses revealed significant correlations between depressive symptoms, perceived stress, substance use, perceived social support, and educational environment. Multivariate analysis showed that depression was strongly associated with: fewer hours of sleep (ß = - 0.683, p = 0.002), high perceived stress (ß = 0.709, p < 0.001) and low perceived social support (ß = - 2.19, p < 0.001). CONCLUSIONS: Only 30% of medical residents in our study had moderate and severe depressive symptoms. Most residents in our study reported high levels of social support, and moderate levels of stress. Though their overall appraisal of medical residency experience was positive, mental health support and self-care skills in the training of medical professionals needs prioritization.

Glucose-lowering therapies, adequacy of metabolic control, and their relationship with comorbid depression in outpatients with type 2 diabetes in a tertiary hospital in Kenya.

BACKGROUND: Depression and diabetes mellitus are important comorbid conditions with serious health consequences. When depression and diabetes are comorbid, depression negatively affects self-management activities of diabetes with serious consequences. Relationship between treatment regimens of diabetes, the adequacy of glycemic control, and occurrence of comorbid depression is not known among our patients. PATIENTS AND METHODS: This was a cross-sectional descriptive study at the outpatient diabetes clinic of the Kenyatta National Hospital where 220 ambulatory patients with type 2 diabetes on follow-up were systematically sampled. Sociodemographic data and clinical information were documented. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depression. Ethylenediaminetetraacetic acid-anticoagulated blood was used for glycated hemoglobin (HbA1C) assay on automated system, COBAS INTEGRA machine. RESULTS: Two hundred twenty patients with type 2 diabetes were enrolled. The prevalence of comorbid depression by PHQ-9 was 32.3% (95% confidence interval: 26.4%-38.6%). The majority, 69.5%, had poor glycemic control, HbA1C >7.0%, mean HbA1C was 8.9%±2.4%. Half, 50.4%, of the study subjects were on insulin-containing regimens. Over 8% (84.5%) of the participants with comorbid depression had poor glycemic control, which worsened with increasing severity of depression. There was significant correlation between comorbid depression and poor glycemic control, which is more consistent in the insulin-treated patients. However, patients on oral agents only, both with and without comorbid depression, were similar in their glycemic control. CONCLUSION: Among our type 2 diabetic population with comorbid depression, a large proportion had poor glycemic control, which worsened with increasing severity of depression. The insulin treatment increased the odds of comorbid depression and poor glycemic control in patients. It is justifiable to screen for comorbid depression in patients with type 2 diabetes who are in poor glycemic control, especially the insulin-treated, and then provide specific and appropriate interventions that are necessary to optimize their metabolic outcomes.