Mental health and urban living in sub-Saharan Africa: major depressive episodes among the urban poor in Ouagadougou, Burkina Faso

Abstract

BackgroundIn 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.MethodsThe 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.ResultsMajor 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.ConclusionsMajor 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.

An exploratory study assessing psychological distress of indigents in Burkina Faso: a step forward in understanding mental health needs in West Africa

“…Similarly, lack of income and experiencing difficulty accessing food has been reported by Duthé and colleagues [ 35 ] as significantly associated with depressive symptoms in Ouagadougou. Nanama and Frongillo [ 34 ] found, in a rural setting in Burkina Faso, that food insecurity was an important vulnerability factor associated with anxious, depressive, and somatic symptoms.…”

“…Our results yielded higher proportions than did previous studies conducted in Burkina Faso. For instance, in their recent study on the prevalence of major depressive episodes in populations living in poor neighbourhoods nearby Ouagadougou, Duthé and colleagues [ 35 ] found that 9.0% of their sample ( n = 2187) reported feeling depressed, sad, or empty, and 7.2% reported having lost interest or pleasure in doing things they usually enjoyed during the past two weeks. While it may not be surprising that people living in extreme poverty conditions in rural settings would report more symptoms than the general population, our results are still alarmingly high.…”

“…Nanama and Frongillo [ 34 ] found, in a rural setting in Burkina Faso, that food insecurity was an important vulnerability factor associated with anxious, depressive, and somatic symptoms. Duthé and colleagues also found that poor health status predicted the risk of developing depressive symptoms [ 35 ], and a qualitative study conducted with indigents and their relatives showed that poor health status was an indicator of extreme vulnerability, even among the least poor households identified as worst-off in rural settings [ 22 ].…”

“…The qualitative study by Nanama and Frongillo [ 34 ] conducted in a rural area in the north of the country showed how food insecurity could be related to a high level of psychological distress and to certain anxious, depressive, and somatic symptoms. The study by Duthé and colleagues [ 35 ], conducted in the peripheral neighbourhoods of Ouagadougou, found that chronic illnesses or handicaps, extreme poverty, and food insecurity predicted the risk of developing a depressive disorder among their participants.…”

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“…Additionally, while urban life offers many benefits, some argue that urban spaces may create negative psychosocial factors due to experiences of social fragmentation, overcrowding, and crime prevalent in some cities [ 7 ]. A study in Burkina Faso found high rates of major depressive episodes among the urban poor due to chronic health problems and poor standard of living [ 8 ].…”