This is a descriptive cross-sectional study conducted in the internal medicine outpatient department of Kigali University Teaching hospital (CHUK) from October 7 to November 6, 2019. The University teaching hospital of Kigali/CHUK is the largest hospital located in the District of Nyarugenge at KN 4 Ave, Kigali City. It is also the biggest referral hospital in the country with a capacity of 519 beds. CHUK provides quality healthcare to the population, training, clinical research, and technical support to district hospitals. The hospital is organized into ‘divisions’. One of these covers clinical areas such as the clinical service division and other is non-medical - for example, corporate service and research & education divisions. Each clinical division is managed by a team - usually a consultant and a senior nurse. Non-clinical divisions are led by executive directors. Every division has its own budget and reports to the hospital’s management team or Hospital Administrative Board. The divisions are split into medical, nursing, allied directorates and up to the clinical departments and units. CHUK clinical service division offers varied health care services such as surgical services, which include pediatrics, urology, orthopedic surgery, general surgery, plastic surgery, neurosurgery, ENT surgery, ophthalmology and dentistry, specialized clinics in the internal medicine department: nephrology, cardiology, Pneumology, dermatology, oncology, and endocrinology. Nursing care and Allied healthcare services. The internal medicine department has an outpatient department (OPD) and Inpatient service, the OPD receives monthly at least 1200 patients with regular appointments or new consultations.
Participants, Sampling, and Tools: The participants were the outpatients who consulted the department during the predefined period. The sample size was calculated according to Slovin’s formula n = N / (1+ Ne2) where sample size n (300) was taken from the given population N (1200) with the largest margin error of e (0.050). The patients were approached for participation in the study while they were waiting for their appointments with their physicians (Figure 1) below
Patients aged 18 years and older on the day of the appointment and who agreed to participate in the study after written informed consent were included. We excluded patients if severe illness, special needs patients below 18 years, and patients with cognitive impairment.
The data were collected by using a structured questionnaire including the Patient Health Questionnaire-9 (PHQ-9). The questionnaire collected socio-demographic and clinical characteristics; it was translated into the local language (mother tongue) and accepted by the national mental division and Department of Psychiatry of the University in the previous studies regarding the screening of depression.
The clinical questions were aggregated in four domains such as family psychiatric history, personal psychiatric history, chronic medical illness, and current chief complaints. The score of 10 was used as the cut-off score for diagnosing likely depressive disorder(16), no depression below 10, and three types of depression above 10 according to severity (Table 1) below. The questionnaire was completed by the patient or researcher depending on the choice of the participant. The data collected were entered into statistical package for social science (SPSS) version 16 for analysis purposes. We carried out descriptive statistics for all variables. Chi-Square test was calculated to determine associations between variables and a 2-sided P value of <0.05 was considered statistically significant
Table 1
Provisional diagnoses to scoring classes
| PHQ-9 score | Depression severity |
| Below 10 | none |
| 10 -14 | Moderate depression |
| 14 -19 | Moderately severe depression |
| 20 -27 | Severe depression |
Benefits and significance
The participants were offered information about their level of depression and ability to get bio-psychosocial support the same day as those ones who scored 10 or more were referred to the mental department.
The study results could be used to give a valid recommendation to the ministry of health through the hospital in integrating the systematic screening for depression among the adult outpatients attending the internal medicine. It could also remind and motivate physicians to screen patients for depression and other mental illnesses. The results could help the policymakers in upgrading the existing policy about mental disorders. As it is the first study, it could serve as baseline data for future studies.