¹University of Rwanda, Department of Psychiatry and Behavioral Sciences, Kigali, Rwanda, ²University Teaching Hospital of Kigali, Department of Internal Medicine, Kigali, Rwanda, ³Ndera Neuropsychiatric Teaching Hospital, Department of Psychiatry, Kigali, Rwanda, ⁴University Teaching Hospital of Kigali, Department of Pathology, Kigali, Rwanda, ⁵University of Newcastle, School of Medicine and Public Health, Callaghan, Australia, ⁶University of South Africa, Department of Statistics, Pretoria, South Africa

Background: Depression is a leading contributor to global disability and frequently presents with somatic complaints in medical settings, resulting in under-recognition, particularly in low- and middle-income countries. In Rwanda, routine screening for depression is rarely performed in general medical clinics despite a high burden of mental disorders and limited psychiatric resources.

Aims & Objectives: To determine the prevalence and severity of depressive symptoms among medical outpatients and to identify associated socio-demographic and clinical factors, while assessing the relevance of routine screening in an internal medicine outpatient department.

Method: A cross-sectional study was conducted among 300 adult outpatients attending the internal medicine clinic of the University Teaching Hospital of Kigali between October and November 2019. Depressive symptoms were assessed using the Kinyarwanda version of the Patient Health Questionnaire-9 (PHQ-9), with a cut-off score ≥10 indicating probable depression. Socio-demographic and clinical variables were collected using a structured questionnaire. Logistic regression analysis was performed to identify factors associated with depression.

Results: The prevalence of depression was 45.7%. Among affected participants, 21% had moderate, 17% moderately severe, and 8% severe depression. The most commonly reported symptoms were fatigue, sleep disturbance, and sadness. Significant predictors of depression included lack of formal education, secondary education level, low income, and headache as a chief complaint. Approximately one in five participants reported suicidal ideation. Many patients presented primarily with physical symptoms rather than psychological complaints.

Discussion & Conclusions: Depression is highly prevalent among medical outpatients and frequently manifests through somatic complaints, contributing to missed diagnosis in routine care. The findings support the integration of systematic depression screening into general medical services to improve early detection and intervention. Implementing routine screening may enhance patient outcomes, reduce stigma, and strengthen mental health care delivery in resource-limited settings. Further studies should evaluate long-term effectiveness and feasibility of integrated screening programs.