Perceived stress and depression in 45 low- and middle-income countries

Background: There is limited research examining the association between perceived stress and depression using large population-based datasets, particularly from low- and middle-income countries (LMICs). Thus, the aim of the study was to assess the association between perceived stress and depression in 45 LMICs. Methods: We analyzed cross-sectional, predominantly nationally representative data from the World Health Survey. A perceived stress score [range 2 (lowest stress) -10 (highest stress)] was computed based on two questions from the Perceived Stress Scale. DSM-IV depression was based on past 12-month symptoms. Multivariable logistic regression analysis (adjusting for sex and age) and meta-analysis were used to examine the associations. Results: Data on 232,243 adults aged 18 years were analyzed. The overall mean (SD) perceived stress score was 4.8 (2.2), while the prevalence of depression was 6.2% (95%CI = 5.9%-6.5%). Overall, there was a linear increase in the prevalence of depression with increasing perceived stress scores [i.e., score 2 (1.9%) to score 10 (22.0%)]. Country-wise analysis showed that higher perceived stress levels were significantly associated with increased odds for depression in all countries with the exception of Georgia and Vietnam. The results of the meta-analysis showed that a one-unit increase in the perceived stress score was associated with a 1.40 (95%CI =1.35-1.44) times higher odds for depression. Limitations: The cross-sectional nature of the study limits interpretations about causation. Conclusion: Perceived stress is positively associated with depression across the globe. Future longitudinal and intervention studies from LMICs are warranted to elucidate the potential impact of addressing stress on depression in this setting.