The interface between family structure, life events and major depression in Uganda
Author: Muhwezi, Wilson Winstons
Date: 2007-11-28
Location: Föreläsningssal R64, Karolinska Universitetssjukhuset, Huddinge
Time: 10.00
Department: Institutionen för klinisk neurovetenskap / Department of Clinical Neuroscience
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Abstract
Background: Poor detection of depression in primary health care is
universal but worse in resource-constrained societies, yet the illness
must be recognized first if it is to be appropriately managed. While
current debates about life events in Western societies is on their role
in the gene-environment interaction to cause depression, research on the
interface between life events, family structure and major depression in
many developing countries is still rare. Prevention of depression by
preventing life events may not be feasible but knowing depressogenic life
events is a cue for rapid intervention.
Aim: To describe the feasibility of detecting current major depressive episodes (MDEs) in physically ill patients, identify life events associated with the MDEs, describe the interaction between life events, family structure and MDEs, and to explore how patients caregivers perceive such depression.
Methods: Consecutive outpatients at three PHC centres were interviewed in each of the first three studies. A cross-section of 199 physically ill patients (74 with DSM-diagnosis of major depression and 125 without) were the respondents in the study for Paper I. A case control research design was used for Paper II to compare life event experiences of the 74 physically ill and depressed patients with 64 general population controls and for Paper III in which comparison was between 85 depressed and 170 non-depressed physically ill patients. The study for Paper IV used a qualitative approach to interview 29 adult caregivers of physically ill patients that were depressed.
Main findings: In Paper I, it is demonstrated that four simple subjective well-being questions could predict successfully the presence of a current major depressive episode. Paper II shows that losses related to interpersonal relationships and work as well as health and bereavement-related life events were predominant among patients with major depressive episodes. In spite of the buffer provided by the family, life events related to work, education, health and courtship/cohabitation significantly had more negative impact ratings among the depressed. Independent life events clustered around work, health, bereavement and marriage were associated with an increased risk of major depressive episodes in patients compared to controls. Similarly, findings in Paper III show that depressed patients from extended families experienced significantly more negative life events related to loss and bereavement. Distressing and bereavement-related life events were predictors of depression among patients from extended families. Given the concealment of depression in physical illness, caregivers could not identify the depressive episodes thereby undermining appropriate care-giving (Paper IV). However, they identified and associated a number of life experiences to what they referred to as thinking a lot . Care-giving was found to be challenging.
Conclusions: Four simple questions reflecting subjective well-being appear to have the potential to detect diagnosable patients likely to have a current major depressive episode. While the extended family is often assumed to cushion members from shocks of stressful life events, it appears to be weakening and unable to protect at risk individuals from developing depression. Psychosocial interventions as well as training and deployment of mental health workers in communities to promote coping are needed. Caregivers deserve support since their physical, psychological, economic and social resources are necessary in management of depression yet, such resources are being drained.
Aim: To describe the feasibility of detecting current major depressive episodes (MDEs) in physically ill patients, identify life events associated with the MDEs, describe the interaction between life events, family structure and MDEs, and to explore how patients caregivers perceive such depression.
Methods: Consecutive outpatients at three PHC centres were interviewed in each of the first three studies. A cross-section of 199 physically ill patients (74 with DSM-diagnosis of major depression and 125 without) were the respondents in the study for Paper I. A case control research design was used for Paper II to compare life event experiences of the 74 physically ill and depressed patients with 64 general population controls and for Paper III in which comparison was between 85 depressed and 170 non-depressed physically ill patients. The study for Paper IV used a qualitative approach to interview 29 adult caregivers of physically ill patients that were depressed.
Main findings: In Paper I, it is demonstrated that four simple subjective well-being questions could predict successfully the presence of a current major depressive episode. Paper II shows that losses related to interpersonal relationships and work as well as health and bereavement-related life events were predominant among patients with major depressive episodes. In spite of the buffer provided by the family, life events related to work, education, health and courtship/cohabitation significantly had more negative impact ratings among the depressed. Independent life events clustered around work, health, bereavement and marriage were associated with an increased risk of major depressive episodes in patients compared to controls. Similarly, findings in Paper III show that depressed patients from extended families experienced significantly more negative life events related to loss and bereavement. Distressing and bereavement-related life events were predictors of depression among patients from extended families. Given the concealment of depression in physical illness, caregivers could not identify the depressive episodes thereby undermining appropriate care-giving (Paper IV). However, they identified and associated a number of life experiences to what they referred to as thinking a lot . Care-giving was found to be challenging.
Conclusions: Four simple questions reflecting subjective well-being appear to have the potential to detect diagnosable patients likely to have a current major depressive episode. While the extended family is often assumed to cushion members from shocks of stressful life events, it appears to be weakening and unable to protect at risk individuals from developing depression. Psychosocial interventions as well as training and deployment of mental health workers in communities to promote coping are needed. Caregivers deserve support since their physical, psychological, economic and social resources are necessary in management of depression yet, such resources are being drained.
List of papers:
I. Muhwezi WW, Agren H, Musisi S (2007). "Detection of major depression in Ugandan primary health care settings using simple questions from a subjective well-being (SWB) subscale." Soc Psychiatry Psychiatr Epidemiol 42(1): 61-9.
Fulltext (DOI)
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II. Muhwezi WW, Ågren H, Neema S, Maganda AK, Musisi S (2007). "Life events associated with major depression in Ugandan Primary Health Care (PHC) Patients: Issues of cultural specificity." International Journal of Social Psychiatry. [Accepted]
III. Muhwezi WW, Ågren H, Neema S, Musisi S, Maganda AK (2007). "Life events and depression in the context of the changing African family: The case of Uganda." World Cultural Psychiatry Research Review Jan: 10-26.
IV. Muhwezi WW, Okello ES, Neema S, Musisi S (2007). "Caregivers perceptions concerning the interface between life events and major depressive illness as seen among patients at Primary Health Care Centers in Central Uganda." Qualitative Health Research. [Submitted]
I. Muhwezi WW, Agren H, Musisi S (2007). "Detection of major depression in Ugandan primary health care settings using simple questions from a subjective well-being (SWB) subscale." Soc Psychiatry Psychiatr Epidemiol 42(1): 61-9.
Fulltext (DOI)
Pubmed
View record in Web of Science®
II. Muhwezi WW, Ågren H, Neema S, Maganda AK, Musisi S (2007). "Life events associated with major depression in Ugandan Primary Health Care (PHC) Patients: Issues of cultural specificity." International Journal of Social Psychiatry. [Accepted]
III. Muhwezi WW, Ågren H, Neema S, Musisi S, Maganda AK (2007). "Life events and depression in the context of the changing African family: The case of Uganda." World Cultural Psychiatry Research Review Jan: 10-26.
IV. Muhwezi WW, Okello ES, Neema S, Musisi S (2007). "Caregivers perceptions concerning the interface between life events and major depressive illness as seen among patients at Primary Health Care Centers in Central Uganda." Qualitative Health Research. [Submitted]
Issue date: 2007-11-07
Rights:
Publication year: 2007
ISBN: 978-91-7357-393-1
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