Poverty, life events and the risk for depression in Uganda (original) (raw)
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Research Square (Research Square), 2022
Background. This study concerns the prevalence, risk factors and prevention of depression in the adult population in three sub-counties in Mbarara district. Depression is a common mental disorder which presents with a wide array of symptoms including loss of energy, poor sleep, poor eating habits, fatigue, irritability and social withdrawal. The main objective of the present study was to determine the prevalence and factors associated with depression and to identify measures that can be implemented to reduce risk factors of the disease among adults in Nyamitanga, Rugando and Rwanyamahembe sub-counties in Mbarara district. Methods. A cross-sectional design was used to capture data from a study sample size of 383 participants who were involved in completion of screening tests for depression. Scores from a 7-item version of Hopkins Symptom Checklist for Depression were averaged and the probable depression determined for each participant using a cutoff of 1.75. Logistic regression analyses were used to examine associations between depression outcomes and socio-demographic, behavioural and medical history variables. Results.
Life events and depression in the context of the changing African family The case of Uganda
Introduction: Traditionally, the African extended family gave psychosocial support to all members, which cushioned any illness effects including depression. Recent changes in the African family, notably urbanization and market economies, have changed that structure. Changes, especially roles of the family and its relationship to life events and depression, have not received much research attention. Aim: To compare depressed and non-depressed patients in terms of their demographics, family structure, life events and depression. Methods: We compared quantitative data from 85 DSM-IV depressed patients that sought care at three Primary Health Care (PHC) centres with 170 unmatched non-depressed patients. To each group, we administered three questionnaires covering socio-demographics, family structure and an adapted Interview For Recent Life Events (IRLE). Results: Of the depressed patients, over 70% were females giving a M:F ratio of 2.3:1; 71.8% were aged < 39 years and 50.6% were ma...
The interface between family structure, life events and major depression in Uganda
year: 2007, 2007
Background: Poor detection of depression in primary health care is universal but worse in resource-constrained societies, yet the illness must be recognized first if it is to be appropriately managed. While current debates about life events in Western societies is on their role in the gene-environment interaction to cause depression, research on the interface between life events, family structure and major depression in many developing countries is still rare. Prevention of depression by preventing life events may not be feasible but knowing depressogenic life events is a cue for rapid intervention. Aim: To describe the feasibility of detecting current major depressive episodes (MDEs) in physically ill patients, identify life events associated with the MDEs, describe the interaction between life events, family structure and MDEs, and to explore how patients' caregivers perceive such depression. Methods: Consecutive outpatients at three PHC centres were interviewed in each of the first three studies. A cross-section of 199 physically ill patients (74 with DSM-diagnosis of major depression and 125 without) were the respondents in the study for Paper I. A case control research design was used for Paper II to compare life event experiences of the 74 physically ill and depressed patients with 64 general population controls and for Paper III in which comparison was between 85 depressed and 170 non-depressed physically ill patients. The study for Paper IV used a qualitative approach to interview 29 adult caregivers of physically ill patients that were depressed. Main findings: In Paper I, it is demonstrated that four simple subjective well-being questions could predict successfully the presence of a current major depressive episode. Paper II shows that losses related to interpersonal relationships and work as well as health and bereavement-related life events were predominant among patients with major depressive episodes. In spite of the buffer provided by the family, life events related to work, education, health and courtship/cohabitation significantly had more negative impact ratings among the depressed. Independent life events clustered around work, health, bereavement and marriage were associated with an increased risk of major depressive episodes in patients compared to controls. Similarly, findings in Paper III show that depressed patients from extended families experienced significantly more negative life events related to loss and bereavement. Distressing and bereavement-related life events were predictors of depression among patients from extended families. Given the concealment of depression in physical illness, caregivers could not identify the depressive episodes thereby undermining appropriate care-giving (Paper IV). However, they identified and associated a number of life experiences to what they referred to as 'thinking a lot'. Care-giving was found to be challenging. Conclusions: Four simple questions reflecting subjective well-being appear to have the potential to detect diagnosable patients likely to have a current major depressive episode. While the extended family is often assumed to cushion members from shocks of stressful life events, it appears to be weakening and unable to protect at risk individuals from developing depression. Psychosocial interventions as well as training and deployment of mental health workers in communities to promote coping are needed. Caregivers deserve support since their physical, psychological, economic and social resources are necessary in management of depression yet, such resources are being drained.
Clinical features of depression in Uganda.pdf
Objective: Depressive illness is the most common psychiatric disorder in HIV/AIDS with prevalence 2 to 3 times higher than the general population. It's still questionable whether HIV related depression is clinically different from depression in HIV-negative populations, a fact that could have treatment implications.This study compared the clinical features of major depression between HIV-Positive and HIV-negative patients with a view to intervention strategies. Method: A comparative, descriptive, cross-sectional study was carried out on 64 HIV-Positive depressed patients and 66 HIV-negative depressed patients in Butabika and Mulago hospitals. They were compared along the parameters of clinical features of depression, physical examination and laboratory findings. Pair wise comparisons, logistic regression and Multivariate analysis were done for the two groups on a number of variables. Results: Compared to HIV-Negative patients, HIV-Positive patients were more likely to be widowed ; older (≥ 30years), less likely to have a family member with a mental illness; a later onset of depressive illness (≥30years); more likely to have a medical illness and taking medication before onset of depressive, symptomatically compared to HIV-Negative patients, HIV-Positive patients were more critical of themselves ; had significantly more problems making decisions ; had poorer sleep; felt more easily tired; more appetite changes; more cognitive impairment. Low CD4 counts were not significantly associated with depression, but HIV related depression was more likely to occur in stages II and III illness. Conclusion: These findings show that the clinical and associated features of depression differ between HIV-Positive and HIV-Negative patients, thus requiring different management approaches and further studies related to HIV-related depression.
The prevalence of depression in two districts of Uganda
Social Psychiatry and Psychiatric Epidemiology, 2005
DEDICATION TO ALL IN SEARCH OF PEACE OF MIND "When the (suicidal) force comes over me it is so strong that I cannot overcome it. But when it goes I realize that it would have been bad if I had done it." In the face of overwhelming despair and intolerable mental pain death offers itself as an alternative to a life full of pain and suffering, and suicide may seem "like shinning a torch into the dark". However "No man can think like that" and suicidal feelings may be temporary if only they are recognized and, time is given the chance to be the natural healer. The challenge is how to detect and understand the silent sufferer and potential suicide in our midst. Quotations are from two of my patients.
Public health nutrition, 2017
To assess the association between food insecurity and depression symptom severity stratified by sex, and test for evidence of effect modification by social network characteristics. A population-based cross-sectional study. The nine-item Household Food Insecurity Access Scale captured food insecurity. Five name generator questions elicited network ties. A sixteen-item version of the Hopkins Symptom Checklist for Depression captured depression symptom severity. Linear regression was used to estimate the association between food insecurity and depression symptom severity while adjusting for potential confounders and to test for potential network moderators. In-home survey interviews in south-western Uganda. All adult residents across eight rural villages; 96 % response rate (n 1669). Severe food insecurity was associated with greater depression symptom severity (b=0·4, 95 % CI 0·3, 0·5, P<0·001 for women; b=0·3, 95 % CI 0·2, 0·4, P<0·001 for men). There was no evidence of effect ...
Journal of acquired immune deficiency syndromes (1999), 2018
There is still wide variability in HIV disease course and other HIV related outcomes, attributable in part to psychosocial factors such as major depressive disorder (MDD), a subject that has received little attention in sub-Saharan Africa. Using a longitudinal cohort of 1099 HIV positive antiretroviral therapy (ART) naïve persons, we investigated the impact of MDD on four HIV related negative outcome domains in Uganda. MDD was assessed using a Diagnostic Statistical Manual IV based tool. Also collected was data on surrogate measures of the HIV related outcome domains. Data was collected at the three time points of baseline, 6 and 12 months. Multiple regression and discrete time survival models were used to investigate the relationship between MDD and indices of the HIV outcomes. MDD was a significant predictor of 'missed ART doses' (aOR=4.75, 95% CI, 1.87-12.04, p=0.001), 'time to first visit to healthy facility' (aOR=1.71; 95% CI, 1.07-2.73; p=0.024), 'time to f...
Population Health Metrics, 2016
Background: In sub-Saharan African cities, the epidemiological transition has shifted a greater proportion of the burden of non-communicable diseases, including mental and behavioral disorder, to the adult population. The burden of major depressive disorder and its social risk factors in the urban sub-Saharan African population are not well understood and estimates vary widely. We conducted a study in Ouagadougou, Burkina Faso, in order to estimate the prevalence of major depressive episodes among adults in this urban setting. Methods: The Ouagadougou Health and Demographic System Site (HDSS) has followed the inhabitants of five outlying neighborhoods of the city since 2008. In 2010, a representative sample of 2,187 adults (aged 15 and over) from the Ouaga HDSS was interviewed in depth regarding their physical and mental health. Using criteria from the Mini International Neuropsychiatric Interview (MINI), we identified the prevalence of a major depressive episode at the time of the interview among respondents and analyzed its association with demographic, socioeconomic, and health characteristics through a multivariate analysis. Results: Major depressive episode prevalence was 4.3 % (95 % CI: 3.1-5.5 %) among the survey respondents. We found a strong association between major depressive episode and reported chronic health problems, functional limitations, ethnicity and religion, household food shortages, having been recently a victim of physical violence and regularly drinking alcohol. Results show a U-shaped association of the relationship between major depressive episode and standard of living, with individuals in both the poorest and richest groups most likely to suffer from major depressive disorder than those in the middle. Though, the poorest group remains the most vulnerable one, even when controlling by health characteristics. Conclusions: Major depressive disorder is a reality for many urban residents in Burkina Faso and likely urbanites throughout sub-Saharan Africa. Countries in the region should incorporate aspects of mental health prevention and treatment as part of overall approaches to improving health among the region's growing urban populations.