THE EPIDEMIC OF DEPRESSION AMONG YOUNG PEOPLE IN NIGERIA (LITERATURE REVIEW)
THE EPIDEMIC OF DEPRESSION
AMONG YOUNG PEOPLE IN NIGERIA (LITERATURE REVIEW)
Mugariri Synclair, Student
Medical Institute People’s Friendship University of Russia named after Patrice Lumumba
E-mail: mugaririsynclair@gmail.com
Okoli Ubamara Uchechukwu, Student
Medical Institute, People’s Friendship University of Russia named after Patrice Lumumba
E-mail: okoliubamara@gmail.com
D.A. Kaneva, PhD, Assistant Professor of the Department of Public Health, Healthcare and Hygiene
Medical Institute of Peoples' Friendship University of Russia after Patrice Lumumba
E-mail: kaneva-da@rudn.ru
T.Yu. Tararaeva, PhD, Assistant Professor of the Department of Public Health, Healthcare and Hygiene
Medical Institute of Peoples' Friendship University of Russia after Patrice Lumumba
E-mail: tararaeva-tyu@rudn.ru
Abstract. Depression-related suicide is the second leading cause of death among young adults in Nigeria. These depressive disorders have deep and diverse roots which include poverty, social media, government policies, ignorance and the inaccessibility of intervention services. Innovative and strategic methods are necessary to improve awareness identification, management and treatment of depressive disorders in the Nigerian population. The purpose of the study was to analyze the main causes of depression and measures to prevent it in young people from Nigeria. Materials and Methods. A systematic search from PubMed, PsycINFO, Science Direct, Web of Science, and Google Scholar databases was done for recently published and relevant articles from 2018-2024, 993 in number. The subject of the study: Nigerian youth in the age group 15-26 years with depressive disorders. Results. The underlying causative factors to depressive disorders include stigma and conventional attitudes informed by cultural and religious beliefs. Ignorance at the individual, communal and organizational level of the Nigerian society builds up a barrier against access to care for depressed patients. Government policies in Nigeria reflect institutional under prioritization to funding research and treatment efforts for mental health disorders. Poverty and depression have a bi-directional causative relationship. The indisputable impact of social media was also made clear since it promoted inflated expectations, cyberbullying, and social isolation – all of which were strongly associated with increased mental discomfort. This study emphasizes the urgent need for comprehensive interventions, including the integration of mental health into primary health care, creating mental health policies at governmental levels, creating consumer organizations for advocacy of the issues of depression and anxiety, embracing and funding telepsychiatry into mental health intervention provisions, implementing anti-poverty measures, and creating and funding community mental health relief organizations.
Keywords: Depression, young adults, Nigeria, interventions, mortality.
INTRODUCTION
The growth and development of a country is largely dependent on the productivity of the youth population. Several factors have been proven to affect the productivity of individuals of which the mental state of that individual is very vital.
According to the WHO, 25% of the total population will have a mental health issue throughout their lifetime and an estimate of 600 million people will get handicapped globally as a result of this [9]. In Nigeria, which is representative of low- and middle-income countries, the burden of depression is increasingly becoming worse. It is estimated that of the projected 500 million people dealing with a mental health illness, a large fraction of them are citizens of low- and middle-income countries and 85% of the world population is living there [13]. According to WHO (2017), the depression rate is 3.9% which translates to 7,079,815 people who are affected.
Fig. 1. Depression rates based on age groups Fig. 2. Depression rates based on sex
Figure 1 and 2 show patterns of psychiatric disorders, particularly depression among young person’s attending psychiatric clinics in Benin, which is the capital city of the Edo State in the South-South region of Nigeria [14]. According to figure 1, depression rates were highest among the young people aged 20-24 (71.7%), followed by those aged 14-15(14.5%) and those aged 15-19(13.8%) (Fig. 1). As indicated in figure 2, the male to female ratio is 1:1.12, with 52.7 % male depressed youths and 47.3% depressed female youths (Fig. 2).
Untreated depression finds an outlet in suicide ideation, attempt and mortality. Figure 3 indicates the suicide mortality rates for a 10-year span from 2009-2019, with the highest rate being 4.9 in 2009 and lowest being 3.5 in 2019 (Fig. 3) [12].
The aim of the study was to analyze the main causes of depression and measures to prevent it in young people from Nigeria.
Fig. 3. Suicide Mortality Rates (per 100,000 population)
The aim of the study was to analyze the main causes of depression and measures to prevent it in young people from Nigeria.
MATERIALS AND METHODS
A systematic search from PubMed, PsycINFO, Science Direct, Web of Science, and Google Scholar databases was done for recently published and relevant articles from 2018-2024, 993 in number of which 14 were selected. The subject of the study – Nigerian youth in the age group 15-26 years with depressive disorders. Also Interviews with psychologists, hospital directors and health journalists were analyzed for relevant information. The methodological foundation for this scoping review was based on the recommended reporting items for systematic reviews and meta-analysis (PRISMA) standards. We utilized EPPI-Reviewer (Version 4.12.2.0) to manage the discovered studies' references, and duplicates were automatically eliminated before beginning the two-stage selection procedure. Inclusion and exclusion criteria (study subjects – Nigerian youth within the 15-26 years age range, studies done on the Nigerian population) were used to examine study titles and abstracts for eligibility. Two authors (SM and UUM) worked independently on the screening, and disputes were settled by consensus. The following data was gathered from both the reviewed literature and : (i) study and sample characteristics (publication year, the country in which the research was done, design of study, sample size, target population, and age of participants); (ii) type of factor mentioned as a cause of depressive disorders; and (iii) intervention and program features (intervention name, intervention type, who executed the solutions and study outcomes) (iv) attitudes and experiences with depressive disorders from interviewees and survey responders. A comprehensive study design was employed to collect data on symptoms, experiences and attitudes towards depression using questionnaires to Nigerian youth in the age group 15-26 years. We synthesized a narrative report of our findings.
RESULTS
Poverty. Depression, anxiety, and suicide rates are directly proportional to low income and unemployment [6]. Over 9 000 000 Nigerians are unemployed as of the first quarter of 2023 (4.1% unemployment rate). Poverty has many dimensions and its economic dimensions and depression have a bidirectional causal relationship. Low income increases exposure to disease-causing environmental factors (poor sanitation, poor access to clean water, lack of access to balanced diets, etc),which associated with restricted access to quality healthcare eventually leads to acute and chronic diseases. Poor physical health will strengthen chronic stress, fears of death, worry about the financial burden of the disease, all of which leads to depressive disorders [1]. Violent crime, the probability of trauma from the death of family members and acquaintances and domestic abuse is disproportionately high in low income households [7]. Living in poverty is associated with social marginalization, isolation and loneliness from comparatively well-up members of the society and this is linked to depression. 47% of Nigerian graduates cannot secure employment which explains the higher rates of depression among young adults because of the unfulfilled financial expectations burdening them [11].
Once depressed, the cognitive detriments of depression such as overthinking and distorted perceptions of abilities negatively affect economic behaviors like employment seeking, saving of money, education and the capacity to work. All of these worsens poverty and depressed individuals will be stuck in a vicious cycle of poverty and depression.
Inadequacies of Government Policies and poor access to Treatment. The health system governance (HSG) is responsible for the implementation of healthcare policies and interventions and if it is faulty, it will affect the general outlook on health problems and access to their treatment. The HSG framework in Nigeria excludes mental health in its key areas for instance, mental health care is excluded from the National Health Policy of the Federal Ministry of Health and the National Strategic Health Development Plan (2010-2015). There is a mental health policy introduced in 1991 which recommends incorporation of mental health into primary care; it was revised in 2013 but hasn’t been implemented because of lack of support and these inadequacies worsen underfunding of mental health services. Even though depression and other mental health disorders contribute to 14% of the years lived with disability globally, the average expenditure on mental health for countries averages 1.7% of the health budget [10].
In Nigeria a specific mental health budget doesn’t even exist. Under prioritization of mental health care builds a barrier against access to treatment. Less than 10% of mentally ill Nigerians have access to mental health care [8].
Ignorance and Stigma. Cultural and religious beliefs create the basis for the world views of individuals and in most African cultures including Nigeria, depression is not a definite medical disease that requires medical treatment. 56% of the respondents to the questionnaires on the section of ‘attitudes towards depression’ identified depression as “stress”, “thinking too much” (“oke echiche”, “irewesi okan”) in the Igbo and Yoruba cultures. Life misfortunes are often thought to be the result of wicked spiritual powers which, unattended in a spiritual way, will lead to depression. Depressed individuals are in some instances thought to be “mad” or “mentally disturbed”. Some survey participants could not comprehend depression as a concept since it was believed to be “not a real disease” with claims of “no scientific explanations” in the Nigerian culture. This strengthens ignorance and extremely low levels of mental health advocacy and thus another barrier to treatment as depressed individuals will not present themselves to healthcare providers as their initial point of contact. In Nigeria, 23% of children and young people with depression are taken to faith healing centers and 7% of depressed patients go to traditional healers for mental health care [3].
Internet Abuse and Social Media Addiction. Social media is more significant in the lives of young people than ever, since it is a simple way to communicate, be informed about the world and find entertainment. However, excessive internet use leads to addiction. According to a study conducted in the south-eastern part of Nigeria, the more a young person is addicted to the internet, the more psychologically disturbed they become and the more likely they are to be depressed [4]. Depression by addiction eventually comes about by an encouragement of poor self-esteem through repeated comparison, by feeding into the fear of missing out(FOMO) through exaggerated perception of the ideal lives of social media personalities, by substituting in-person social connections and through the lack of social contact increase loneliness.
Solutions
1. Integration of Mental Health into primary health care. Primary care is the first point of contact for a patient with a formal health service provision and we propose an incorporation of mental health care from the lowest levels of the healthcare system through decentralization. Uganda’s primary care system can serve as a template: The order of decentralization starts from the ministry of health to the national referral hospitals to regional referral hospitals to district hospitals to the county level to sub county level to the parish level and then to the village health team. Mental health disorders start being managed in the village health team with the help of general health nurses and volunteer nurses who are taught the skills needed to detect and treat mental health disorders as well as refer complex cases to higher levels of care. This integration model leads to health services becoming more accessible, inexpensive and acceptable with depressed patients receiving treatment in local communities in the place of distant hospitals [5].
2. Telepsychiatry. Owing to the restrictions on face-to-face healthcare interactions due to COVID-19 and an increase in mental health disorders, telepsychiatry has emerged as an appealing alternative for the delivery and treatment. Kenya has a rise in new technology in the provision of problem-solving therapy offered by trained sympathetic individuals rather than professional psychologists and is evidence-based. The possible solutions include funding Nigerian developers to create user-friendly and cost-effective interfaces for mental healthcare provisions to maximize its use; staff training healthcare providers on ICT and telemedicine technology; international investment in boosting Wi-Fi availability and creating law and regulations to oversee telemedicine and healthcare to smoothen security secrecy and privacy [2].
3. Anti-Poverty Measures. As discussed, poverty and depression have a bidirectional causal relationship. Historically, policy makers and economists have not prioritized mental health and its treatment has not been studied as an anti-poverty strategy until recently. Several studies that looked into anti-poverty initiatives and money transfers found that they had significance positive influence in alleviating depression. Cash transfers of “$400 to $1500 at purchasing power parity (approximately 3 to 12 months of household income) to Kenyan households improved consumption and satisfaction while decreasing sadness, stress, and anxiety. Depression scale scores were 0.12 standard deviations (SD; closely comparable to Cohen's d) lower 4 months after completion and 0.16 SD lower almost 3 years later, with bigger transfers having a much higher effect” [6]. We propose structured, consistent financial support to severely impoverished families and funding of non-governmental organizations that provide economic literacy, asset building services, and financial project initiations to Nigerian young adults as solutions to depression and anxiety.
CONCLUSION
The main causes of depression are poverty, inadequacies of government policies and poor access to treatment, internet abuse and social media addiction, ignorance and stigma. Depression is a complex problem that requires consistent and determined efforts from the different parties of the different sectors of the society including improving mental health advocacy to deal with stigma and ignorance, governmental and non-governmental interventions to improve the economic situation for young adults and reconsideration by policy makers to include psychological therapy in the minimum healthcare package. The problem is not yet fully surveyed and understood; more research work is still being done in this direction.
REFERENCES
1. About half of the university graduates in Nigeria cannot find jobs. Accessed: Sep. 28, – 2023. [Online]. Available:https://qz.com/africa/603967/about-half-of-the-university-graduates-in-nigeria-cannot-findjobs.
2. Dodoo J.E., Al-Samarraie H., Alzahrani A.I. “Telemedicine use in Sub-Saharan Africa: Barriersand policy recommendations for Covid-19 and beyond,” Int J Med Inform. – Vol. 151. – Pp. 4-8, Jul. – 2021, doi: 10.1016/J.IJMEDINF.2021.104467.
3. Foy J.M., Earls M.F. “A process for developing community consensus regarding the diagnosis and management of attention-deficit/hyperactivity disorder,” Pediatrics. – Vol. 115. – No. 1, Jan. – 2005, doi:10.1542/peds.2004-0953.
4. Friday O. et al., “Age and Class in School Differences in Internet Addiction and Psychological Distress among Adolescents in a Nigerian Urban City Article in International Neuropsychiatric Disease Journal,” Int Neuropsychiatr Dis J. – Vol. 4. – No. 3. – 2015, doi: 10.9734/INDJ/2015/18933.
5. Funk M., Dr W., Ivbijaro G. “Integrating mental health into primary care A global perspective”.
6. Lund C. et al., “Poverty and common mental disorders in low and middle income countries: A systematic review,” Soc Sci Med. – Vol. 71. – No. 3. – Pp. 517-528, Aug. – 2010, doi:10.1016/J.SOCSCIMED.2010.04.027.
7. Marmot M. “Social determinants of health inequalities,” Lancet. – Vol. 365. – No. 9464. – Pp. 1099-1104, Mar. – 2005, doi: 10.1016/S0140-6736(05)71146-6.
8. Nigeria Has A Mental Health Problem. Accessed: Feb. 27, 2024. [Online]. Available https://www.aljazeera.com/economy/2019/10/2/nigeria-has-a-mental-health-problem.
9. Patterson J.E., Edwards T.M., Vakili S. “Global Mental Health: A Call for Increased Awareness and Action for Family Therapists,” Fam Process. – Vol. 57. – No. 1. – Pp. 70-82, Mar. – 2018, doi:10.1111/FAMP.12281.
10. Ridley M., Rao G., Schilbach F., Patel V. “Poverty, depression, and anxiety: Causal evidence and mechanisms,” Science (1979). – Vol. 370. – No. 6522, Dec. – 2020, doi:10.1126/SCIENCE.AAY0214/SUPPL_FILE/AAY0214-RIDLEY-SM.PDF.
11. Scott K.M. et al., “Association of Mental Disorders With Subsequent Chronic Physical Conditions:World Mental Health Surveys From 17 Countries,” JAMA Psychiatry. – Vol. 73. – No. 2. – Pp. 150-158, Feb. – 2016, doi: 10.1001/JAMAPSYCHIATRY.2015.2688.
12. Suicide Mortality Rate (per 100,000 Population. Accessed: Feb. 26. – 2024. [Online]. Available https://data.worldbank.org/indicator/SH.STA.SUIC.P5?end=2019&locations=NG&start=2000&view=chart.
13. Votruba N., Eaton J., Prince M., Thornicroft G. “The importance of global mental health for the Sustainable Development Goals,” Journal of Mental Health. – Vol. 23. – No. 6. – Pp. 283-286, Dec. – 2014,doi: 10.3109/09638237.2014.976857.
14. Young People's MentalHealth Is A Ticking Time-Bomb. Accessed: Feb 27. – 2024. [Online]. Available https://guardian.ng/features/young-peoples-mental-health-is-a-ticking-time-bomb/
REFERENCES
1. About half of the university graduates in Nigeria cannot find jobs. Accessed: Sep. 28, 2023. [Online]. Available:https://qz.com/africa/603967/about-half-of-the-university-graduates-in-nigeria-cannot-findjobs.
2. Dodoo J.E., Al-Samarraie H., Alzahrani A.I. “Telemedicine use in Sub-Saharan Africa: Barriersand policy recommendations for Covid-19 and beyond,” Int J Med Inform. Vol. 151. Pp. 4-8, Jul. 2021, doi: 10.1016/J.IJMEDINF.2021.104467.
3. Foy J.M., Earls M.F. “A process for developing community consensus regarding the diagnosis and management of attention-deficit/hyperactivity disorder,” Pediatrics. Vol. 115. No. 1, Jan. 2005, doi:10.1542/peds.2004-0953.
4. Friday O. et al., “Age and Class in School Differences in Internet Addiction and Psychological Distress among Adolescents in a Nigerian Urban City Article in International Neuropsychiatric Disease Journal,” Int Neuropsychiatr Dis J. Vol. 4. No. 3. 2015, doi: 10.9734/INDJ/2015/18933.
5. Funk M., Dr W., Ivbijaro G. “Integrating mental health into primary care A global perspective”.
6. Lund C. et al., “Poverty and common mental disorders in low and middle income countries: A systematic review,” Soc Sci Med. Vol. 71. No. 3. Pp. 517-528, Aug. 2010, doi:10.1016/J.SOCSCIMED.2010.04.027.
7. Marmot M. “Social determinants of health inequalities,” Lancet. Vol. 365. No. 9464. Pp. 1099-1104, Mar. 2005, doi: 10.1016/S0140-6736(05)71146-6.
8. Nigeria Has A Mental Health Problem. Accessed: Feb. 27, 2024. [Online]. Available https://www.aljazeera.com/economy/2019/10/2/nigeria-has-a-mental-health-problem.
9. Patterson J.E., Edwards T.M., Vakili S. “Global Mental Health: A Call for Increased Awareness and Action for Family Therapists,” Fam Process. Vol. 57. No. 1. Pp. 70-82, Mar. 2018, doi:10.1111/FAMP.12281.
10. Ridley M., Rao G., Schilbach F., Patel V. “Poverty, depression, and anxiety: Causal evidence and mechanisms,” Science (1979). Vol. 370. No. 6522, Dec. 2020, doi:10.1126/SCIENCE.AAY0214/SUPPL_FILE/AAY0214-RIDLEY-SM.PDF.
11. Scott K.M. et al., “Association of Mental Disorders With Subsequent Chronic Physical Conditions:World Mental Health Surveys From 17 Countries,” JAMA Psychiatry. Vol. 73. No. 2. Pp. 150-158, Feb. 2016, doi: 10.1001/JAMAPSYCHIATRY.2015.2688.
12. Suicide Mortality Rate (per 100,000 Population. Accessed: Feb. 26. 2024. [Online]. Available https://data.worldbank.org/indicator/SH.STA.SUIC.P5?end=2019&locations=NG&start=2000&view=chart.
13. Votruba N., Eaton J., Prince M., Thornicroft G. “The importance of global mental health for the Sustainable Development Goals,” Journal of Mental Health. Vol. 23. No. 6. Pp. 283-286, Dec. 2014,doi: 10.3109/09638237.2014.976857.
14. Young People's MentalHealth Is A Ticking Time-Bomb. Accessed: Feb 27. 2024. [Online]. Available https://guardian.ng/features/young-peoples-mental-health-is-a-ticking-time-bomb/
Материал поступил в редакцию 01.03.24
ЭПИДЕМИЯ ДЕПРЕССИИ СРЕДИ МОЛОДЫХ ЛЮДЕЙ В НИГЕРИИ (ОБЗОР ЛИТЕРАТУРЫ)
Мугарири Синклэр, студент
Медицинский институт ФГАОУ ВО “Российский университет дружбы народов имени Патриса Лумумбы”
(117198, Россия, г. Москва, ул. Миклухо-Маклая, д. 6)
E-mail: mugaririsynclair@gmail.com
Околи Убамара Учечукву, студент
Медицинский институт ФГАОУ ВО “Российский университет дружбы народов имени Патриса Лумумбы”
(117198, Россия, г. Москва, ул. Миклухо-Маклая, д. 6)
E-mail: okoliubamara@gmail.com
Д.А. Канева, кандидат медицинских наук,
ассистент кафедры общественного здоровья, здравоохранения и гигиены
Медицинский институт ФГАОУ ВО “Российский университет дружбы народов имени Патриса Лумумбы”
(117198, Россия, г. Москва, ул. Миклухо-Маклая, д. 6)
E-mail: kaneva-da@rudn.ru
Т.Ю. Тарараева, кандидат медицинских наук,
ассистент кафедры общественного здоровья, здравоохранения и гигиены
Медицинский институт ФГАОУ ВО “Российский университет дружбы народов имени Патриса Лумумбы”
(117198, Россия, г. Москва, ул. Миклухо-Маклая, д. 6)
E-mail: tararaeva-tyu@rudn.ru
Аннотация. Самоубийства, связанные с депрессией, являются второй по значимости причиной смерти среди молодых людей в Нигерии. Эти депрессивные расстройства имеют глубокие и разнообразные причины, которые включают бедность, социальные сети, политику правительства, невежество и недоступность служб вмешательства. Необходимы инновационные и стратегические методы для повышения осведомленности о выявлении, ведении и лечении депрессивных расстройств у населения Нигерии. Целью исследования было проведение анализа основных причин депрессии и мер по ее профилактике у молодых людей из Нигерии. Материалы и методы. Был выполнен систематический поиск актуальных статей в базах данных PubMed, PsycINFO, Science Direct, Web of Science и Google Scholar за 2018-2024 годы в количестве 993, из которых отобрано было 14. Объект исследования: нигерийская молодежь в возрасте 15-26 лет с депрессивными расстройствами. Результаты. К основным причинным факторам депрессивных расстройств относятся стигма и традиционные взгляды, основанные на культурных и религиозных убеждениях. Невежество на индивидуальном, общественном и организационном уровне нигерийского общества создает барьер для доступа к помощи пациентам с депрессией. Политика правительства в Нигерии отражает недостаточное институциональное внимание к финансированию исследований и лечения психических расстройств. Бедность и депрессия имеют двунаправленную причинную связь. Также стало очевидным неоспоримое влияние социальных сетей, поскольку они способствовали завышенным ожиданиям, киберзапугиванию и социальной изоляции — все это было тесно связано с усилением психического дискомфорта. В этом исследовании подчеркивается острая необходимость комплексных мер, включая интеграцию психического здоровья в первичную медико-санитарную помощь, разработку политики в области психического здоровья на правительственном уровне, создание потребительских организаций для пропаганды проблем депрессии и тревоги, внедрение и финансирование телепсихиатрии в рамках вмешательства в области психического здоровья. положения, реализацию мер по борьбе с бедностью, а также создание и финансирование общественных организаций по оказанию помощи в области психического здоровья.
Ключевые слова: депрессия, молодые люди, Нигерия, вмешательства, смертность.