Explanatory models of depression in sub-Saharan Africa: Synthesis of qualitative evidence

Mayston, Rosie; Frissa, Souci; Tekola, Bethlehem; Hanlon, Charlotte; Prince, Martin; Fekadu, Abebaw

doi:10.1016/j.socscimed.2019.112760

Cited by 56 publications

(60 citation statements)

References 56 publications

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“…In our study, affective symptoms were the main ones with few mentions of somatic symptoms described whereas in previous studies somatic symptoms were predominantly reported by PLWHA [6,19,45]. Our study participants may have been prompted to focus on affective symptoms of depression after listening to the presented case study.…”

Section: Discussionmentioning

confidence: 66%

“…This indicates the need for dynamic adaptation and contextualization of psychological treatments when they are replicated in different settings [2,4]. The use of Western treatment models in diversified settings using an etic approach can invalidate psychological treatments [6]. Chowdhary and colleagues support this argument in a systematic review showing that trials following proper adaptation and contextualization of psychological treatments were more effective than trials that used non-adapted treatments [7].…”

Section: Introductionmentioning

confidence: 99%

“…Symptoms of depression and HIV/AIDS are intertwined with each other [6,19]. For instance, several narratives indicate that PLWHA consider depressive symptoms as part of HIV/AIDS [6,14,19] and they believe that depression is caused by HIV/AIDS [14,19]. Moreover, many others attribute depression to spiritual possession and witchcraft [6,14].…”

Section: Introductionmentioning

confidence: 99%

“…For instance, several narratives indicate that PLWHA consider depressive symptoms as part of HIV/AIDS [6,14,19] and they believe that depression is caused by HIV/AIDS [14,19]. Moreover, many others attribute depression to spiritual possession and witchcraft [6,14]. Similarly, PLWHA may have different beliefs on the impacts of depression and treatment needs including on the preferred approach of interventions and delivering agents for the intervention.…”

Section: Introductionmentioning

confidence: 99%

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Adaptation of the WHO group interpersonal therapy for people living with HIV/AIDS in Northwest Ethiopia: A qualitative study

et al. 2020

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Background Psychological treatments improve depressive symptoms in people living with HIV/AIDS (PLWHA). Adaptation of treatments should be based on explanatory models of depression and other elements within the given context. Aim This study aimed to examine explanatory models of depression and acceptable approaches for implementation of group IPT in Northwest Ethiopia. Methods Qualitative data were collected from April to May 2019 from case managers, adherence supporters and service users using focus group discussion and analysed thematically. Results PLWHA attributed depression to psychosocial problems, spiritual factors and biological factors. Depression had several impacts at individual and family level. Group-based interpersonal therapy (IPT) was acceptable if provided by trained peer counselors. Conclusion The current study findings informed how to conduct feasibility and acceptability trials of group IPT in the HIV population in Ethiopia.

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Section: Discussionmentioning

confidence: 66%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Adaptation of the WHO group interpersonal therapy for people living with HIV/AIDS in Northwest Ethiopia: A qualitative study

et al. 2020

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“…The utilization of mental health services does not happen frequently because many people in sub-Saharan Africa only engage with the health care system for services when all other social resources and self-help methods fail or if symptoms get very severe. 40 Some of the resources people access for relief from stress and mental problems include keeping in touch with others, attending faith and religious events, engaging in prayers and reading scriptures. [41][42][43][44][45][46][47][48][49][50][51][52] The COVID-19 lockdowns in sub-Saharan Africa have hindered access to social resources.…”

Section: Preventing and Addressing Mental Health Problems/disorders Imentioning

confidence: 99%

The mental health impact of the COVID-19 pandemic: Implications for sub-Saharan Africa.

Frissa¹,

Dessalegn²

2020

Preprint

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The COVID-19 pandemic is leading to mental health problems due to disease experience, physical distancing, stigma and discrimination, and job losses in many of the settings hardest hit by the pandemic. Health care workers, patients with COVID-19 and other illnesses, children, women, youth, and the elderly are experiencing post-traumatic stress disorders, anxiety, depression, and suicidal ideation. Virtual mental health services have been established in many settings and social media is being used to impart mental health education and communication resources. Mental health services across countries hardest hit by the COVID-19 pandemic need to be scaled up further and coordinated better to ensure equity and efficiency.The impact of COVID-19 on mental health in sub-Saharan Africa could be immense, given the weak health care systems. Similar to the Ebola epidemic of 2014-2016, COVID-19 will cause anxiety, depression and post-traumatic stress disorders. Uptake of mental health care services is generally low, and communities rely on social resources. Hence, efforts to control the disease transmission should be contextualized. Low digital literacy, low smartphone penetration and limited internet connection make online mental health services a limited option for service delivery. Safeguarding social and cultural resilience factors and coping mechanisms is critical in the sub-Saharan African context. Mass media is a feasible way of providing social resources. Community health workers can quickly be trained to provide mental health education, screening and counselling services. Toll-free mental health helplines can be used to provide services to health care workers and those needing customized care. Mental health and psychosocial support services need to be integrated into the pandemic response and coordinated nationally. It is vital for these services to continue during and after the epidemic

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Refugees and asylum seekers who have experienced trauma: Thematic synthesis of therapeutic boundary considerations

Davoren,

McEleney,

Corcoran

et al. 2023

Clin Psychology and Psychoth

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ObjectiveTherapeutic boundaries are limits to appropriate behaviours within a therapist–client relationship (e.g. related to accepting gifts, self‐disclosures, therapist neutrality and advocacy). Therapeutic boundary considerations are fundamental in the care of refugees and asylum seekers. Research on the experiences of therapists navigating such boundaries is sparse and warrants further exploration. The aim of this qualitative systematic review was to thematically synthesise literature regarding therapists' (psychologists, psychotherapists, counsellors) experiences of implementing flexible therapeutic boundaries with refugee and asylum seeker clients and determine how such applications have been helpful for therapeutic interventions.MethodSix databases were searched. Following full‐text screening, 21 papers were included in the analysis. Boundary theory underpinned the analysis.ResultsThree major themes were developed: (i) Changes to Therapeutic Practice & Therapeutic Intervention, (ii) Re‐Conceptualisation of Therapy as ‘Clinical Political’ and Re‐Conceptualisation of Therapist Identity and (iii) Careful Monitoring of Personal Boundaries—Not becoming ‘Hardened’ or ‘Haunted’. Papers described how, when used in a reflective, considerate way, flexible therapeutic boundaries can strengthen the therapist–client alliance and positively impact therapeutic interventions. Many therapists acknowledged making conscious efforts to re‐conceptualise therapeutic work with refugee and asylum seeker clients from advocacy standpoints. However, systemic constraints, and lack of guidance, made this difficult to navigate and contributed to therapist burn‐out.ConclusionsBoundary considerations manifested as interpersonal, structural and cultural changes to practice. These have implications for clinical practice and developing guidelines on boundary practices with refugees and asylum seekers. Future research should explore promoting therapist well‐being and training needs for therapists supporting this population.

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Explanatory models of depression in sub-Saharan Africa: Synthesis of qualitative evidence

Cited by 56 publications

References 56 publications

Adaptation of the WHO group interpersonal therapy for people living with HIV/AIDS in Northwest Ethiopia: A qualitative study

Adaptation of the WHO group interpersonal therapy for people living with HIV/AIDS in Northwest Ethiopia: A qualitative study

The mental health impact of the COVID-19 pandemic: Implications for sub-Saharan Africa.

Refugees and asylum seekers who have experienced trauma: Thematic synthesis of therapeutic boundary considerations

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