Measuring and Understanding Depression in Women in Kisoro, Uganda

Abstract

Depression is highly prevalent and the cause of considerable suffering for peoples across the globe. Case finding for depression is challenging because individuals often do not recognize the symptoms in themselves or may resist the diagnosis as a result of cultural stigma. Screening instruments, to be accurate, must be valid in the particular setting in which they are being applied, and diagnosis in primary care settings, is further made challenging because patients often present with a wide variety of somatic symptoms that could be medical. 115 women were screened for depression in this study in one community in Uganda, and 87 were found to be depressed using the SRQ-20. The cognitive impairment and decreased energy sub-scales of the SRQ-20 seemed to best differentiate for depression. We then interviewed the 87 women and found that, overwhelmingly, their complaints were somatic, and that their expectation for treatment was to receive medical tests and medications. Caregivers in primary care clinics in Uganda should know that in the reporting of their somatic symptoms patients may be trying to communicate more about themselves than just the state of their physical health; and that feelings of uselessness or of hopelessness when expressed by a patient should lead them to suspect severe mental illness since these symptoms were not found to be characteristic of the milder depression that is highly prevalent in Ugandan women.

Intimate partner violence, spouse extramarital affairs, and depression among women in rural Uganda

“…The study in Kisoro involved women recruited from a hospital setting who had presented for care with various medical conditions and somatic symptoms. As documented in previous research individuals with somatic symptoms may have ongoing depression, and this may explain the high prevalence of depression in the Kisoro study compared to the current study where women were recruited from the community [11,36]. On the other hand, the prevalence of depression found in our study was much higher than that found in another study (38%) conducted in urban setting (Mbarara) using the Hopkins Symptom Checklist-Depression Subscale [37].…”

“…Our study ndings show a high prevalence of depression among the study participants and a statistically signi cant association between depression and spouse extra marital affairs. The prevalence of 65% was slightly lower than that documented in a study in Kisoro (75%) another rural district in southwestern Uganda among women aged 18 to 35 years based on the Self-Reporting Questionnaire (SRQ-20) [11]. The difference may be due to the study population recruited in the two studies.…”

“…Depression, IPV, and substance use among married men, and extramarital relationships be creating an end loop cycle of traumatizing events to women and hence the high risk of depression. Unfortunately, depression in such communities goes undetected, and individuals may resist seeking mental health care due to cultural stigma for mental illness [11]. Coupled with reduced care from their spouse due to extramarital affairs, the symptoms are seen as a sign of attention-seeking and hence ignored by the spouse and hence many of the affected women don't seek care.…”

“…In addition women in rural areas experience higher rates of depression and its complications such as suicide, compared to women in the urban areas [5][6][7][8][9][10]. The high prevalence of depression among women in rural settings has been attributed to early marriages/reproductive age, low self-esteem, intimate spouse violence (IPV), gender-based discrimination, and low social-economic status [4,10,11]. With substandard mental health services and limited expertise among the available health workers in most rural settings; mental health problems including depression remain highly prevalent yet untreated, thus contributing to the functional decline of women in these settings [12].…”

“…Various factors have been associated with depression among married women including personal and spouse related factors. Personal factors include: the number of children (four or more), low levels of education, increasing number of years in marriage, use of substances of addiction, and mental illness history especially depression [4,11,13]. Spouse related factors include lack of support from spouses or in-laws, misuse of substances of addiction by the partner, mental illness, low level of education, and extramarital relationships [3,4,13].…”