Abstract
BackgroundThe problem of severe mental distress (SMD) in sub-Saharan Africa is difficult to investigate given that a substantial proportion of patients with SMD never access formal health care.This study set out to investigate SMD and it's associated factors in a rural population-based cohort in south-west Uganda.Methods6,663 respondents aged 13 years and above in a general population cohort in southwestern Uganda were screened for probable SMD and possible associated factors.Results0.9% screened positive for probable SMD. The factors significantly associated with SMD included older age, male sex, low socio-economic status, being a current smoker, having multiple or no sexual partners in the past year, reported epilepsy and consulting a traditional healer.ConclusionSMD in this study was associated with both socio-demographic and behavioural factors. The association between SMD and high risk sexual behaviour calls for the integration of HIV prevention in mental health care programmes in high HIV prevalence settings.
Highlights
The problem of severe mental distress (SMD) in sub-Saharan Africa is difficult to investigate given that a substantial proportion of patients with SMD never access formal health care
Governments in sub-Saharan Africa including those in Uganda, Liberia and Southern Sudan are slowly realizing that mental illness makes a significant contribution to the overall health burden which is projected to rise
SMD as conceived in this study and in this socio-cultural setting may be due to the following causes: i) severe mental illnesses- schizophrenia, paranoid psychoses and manic-depressive disorder; ii) acute transient psychoses secondary to socio-cultural stress such as the ‘brain fag syndrome’; iii) psychoses resulting from cerebral involvement in infectious diseases such as malaria, typhoid fever, and HIV infection; iv) epilepsy largely due to inadequate care at child birth, malnutrition, malaria, parasitic diseases and head trauma; v) post-traumatic stress disorders secondary to conflict and civil strife, which is endemic on the continent; vi) conversion-dissociative states including mass hysteria; and vii) alcohol and marijuana use and other drug-related problems [4,5,6,7,8,9]
Summary
The problem of severe mental distress (SMD) in sub-Saharan Africa is difficult to investigate given that a substantial proportion of patients with SMD never access formal health care. The underlying philosophy behind the use of this term was the need to capture all forms of severe psychological disturbances as seen at community level in an sub-Saharan African setting, where in SMD as conceived in this study and in this socio-cultural setting may be due to the following causes: i) severe mental illnesses- schizophrenia, paranoid psychoses and manic-depressive disorder; ii) acute transient psychoses secondary to socio-cultural stress such as the ‘brain fag syndrome’; iii) psychoses resulting from cerebral involvement in infectious diseases such as malaria, typhoid fever, and HIV infection; iv) epilepsy largely due to inadequate care at child birth, malnutrition, malaria, parasitic diseases and head trauma; v) post-traumatic stress disorders secondary to conflict and civil strife, which is endemic on the continent; vi) conversion-dissociative states including mass hysteria; and vii) alcohol and marijuana use and other drug-related problems [4,5,6,7,8,9]. In a study in urban Ethiopia having at least two of the four WHO Self Report Questionnaire25 [10] items was taken as indicative of ‘probable psychosis’ (for purposes of this study taken to be equivalent to SMD) where a prevalence of 5% SMD was obtained [11]
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