Common symptoms of depression among patients with depressive disorders receiving outpatient care in tertiary hospitals in Addis Ababa, Ethiopia: A cross-sectional study

Background- While DSM-5 criteria for Depressive Disorders focuses on affective and cognitive symptoms, research in Ethiopia indicates that distress is commonly expressed through physical and culturally specific symptoms, reflecting differences in symptom expression across settings. In practice, screening tools and clinical interviews incorporate symptoms not included in DSM-5. We aimed to identify the common presentations and symptom domains of depressive disorders (somatic, cognitive, affective, and other) and examine their association with socio-demographic factors among outpatients in Ethiopia. Methods- We conducted a facility-based cross-sectional study at three tertiary hospitals in Addis Ababa, Ethiopia. Consecutive sampling was employed to include 165 adult patients who received outpatient care for depressive disorders at one of the three hospitals within the last two years. We collected data through a questionnaire designed for extracting sociodemographic and clinical factors from clinical records and face-to-face interviews. We used the validated Amharic versions of PHQ-9 and PHQ-15 with additional symptoms identified as locally relevant idioms of distress to identify depressive symptoms. We analyzed the data using SPSS version 26 and employed descriptive statistical methods to summarize the data. Cross-tabulation was done to examine associations between sociodemographic and clinical characteristics and symptom domains. Results- Feeling down, depressed or hopeless was the most frequently endorsed symptom (90.3%) of depression. Nearly all participants endorsed the “Somatic symptoms” domain (98.8%), followed by “Affective symptoms” (96.4%), and “Other symptoms” (93.3%) domains — which include local idioms of distress — while only 78.2% endorsed symptoms in the “Cognitive symptoms” domain. Among participants who responded to the most distressing symptom question, sleep problems were reported as the most distressing symptoms, while most of the reported symptoms, 58(35.2%), belonged to the “Affective symptoms” domain. Conclusions- Our study highlighted that patients seeking care for depressive disorders experience distress in ways that are not fully captured by routinely used diagnostic criteria such as the DSM-5. This calls for further research to understand broader clinical presentation of depressive disorders in Ethiopia, that would inform contextually sensitive and patient- centered approaches to diagnosis and treatment. This would ensure that even less commonly reported but highly distressing symptoms receive adequate attention in clinical care.