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Study protocol of DIVERGE, the first genetic epidemiological study of major depressive disorder in Pakistan.

Valkovskaya, Maria; Hassan, Arsalan; Zartaloudi, Eirini; Hussain, Fahad; Umar, Muhammad; Khizar, Bakht; Khattak, Inzemam; Gill, Shamshad Ahmed; Khan, Shams-Ud-Din Ahmad; Dogar, Imtiaz Ahmad; Mustafa, Ali Burhan; Ansari, Moin Ahmed; Qalb I Hyder, Syed; Ali, Muhammad; Ilyas, Nilofar; Channar, Parveen; Mughal, Nazish; Channa, Sumera; Mufti, Khalid; Mufti, Ali Ahsan; Hussain, Mian Iftikhar; Shafiq, Sadia; Tariq, Muhammad; Khan, Muhammad Kamran; Chaudhry, Shahzad Tahir; Choudhary, Abdul Rashid; Ali, Mian Nizam; Ali, Gohar; Hussain, Ashfaq; Rehman, Muhammad; Ahmad, Noman; Farooq, Saeed; Naeem, Farooq; Nasr, Tanveer; Lewis, Glyn; Knowles, James A.; Ayub, Muhammad; Kuchenbaecker, Karoline

Study protocol of DIVERGE, the first genetic epidemiological study of major depressive disorder in Pakistan. Thumbnail


Maria Valkovskaya

Arsalan Hassan

Eirini Zartaloudi

Fahad Hussain

Muhammad Umar

Bakht Khizar

Inzemam Khattak

Shamshad Ahmed Gill

Shams-Ud-Din Ahmad Khan

Imtiaz Ahmad Dogar

Ali Burhan Mustafa

Moin Ahmed Ansari

Syed Qalb I Hyder

Muhammad Ali

Nilofar Ilyas

Parveen Channar

Nazish Mughal

Sumera Channa

Khalid Mufti

Ali Ahsan Mufti

Mian Iftikhar Hussain

Sadia Shafiq

Muhammad Tariq

Muhammad Kamran Khan

Shahzad Tahir Chaudhry

Abdul Rashid Choudhary

Mian Nizam Ali

Gohar Ali

Ashfaq Hussain

Muhammad Rehman

Noman Ahmad

Farooq Naeem

Tanveer Nasr

Glyn Lewis

James A. Knowles

Muhammad Ayub

Karoline Kuchenbaecker


INTRODUCTION: Globally, 80% of the burdenof major depressive disorder (MDD) pertains to low- and middle-income countries. Research into genetic and environmental risk factors has the potential to uncover disease mechanisms that may contribute to better diagnosis and treatment of mental illness, yet has so far been largely limited to participants with European ancestry from high-income countries. The DIVERGE study was established to help overcome this gap and investigate genetic and environmental risk factors for MDD in Pakistan. METHODS: DIVERGE aims to enrol 9000 cases and 4000 controls in hospitals across the country. Here, we provide the rationale for DIVERGE, describe the study protocol and characterise the sample using data from the first 500 cases. Exploratory data analysis is performed to describe demographics, socioeconomic status, environmental risk factors, family history of mental illness and psychopathology. RESULTS AND DISCUSSION: Many participants had severe depression with 74% of patients who experienced multiple depressive episodes. It was a common practice to seek help for mental health struggles from faith healers and religious leaders. Socioeconomic variables reflected the local context with a large proportion of women not having access to any education and the majority of participants reporting no savings. CONCLUSION: DIVERGE is a carefully designed case-control study of MDD in Pakistan that captures diverse risk factors. As the largest genetic study in Pakistan, DIVERGE helps address the severe underrepresentation of people from South Asian countries in genetic as well as psychiatric research.


Valkovskaya, M., Hassan, A., Zartaloudi, E., Hussain, F., Umar, M., Khizar, B., …Kuchenbaecker, K. (2023). Study protocol of DIVERGE, the first genetic epidemiological study of major depressive disorder in Pakistan. Psychiatric Genetics, 33(2), 69-78.

Journal Article Type Article
Acceptance Date Nov 22, 2022
Publication Date Apr 1, 2023
Journal Psychiatric Genetics
Print ISSN 0955-8829
Electronic ISSN 1473-5873
Publisher Lippincott, Williams & Wilkins
Peer Reviewed Peer Reviewed
Volume 33
Issue 2
Pages 69-78
Keywords Biological Psychiatry, Psychiatry and Mental health, Genetics (clinical), Genetics
Publisher URL,_the_first_genetic.4.aspx


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