GENDER DISPARITIES IN DEPRESSION AND ITS ASSOCIATION WITH CARDIOMETABOLIC RISK FACTORS AMONG YOUNG ADULTS IN A LOW-MIDDLE INCOME COUNTRY: A CROSS-SECTIONAL STUDY

Abstract

Therapeutic Area

ASCVD/CVD Risk Factors

Background

Depression is a leading cause of disability globally, with higher burdens in low-middle income countries (LMICs) like Pakistan. Emerging evidence links depression to cardiometabolic diseases, but data from primary care settings in Pakistan remain limited. This study assessed the burden of depression and its association with gender and cardiometabolic risk factors among young adults in Karachi, Pakistan.

Methods

A cross-sectional study was conducted from September 2022 to February 2023 at five primary care clinics affiliated with Aga Khan University. Adults aged 18 - 50 years (men) and 18 - 60 years (women) with at least one atherosclerotic cardiovascular disease (ASCVD) risk factor were included. A total of 614 participants were enrolled via non-probability consecutive sampling. Depression was assessed using the PHQ-9, with scores ≥10 indicating depression. Cardiometabolic risk factors included hypertension, diabetes, dyslipidemia, obesity (BMI and waist circumference), and smoking. Physical activity (IPAQ) and socioeconomic status (WAMI index) were recorded. Multivariable logistic regression was used to assess associations between gender and depression.

Results

Among 614 participants (mean age: 41.9 ± 9.2 years), 373 (60.7%) were women. Depression was present in 18.2% overall, significantly higher in women (22.2%) than men (12.0%) (p=0.001). Adjusted analysis showed women had 2.6 times higher odds of depression (OR: 2.645; 95% CI: 1.478–4.733). Dyslipidemia (84.7%), obesity (90.6%), and hypertension (49.7%) were common, but these were not associated with depression. An inverse relationship was found between depression and obesity by BMI (p=0.001), though not by waist circumference. Depressed participants had lower physical activity (p=0.027) and WAMI scores (p=0.007). Smoking was more prevalent among those with depression (21.4% vs. 12.2%, p=0.014), though not significant after adjustment.

Conclusions

Depression is highly prevalent among young adults in Karachi, with women disproportionately affected. The lack of association with cardiometabolic risk factors contrasts with global literature, possibly due to cultural perceptions of obesity. These findings underscore the need for gender-sensitive mental health interventions in primary care. While traditional cardiometabolic risks were not independently associated with depression, links with lower physical activity, socioeconomic status, and smoking highlight the need for integrated mental and physical health strategies in primary care.