Discussion
depressive disorder, ’ depressive symptoms, depressive symptoms, MDD, depression
DISEASES, DISORDERS
To our knowledge, this is one of the first studies to assess the prevalence and correlates of depressive symptoms and depressive disorder among household members of patients with MDD. We found a high prevalence of depressive symptoms: 91% of household respondents endorsed one or more symptoms, a figure similar to that observed by Docrat and colleagues (2019) among household members within a primary healthcare setting in South Africa [The prevalence of depressive disorder among household members (19%) was higher than estimates reported for other sub-populations in Malawi [We also found that specific constructs were associated with greater or lesser depression severity. For example, household members who reported high levels of social support also reported lower levels of depression symptoms. This corroborates a previous study set in Malawi, which found the same pattern among caregivers of children in vulnerable households [Among household members, screening positive for depressive disorder was associated with greater functional impairment. Significant functional impairment and/or distress are requirements for the diagnosis of major depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD) criteria [In contrast with past studies, we do not find evidence that household members’ depressive symptoms and depression were related to demographic characteristics such as age, gender, marital status, or income [Our study has several limitations. First, as just noted, study participants were relatively homogeneous. This reduces variance and limits our ability to generalize findings to other Malawian or similar regional settings. Second, unlike prior investigations, we did not restrict analyses to principal caregivers of the patients and instead extended eligibility to all adult household members. This determination was based, in part, on the age range of our sample. Third, all significant relationships reported in this study are correlational. To conclude directionality of relationships would require an experimental or quasi-experimental approach. Likewise, some relationships of interest (e.g. CD4 count) were unmeasurable due to resource limitations in the setting. Lastly, we quantified depressive symptoms using the PHQ-9. While the PHQ-9 has been validated for use in Malawi [