Outcomes of common mental disorders in a rural community in South India

Background: Common mental disorders that refer to anxiety and depression syndromes are important cause of psychiatric
morbidity in primary health center. Studies evaluating outcomes of common mental disorders (CMD) from India are few.
Objectives: The aim of the present study was to examine the outcomes of the broad category of CMD and specifically major
depression in individuals resident in a rural community following naturalistic treatment with antidepressants. Methods:
Individuals with a diagnosis of CMD using a 2 stage diagnostic process were invited to seek treatment from a Primary health
center. Outcome was assessed in 144 patients diagnosed with major depression using a structured interview schedule
(SCID) at 6 months. Outcome was measured using 17-item Hamilton Depression Rating Scale (HAMD) and WHO QOL (Brev)
version. Individuals with a score of = 7 on HAMD were deemed to have incomplete remission. Results: 114 (79%) individuals
with CMD continued to be symptomatic at 6 months. Co-morbid psychiatric conditions especially anxiety was associated with
poor outcome. Individuals with higher score on HAMD had poorer quality of life as measured by WHO QOL. Treatment with
antidepressant medication did not significantly influence the outcome. Conclusion: A significant majority of individuals
diagnosed with major depression resident in a rural community had a poor outcome. However, many patients either did not
seek treatment or prematurely discontinued treatment. Implications for public health approach to the treatment of CMD are
highlighted.