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Conceptualization of depression amongst older adults in rural Tanzania: a qualitative study

  • Kate Howorth (a1), Stella-Maria Paddick (a2), Jane Rogathi (a3), Richard Walker (a1) (a2), William Gray (a1), Lloyd L. Oates (a1), Damas Andrea (a4), Ssenku Safic (a5), Sarah Urasa (a6), Irene Haule (a7) and Catherine Dotchin (a1) (a2)...

Abstract

Background:

Depression in older people is likely to become a growing global health problem with aging populations. Significant cultural variation exists in beliefs about depression (terminology, symptomatology, and treatments) but data from sub-Saharan Africa are minimal. Low-resource interventions for depression have been effective in low-income settings but cannot be utilized without accurate diagnosis. This study aimed to achieve a shared understanding of depression in Tanzania in older people.

Methods:

Using a qualitative design, focus groups were conducted with participants aged 60 and over. Participants from rural villages of Kilimanjaro, Tanzania, were selected via randomized sampling using census data. Topic guides were developed including locally developed case vignettes. Transcripts were translated into English from Swahili and thematic analysis conducted.

Findings:

Ten focus groups were held with 81 participants. Three main themes were developed: a) conceptualization of depression by older people and differentiation from other related conditions (“too many thoughts,” cognitive symptoms, affective and biological symptoms, wish to die, somatic symptoms, and its difference to other concepts); b) the causes of depression (inability to work, loss of physical strength and independence, lack of resources, family difficulties, chronic disease); c) management of depression (love and comfort, advice, spiritual support, providing help, medical help).

Conclusions:

This research expands our understanding of how depression presents in older Tanzanians and provides information about lay beliefs regarding causes and management options. This may allow development of culturally specific screening tools for depression that, in turn, increase diagnosis rates, support accurate diagnosis, improve service use, and reduce stigma.

Copyright

Corresponding author

Correspondence should be addressed to: Kate Howorth, Education Centre, North Tyneside General Hospital, Rake Lane, North Shields, NE29 8NH, UK. Phone: 0344 811 8111; Fax: +44191 293 4149. Email: katehoworth@hotmail.co.uk

References

Hide All
Alexopoulos, G. S. (2005). Depression in the elderly. Lancet, 365, 19611970. doi: 10.1016/S0140-6736(05)66665-2.
Baiyewu, O., et al. (2007). Prevalence estimates of depression in elderly community-dwelling African Americans in Indianapolis and Yoruba in Ibadan, Nigeria. International Psychogeriatrics, 19, 679689. doi: 10.1017/S1041610207005480.
Beck, A. T. and Haigh, E. A. P. (2014). Advances in cognitive theory and therapy: the generic cognitive model. Annual Review of Clinical Psychology, 10, 124. doi: 10.1146/annurev-clinpsy-032813-153734.
Braun, V. and Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77101. doi: 10.1191/1478088706qp063oa.
Dening, T. and Thomas, A. (2013). Oxford Textbook of Old Age Psychiatry. 2nd ed. Oxford: Oxford University Press.
Ferrari, A. J., et al. (2013). Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS Medicine, 10, e1001547. doi: 10.1371/journal.pmed.1001547.
Fiske, A., Wetherell, J. L. and Gatz, M. (2009). Depression in older adults. Annual Review of Clinical Psychology, 5, 363389. doi: 10.1146/annurev.clinpsy.032408.153621.
Gallo, J. J., Cooper-Patrick, L. and Lesikar, S. (1998). Depressive symptoms of whites and African Americans aged 60 years and older. The Journals of Gerontology: Series B, Psychological Sciences and Social Sciences, 53, P277P286. doi: 10.1093/geronb/53B.5.P277.
Gureje, O., Kola, L. and Afolabi, E. (2007). Epidemiology of major depressive disorder in elderly Nigerians in the Ibadan Study of ageing: a community-based survey. Lancet, 370, 957964. doi: 10.1016/S0140-6736(07)61446-9.
Gureje, O., Oladeji, B. and Abiona, T. (2011). Incidence and risk factors for late-life depression in the Ibadan Study of ageing. Psychological Medicine, 41, 18971906. doi: 10.1017/S0033291710002643.
Gureje, O., Uwakwe, R., Oladeji, B., Makanjuola, V. O. and Esan, O. (2010). Depression in adult Nigerians: results from the Nigerian Survey of Mental Health and Well-being. Journal of Affective Disorders, 120, 158164. doi: 10.1016/j.jad.2009.04.030.
Hindley, G., et al. (2016). The role of traditional and faith healers in the treatment of dementia in Tanzania and the potential for collaboration with allopathic healthcare services. Age and Ageing, 46, 130137. doi: 10.1093/ageing/afw167.
Hunter, E., et al. (2012). Prevalence of active epilepsy in rural Tanzania: a large community-based survey in an adult population. Seizure, 21, 691698. doi: 10.1016/j.seizure.2012.07.009.
Jorm, A. F., Korten, A. E., Jacomb, P. A., Christensen, H., Rodgers, B. and Pollitt, P. (1997). “Mental health literacy”: a survey of the public’s ability to recognise mental disorders and their beliefs about the effectiveness of treatment. The Medical Journal of Australia, 166, 182186.
Kaiser, B. N., Haroz, E. E., Kohrt, B. A., Bolton, P. A., Bass, J. K. and Hinton, D. E. (2015). “Thinking too much”: a systematic review of a common idiom of distress. Social Science & Medicine, 147, 170183. doi: 10.1016/j.socscimed.2015.10.044.
Kirmayer, L. J., Gomez-Carrillo, A. and Veissière, S. (2017). Culture and depression in global mental health: an ecosocial approach to the phenomenology of psychiatric disorders. Social Science & Medicine, 183, 163168. doi: 10.1016/j.socscimed.2017.04.034.
Lawrence, V., Banerjee, S., Bhugra, D., Sangha, K., Turner, S. and Murray, J. (2006). Coping with depression in later life: a qualitative study of help-seeking in three ethnic groups. Psychological Medicine, 36, 13751383. doi: 10.1017/S0033291706008117.
Lyubomirsky, S., Layous, K., Chancellor, J. and Nelson, S. K. (2015). Thinking about rumination: the scholarly contributions and intellectual legacy of Susan Nolen-Hoeksema. Annual Review of Clinical Psychology, 11, 122. doi: 10.1146/annurev-clinpsy-032814-112733.
Ministry of Health, Tanzania (2004). Policy implications of adult morbidity and mortality: final report. Available at https://research.ncl.ac.uk/ammp/finrep/executive_summary/normal/executive%20summary.pdf (Accessed 11 April 2018).
Paddick, S.-M., Longdon, A., Gray, W. K., Dotchin, C., Kisoli, A., Chaote, P. and Walker, R. (2014). The association between education level and dementia in rural Tanzania. Dementia & Neuropsychologia, 8, 117125. doi: 10.1590/S1980-57642014DN82000006.
Patel, V., Gwanzura, F., Simunyu, E., Lloyd, K. and Mann, A. (1995). The phenomenology and explanatory models of common mental disorder: a study in primary care in Harare, Zimbabwe. Psychological Medicine, 25, 11911199. doi: 10.1017/S003329170003316X.
Patel, V., Simon, G., Chowdhary, N., Kaaya, S. and Araya, R. (2009). Packages of care for depression in low- and middle-income countries. PLoS Medicine, 6, e1000159. doi: 10.1371/journal.pmed.1000159.
Soonthornchaiya, R. and Dancy, B. L. (2006). Perceptions of depression among elderly Thai immigrants. Issues in Mental Health Nursing, 27, 681698. doi: 10.1080/01612840600643040.
Tanzanian National Bureau of Statistics (2012). Tanzanian national census. Available at http://www.nbs.go.tz/sensa/ (Accessed 14 August 2013).
The United Nations (2013). The United Nations 2012 population projections. Population and Development Review, 39, 551555. doi: 10.1111/j.1728-4457.2013.00625.x.
Tomlinson, M., Swartz, L., Kruger, L.-M. and Gureje, O. (2007). Manifestations of affective disturbance in sub-Saharan Africa: key themes. Journal of Affective Disorders, 102, 191198. doi: 10.1016/j.jad.2006.09.029.
Ugarriza, D. N. (2002). Elderly women’s explanation of depression. Journal of Gerontological Nursing, 28, 2229. doi: 10.3928/0098-9134-20020501-07.
United Nations (1981). Tanzania penal code: Chapter 16 of the laws (revised); section 217. Available at http://www.un.org/Depts/los/LEGISLATIONANDTREATIES/PDFFILES/TZA_penal_code.pdf (Accessed 9 April 2018).
van Ginneken, N., et al. (2013). Non-specialist health worker interventions for the care of mental, neurological and substance-abuse disorders in low- and middle-income countries. Cochrane Database of Systematic Reviews, 11, 1377. doi: 10.1002/14651858.CD009149.pub2.
World Bank Group (2017). Tanzania economic update, April 2017: money within reach– extending financial inclusion in Tanzania. Available at https://openknowledge.worldbank.org/handle/10986/26393 (Accessed 26 March 2018).
World Health Organization (2017). WHO Model List of Essential Medicines. Geneva: WHO.

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