Contents lists available at ScienceDirect Journal of Affective Disorders journal homepage: www.elsevier.com/locate/jad Research paper The prevalence and correlates of severe depression in a cohort of Mexican teachers Rene Soria-Saucedo a , Ruy Lopez-Ridaura b , Martin Lajous b,e, ⁎ , Veronika J. Wirtz c,d a Department of Pharmaceutical Outcomes and Policy, University of Florida, United States b Center for Population Research, National Institute of Public Health, 7a. Cerrada de Fray Pedro de Gante #50, Col. Sección XVI Tlalpan, C.P. 14080 México D.F., Mexico c Department of Global Health, Boston University School of Public Health, United States d Center of Health Systems Research, National Institute of Public Health, Mexico e Department of Global Health and Population, Harvard T.H. Chan School of Public Health, United States ARTICLE INFO Keywords: Depression Psychotropics Unhealthy behaviors PHQ9 Mexico ABSTRACT Background: Depression is among the 10 major causes of disability in Mexico. Yet, local contextual factors associated to the disorder remain poorly understood. We measured the impact of several factors on severe depression such as demographics, pharmacotherapy, multimorbidity, and unhealthy behaviors in Mexican teachers. Methods: A total of 43,845 Mexican female teachers from 12 Mexican states answered the Patient Health Questionnaire (PHQ9). Data were part the Mexican Teacher's Cohort prospective study, the largest ongoing cohort study in Latin America. Unadjusted and adjusted estimates assessed the impact of several contextual factors between severe versus mild-no depression cases. Results: In total 7026 teachers (16%) had a PHQ9 score compatible with severe depression. From them, only 17% received psychotropics, compared to 60% for those with a formal diagnosis. Less than 5% of teachers with PHQ9 scores compatible with severe depression had a formal diagnosis. Adjusted analysis reported higher odds of pharmacotherapy, having ≥ 3 comorbidities, higher levels of couple, family and work stress, fewer hours of vigorous physical activity, higher alcohol consumption, and smoking as risk factors for severe depression. Also, rural residents of northern and center states appeared more severely depressed compared to their urban coun- terparts. On average, the PHQ9 scores differed by ~ 10 points between severe and mild-no depressed teachers. Limitations: A cross-sectional design. Also, the study focused on female teachers between ages 25 and 74 years old, reducing the generalizability of the estimates. Conclusion: Under-diagnosis of clinical depression in Mexican teachers is concerning. Unhealthy behavior is associated with severe depression. The information collected in this study represents an opportunity to build prevention mechanisms of depression in high-risk subgroups of female educators and warrants improving access to mental care in Mexico. 1. Introduction Depression is a common mental disorder and the second leading cause of disability globally (World Health Organization(WHO), 2012). An estimated 350 million people suffer from depression worldwide. In Mexico, mayor depressive disorder is ranked the 6th leading cause of disability (Institute for Health Metrix and Evaluation (IHME), 2015), ranking higher than chronic kidney disease, oral disorders, and anxiety. The estimated mean life-time prevalence of depression in Mexico is 8% with slightly higher life-time prevalence for women 10.4% than for men 5.4% (Rafful et al., 2012). Data gathered worldwide reports several risk factors linked to depression. For example, age between 45 and 55 re- presents the highest life-time prevalence in women and over 55 years old in men. The twelve-month prevalence of major depressive disorder has been estimated at 3.7% (Medina-Mora et al., 2005). In short, younger age, low income, female gender and the group of divorced, widowed and separated individuals are strongly associated factors with an increase in 12 month prevalence in reporting mental disorders (Medina-Mora et al., 2005). Compared to the general population, tea- chers tend to present higher levels of stress and higher proportion of common mental issues, but no previous study has examined in the Mexican context which contextual factors are more impactful on poor https://doi.org/10.1016/j.jad.2018.02.036 Received 12 July 2017; Received in revised form 17 January 2018; Accepted 16 February 2018 ⁎ Corresponding author. E-mail address: mlajous@insp.mx (M. Lajous). Abbreviations:PHQ9, Patient Health Questionnaire – 9 items version depression module Journal of Affective Disorders 234 (2018) 109–116 Available online 28 February 2018 0165-0327/ © 2018 Published by Elsevier B.V. T