Millions of Ugandans suffering from depression unknowingly

Mar 09, 2019

Depression is the third most common reasons for admission to Butabika Hospital, after alcohol and drug abuse; and organic mental illnesses.

MENTAL HEALTH

When his father died, Robert Ahairwe, a student of Maddox Secondary School in Kyenjojo district was overwhelmed by an enormous mental and financial burden.

Ahairwe became dejected, dropped out of school because he could not afford school fees, and isolated himself. After seven months of his father's death, Ahairwe's condition worsened; he turned to alcohol to curb the situation.

He drunk every day from morning to evening, started selling household items to get money to buy alcohol. His friends distanced themselves from him, worsening the situation. 

"I always felt that no one understood me, everyone around me was hurting me," Ahairwe says.

Because of sadness, Ahairwe started planning to commit suicide. And he eventually did it.

"I remember driving the motorcycle all determined to crash it into a coming vehicle so that I could die and end the pain," Ahairwe says.

 "I don't know how I survived the crush but after three days I woke up in hospital with bandages on my head and a fractured hand."

He explains that he did not know what was happening to him though people kept referring him to witch doctors saying he could be having a spell.

"I can't say I knew what was happening to me, my life had turned into dark episode everything was not working out and the people around me were not helping. And being a , referring me to witchcraft was hurting."

Ahairwe was rescued from the jaws of depression by an old friend of his who had suffered the same and had been treated of depression.

"He encouraged me to go for a counseling and treatment at Fort Portal mental health unit, which I was against. But when he shared his experience, it related to mine and I went for treatment," Ahairwe says.

He says if it wasn't for his friend, he would be dead or would be suffering ignorantly.

Like Ahairwe, many people are battling with depression without help.

The director of Butabika National Referral Hospital, Dr David Basangwa, says millions of Ugandans are battling with depression due to lack of knowledge to identify features of depression and ignorance about how to access treatment. 

Basangwa says this is a worrying trend since depression, if left untreated, affects people's ability to work, and may lead to suicide or homicide in the extreme cases. He says the impacts of mental illness are certainly also felt by millions more in the form of family members, friends and coworkers.

"We know the burden is increasing but one of the biggest challenges we are facing is that a lot of people don't know that they have depression and go untreated. They are going through a lot of suffering and some end up committing suicide," Basangwa says.

Many people are getting confused about the fact that they feel unwell, down or low many times not knowing that they are suffering from depression.

Although the majority of people who have depression do not die by suicide, having major depression does increase suicide risk compared to people without depression.

Basangwa explains that even those who get to know that they are depressed sometimes do not seek treatment because they don't know where to seek treatment or shun known mental health facilities because of stigma.

"Society has for a long time treated people with mental health disorders with abuse and discrimination. They are always labeled names, which is stigmatizing and keeping people away from seeking treatment," Basangwa says.

Untreated depression can also ruin relationships, because problems at work, lead to drug abuse and make it difficult to overcome serious illnesses.

Depression is the third most common reasons for admission to Butabika Hospital, after alcohol and drug abuse; and organic mental illnesses. 

A February 2017 World Health Organisation (WHO) report indicates that depression is the largest single mental health problem and a major contributor to suicide deaths whose number is close to 800,000 per year.

Uganda was among the top six countries with the highest number of people suffering from depressive disorders out of the 50 African countries ranked by WHO.

The report says 1.7 million Ugandans suffer from depressive disorders and 1.07 million Ugandans suffer from anxiety disorders.

By 2030, WHO estimates that depression will be the second leading cause of world disability where it is also expected to be the largest contributor to the disease burden in both developed and developing countries. 

Studies done in Uganda show, high levels of depression with the highest being in Northern Uganda where three out of 10 people had serious depression, according to the Mental health Gap action Project in 2014. This is mainly due to the effects of the war and high poverty levels.

Godfrey Rukundo from the department of Psychiatry at Mbarara University of Science and Technology (MUST) says it is very dangerous not to detect depression.

"A person who is depressed for two weeks will not be like someone who is depressed for a month. Early detection is very crucial," Rukundo says.

He explains that majority of the mental problems in adults are a result of some of the mental problems encountered during childhood.

"Early diagnosis improves prognosis or outcome of a situation. It is difficult to handle diagnosis in children but with the proper training we can," he says.

Depression treatment

There are effective treatments for moderate and severe depression, the World Health Organisation stipulates that health-care providers may offer psychological treatments (such as behavioural activation, cognitive behavioural therapy and interpersonal psychotherapy or antidepressant medication and tricyclic antidepressants.

Psychosocial treatments are also effective for mild depression. Antidepressants can be an effective form of treatment for moderate-severe depression but are not the first line of treatment for cases of mild depression. They should not be used for treating depression in children and are not the first line of treatment in adolescents, among whom they should be used with extra caution.

The minister for Primary Healthcare, Joyce Moriku, explains that people need to know that depression can be prevented and treated. 

"A better understanding of depression, how it can be prevented and treated will help reduce the stigma associated with the condition and lead to more people seeking help," Moriku says.

She encourages communities to take interest in their members who manifest symptoms of depression and who express ideas of suicide and support them to get care. 

"Let us be on the alert, by recognizing early signs of depression and putting in place measure to curb complications following stressful events," Moriku says.

The ministry has also embarked on training Village Health Teams (VHTs) about depression including identification, referral and follow up after discharge from a health facility.

"We also provide first line treatment medicines for depression at all levels of care and this medicine is very efficacious. General and Regional Hospitals provide more highly skilled professional treatment and other psychosocial interventions," Moriku says.

Although studies have indicated the effectiveness of treatment for depression, the majority of the people in need of treatment do not receive it due to lack of information about the illness. 

Other barriers to care include lack of skilled providers, inadequate resources, and social stigma associated with depression.

What is depression?

According to the Ministry of Health, depression is a common mental disorder that presents with persistent low mood (sadness) or loss of interest in pleasurable activities. The mood disturbance is commonly associated with unexplained sadness for at least two weeks, lack of sleep or disturbed sleep, loss of interest in social contact and what one previously used to enjoy, poor concentration, feelings of worthlessness, failure, self-blame and low self-esteem. At the extreme, recurrent thoughts about death and acts of self-harm or suicide are common.

Causes

According to WHO, depression results from a complex interaction of social, psychological and biological factors. People who have gone through adverse life events (unemployment, bereavement, psychological trauma) are more likely to develop depression. Depression can, in turn, lead to more stress and dysfunction and worsen the affected person's life situation and depression it.

It can be caused by continuing difficulties, long-term unemployment, living in an abusive or uncaring relationship, long-term isolation or loneliness and prolonged work stress, among others.

How to avoid depression

Effective community approaches to prevent depression include school-based programmes to enhance a pattern of positive thinking in children and adolescents. Interventions for parents of children with behavioural problems may reduce parental depressive symptoms and improve outcomes for their children. Exercise programmes for the elderly can also be effective in depression prevention.

Moreover, depression often comes with symptoms-(inability to set aside a worry and restlessness unwanted thoughts, excessive worry, fear, feeling of impending doom, insomnia). These problems can become chronic or recurrent and lead to substantial impairments in an individual's ability to take care of his or her everyday responsibilities. 

Depression is a disorder that can be reliably diagnosed and treated in primary care. Depression in adolescents constitutes a global public health concern. However, data on its prevalence and associated factors are limited in low income countries like Uganda.

 

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