Social factors associated with chronic depression among a population-based sample of women in rural Pakistan

Previous studies have reported a high prevalence of depression in women in Pakistan. This paper investigates whether risk factors for chronic depression established in studies performed in Western countries can explain this high prevalence. A two-phase survey using the self-rating questionnaire (SRQ) for common mental disorders and the Psychiatric Assessment Schedule was performed on a general population sample in rural Pakistan. Demographic data and results of the Life Events and Difficulties Schedule were analysed in relation to SRQ score and psychiatric disorder. A total of 145 women were screened. High SRQ score was associated with low educational status, not having a confidant, having four or more children, being older, not being married and living in a house with more than three people per room. Regression analysis demonstrated that the first three of these independently contributed to SRQ score. In the interviewed sample (74 women), only educational level independently contributed to the presence of depression. In addition, the least educated group experienced the greatest number of marked difficulties: 67% of them had experienced both marked housing and financial difficulties compared to 28% and 25% of the other educational groups (p = 0.005). Experiencing both housing and financial difficulties was a significant risk factor for depression in women with secondary education, but not for those without secondary education. This study suggests that high levels of social adversity and low levels of education are strongly associated with depression in women in Pakistan. The other vulnerability factors found in the West (such as lack of a confidant, the presence of three or more young children at home, or loss of mother during childhood) may be of lesser importance in this population.