by Moses K. Nyongesa, MSc Global Mental Health candidate
Globally, depression is one of the leading cause of disability and is also a major contributor to the global burden of disease. Recent estimates from the WHO show that over 300 million people around the world are depressed[1]. Kenya, not an exception of this global picture, has about 1.9 million depression cases. It has been ranked fifth among African countries with the highest number of depression cases after South Africa (2.4 million cases), Democratic Republic of Congo (2.9 million cases), Ethiopia (4.5 million cases) and Nigeria (7.1 million cases)35.
A large proportion of depression cases in Kenya may still be under-detected and therefore undertreated. The 1.9 million figure above may only be reflective of the diagnosed hospital cases. On the other hand, what might be missing and therefore underreported is the proportion of individuals in the community who are depressed but not seeking any form of help because of various reasons. On top of the list is stigma. Stigmatization of mental illness in Kenya is a common problem, so much that the original name of a tertiary mental health hospital in the country – Mathari Mental Hospital – had to be changed to drop the word ‘mental’ because many people were shunning it[2]. The move has not greatly changed the attitude of Kenyans against mental illness nevertheless. Many still shy off from seeking help because of the fear of being branded ‘mentally ill’ by the community. On the other hand, it is also true that majority of Kenyans may not be aware that they are depressed. It is quite common to hear people talk of being ‘stressed’ or ‘thinking too much’ but since this is regarded as normal day-to-day experiences, rather than a mental health concern warranting attention like, say, malaria or any other form of physical illness would, help seeking behaviour is generally poor. The shortage of mental health experts to effectively diagnose and treat depression in Kenya may also be another reason. It was estimated that about 30% of people seeking outpatient services in local health facilities had a treatable mental illness but most end up being misdiagnosed[3]. As of 2010, Kenya had only 70 psychiatrists (24 in private practice) and 250 practicing psychiatric nurses for a population well above 38 million people[4].
In Kenya, just like most resource-poor settings, poverty and unemployment are among the leading causes of depression for the population. A diagnosis of HIV is also an added stressor. A recent study has estimated a prevalence of 28% for comorbid HIV infection and depression[5]. There is also an emerging trend of depression among the youth, especially those within the education system. A study looking at depression among university students in Kenya reported that out of the 923-student sample, 35.7% and 5.6% had moderate depressive symptoms and severe depression respectively and this was significantly associated with year of study, economic deprivation, and academic performance among others[6]. In terms of coping strategies to persistent depression, drug or substance abuse, especially alcohol (more so among men) is common in the Kenyan context. There are also suicide cases due to depression, but since suicide is a crime in the country, it is often concealed[7], another reason why we might be getting the statistics wrong.
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References
[1] WHO. (2017). Depression and other common mental disorders: global health estimates. Retrieved from http://apps.who.int/iris/bitstream/10665/254610/1/WHO-MSD-MER-2017.2-eng.pdf?ua=1&ua=1
[2] Karanja J. (2011). Why Kenyans would rather take the mentally ill to a faith healer. Daily Nation. Retrieved from http://www.nation.co.ke/news/Kenyans-would-rather-take-the-mentally-ill-to-a-faith-healer-/1056-1122722-om6yin/index.html
[3] Siringi, S. (2001). Doctors in Kenya call for fair mental health policy. The Lancet, 357(9264), 1273.
[4] Kiima, D., & Jenkins, R. (2010). Mental health policy in Kenya-an integrated approach to scaling up equitable care for poor populations. International Journal of Mental Health Systems, 4(1), 19.
[5] Seth, P., Kidder, D., Pals, S., Parent, J., Mbatia, R., Chesang, K., . . . Katuta, F. (2014). Psychosocial functioning and depressive symptoms among HIV-positive persons receiving care and treatment in Kenya, Namibia, and Tanzania. Prevention Science, 15(3), 318-328.
[6] Othieno, C. J., Okoth, R. O., Peltzer, K., Pengpid, S., & Malla, L. O. (2014). Depression among university students in Kenya: prevalence and sociodemographic correlates. Journal of affective disorders, 165, 120-125.
[7] Nyaboga Kiage, & Angela Oketch. (2017). WHO report reveals 2m Kenyans are depressed. Daily Nation. Retrieved from http://www.nation.co.ke/news/report-reveals-2m-Kenyans-depressed/1056-3828982-134wls7/