Mental Distress of Women in Southwest Uganda: Expression and Measure
Creators: name: Fischer, Michael
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2016

description: Background: Anxiety and mood disorders are common around the globe and the cause of significant morbidity for all the world’s populations. Case finding of mental disorders is challenging since screening instruments, to be accurate, must be valid in the particular setting in which they are being applied Diagnosis in primary care clinics can also be challenging since patients usually present with a wide variety of problems that can be difficult to interpret. Our objective was to screen women for anxiety and depression in one district of southwest Uganda and to investigate their complaints and illness concepts. A second objective was to describe their idioms of distress, especially how their social circumstances relate to their illness. We chose to focus on women age 18-35 as a sample of convenience in our exploratory study. Methods: We screened for anxiety and depression 115 women chosen by convenience sampling at three sites providing services for women in the Kisoro district using the SRQ-20 Yes-No Questionnaire.Those who met criteria were immediately interviewed in the local language by a female Ugandan team member using Kleinman’s Eight Questions in order to elicit their explanatory model of illness. Results: Very few participants had more than a primary school education, most were married and only a few received income from employment outside the home. Depression was common in women at all three study sites, but was particularly prevalent among participants recruited at a women’s center located in an area that was geographically remote. These women were older than their counterparts at the other two sites, living in larger households with more children to care for. They were statistically more likely to endorse cognitive, and decreased energy domains of depression on the SRQ 20 compared with their counterparts at a clinic for mothers and babies. They were not more likely to endorse somatic or affective symptoms or depressive thoughts., In the Kleinman interview, all 87 of the participants with depression (100 %) used somatic symptoms to describe their illness. The average number of somatic symptoms offered was 3.9. 32% reported five or more somatic symptoms. 29% reported one psychiatric symptom and 1 % (one participant) reported 2 psychiatric symptoms. 84% considered their illness to be moderately or very severe and 80% feared that it would result in premature death or disability. 67% said that their physical health had declined as a result of their illness and 39% reported that they were not keeping up with their daily activities as a result of their problem. Marital problems (53%), and being overworked (46%), as well as other environmental factors such as not enough food (24%), reproductive health concerns (22%) and poverty (15%) were the most common causes of illness offered by participants. 22% suggested that the cause was in some way related to mental health, and 11% said that it was due to witchcraft. 36 % responded “do not know” to the question about cause. Expectations regarding illness treatment for 76% were for x-ray or medication and, for 83%, to feel better. Sample narratives from the Kleinman interviews illuminate symptom meanings. In their idioms of distress are heard echoes of their economic and marital problems. Conclusion:. The somatic and affective symptoms and depressed thoughts sub-scales of the SRQ-20 screening instrument may not differentiate as well for depression compared with cognitive impairment and decreased energy sub-scales in this milieu. At the same time, women with depression in southwest Uganda complain primarily of somatic symptoms, and therefore it is important to train health providers to look beyond these symptoms for evidence of cognitive problems and decreased energy. The somatic idiom may be how women in southwest Uganda express every day levels of distress or social concern. Having depressive thoughts, however, especially feelings of uselessness and hopelessness, is not how mild depression manifests itself in this population.