Abstract
Available evidence in Africa suggests that the prevalence of depression in primary care settings is high but it often goes unrecognized. In this study, we explored how depression is conceptualized and communicated among community members and primary care attendees diagnosed with depression in rural Ethiopia with the view to informing the development of interventions to improve detection. We conducted individual interviews with purposively selected primary care attendees with depression (n = 28; 16 females and 12 males) and focus group discussions (FGDs) with males, females, and priests (n = 21) selected based on their knowledge of their community. Data were analyzed using thematic analysis. None of the community members identified depression as a mental illness. They considered depressive symptoms presented in a vignette as part of a normal reaction to the stresses of life. They considered medical intervention only when the woman's condition in the vignette deteriorated and "affected her mind." In contrast, participants with depression talked about their condition as illness. Symptoms spontaneously reported by these participants only partially matched symptoms listed in the current diagnostic criteria for depressive disorders. In all participants' accounts, spiritual explanations and traditional healing were prominent. The severity of symptoms mediates the decision to seek medical help. Improved detection may require an understanding of local conceptualizations in order to negotiate an intervention that is acceptable to affected people.
Highlights
The World Health Organization estimates that depression affects more than 300 million people globally, which amounts to 4.4% of the world’s population (WHO, 2017)
In this study, building on this growing qualitative literature, we aimed to explore how depression is conceptualized and communicated among community members and primary care attendees diagnosed with depression in rural Ethiopia with the view to informing the development of interventions to improve detection
The district was selected for our study because it is the site of a global mental health initiative—the Programme for Improving Mental Health Care (PRIME) (Lund et al, 2012)—which gave us the opportunity to explore the experience of depression in the context of implementing a new mental health service in primary care
Summary
The World Health Organization estimates that depression affects more than 300 million people globally, which amounts to 4.4% of the world’s population (WHO, 2017). Depression is described as the second leading cause of years of life lived with disability (Vos et al, 2012) and a major contributor to disability-adjusted life years (DALYs) (Vos et al, 2017). Those who receive a diagnosis of depression have increased mortality risk by all causes and by suicide (Walker et al, 2015). This is found to be the case across both high- (Gilman et al, 2017) and lowincome countries (Fekadu et al, 2015). Treatment is often unavailable, especially in low- and middle-income countries (LMICs)
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