Natural remission rates of depression among rural adult populations in India: multilevel analysis of the SMART Mental Health Project.

Abstract

BACKGROUND Natural remission from common mental disorders (CMDs), in the absence of intervention, varies greatly. The situation in India is unknown. AIMS This study examined individual, village and primary health centre (PHC)-level determinants for remission across two rural communities in north and south India and reports natural remission rates. METHOD Using pre-intervention trial data from 44 PHCs in Andhra Pradesh and Haryana, adults ≥18 years were screened for CMDs. Screen-positive people (Patient Health Questionnaire-9 Item (PHQ9) or Generalised Anxiety Disorder-7 Item (GAD7) score ≥10, or a score ≥2 on the self-harm PHQ9 question) were re-screened after 5-7 months (mean). Remission was defined <5 scores on both PHQ9 and GAD7 and <2 score on self-harm. Multilevel Poisson regression models with random effects at individual, village and PHC levels were developed for each state to identify factors associated with remission. Time to re-screening was included as offset in regression models. RESULTS Of 100 013 people in Andhra Pradesh and 69 807 people in Haryana, 2.4% and 7.1%, respectively, were screen positive. At re-screening, remission rate in Andhra Pradesh was 82.3% (95% CI 77.5-87.4%) and 59.4% (95% CI 55.7-63.3%) in Haryana. Being female, increasing age and higher baseline depression and anxiety scores were associated with lower remission rates. None of the considered village- and PHC-level factors were found to be associated with remission rate, after adjusting for individual-level factors. CONCLUSION Natural remission for CMDs vary greatly in two Indian states and are associated with complex, multilevel factors. Further research is recommended to better understand natural remission.