Late-life depression in sub-Saharan Africa: lessons from the Ibadan Study of Ageing

Abstract

The population surviving to old age in sub-Saharan Africa (SSA) is increasing rapidly in consonance with the rest of the world. Nevertheless, the sub-region offers unique challenges to survival across the lifespan. The determinants of health and ageing in SSA are thus likely different from those in higher income countries. The need to explore pressing epidemiological and health service challenges of older people living in SSA in the context of multiple social changes and rapid ageing of the population provided the rationale for the Ibadan Study of Ageing (ISA). This article appraises ISA findings in relation to late-life depression. It concludes that healthcare policies in SSA need to deliberately prioritise the treatment of depression and other mental health problems in late-life in order to stem the neglect of older people's mental health in the region.

Depression in Sub-Saharan Africa

“…Again, the geographical location and socio-economic environment of individuals has been shown to affect the rate of depression. For instance, a recent report indicates a higher rate of depression among elderly persons in low- and middle-income countries compared to those in high income countries ( Ojagbemi et al, 2020 ). Unsurprisingly, the Ibadan Study of Ageing which was carried out in a low- and middle-income country (Nigeria) reported one of the highest rates of major depressive disorder in the literature with a 12-month prevalence of about 7% ( Gureje et al, 2007 ) compared to an average rate of about 3% reported in high-income countries ( De La Torre-Luque and Ayuso-Mateos, 2020 ).…”

Late-life depression in socially and culturally diverse settings

“…With a life expectancy at birth of about 60 years (compared to over 78 years in Europe and North America), persons who survive to 65 years and beyond in SSA are clearly a highly selected few making their study of potential interest to understanding factors that conduce to survival in otherwise difficult circumstances (United Nations Department of Economic and Social Affairs, 2020 ). The two editorials (de la Torre-Luque and Ayuso-Mateos, 2020 ; Ojagbemi et al ., 2020 ) in this issue provide an opportunity to reflect on some of such factors as well as on features of ageing that may be universal and those that may be more contextually determined. In this regard, the contrasts between the demographic profiles of populations in SSA and those in Europe and North America are relevant in considering key messages of the studies that the two editorials in this issue have highlighted.…”

“…This contrasts with an average rate of about 3% reported in high-income countries (HIC) (de la Torre-Luque and Ayuso-Mateos, 2020 ). The authors note a pattern of higher rates of depression among elderly persons in low- and middle-income countries, compared to those in HIC (Ojagbemi et al ., 2020 ). It is interesting that de la Torre-Luque and Ayuso-Mateos ( 2020 ) observed that, contrary to the trend for rates of categorical diagnoses of depression to decline with age, the reverse is often the case when a symptom-based approach is used for diagnosis.…”

The longitudinal association of stressful life events with depression remission among SHARP trial participants with depression and hypertension or diabetes in Malawi

“…Depression prevalence is increasing globally and disproportionately in low-and middleincome countries (LMICs), further burdening health systems already faced with inequitable access to mental health care [1][2][3]. Approximately five percent of the global adult population, six percent of the Sub-Saharan African (SSA) population, and six percent of the general Malawian population lives with depression [3][4][5][6]. Prevalence in primary-care seeking settings in Malawi is estimated to be closer to thirty percent, as many cases are undetected in primary point of care settings [7][8][9].…”