Depressive disorder and social stress in Pakistan compared to people of Pakistani origin in the UK

Depressive disorder is more common in low to middle than high-income countries, but the reasons for this have not been explicitly defined.

We compared the results of two population-based studies of people of Pakistani origin: one living in rural Pakistan and one in UK. Both samples were screened with the self-reporting questionnaire followed by research interview to determine depressive disorders and social stress.

Logistic regression was used to compare the prevalence of depressive disorder in the two countries after adjustment for socio-demographic characteristics and social stress. The estimated prevalence of depression for men was 35.8% (95% CI 16.1–55.5) in Pakistan and 9% (5.0–13.0) in Manchester (p < 0.001). Corresponding figures for women were 50.2% (40.8–59.6) and 31.1% (24.1–38.0) in Mandra and Manchester, respectively (p = 0.006). The differences remained significant after adjustment for socio-demographic characteristics until we adjusted for either years of education (women only) or severe social stress (both sexes). 35% of women in Pakistan and 71% of those in UK had received 8 years or more of education. Extremely poor housing and marked poverty were experienced by 36.1% of women in Pakistan and 0.6% of those in Manchester. In Pakistan, housing and poverty predominated as correlates of depression, whereas in Manchester it was marked difficulties in physical health and close relationships.

The results suggest that the higher rate of depressive disorder amongst women in Pakistan compared to UK can be attributed to less education and frequent severe social difficulties. These differences have implications for treatment.