Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-27T13:47:01.718Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  03 January 2019

Kate Howorth ,
Stella-Maria Paddick ,
Jane Rogathi ,
Richard Walker ,
William Gray ,
Lloyd L. Oates ,
Damas Andrea ,
Ssenku Safic ,
Sarah Urasa  and
Irene Haule
...Show all authors
Kate Howorth*
Affiliation:
Department of Medicine, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
Stella-Maria Paddick
Affiliation:
Newcastle University, Newcastle Upon Tyne, UK
Jane Rogathi
Affiliation:
Community Health Department, Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
Richard Walker
Affiliation:
Department of Medicine, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK Newcastle University, Newcastle Upon Tyne, UK
William Gray
Affiliation:
Department of Medicine, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
Lloyd L. Oates
Affiliation:
Department of Medicine, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
Damas Andrea
Affiliation:
Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
Ssenku Safic
Affiliation:
Department of Mental Health, Mount Meru Regional Hospital, Arusha, Tanzania
Sarah Urasa
Affiliation:
Department of Medicine, Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania
Irene Haule
Affiliation:
District Medical Office, Hai District Hospital, Bomangombe, Hai, Tanzania
Catherine Dotchin
Affiliation:
Department of Medicine, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK Newcastle University, Newcastle Upon Tyne, UK
*
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
Get access

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.

Keywords

depressionqualitative researchdeveloping countrypsychogeriatrics
Type
Original Research Article
Information
International Psychogeriatrics , Volume 31 , Issue 10: Issue Theme: Dementia and the Society , October 2019 , pp. 1473 - 1481
Copyright
© International Psychogeriatric Association 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alexopoulos, G. S. (2005). Depression in the elderly. Lancet, 365, 1961–1970. doi: 10.1016/S0140-6736(05)66665-2.CrossRefGoogle ScholarPubMed
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, 679–689. doi: 10.1017/S1041610207005480.CrossRefGoogle ScholarPubMed
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, 1–24. doi: 10.1146/annurev-clinpsy-032813-153734.CrossRefGoogle ScholarPubMed
Braun, V. and Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101. doi: 10.1191/1478088706qp063oa.CrossRefGoogle Scholar
Dening, T. and Thomas, A. (2013). Oxford Textbook of Old Age Psychiatry. 2nd ed. Oxford: Oxford University Press.CrossRefGoogle Scholar
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.CrossRefGoogle ScholarPubMed
Fiske, A., Wetherell, J. L. and Gatz, M. (2009). Depression in older adults. Annual Review of Clinical Psychology, 5, 363–389. doi: 10.1146/annurev.clinpsy.032408.153621.CrossRefGoogle ScholarPubMed
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, P277–P286. doi: 10.1093/geronb/53B.5.P277.CrossRefGoogle ScholarPubMed
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, 957–964. doi: 10.1016/S0140-6736(07)61446-9.CrossRefGoogle ScholarPubMed
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, 1897–1906. doi: 10.1017/S0033291710002643.CrossRefGoogle ScholarPubMed
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, 158–164. doi: 10.1016/j.jad.2009.04.030.CrossRefGoogle ScholarPubMed
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, 130–137. doi: 10.1093/ageing/afw167.Google Scholar
Hunter, E., et al. (2012). Prevalence of active epilepsy in rural Tanzania: a large community-based survey in an adult population. Seizure, 21, 691–698. doi: 10.1016/j.seizure.2012.07.009.CrossRefGoogle Scholar
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, 182–186.CrossRefGoogle Scholar
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, 170–183. doi: 10.1016/j.socscimed.2015.10.044.CrossRefGoogle ScholarPubMed
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, 163–168. doi: 10.1016/j.socscimed.2017.04.034.CrossRefGoogle ScholarPubMed
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, 1375–1383. doi: 10.1017/S0033291706008117.CrossRefGoogle ScholarPubMed
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, 1–22. doi: 10.1146/annurev-clinpsy-032814-112733.CrossRefGoogle ScholarPubMed
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).Google Scholar
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, 117–125. doi: 10.1590/S1980-57642014DN82000006.CrossRefGoogle ScholarPubMed
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, 1191–1199. doi: 10.1017/S003329170003316X.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Soonthornchaiya, R. and Dancy, B. L. (2006). Perceptions of depression among elderly Thai immigrants. Issues in Mental Health Nursing, 27, 681–698. doi: 10.1080/01612840600643040.CrossRefGoogle ScholarPubMed
Tanzanian National Bureau of Statistics (2012). Tanzanian national census. Available at http://www.nbs.go.tz/sensa/ (Accessed 14 August 2013).Google Scholar
The United Nations (2013). The United Nations 2012 population projections. Population and Development Review, 39, 551–555. doi: 10.1111/j.1728-4457.2013.00625.x.CrossRefGoogle Scholar
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, 191–198. doi: 10.1016/j.jad.2006.09.029.CrossRefGoogle ScholarPubMed
Ugarriza, D. N. (2002). Elderly women’s explanation of depression. Journal of Gerontological Nursing, 28, 22–29. doi: 10.3928/0098-9134-20020501-07.CrossRefGoogle Scholar
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).Google Scholar
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, 1–377. doi: 10.1002/14651858.CD009149.pub2.Google Scholar
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).Google Scholar
World Health Organization (2017). WHO Model List of Essential Medicines. Geneva: WHO.Google Scholar
Supplementary material: File

Howorth et al. supplementary material

Howorth et al. supplementary material 1

Download Howorth et al. supplementary material(File)
File 15.6 KB
Supplementary material: File

Howorth et al. supplementary material

Howorth et al. supplementary material 2

Download Howorth et al. supplementary material(File)
File 20 KB