Contrasting concepts of depression in Uganda: Implications for service delivery in a multicultural context.

Abstract

Depression is a rising public health concern worldwide. Understanding how people conceptualize depression within and across cultures is crucial to effective treatment in a global environment. In this article, we highlight the importance of considering both lay and professional perspectives when developing a culturally competent and contextually relevant model for service delivery. We conducted interviews with 246 Ugandan adults to elicit their explanatory belief models (EMs) about the nature of depression, its causes, social meanings, effects, help seeking, and treatment. Interviews were transcribed, content analyzed, and coded. We compared EMs of community members (n = 135) to those of professional practitioners (n = 111), whom we further categorized into traditional healers, primary care providers, and mental health professionals. We found significant differences between lay and professional EMs and between 3 types of professionals. Contrary to our expectations, lay concepts did not overlap more with traditional healers than with other professional EMs. We discuss the diverse concepts of depression in Uganda, the nature of group differences, and implications for service delivery and treatment.

Becoming and Coming Undone on the Streets of Dar es Salaam

“…The others interpreted his erratic behavior as a sign that he, like others before him, had "gone crazy from confusion" about the problems of life. According to the men who were the focus of our research, a person 11 experiencing this kind of psychic crisis is plagued by persistent and overwhelming bad thoughts and anxieties, echoing previous work demonstrating that thinking too much and having too many thoughts are common idioms for mental distress in several African contexts (Johnson et al 2009;Mains 2012;Okello and Ekblad 2006;Patel et al 1995).…”

Lost in Translation: Staff and Interpreters’ Experiences of the Edinburgh Postnatal Depression Scale with Women from Refugee Backgrounds

“…Without tight boundaries, and a firm grasp of the principles of ethical behaviour, leakage of sensitive information could seriously threaten individual and group stability. Traditional beliefs linking mental illness to sorcery, unavenged spirits, or curses, typically heighten women's fears about being labelled as "unclean" and perceived as a danger to themselves and others in close proximity (Hanlon, Whitley, Wondimagegn, Alem, & Prince, 2009;Johnson, Mayanja, Bangirana, & Kizito, 2009). These negative attributions, indicators of a stigmatised identity (Goffman, 1986), effectively deter women from disclosing pertinent information or seeking help.…”

Spiritual Explanatory Models of Mental Illness in West Nile, Uganda

“…Research conducted in Uganda shows that mental illnesses with psychotic features, such as psychotic depression, bipolar disorder, and schizophrenia (Abbo, 2011; Okello & Ekblad, 2006; Okello & Musisi, 2006), and dissociative disorders, such as dissociative identity disorder and dissociative trance (van Duijl, Cardena, & de Jong, 2005; van Duijl, Kleijn, & de Jong, 2014; van Duijl, Nijenhuis, Komproe, Gernaat, & de Jong, 2010), are mostly attributed to witchcraft and a bad relationship with the ancestors. Nonpsychotic depression, on the other hand, is considered to be caused by psychosocial, financial, and biomedical problems, but not by supernatural forces (Johnson, Kajumba, Bangirana, & Kizito, 2009; Okello & Ekblad, 2006). Some authors specify what motivates the ancestral spirits to send mental illness (Okello & Musisi, 2006; van Duijl et al, 2014), but in most studies, the distinction between supernatural causes is just made at the level of witchcraft and clan issues (Abbo, 2011; Johnson et al, 2009; Okello & Ekblad, 2006).…”