Depression and its major risk factors in India: A narrative review

Abstract

Major depressive disorder is a complex neurological condition marked by persistent sadness, hopelessness, and loss of interest in daily activities for at least 2 weeks. It significantly affects mental, emotional, and physical health and is a major contributor to global disease. In India, rising depression rates have demonstrated the necessity of better understanding its causes for improved interventions and public health policies. This review comprehensively explores the diverse factors contributing to the increasing prevalence of depression in India. An unstructured survey of research articles and a detailed literature review were conducted using electronic databases, including Google Scholar, PubMed, Springer, and Elsevier. The findings reveal that in India, depression stems from a combination of external and internal risk factors. External factors such as cultural norms and gender roles heavily influence societal perceptions of mental health and individual psychological experiences. Other significant external contributors include educational stress, unemployment, occupational pressure, and challenges from rapid urbanization. Meanwhile, internal factors including genetic predisposition and epigenetic mechanisms play a critical role in individual susceptibility to depression. These biological factors interact with environmental stressors to shape the onset and progression of depression. Based on the findings, rising depression rates in India necessitate targeted efforts to address modifiable factors, such as stigma, work stress, and mental healthcare access, while recognizing genetic influences. A comprehensive strategy that integrates policy reforms and community initiatives is crucial for reducing the burden of depression in India.

Keywords

Major depressive disorder / Healthcare in India / Depression risk factors / Mental health / Public health policy / Culture / Gender

Funding

None.

Conflict of interest

The authors declare that they have no conflicts of interest.

References

[1] Schneiderman N, Ironson G, Siegel SD. Stress and health: Psychological, behavioral, and biological determinants. Annu Rev Clin Psychol. 2005; 1:607-628. doi: 10.1146/annurev.clinpsy.1.102803.144141

[2] Chu B, Marwaha K, Sanvictores T, Awosika AO, Ayers D. Physiology, stress reaction. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2019.

[3] Santomauro DF, Herrera AMM, Shadid J, et al. Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. Lancet. 2021; 398(10312):1700-1712. doi: 10.1016/S0140-6736(21)02143-7

[4] Patel V, Kleinman A. Poverty and common mental disorders in developing countries. Bull World Health Organ. 2003; 81(8):609-615.

[5] Manoharan A, Shewade DG, Rajkumar RP, Adithan S. Serotonin transporter gene (SLC6A4) polymorphisms are associated with response to fluoxetine in South Indian major depressive disorder patients. Eur J Clin Pharmacol. 2016; 72(10):1215-1220. doi: 10.1007/s00228-016-2099-9

[6] Sureshkumar R, Bharath S, Jain S, et al. ApoE4 and late onset depression in Indian population. J Affect Disord. 2012; 136(3):244-248. doi: 10.1016/j.jad.2011.12.022

[7] Ramesh V, Venkatesan V, Ramasamy B. Role of serotonin transporter and receptor gene polymorphisms in treatment response to selective serotonin reuptake inhibitors in major depressive disorder. Hum Psychopharmacol. 2022; 37(4):e2830. doi: 10.1002/hup.2830

[8] Margoob MA, Mushtaq D, Murtza I, Mushtaq H, Ali A. Serotonin transporter gene polymorphism and treatment response to serotonin reuptake inhibitor (escitalopram) in depression: An open pilot study. Indian J Psychiatry. 2008; 50(1):47-50. doi: 10.4103/0019-5545.39759

[9] Haldar S, Roy S, Sen S, Dasgupta A, Ghosh S. Association of the Val66Met polymorphism of the BDNF gene and the deletional mutation of CYP2D6 gene with the prevalence and severity of depressive disorder in an Eastern Indian population. Indian J Psychiatry. 2022; 64(3):269-276. doi: 10.4103/indianjpsychiatry.indianjpsychiatry_541_21

[10] Mushtaq R, Shoib S, Shah T, Mushtaq S. Tryptophan hydroxylase 2 gene polymorphism in anxiety and depressive disorder in Kashmiri population. J Clin Diagn Res. 2014; 8(6):WC01-WC03. doi: 10.7860/JCDR/2014/9293.4453

[11] Upasna S, Kumari R, Agrawal A, Karmakar D, Dubey GP. Methylenetetrahydrofolate reductase gene (MTHFR_677C→T) associated with the development of depression. Int J Sci Res Dev. 2014; 2(7):551-553. doi: 10.13140/RG.2.2.20398.74562

[12] Basu A, Chadda RK, Sood M, Kaur H, Kukreti R. Association of serotonin transporter (SLC6A4) and receptor (5HTR1A, 5HTR2A) polymorphisms with response to treatment with escitalopram in patients with major depressive disorder: A preliminary study. Indian J Med Res. 2015; 142(1):40-45. doi: 10.4103/0971-5916.162094

[13] Ghosh M, Ali A, Joshi S, Srivastava AS, Tapadia MG. SLC1A3 C3590T but not BDNF G196A is a predisposition factor for stress as well as depression, in an adolescent Eastern Indian population. BMC Med Genet. 2020; 21(1):53. doi: 10.1186/s12881-020-0993-6

[14] Dovjak M, Kukec A. Creating Healthy and Sustainable Buildings: An Assessment of Health Risk Factors. Berlin, Germany: Springer Nature; 2019. p. 160. doi: 10.1007/978-3-030-19412-3_3

[15] Fink G. Stress: Definition and history. In: Stress Science: Neuroendocrinology. Vol. 3. Amsterdam, Netherlands: Elsevier Science; 2010. p. 3-14.

[16] Pushap AC, Sudershan A, Sudershan S, et al. Stress among college students is linked to headache, PCOS, hypertension, and depression: A cross-sectional study. Psychol Behav Sci Int J. 2022; 20(2):556031. doi: 10.19080/pbsij.2022.20.556031

[17] Putul M, Kahua TD, Choudhury MK, Shobhana M. The influence of culture and society on mental health. Med Legal Update. 2018; 18(2):198. doi: 10.5958/0974-1283.2018.00156.1

[18] Burger K, Strassmann Rocha D. Mental health, gender, and higher education attainment. Z Erziehungswiss. 2023;27:89-122. doi: 10.1007/s11618-023-01187-3

[19] Patel V. Cultural factors and international epidemiology: Depression and public health. Br Med Bull. 2001; 57(1):33-45. doi: 10.1093/bmb/57.1.33

[20] Strasser B, Sperner-Unterweger B, Fuchs D, Gostner JM. Mechanisms of inflammation-associated depression: Immune influences on tryptophan and phenylalanine metabolisms. Curr Top Behav Neurosci. 2017;31:95-115. doi: 10.1007/7854_2016_23

[21] Bone JK, Lewis G, Lewis G. The role of gender inequalities in adolescent depression. Lancet Psychiatry. 2020; 7(6):471-472. doi: 10.1016/S2215-0366(20)30081-X

[22] Jambunathan J. Sociocultural factors in depression in Asian Indian women. Health Care Women Int. 1992; 13(3):261-270. doi: 10.1080/07399339209516001

[23] Aggarwal S, Francis KL, Dashti SG, Patton G. Child marriage and the mental health of adolescent girls: A longitudinal cohort study from Uttar Pradesh and Bihar, India. Lancet Reg Health Southeast Asia. 2022;8:100102. doi: 10.1016/j.lansea.2022.100102

[24] Vikram K. Early marriage and health among women at midlife: Evidence from India. J Marriage Fam. 2021; 83(5):1480-1501. doi: 10.1111/jomf.12793

[25] Fan S, Koski A. The health consequences of child marriage: A systematic review of the evidence. BMC Public Health. 2022; 22(1):309. doi: 10.1186/s12889-022-12707-x

[26] Remes O, Mendes JF, Templeton P. Biological, psychological, and social determinants of depression: A review of recent literature. Brain Sci. 2021; 11(12):1633. doi: 10.3390/brainsci11121633

[27] Marmot M. Health equity in England: The Marmot review 10 years on. BMJ. 2020;368:m693. doi: 10.1136/bmj.m693

[28] Ngin C, Pal K, Tuot S, Chhoun P, Yi R, Yi S. Social and behavioural factors associated with depressive symptoms among university students in Cambodia: A cross-sectional study. BMJ Open. 2018; 8(9):e019918. doi: 10.1136/bmjopen-2017-019918

[29] Nieuwsma JA, Pepper CM, Maack DJ, Birgenheir DG. Indigenous perspectives on depression in rural regions of India and the United States. Transcult Psychiatry. 2011; 48(5):539-568. doi: 10.1177/1363461511419274

[30] Patel PA, Patel PP, Khadilkar AV, Chiplonkar SA, Patel AD. Impact of occupation on stress and anxiety among Indian women. Women Health. 2017; 57(3):392-401. doi: 10.1080/03630242.2016.1164273

[31] Casey BJ, Jones RM, Levita L, et al. The storm and stress of adolescence: Insights from human imaging and mouse genetics. Dev Psychobiol. 2010; 52(3):225-235. doi: 10.1002/dev.20447

[32] Devi S, Kaushal S, Agnihotri G, Mittal N. Stress, depression, and anxiety of female adolescents of higher senior secondary school: A cross-sectional comparative study of humanities, commerce, and science streams. J Pharm Bioallied Sci. 2023; 15(Suppl 2):S1050-S1052. doi: 10.4103/jpbs.jpbs_229_23

[33] Sundari T, George AJ, Sinu E. Psychosocial problems of adolescent girls during menstruation. J Ment Health Educ. 2022; 3(2):47-63.

[34] Verma K, Baniya GC. Prevalence of depression, anxiety and quality of life in adolescent girls with Dysmenorrhoea in a remote area of Western Rajasthan. J Obstet Gynaecol India. 2022; 72(Suppl 1):281-289. doi: 10.1007/s13224-021-01603-w

[35] Dasog SB. Dowry system in rural India. Maharashtra: Ashok Yakkaldevi; 2021.

[36] Shidhaye P, Shidhaye R, Phalke V. Association of gender disadvantage factors and gender preference with antenatal depression in women: A cross-sectional study from rural Maharashtra. Soc Psychiatry Psychiatr Epidemiol. 2017; 52(6):737-748. doi: 10.1007/s00127-017-1380-2

[37] Stroope S, Kroeger RA, Fan J. Gender contexts, dowry and women’s health in India: A national multilevel longitudinal analysis. J Biosoc Sci. 2021; 53(4):508-521. doi: 10.1017/S0021932020000334

[38] Patel P, Bhattacharyya K, Singh M, Jha RP, Dhamnetiya D, Shri N. Depression among currently married ever pregnant adolescents in Uttar Pradesh and Bihar: Evidence from understanding the lives of adolescents and young adults (UDAYA) survey, India. Indian J Psychiatry. 2024; 66(2):148-156. doi: 10.4103/indianjpsychiatry.indianjpsychiatry_176_23

[39] Kundu S, Ali B, Dhillon P. Surging trends of infertility and its behavioural determinants in India. PLoS One. 2023; 18(7):e0289096. doi: 10.1371/journal.pone.0289096

[40] Patel AR, Weobong B, Patel VH, Singla DR. Psychological treatments for depression among women experiencing intimate partner violence: Findings from a randomized controlled trial for behavioral activation in Goa, India. Arch Womens Ment Health. 2019; 22(6):779-789. doi: 10.1007/s00737-019-00992-2

[41] Bondade S, Iyengar RS, Shivakumar BK, Karthik KN. Intimate partner violence and psychiatric comorbidity in infertile women: A cross-sectional hospital-based study. Indian J Psychol Med. 2018; 40(6):540-546. doi: 10.4103/IJPSYM.IJPSYM_158_18

[42] Dadhwal V, Choudhary V, Perumal V, Bhattacharya D. Depression, anxiety, quality of life and coping in women with infertility: A cross-sectional study from India. Int J Gynaecol Obstet. 2022; 158(3):671-678. doi: 10.1002/ijgo.14084

[43] Chandra R, Srivastava S, Singh A, Mukherjee S, Patel JK. Locating perpetrators of violence against women in India: An analysis of married men’s characteristics associated with intimate partner violence. PLoS One. 2023; 18(8):e0289596. doi: 10.1371/journal.pone.0289596

[44] Patel V, Rodrigues M, DeSouza N. Gender, poverty, and postnatal depression: A study of mothers in Goa, India. Am J Psychiatry. 2002; 159(1):43-47. doi: 10.1176/appi.ajp.159.1.43

[45] Upadhyay A, Singh AP. Role of occupational stress and social support in negative mental health among women employees in banking sectors. J Indian Acad Appl Psychol. 2017; 43(2):222-229.

[46] Swain D, P I, Saha PR, Mukherjee S, Abraham A, AJ CJ, Yadav K. Psychosocial and obstetric determinants of women experiencing postpartum depression in a Southeastern region of India. Asian J Psychiatry. 2021;58:102596. doi: 10.1016/j.ajp.2021.102596

[47] George C, Lalitha AR, Antony A, Kumar AV, Jacob KS. Antenatal depression in coastal South India: Prevalence and risk factors in the community. Int J Soc Psychiatry. 2016; 62(2):141-147. doi: 10.1177/0020764015607919

[48] Chandran M, Tharyan P, Muliyil J, Abraham S. Post-partum depression in a cohort of women from a rural area of Tamil Nadu, India. Incidence and risk factors. Br J Psychiatry. 2002; 181:499-504. doi: 10.1192/bjp.181.6.499

[49] Dubey C, Gupta N, Bhasin S, Muthal RA, Arora R. Prevalence and associated risk factors for postpartum depression in women attending a tertiary hospital, Delhi, India. Int J Soc Psychiatry. 2012; 58(6):577-580. doi: 10.1177/0020764011415210

[50] Raghavan V, Khan HA, Seshu U, et al. Prevalence and risk factors of perinatal depression among women in rural Bihar: A community-based cross-sectional study. Asian J Psychiatry. 2021;56:102552. doi: 10.1016/j.ajp.2021.102552

[51] Nawab T, Akram A, Rafat D, Khan T. Antepartum depression and its clinico-social correlates: A cross sectional study in a tertiary hospital of North India. J Obstet Gynaecol India. 2023; 73(Suppl 2):247-254. doi: 10.1007/s13224-023-01878-1

[52] Anoop S, Saravanan B, Joseph A, Cherian A, Jacob KS. Maternal depression and low maternal intelligence as risk factors for malnutrition in children: A community-based case-control study from South India. Arch Dis Child. 2004; 89(4):325-329. doi: 10.1136/adc.2002.009738

[53] Chandra PS, Bajaj A, Desai G, et al. Anxiety and depressive symptoms in pregnancy predict low birth weight differentially in male and female infants-findings from an urban pregnancy cohort in India. Soc Psychiatry Psychiatr Epidemiol. 2021; 56(12):2263-2274. doi: 10.1007/s00127-021-02106-9

[54] Chaudhuri S. The desire for sons and excess fertility: A household-level analysis of parity progression in India. Int Perspect Sex Reprod Health. 2012; 38(4):178-186. doi: 10.1363/3817812

[55] Gupta S, Kishore J, Mala YM, Ramji S, Aggarwal R. Postpartum depression in North Indian women: Prevalence and risk factors. J Obstet Gynaecol India. 2013; 63(4):223-229. doi: 10.1007/s13224-013-0399-x

[56] Gopalakrishnan L, Acharya B, Puri M, Diamond-Smith N. A longitudinal study of the role of spousal relationship quality and mother-in-law relationship quality on women’s depression in rural Nepal. SSM Ment Health. 2023;3:100193. doi: 10.1016/j.ssmmh.2023.100193

[57] Wilcox S, Evenson KR, Aragaki A, Wassertheil-Smoller S, Mouton CP, Loevinger BL. The effects of widowhood on physical and mental health, health behaviors, and health outcomes: The Women’s Health Initiative. Health Psychol. 2003; 22(5):513-522. doi: 10.1037/0278-6133.22.5.513

[58] Jangam K, Devasthali G, Tansa KA, Raj A, Muralidharan K. Childhood abuse in adult women with unipolar depression compared to healthy women: Data from a tertiary care centre in India. Asian J Psychiatr. 2016; 22:138-139. doi: 10.1016/j.ajp.2016.06.019

[59] Banu P, Deb S, Vardhan V, Rao T. Perceived academic stress of university students across gender, academic streams, semesters, and academic performance. Indian J Health Wellbeing. 2015; 6(3):231-235.

[60] Sarkar S, Sinha VK, Praharaj SK. Depressive disorders in school children of suburban India: An epidemiological study. Soc Psychiatry Psychiatr Epidemiol. 2012; 47(5):783-788. doi: 10.1007/s00127-011-0383-7

[61] Steptoe A, Tsuda A, Tanaka Y, Wardle J. Depressive symptoms, socio-economic background, sense of control, and cultural factors in university students from 23 countries. Int J Behav Med. 2007; 14(2):97-107. doi: 10.1007/BF03004175

[62] Verma S, Sharma D, Larson RW. School stress in India: Effects on time and daily emotions. Int J Behav Dev. 2002; 26(6):500-508. doi: 10.1080/01650250143000454

[63] Kadapatti MG, Vijayalaxmi AHM. Stressors of academic stress-a study on pre-university students. Indian J Sci Res. 2012; 3(1):171-175.

[64] Sharma B, Wavare R. Academic stress due to depression among medical and para-medical students in an Indian medical college: Health initiatives cross-sectional study. J Health Sci. 2013; 3(5):29-38.

[65] Nagle YK, Sharma U. Academic stress and coping mechanism among students: An Indian perspective. J Child Adolesc Psychol. 2018; 2(1):6-8.

[66] Jayanthi P, Thirunavukarasu M, Rajkumar R. Academic stress and depression among adolescents: A cross-sectional study. Indian Pediatr. 2015; 52:217-219. doi: 10.1007/s13312-015-0609-y

[67] Saxena SK, Mani RN, Dwivedi AK, Ryali VSSR, Timothy A. Association of educational stress with depression, anxiety, and substance use among medical and engineering undergraduates in India. Ind Psychiatry J. 2019; 28(2):160-169. doi: 10.4103/ipj.ipj_3_20

[68] Reddy KJ, Menon KR, Thattil A. Academic stress and its sources among university students. Biomed Pharmacol J. 2018; 11(1):531-537. doi: 10.13005/bpj/1404

[69] Dimitrov BGA. A study on the impact of academic stress among college students in India. Ideal Res Int Multidiscip. 2017; 2(4):21-34.

[70] Bayram N, Bilgel N. The prevalence and socio-demographic correlations of depression, anxiety and stress among a group of university students. Soc Psychiatry Psychiatr Epidemiol. 2008; 43(8):667-672. doi: 10.1007/s00127-008-0345-x

[71] Bhujade VM. Depression, anxiety and academic stress among college students: A brief review. Indian J Health Wellbeing. 2017; 8(7):748-751.

[72] Deb S, Strodl E, Sun J. Academic-related stress among private secondary school students in India. Asian Educ Dev Stud. 2014; 3(2):118-134. doi: 10.1108/AEDS-02-2013-0007

[73] Mannapur B, Dorle AS, Hiremath LD, Ghattargi CH, Ramadurg U, Kulkarni KR. A study of psychological stress in undergraduate medical students at SN Medical College, Bagalkot, Karnataka. J Clin Diagn Res. 2010; 4(04):2869-2874. doi: 10.7860/JCDR/2010/.850

[74] Sandal RK, Goel NK, Sharma MK, Bakshi RK, Singh N, Kumar D. Prevalence of depression, anxiety and stress among school going adolescent in Chandigarh. J Fam Med Prim Care. 2017; 6(2):405-410. doi: 10.4103/2249-4863.219988

[75] Singh A, Lal A, Shekhar A. Prevalence of depression among medical students of a private medical college in India. Online J Health Allied Sci. 2010; 9(4):8-12.

[76] Thomas ABHILASH, Dubey SK, Samanta MK, Alex A, Jose SP. Assessment of psychological stressors of depression and anxiety using depression anxiety stress scale-21 in South Indian healthy volunteers. Int J Pharm Sci. 2016; 8(5):288-295.

[77] Bhat MA, Joshi J. Impact of unemployment on the mental health of youth in the Kashmir valley. J Psychol Psychother. 2020; 10(372):373. doi: 10.35248/2161-0487.20.10.373

[78] Buvneshkumar M, John KR, Logaraj M. A study on prevalence of depression and associated risk factors among elderly in a rural block of Tamil Nadu. Indian J Public Health. 2018; 62(2):89-94. doi: 10.4103/ijph.IJPH_33_17

[79] Sengupta P, Benjamin AI. Prevalence of depression and associated risk factors among the elderly in urban and rural field practice areas of a tertiary care institution in Ludhiana. Indian J Public Health. 2015; 59(1):3-8. doi: 10.4103/0019-557X.152845

[80] Verma S, Mishra A. Depression, anxiety, and stress and socio-demographic correlates among general Indian public during COVID-19. Int J Soc Psychiatry. 2020; 66(8):756-762. doi: 10.1177/0020764020934508

[81] Sahu S, Ram Pratap Beniwal M, Chandra M, et al. Overview of workplace depression: Stressors, consequences and assessment. Asia Pac Environ Occup Health J. 2021; 7(1):7-18.

[82] Amiri S. Unemployment associated with major depression disorder and depressive symptoms: A systematic review and meta-analysis. Int J Occup Saf Ergon. 2022; 28(4):2080-2092. doi: 10.1080/10803548.2021.1954793

[83] Pandya A, Khanal N, Upadhyaya M. Workplace mental health interventions in India: A rapid systematic scoping review. Front Public Health. 2022;10:800880. doi: 10.3389/fpubh.2022.800880

[84] Buunk BP, de Jonge J, Ybema JF, de Wolff CJ. Psychosocial aspects of occupational stress. In: A Handbook of Work and Organizational Psychology. United Kingdom: Psychology Press; 2013. p. 145-182.

[85] Garg P, Kumar R. Study of depression, anxiety and stress among Class IV workers in a medical college in Delhi. Indian J Soc Psychiatry. 2019; 35(1):57-63. doi: 10.4103/ijsp.ijsp_85_17

[86] Upadhyay RP, Chowdhury R, Salehi A, et al. Postpartum depression in India: A systematic review and meta-analysis. Bull World Health Organ. 2017; 95(10):706-717C. doi: 10.2471/BLT.17.192237

[87] Malamardi SN, Kamath R, Tiwari R, Nair BV, Chandrasekaran V, Phadnis S. Occupational stress and health-related quality of life among public sector bank employees: A cross-sectional study in Mysore, Karnataka, India. Indian J Occup Environ Med. 2015; 19(3):134-137. doi: 10.4103/0019-5278.173998

[88] Rao S, Ramesh N. Depression, anxiety and stress levels in industrial workers: A pilot study in Bangalore, India. Ind Psychiatry J. 2015; 24(1):23-28. doi: 10.4103/0972-6748.160927

[89] Ragesh G, Tharayil HM, Raj MT, Philip M, Hamza A. Occupational stress among police personnel in India. Open J Psychiatry Allied Sci. 2017; 8(2):148-152. doi: 10.5958/2394-2061.2017.00012.X

[90] Vimala B, Madhavi C. A study on stress and depression experienced by women IT professionals in Chennai, India. Psychol Res Behav Manag. 2009; 2:81-91. doi: 10.2147/prbm.s6049

[91] Kaur M, Kumar R. Determinants of occupational stress among urban Indian school teachers. Res Educ. 2019; 105(1):3-17. doi: 10.1177/0034523717745341

[92] Roz HB, Raval DT. A study of occupational stress, burnout, presumptive life events, depression and anxiety among Ahmedabad city police officers. Indian J Health Wellbeing. 2017; 8(12):1485-1492.

[93] Kaushik A, Ravikiran SR, Suprasanna K, Nayak MG, Baliga K, Acharya SD. Depression, anxiety, stress and workplace stressors among nurses in tertiary health care settings. Indian J Occup Environ Med. 2021; 25(1):27-32. doi: 10.4103/ijoem.IJOEM_123_20

[94] Darshan MS, Raman R, Rao TS, Ram D, Annigeri B. A study on professional stress, depression and alcohol use among Indian IT professionals. Indian J Psychiatry. 2013; 55(1):63-69. doi: 10.4103/0019-5545.105512

[95] Aryal S, D’mello MK. Occupational stress and coping strategy among community health workers of Mangalore Taluk, Karnataka. Indian J Public Health. 2020; 64(4):351-356. doi: 10.4103/ijph.IJPH_549_19

[96] Rathi A, Kumar V, Singh A, Lal P. A cross-sectional study of prevalence of depression, anxiety and stress among professional cab drivers in New Delhi. Indian J Occup Environ Med. 2019; 23(1):48-53. doi: 10.4103/ijoem.IJOEM_158_18

[97] Singh KK, Jyotirmay, Kumar A, Goel A, Gulati S, Nayak BB. Prevalence of anxiety, stress, and depression among health care and nonhealth-care professionals in India. J Educ Health Promot. 2021;10:83. doi: 10.4103/jehp.jehp_754_20

[98] Dahal S, Longkumar I, Bhattacharjee D, Devi NK. Association of CBS 844ins68, MTR A2756G and MTRR A66G gene polymorphisms with depression: A population-based study from North India. Gene Rep. 2022;30:101714. doi: 10.1016/j.genrep.2022.101714

[99] Kaur G, Gaur R, Thakur MK, Saraswathy KN. Depression and one carbon metabolic pathway: A study among a Mendelian population from North India. Curr Psychol. 2021;40(3):1280-1286. doi: 10.1007/s12144-018-0056-8

[100] Saraswathy KN, Ansari SN, Kaur G, Joshi PC, Chandel S. Association of vitamin B12 mediated hyperhomocysteinemia with depression and anxiety disorder: A cross-sectional study among Bhil indigenous population of India. Clin Nutr Espen. 2019; 30:199-203. doi: 10.1016/j.clnesp.2019.01.009

[101] Mahdi RA, Ahmad I, Jilani T, et al. Dopamine gene polymorphism, biochemical and oxidative stress parameters in geriatric population with and without depression: A pilot study. Indian J Clin Biochem. 2022; 37:69-76. doi: 10.1007/s12291-020-00928-z

[102] Wray NR, Wijmenga C, Sullivan PF, Yang J, Visscher PM. Common disease is more complex than implied by the core gene omnigenic model. Cell. 2018; 173(7):1573-1580. doi: 10.1016/j.cell.2018.05.051

[103] Sudershan A, Bharti S, Sheikh JH, Wani SA, Kumar H, Kumar P. Epigenetics in migraine: A review. IP Indian J Neurosci. 2023; 9(3):122-131. doi: 10.18231/j.ijn.2023.026

[104] Czarny P, Białek K, Ziółkowska S, Strycharz J, Barszczewska G, Sliwinski T. The importance of epigenetics in diagnostics and treatment of major depressive disorder. J Pers Med. 2021; 11(3):167. doi: 10.3390/jpm11030167

[105] Prabu P, Poongothai S, Shanthirani CS, Anjana RM, Mohan V, Balasubramanyam M. Altered circulatory levels of miR-128, BDNF, cortisol and shortened telomeres in patients with type 2 diabetes and depression. Acta Diabetol. 2020;57:799-807. doi: 10.1007/s00592-020-01486-9

[106] Rawat S, Kaur G, Yadav S, Khan MA, Nava SK. Global DNA methylation and depression: Preliminary result from community based epidemiological study. Meta Gene. 2018; 15:84-86. doi: 10.1016/j.mgene.2017.12.004

[107] Mulchandani R, Lyngdoh T, Nangia R, Singh S, Grover S, Thakur JS. Relationship between serum lipids and depression: A cross sectional survey among adults in Haryana, India. Indian J Psychiatry. 2023; 65(1):61-67. doi: 10.4103/indianjpsychiatry.indianjpsychiatry_967_21

[108] Patra BN, Khandelwal SK, Chadda RK, Ramakrishnan L. A controlled study of serum lipid profiles in Indian patients with depressive episode. Indian J Psychol Med. 2014; 36(2):129-133. doi: 10.4103/0253-7176.130968

[109] Varambally S, Naveen GH, Rao MG, Thirthalli J, Sharma R, Christopher R, Gangadhar BN. Low serum brain derived neurotrophic factor in non-suicidal out-patients with depression: Relation to depression scores. Indian J Psychiatry. 2013; 55(Suppl 3):S397-S399. doi: 10.4103/0019-5545.116311

[110] Khalid A, Lal N, Trivedi JK, Dalal PK, Asthana OP, Srivastava JS, Akhtar A. Serum lipids: New biological markers in depression? Indian J Psychiatry. 1998; 40(3):217-223.

[111] Dhiman P, Pillai RR, Wilson AB, et al. Cross-sectional association between vitamin B 12 status and probable postpartum depression in Indian women. BMC Pregnancy Childbirth. 2021;21:146. doi: 10.1186/s12884-021-03622-x

[112] Pal VS, Bagul KR, Mudgal V, Jain P. Serum kynurenine levels in patients of depression with and without suicidality: A case-control study. J Clin Diagn Res. 2022; 16(7):VC01-VC05. doi: 10.7860/JCDR/2022/56912.16558

[113] Sudershan A, Mahajan K, Singh K, Dhar MK, Kumar P. The complexities of migraine: A debate among migraine researchers: A review. Clin Neurol Neurosurg. 2022;214:107136. doi: 10.1016/j.clineuro.2022.107136

[114] Sahoo S, Khess CRJ. Prevalence of depression, anxiety, and stress among young male adults in India: A dimensional and categorical diagnoses-based study. J Nerv Ment Dis. 2010; 198(12):901-904. doi: 10.1097/NMD.0b013e3181fe75dc

[115] Jayashree K, Mithra PP, Nair MKC, Unnikrishnan B, Pai K. Depression and anxiety disorders among schoolgoing adolescents in an urban area of South India. Indian J Community Med. 2018; 43(Suppl 1):S28-S32. doi: 10.4103/ijcm.IJCM_209_18

[116] Singh K, Junnarkar M, Sharma S. Anxiety, stress, depression, and psychosocial functioning of Indian adolescents. Indian J Psychiatry. 2015; 57(4):367-374. doi: 10.4103/0019-5545.171841

[117] Taneja N, Sachdeva S, Dwivedi N. Assessment of depression, anxiety and stress among medical students enrolled in a medical college of New Delhi: Indian. Indian J Soc Psychiatry. 2018; 34(2):157-162. doi: 10.4103/ijsp.ijsp_114_17

[118] Kabra N, Nadkarni A. Prevalence of depression and anxiety in irritable bowel syndrome: A clinic based study from India. J Psychiatry. 2013; 55(1):77-80. doi: 10.4103/0019-5545.105520

[119] Banerjee A, Kumar S, Kulhara P, Gupta A. Prevalence of depression and its effect on disability in patients with age-related macular degeneration. Indian J Ophthalmol. 2008; 56(6):469-474. doi: 10.4103/0301-4738.42643

[120] Kumar SD, Kavitha HS, Kulkarni P, Siddalingappa H, Manjunath R. Depression, anxiety and stress levels among medical students in Mysore, Karnataka, India. Int J Community Med Public Health. 2016; 3(1):359-362. doi: 10.18203/2394-6040.ijcmph20151591

[121] Shajan A, Nisha C. Anxiety and depression among nurses working in a tertiary care hospital in South India. Int J Adv Med. 2019; 6(5):1611-1615. doi: 10.18203/2349-3933.ijam20194228

[122] Ghogare A, Saboo A. A cross-sectional study of comorbid depression in patients with chronic tension-type headache in psychiatry outpatient. J Datta Meghe Inst Med Sci Univ. 2019; 14(4):283-287. doi: 10.4103/jdmimsu.jdmimsu_107_19

[123] Thakur M, Gupta B, Kumar R, Mishra AK, Gupta S, Kar SK. Depression among women diagnosed with breast cancer: A study from North India. Indian J Med Paediatr Oncol. 2019; 40(03):347-352. doi: 10.4103/ijmpo.ijmpo_43_18

[124] Govindasamy K, Jacob I, Solomon RM, Darlong J. Burden of depression and anxiety among leprosy affected and associated factors-a cross sectional study from India. PLoS Negl Trop Dis. 2021; 15(1):e0009030. doi: 10.1371/journal.pntd.0009030

[125] Lakshmy S, Balasundaram S, Sarkar S, Audhya M, Subramaniam E. A cross-sectional study of prevalence and implications of depression and anxiety in psoriasis. Indian J Psychol Med. 2015; 37(4):434-440. doi: 10.4103/0253-7176.168587

[126] Sarkar S, Patra P, Mridha K, Ghosh SK, Mukhopadhyay A, Thakurta RG. Personality disorders and its association with anxiety and depression among patients of severe acne: A cross-sectional study from Eastern India. Indian J Psychiatry. 2016; 58(4):378-382. doi: 10.4103/0019-5545.196720

[127] Weaver LJ, Hadley C. Social pathways in the comorbidity between type 2 diabetes and mental health concerns in a pilot study of urban middle‐and upper‐class Indian women. Ethos. 2011; 39(2):211-225. doi: 10.1111/j.1548-1352.2011.01185.x

[128] Rajput R, Gehlawat P, Gehlan D, Gupta R, Rajput M. Prevalence and predictors of depression and anxiety in patients of diabetes mellitus in a tertiary care center. Indian J Endocrinol Metab. 2016; 20(6):746-751. doi: 10.4103/2230-8210.192924

[129] Aminu AS, Chandrasekaran V, Nair S. Depression among patients with diabetes: A community-based study in South India. J Med Sci. 2017; 37(6):237-244. doi: 10.4103/jmedsci.jmedsci_118_16

[130] Karpha K, Biswas J, Nath S, Dhali A, Sarkhel S, Dhali GK. Factors affecting depression and anxiety in diabetic patients: A cross sectional study from a tertiary care hospital in Eastern India. Ann Med Surg (Lond). 2022;84:104945. doi: 10.1016/j.amsu.2022.104945

[131] Phulwari H, Singh P, Daderwal MC, Solanki G, Singh K. Study of association and correlation between biomarkers and cardiovascular risk factors in depression: A cross-sectional study. Int J Dent Med Sci Res. 2021;3:25-31.

[132] Suresh KV, Shenai P, Chatra L, et al. Oral mucosal diseases in anxiety and depression patients: Hospital based observational study from South India. J Clin Exp Dent. 2015; 7(1):e95-e99. doi: 10.4317/jced.51764

[133] Kanodia S, Giri VP, Giri OP, Devi MP, Garima Y. Assessment of anxiety, depression, and serum cortisol level in oral submucous fibrosis patients: A controlled clinical trial. Eur J Dent. 2017; 11(3):293-298. doi: 10.4103/ejd.ejd_9_17

[134] Cherian AV, Narayanaswamy JC, Viswanath B, et al. Gender differences in obsessive-compulsive disorder: Findings from a large Indian sample. Asian J Psychiatry. 2014; 9:17-21. doi: 10.1016/j.ajp.2013.12.012

[135] Srinivasan G, Chaturvedi D, Verma D, et al. Prevalence of depression and anxiety among drug resistant tuberculosis: A study in North India. Indian J Tuberc. 2021; 68(4):457-463. doi: 10.1016/j.ijtb.2021.04.010

[136] Dayal A, Sodimalla KVK, Chelerkar V, Deshpande M. Prevalence of anxiety and depression in patients with primary glaucoma in Western India. J Glaucoma. 2022; 31(1):37-40. doi: 10.1097/IJG.0000000000001935

[137] Jain M, Singh A, Sharma A. Relationship of perceived stress and dental caries among pre university students in Bangalore City. J Clin Diagn Res. 2014; 8(11):ZC131-ZC134. doi: 10.7860/JCDR/2014/11664.5213

[138] Gottlieb L, Waitzkin H, Miranda J. Depressive symptoms and their social contexts: A qualitative systematic literature review of contextual interventions. Int J Soc Psychiatry. 2011; 57(4):402-417. doi: 10.1177/0020764010362863

[139] Perini G, Cotta Ramusino M, Sinforiani E, Bernini S, Petrachi R, Costa A. Cognitive impairment in depression: Recent advances and novel treatments. Neuropsychiatr Dis Treat. 2019; 15:1249-1258. doi: 10.2147/NDT.S199746

[140] Kondapura MB, Manjunatha N, Nagaraj AKM, et al. Work productivity (absenteeism and presenteeism) in persons with common mental disorders: An observational study from South India. Indian J Psychiatry. 2023; 65(4):412-418. doi: 10.4103/indianjpsychiatry.indianjpsychiatry_730_22

[141] Lang C. Inspecting mental health: Depression, surveillance and care in Kerala, South India. Cult Med Psychiatry. 2019; 43(4):596-612. doi: 10.1007/s11013-019-09656-3

[142] Wang K, Burton CL, Pachankis JE. Depression and substance use: Towards the development of an emotion regulation model of stigma coping. Subst Use Misuse. 2018; 53(5):859-866. doi: 10.1080/10826084.2017.1391011

[143] Neelankavil RJ, De Guzman R. Perceived stress as a predictor of depressive symptoms among wives of alcohol dependent persons. Indian J Health Wellbeing. 2020;11:51-61.

[144] Zhang FF, Peng W, Sweeney JA, Jia ZY, Gong QY. Brain structure alterations in depression: Psychoradiological evidence. CNS Neurosci Ther. 2018; 24(11):994-1003. doi: 10.1111/cns.12835

[145] Mullins N, Lewis CM. Genetics of depression: Progress at last. Curr Psychiatry Rep. 2017; 19(8):43. doi: 10.1007/s11920-017-0803-9

[146] Dombrovski AY, Siegle GJ, Szanto K, Clark L, Reynolds CF, Aizenstein H. The temptation of suicide: Striatal gray matter, discounting of delayed rewards, and suicide attempts in late-life depression. Psychol Med. 2012; 42(6):1203-1215. doi: 10.1017/S0033291711002133

[147] Sturm VE, Haase CM, Levenson RW. Emotional dysfunction in psychopathology and neuropathology:Neural and genetic pathways. In: Genomics, Circuits, and Pathways in Clinical Neuropsychiatry. United States: Academic Press; 2016. p. 345-364.

[148] Trivedi MH. The link between depression and physical symptoms. Prim Care Companion J Clin Psychiatry. 2004; 6(Suppl 1):12-16.

[149] Emmelkamp PMG, Spada MM. Depression and suicide: What an evidence-based clinician should know. Clin Psychol Psychother. 2022; 29(5):1491-1493. doi: 10.1002/cpp.2787

[150] Gupta A, Priya B, Williams J, et al. Intra-household evaluations of alcohol abuse in men with depression and suicide in women: A cross-sectional community-based study in Chennai, India. BMC Public Health. 2015;15:636. doi: 10.1186/s12889-015-1864-5

[151] Yadav S, Aathavan KK, Cunningham SA, et al. Changing pattern of suicide deaths in India. Lancet Reg Health Southeast Asia. 2023;16:100265. doi: 10.1016/j.lansea.2023.100265

[152] Masselink M, Van Roekel E, Hankin BL, et al. The longitudinal association between self-esteem and depressive symptoms in adolescents: Separating between-person effects from within-person effects. Eur J Pers. 2018; 32(6):653-671. doi: 10.1002/per.2179

[153] Gautam S, Jain A, Gautam M, Vahia VN, Grover S. Clinical practice guidelines for the management of depression. Indian J Psychiatry. 2017; 59(Suppl 1):S34-S50. doi: 10.4103/0019-5545.196973

[154] Kumar GS, Jain A, Hegde S. Prevalence of depression and its associated factors using beck depression inventory among students of a medical college in Karnataka. Indian J Psychiatry. 2012; 54(3):223-226. doi: 10.4103/0019-5545.102412

[155] Jha KK, Singh SK, Nirala SK, Kumar C, Kumar P, Aggrawal N. Prevalence of depression among school-going adolescents in an urban area of Bihar, India. Indian J Psychol Med. 2017; 39(3):287-292. doi: 10.4103/0253-7176.207326

[156] Mishra SK, Srivastava M, Tiwary NK, Kumar A. Prevalence of depression and anxiety among children in rural and suburban areas of Eastern Uttar Pradesh: A cross-sectional study. J Family Med Prim Care. 2018; 7(1):21-26. doi: 10.4103/jfmpc.jfmpc_248_17

[157] Kumar SG, Kattimani S, Sarkar S, Kar SS. Prevalence of depression and its relation to stress level among medical students in Puducherry, India. Ind Psychiatry J. 2017; 26(1):86-90. doi: 10.4103/ipj.ipj_45_15

[158] Singh MM, Gupta M, Grover S. Prevalence & factors associated with depression among schoolgoing adolescents in Chandigarh, North India. Indian J Med Res. 2017; 146(2):205-215. doi: 10.4103/ijmr.IJMR_1339_15

[159] Kaur S, Deepti SS, Lal M. Prevalence and correlates of depression among college going students of district Amritsar, India. Int Res J Med Sci. 2014; 2(11):5-9.

[160] Raghunathan D, Ramakrishnan D, Iris Valsan KV, Ambika S. Prevalence of depression among students of a dental tertiary care center in Kerala. Indian J Community Med. 2019; 44(Suppl 1):S14-S18. doi: 10.4103/ijcm.IJCM_23_19

[161] Verma N, Jain M, Roy P. Assessment of magnitude and grades of depression among adolescents in Raipur City, India. Int Res J Med Sci. 2014; 2(5):10-13.

[162] Yadav R, Gupta S, Malhotra AK. A cross sectional study on depression, anxiety and their associated factors among medical students in Jhansi, Uttar Pradesh, India. Int J Community Med Public Health. 2016; 3(5):1209-1214. doi: 10.18203/2394-6040.ijcmph20161386

[163] Sharma A, Gupta SK, Khare N, Agarwal SS. Assessment of depression among medical students of private university in Bhopal, India. Natl J Community Med. 2015; 6(02):161-165.

[164] Vankar JR, Prabhakaran A, Sharma H. Depression and stigma in medical students at a private medical college. Indian J Psychol Med. 2014; 36(3):246-254. doi: 10.4103/0253-7176.135372

[165] Nezam S, Golwara AK, Jha PC, Khan SA, Singh S, Tanwar AS. Comparison of prevalence of depression among medical, dental, and engineering students in Patna using Beck’s Depression Inventory II: A cross-sectional study. J Fam Med Prim Care. 2020; 9(6):3005-3009. doi: 10.4103/jfmpc.jfmpc_294_20

[166] Arun P, Ramamurthy P, Thilakan P. Indian medical students with depression, anxiety, and suicidal behavior: Why do they not seek treatment? Indian J Psychol Med. 2022; 44(1):10-16. doi: 10.1177/0253717620982326

[167] Shukla M, Ahmad S, Singh JV, Shukla NK, Shukla R. Factors associated with depression among school-going adolescent girls in a district of Northern India: A cross-sectional study. Indian J Psychol Med. 2019; 41(1):46-53. doi: 10.4103/IJPSYM.IJPSYM_211_18

[168] Kapoor M, Kapur S, Mehra S, Dube U, Sharad S, Sidhu S. Genetic variation in D7S1875 repeat polymorphism of leptin gene is associated with increased risk for depression: A case-control study from India. Depress Anxiety. 2009; 26(9):791-795. doi: 10.1002/da.20570

[169] Mushtaq R, Tarfarosh SFA, Dar MM, et al. Is there a link between depressive disorders and tryptophan hydroxylase 1 (TPH1) gene polymorphism?-A study from a distressed area, Kashmir (India). Cureus. 2016; 8(7):e673. doi: 10.7759/cureus.673

[170] Mandal T, Bairy LK, Sharma PSVN. Association between functional polymorphisms in serotonin transporter gene (SLC6A4) and escitalopram treatment response in depressive patients in a South Indian population. Eur J Clin Pharmacol. 2020; 76(6):807-814. doi: 10.1007/s00228-020-02866-4

[171] Pillai RR, Sharon L, Wilson AB, et al. Association of VDBP (rs4588 and rs7041) gene polymorphisms with susceptibility to postpartum depression in South Indian population: A cross-sectional study. Psychiatry Res. 2022;316:114713. doi: 10.1016/j.psychres.2022.114713

[172] Sharma A, Chaudhary V, Thakur MK, Devi NK, Saraswathy KN. ACE I/D polymorphism in cognitive impairment and depression among North Indian adults: A pilot study. Egypt J Med Hum Genet. 2024; 25(1):43. doi: 10.1186/s43042-024-00515-4

[173] Ramesh V, Venkatesan V, Chellathai D, Silamban S. Association of serum biomarker levels and BDNF gene polymorphism with response to selective serotonin reuptake inhibitors in Indian patients with major depressive disorder. Neuropsychobiology. 2021; 80(3):201-213. doi: 10.1159/000507371

[174] Mushtaq R, Shoib S, Shah T, Arif T, Mushtaq S. Is there a link between anxiety, depressive disorders and 5HT 2A receptor gene polymorphism?-Study from a conflict area, India-controlled Kashmir. J Pioneering Med Sci. 2014;4:132-136.

[175] Arora P, Sagar R, Mehta M, Pallavi P, Sharma S, Mukhopadhyay AK. Serum S100B levels in patients with depression. Indian J Psychiatry. 2019; 61(1):70-76. doi: 10.4103/psychiatry.IndianJPsychiatry_391_16

[176] Saldanha D, Kumar N, Ryali VSS, Srivastava K, Pawar AA. Serum serotonin abnormality in depression. Med J Armed Forces India. 2009; 65(2):108-112. doi: 10.1016/S0377-1237(09)80120-2

[177] Chaudhary V, Longkumer I, Kaur G, Saraswathy KN. Gender-specific association of biochemical variables with depression: A population-based case-control study from North India. Middle East Curr Psychiatry. 2022; 29(1):21. doi: 10.1186/s43045-022-00187-z

[178] Narayan SK, Verman A, Kattimani S, Ananthanarayanan PH, Adithan C. Plasma homocysteine levels in depression and schizophrenia in South Indian Tamilian population. Indian J Psychiatry. 2014; 56(1):46-53. doi: 10.4103/0019-5545.124746

[179] Mathew M, Abish A, Kuriakose A, Isaiah JR, Kiran AM, Vijayakumar K. Predictors of depression among patients with diabetes mellitus in Southern India. Asian J Psychiatry. 2013; 6(4):313-317. doi: 10.1016/j.ajp.2013.01.012

[180] Pallavi P, Sagar R, Mehta M, et al. Serum cytokines and anxiety in adolescent depression patients: Gender effect. Psychiatry Res. 2015; 229(1-2):374-380. doi: 10.1016/j.psychres.2015.06.036

[181] Muthuramalingam A, Menon V, Rajkumar RP, Negi VS. Is depression an inflammatory disease? Findings from a cross-sectional study at a tertiary care center. Indian J Psychol Med. 2016; 38(2):114-119. doi: 10.4103/0253-7176.178772

[182] Kaithwas N, Maurya PK, Shaikh L, Marskole P. Depression and Vitamin D level: An observational study from East Nimar region of Central India. Eur J Cardiovasc Med. 2023; 13(1):1420.

[183] Kale AB, Kale SB, Chalak SS, et al. Lipid parameters - significance in patients with endogenous depression. J Clin Diagn Res. 2014; 8(1):17-19. doi: 10.7860/JCDR/2014/4059.3911

[184] Gupta P, Tripathi A, Saini A, Mahla VP, Jose NA, Kapoor A. Correlation of HDL and LDL cholesterol with severity of depression: A cross-sectional study. J Clin Diagn Res. 2024; 18(1):VC01-VC04. doi: 10.7860/JCDR/2024/65938.18892

[185] Sandeep Varma R, Prashanth Kumar BG, Muralidhar Krishna CM. Serum acetylcarnitine as a diagnostic marker in depression episodes. Biomed Biotechnol Res J. 2024; 8(2):194-199. doi: 10.4103/bbrj.bbrj_132_24

[186] Baradia G, Kumar P, Seth AK, Toora BD, Sharma P, Ranjan R. Levels of serum folate and cobalamine in clinically depressed patients in North Indian population. Ann Int Med Dent Res. 2018; 4(4):BC33-BC38.

[187] Ullas Kamath S, Chaturvedi A, Bhaskar Yerrapragada D, Kundapura N, Amin N, Devaramane V. Increased levels of acetylcholinesterase, paraoxonase 1, and copper in patients with moderate depression - a preliminary study. Reports Biochem Mol Biol. 2019; 7(2):174-180.

[188] Singh AK, Verma P, Gupta S, Saxena J. Variability in serum electrolytes in different grades of depression. Indian J Physiol Pharmacol. 2011;55(1):67-71.

[189] Mishra D, Sardesai U, Razdan R. C-reactive protein level in late-onset depression: A case-control study. Indian J Psychiatry. 2018; 60(4):467-471. doi: 10.4103/psychiatry.IndianJPsychiatry_127_17

[190] Jeenger J, Singroha V, Sharma M, Mathur DM. C-reactive protein, brain-derived neurotrophic factor, interleukin-2, and stressful life events in drug-naive first-episode and recurrent depression: A cross-sectional study. Indian J Psychiatry. 2018; 60(3):334-339. doi: 10.4103/psychiatry.IndianJPsychiatry_169_18

[191] Ray S, Talukdar M, Ray S, Sethy RR, Acharya V, Tripathy SK. Interrelationship of vitamin D and cortisol with depression: A cross-sectional study conducted in a tertiary care hospital of Odisha. Int J Pharm Clin Res. 2024; 16(4):742-746. doi: 10.5281/zenodo.10936135

[192] Verma AK, Bajpai A, Keshari AK, Srivastava M, Srivastava S, Srivastava R. Association of major depression with serum prolidase activity and oxidative stress. Br J Med Res. 2017;20:1-8. doi: 10.9734/BJMMR/2017/31446

[193] Joseph N, Unnikrishnan B, Babu YPR, Kotian MS, Nelliyanil M. Proportion of depression and its determinants among type 2 diabetes mellitus patients in various tertiary care hospitals in Mangalore city of South India. Indian J Endocrinol Metab. 2013; 17(4):681-688. doi: 10.4103/2230-8210.113761

[194] Siddiqui S, Jha S, Waghdhare S, Agarwal NB, Singh K. Prevalence of depression in patients with type 2 diabetes attending an outpatient clinic in India. Postgrad Med J. 2014; 90(1068):552-556. doi: 10.1136/postgradmedj-2014-132593

[195] Raval A, Dhanaraj E, Bhansali A, Grover S, Tiwari P. Prevalence and determinants of depression in type 2 diabetes patients in a tertiary care centre. Indian J Med Res. 2010; 132(2):195-200.

[196] Negi H, Sarkar M, Raval AD, Pandey K, Das P. Presence of depression and its risk factors in patients with chronic obstructive pulmonary disease. Indian J Med Res. 2014; 139(3):402-408.

[197] Das R, Singh O, Thakurta RG, et al. Prevalence of depression in patients with type II diabetes mellitus and its impact on quality of life. Indian J Psychol Med. 2013;35( 3):284-289. doi: 10.4103/0253-7176.119502

[198] Balhara YPS, Sagar R. Correlates of anxiety and depression among patients with type 2 diabetes mellitus. Indian J Endocrinol Metab. 2011; 15(Suppl 1):S50-S54. doi: 10.4103/2230-8210.83057