FREQUENCY OF PRECIPITATING FACTORS AMONG PATIENTS WITH DEPRESSION PRESENTING TO A TERTIARY CARE HOSPITAL: A CROSS-SECTIONAL STUDY

Abstract

Background: Depressive disorder represents a major public health challenge in low- and middle-income countries, where social stressors, economic instability, and limited mental health resources interact to intensify disease burden. In Pakistan, depression frequently presents with diverse psychosocial precipitants that vary across demographic and occupational groups. Understanding these precipitating factors is essential for developing contextually relevant prevention and intervention strategies aimed at reducing the severity and recurrence of depressive illness.

Objective: To determine the frequency and distribution of key precipitating factors of depression among patients presenting to a tertiary care hospital.

Methods: This cross-sectional study was conducted at the Department of Psychiatry, Pakistan Institute of Medical Sciences, Islamabad, from 21st August 2024 to 20th February 2025. A total of 300 adult male and female patients diagnosed with depression using ICD-10 criteria were enrolled through consecutive sampling. Depression severity was assessed using a standardized inventory, and precipitating factors were evaluated through structured interviews. These factors included major life trauma, social failure, low socioeconomic status, and marital dissatisfaction, defined using validated operational criteria and scales. Data were analyzed using SPSS version 26. Quantitative variables were summarized as mean and standard deviation, while categorical variables were expressed as frequencies and percentages. Associations were assessed using appropriate inferential statistical tests, with statistical significance set at p < 0.05.

Results: The mean age of participants was 35.48 ± 10.57 years. Individuals aged 40 years or below constituted 68.0% of the sample, and 50.7% were male. Poor socioeconomic status was the most frequently identified precipitating factor, present in 73.7% of patients, followed by marital dissatisfaction in 66.3% and social failure in 47.3%. Major life trauma was reported by 18.0% of participants. Major life trauma was significantly more common among males than females (22.4% vs. 13.5%, p = 0.046). Social failure was more frequent among salaried individuals compared with those in business professions (54.2% vs. 41.0%, p = 0.023). Marital dissatisfaction was also significantly higher among males (72.4%, p = 0.025). Poor socioeconomic status showed significant associations with gender (p = 0.035) and body mass index (p < 0.001).

Conclusion: Socioeconomic disadvantage and marital dissatisfaction emerged as the most prominent precipitating factors for depression, with distinct variations across gender and occupational groups. These findings emphasize the need for targeted, socially informed mental health interventions within tertiary care settings.