Depressive disorder and its mental comorbidity in patients attending psychiatry OPD at Nepalgunj Medical College

Background: Depression is one of the commonest mental health problem and its association with suicide as the most common etiology makes it a ruthless killer of all the psychiatric problems we fight with. Identification and management of co-morbid condition is important from the epidemiological and management point of view. Aim of this paper is to study about depression and its psychiatric co-morbidity in the subjects visiting to psychiatric care centre of Nepalgunj medical college. Methods: This was a descriptive study done in patients attending psychiatry OPD of Nepalgunj Medical College, Kohalpur, for six months, from the month of Baisakh to Ashwin 2069. Results: Out of the total 266 subjects (n=266), the most common age group was 21-30 years 98 (36.84%), followed by 1120 years 67 (25.19%). Female was the dominant gender in both the age groups representing 71 and 47 respectively. The most common co-morbid diagnosis in depression was dissociation 54 (44.26%) followed by headache (27.05%). Other comorbid diagnosis were; suicidal attempt (5.74%), alcohol use (4.1%) and others (18.85%) Conclusions: Depression is a common psychiatric entity with various psychiatric co-morbidities. The most common comorbid diagnosis was dissociation, followed by headache.


INTRODUCTION
Mental problem is very common but stigmatized medical and social problem worldwide.Mental disorders are not the exclusive preserve of any special groups; they are truly universal.Mental and behavioral disorders are found in people of all regions, all countries and all societies. 1pression is one of the commonest mental health problem and its association with suicide as the most common etiology makes it a ruthless killer of all the psychiatric problems we fight with.Major depressive disorder has the highest life time prevalence (almost 17 %) of any psychiatric disorder and women being twice as likely to be affected as men. 2 The Global Burden of Disease, using the measure of disability adjusted life years determined that unipolar depression was the fourth leading cause of disease burden in the world.It also projected that, in the year 2020, it will be second leading cause of disease burden in the world. 3 typical depressive episode, the individual usually suffers from depressed mood, loss of interest and enjoyment, and reduced energy leading to increased fatigability and diminished activity.A duration of at least 2 weeks is usually required for diagnosis, but shorter periods may be reasonable if symptoms are unusually severe and of rapid onset. 4ccording ECA (National Institute of Mental Health's Epidemiologic Catchment Area) and NCC (National Comorbidity Survey) study, over two thirds of all individuals identified as having an episode of major depression also meet the criteria for one or more other psychiatric disorders and the anxiety and the substance abuse disorders being the most common.a symptom of depression may cause diagnostic difficulty while use of substance in depression could be for self therapeutic purpose of the depression itself or even some patient may get depression because of their substance use disorders.
Comorbidity studies are grossly lacking among psychiatric studies and this study aims to explore the sociodemographic profile of depressive patients along with the existing psychiatric comorbidity.

METHOD
This was a descriptive study done in patients attending psychiatry OPD of Nepalgunj Medical College, Kohalpur for six months from the month of Baisakh to Ashwin 2069.
All the new cases of depression that came to the OPD were included in the study after taking consent for the study and the publication.Total 266 participants were included in the study.Patients were diagnosed using the ICD-10 (International Classification of Disease, 10 th edition) classification of mental and behavioral disorders, clinical description and diagnostic guidelines. 4tients who did not want to participate in the study, those having depression with bipolar disorders, depression in schizoaffective disorders were excluded from the study group.Patients who needed psychological intervention were sent to the psychologist working in the same hospital.Needful laboratory investigations were done from the hospital laboratory.
The basic socio-demographic profile was recorded and all the variables were analyzed using SPSS (Statistical Package for Social Studies) software and tabulated in percentage.

RESULTS
Out of the 266 study subjects (n=266

DISCUSSION
The most common age range for depression found in our study is 21-30 years that represent about 36.84 percent of depression cases.Depression is least common in young age group (<10 years) followed by elderly population of > 60 years.It could be due to the fact that depression is more often found in productive age group and as this is the hospital based study, many elderly and children were not able to visit from their home.From the sex distribution point of view, our findings truly represent the twice as common depressive illness in females (179) than in males (87).
The most common mental comorbidity in the patients with depressive episodes was dissociation 54 (44.26%) followed by headache (27.05%)Dissociation was most common in the age group of 11-20 years (26) followed by 21-30 years (20) and is least common to absent in extreme age groups as mentioned in the most text books.The average age of onset for dissociation is 10-25 years. 6is is similar to one study from western Nepal where majority of the patients of dissociative disorder were from 10-19 years (80%) and 20-29 (14.28%). 7idemiological reports mention 38-50% depressive cases associated with dissociation as a psychiatric comorbidity. 3adache is second most common psychiatric comorbidity comprising 33 (27.05 %) cases which is more or less similar to the result of another hospital based study done in eastern Nepal where 46 % of depressed patient were complaining headache. 8wer prevalence of alcohol abuse could be due to the minimization by patients during the interview and a real low prevalence of alcohol abuse in Terai region due to their different culture in comparision to differently cultured population from cold hilly areas.In one hospital based study done in middle part of Nepal, alcohol use disorder with depressive disorder was found to be 4 (1.52 %). 9 One study based on United States national comorbidity survey replication done in 18 plus adults found that, of 46.4 % of participants reported one or more psychiatric disorders during their life time. 3morbidity is more often a common phenomenon not only with psychiatric problems but also with physical illnesses in patients suffering from mental illness including depression.Their identification helps in better management of overall mental health.
Selection bias due hospital based study, unable to randomize, unable to follow up are some of the limitations of the study.

CONCLUSION
Depression is a common psychiatric entity with various psychiatric comorbidities.The most common comorbid diagnosis is dissociation, followed by headache.Suicidal attempt and alcohol abuse are less often associated with the depressive episodes as found in our study.

ACKNOWLEDGEMENT
My sincere thanks goes to Lord Buddha Educational Academy, NGMCTH, Kohalpur administration, principal office and neuropsychiatry team for their valuable contribution in the permission of the study, technical guidelines and help in literature review respectively in the study.