Explanatory models of depression in sub-Saharan Africa: Synthesis of qualitative evidence. (February 2020)

• Record Type: Journal Article
• Authors: Mayston, Rosie; Frissa, Souci; Tekola, Bethlehem; Hanlon, Charlotte; Prince, Martin; Fekadu, Abebaw
• Is Part Of: Social science & medicine. Volume 246(2020)
• Publication Date: 2020-02
• Subjects: Depression -- Explanatory models -- Qualitative synthesis -- Sub-Saharan Africa; Social medicine -- Periodicals; Medical anthropology -- Periodicals; Public health -- Periodicals; Psychology -- Periodicals; Medicine -- Periodicals; Medicine -- Periodicals; Médecine sociale -- Périodiques; Anthropologie médicale -- Périodiques; Santé publique -- Périodiques; Psychologie -- Périodiques; Médecine -- Périodiques; Electronic journals; 362.105
• DOI: 10.1016/j.socscimed.2019.112760
• Languages: English
• ISSNs: 0277-9536

Abstract

Abstract: Debate about the cross-cultural relevance of depression has been central to cross-cultural psychiatry and global mental health. Although there is now a wealth of evidence pertaining to symptoms across different cultural settings, the role of the health system in addressing these problems remains contentious. Depression is undetected among people attending health facilities. We carried out a thematic synthesis of qualitative evidence published in the scientific literature from sub-Saharan Africa to understand how depression is debated, deployed and described. No date limits were set for inclusion of articles. Our results included 23 studies carried out in communities, among people living with HIV, attendees of primary healthcare and with healthcare workers and traditional healers. Included studies were carried out between 1995 and 2018. In most cases, depression was differentiated from 'madness' and seen to have its roots in social adversity, predominantly economic and relationship problems, sometimes entangled with HIV. Participants described the alienation that resulted from depression and a range of self-help and community resources utilised to combat this isolation. Both spiritual and biomedical causes, and treatment, were considered when symptoms were very severe and/or other possibilities had been considered and discarded. Context shaped narratives: people already engaged with the health system for another illness such as HIV were more likely to describe their depression in biomedical terms. Resolution of depression focussed upon remaking the life world, bringing the individual back to familiar rhythms, whether this was through the mechanism of encouraging socialisation, prayer, spiritual healing or biomedical treatment. Our findings suggest that it is essential that practitioners and researchers are fluent in local conceptualisations and aware of local resources to address depression. Design of interventions offered within the health system that are attuned to this are likely to be welcomed as an option among other resources available to people living with depression. Highlights: Depression was perceived as problem with its roots in social adversity. Context matters-those engaged with the health system adopted biomedical models. Self-help and community resources were the first line in addressing depression. Traditional and biomedical medicine were used when symptoms were chronic or severe. Stepped care interventions should take into account local resources and models.