Mental Health: Depression in Uganda

Wikipedia defines Major Depressive Disorder (MDD) or Depression or as it is commonly known as:

a mental disorder characterized by a pervasive and persistent low mood that is accompanied by low self-esteem and by a loss of interest or pleasure in normally enjoyable activities. The term "depression" is used in a number of different ways. It is often used to mean this syndrome but may refer to other mood disorders or simply to a low mood. Major depressive disorder is a disabling condition that adversely affects a person's family, work or school life, sleeping and eating habits, and general health.

It is important to understand that MDD is more than just low mood. The person diagnosed with MDD cannot just snap out of it. They may require medication or long-term therapy to come to terms with the condition.

In a 2011 study Poverty, life events and the risk for depression in Uganda, 29.3% of people interviewed were found to have MDD. The variability of MDD was strongly associated with district varying from 7.7% in Bushenyi to 49.6% in Moyo. 

Major risk factors for developing MDD in both men and women were identified as:

socioeconomic related to deprivation (no formal education, having no employment, broken family) and poverty (low socioeconomic status).

Other studies have found lower but no less alarming percentages of people affected by MDD. For instance the Assessment of depression prevalence in rural Uganda using symptom and function criteria found that 21% of respondents had depression. The prevalence of depression in two districts of Uganda reported 17.4% incidence of depression. 

In a 2013 study Prevalence and risk factors of depression in childhood and adolescence as seen in 4 districts of north-eastern Uganda the prevalence of 7.6% MDD among children and adolescents was found. Socioeconomic deprivation, experience of war trauma and orphan hood were not significantly associated with depression. However demographic factors like the quality of the child-principal care-giver relationship and the presence of psychiatric co-morbidities in the child's life were the important independent determinants of childhood depression.

Based on these figures it is possible to see that more than 1 in 5 Ugandans is affected by MDD. Moreover in a population of 5,625,000 PWDs (see my blog Number of Persons With Disabilities (PWDs) in Uganda) it is likely that many more than 1,125,000 PWDs will be affected by MDD.

A Yale Global Health Review article highlights the problems Uganda must face caring for individuals with mental health problems:

specific mental health policy does not exist and mental health is not mentioned in the general health policy. Government funding for mental health does not exist. There are a grand total of 28 mental health outpatient facilities in the entire nation. Ugandans face an alarming dearth of mental health professionals and workers: one psychiatrist for more than a million people, one mental health care nurse for every 130,000 people, one psychologist for every five million people.

There is hope, a new type of treatment has been developed:

called Group Interpersonal Therapy, or GIPT. True to its task-shifting roots, this modified form of talk therapy is facilitated by non-professionals. Unlike the aforementioned studies, GIPT was inspired by the second branch of talk therapy, interpersonal therapy. While interpersonal therapy is normally conducted one-on-one, GIPT operates in a group but focuses on improving human interaction to treat depression. In Uganda, GIPT sessions were led by locals who had undergone two weeks of training. The patients receiving GIPT drastically improved in comparison to the control group. Where the control group saw around a 40 percent reduction in depressive symptoms, the intervention group saw almost an 80 percent reduction. A New Jersey-based organization called Strong Minds implemented the GIPT intervention model from this study in other regions of Uganda. After sixteen weeks of group interpersonal therapy, Strong Minds saw incredible results: 94 to 97 percent of patients were found to be depression-free. Their mental health facilitators had been trained for just ten days in GIPT.

In Uganda Strong Minds has a team of Mental Health Facilitators that work to improve the lives of community members facing depression. The team works with individuals in the community to identify then treat depression through GIPT. Strong Minds is helping individuals to learn the skills necessary to manage and reduce their depressive symptoms, so that they can return to their productive lives.

In summary the major risk factors for developing MDD are all socioeconomic. They are:

• Low socioeconomic status
• No formal education
• No employment
• Broken family
• Poverty

It is important to understand that PWDs score significantly less across the board on all socioeconomic indicators (see Poverty and Disability in Uganda). Therefore PWDs are at greater risk than the general population of developing a MDD.