Depression and Diversity in Uganda: A Therapist’s Perspective

by Eve Achan, MSc Global Mental Health candidate

Oh no, it shouldn’t have been me to suffer through all this; I keep wondering whether the God that I serve really exists; I wonder whether I am worth living in this world especially when I cannot do much for myself and my loved ones; no one understands what is going on with me; I have no proper words to explain how I feel about them; I have gone to church and been prayed for; I have done all the blood tests and nothing was found and yet I feel unhealthy and weak; who could have bewitched me? Oh! What a disgusting world!

(Phrase commonly mentioned by patients)

Since many years back, these statements are still echoed by huge numbers of people in Uganda who are struggling with symptoms of depression, a condition that they do not understand and can’t explain to others to make them understand. Depression is among the most common chronic illnesses in Uganda with prevalence rates of up to 26 percent[1]. It has a sneaking ability to damage a person’s physical, psychological and social wellbeing. Depression is more common among the poor, unemployed, alcohol and drug abusers, people living with HIV and Posttraumatic Stress Disorder (PTSD).

Uganda is currently embracing the need to address depression through providing a holistic approach that covers both medical and psychosocial care which include social and economic support. Much as care for the depressed is necessary, the low numbers of mental health professionals in Uganda makes it hard for a significant number of depressed people to get professional attention. Most of them never get access to treatment at all.

Uganda is a typical multicultural country, consisting of 45 tribes with different cultures and beliefs. Description of symptoms of depression vary according to context, in that each culture describes it in their own way. The multicultural setting in Uganda requires therapists to be alert in that regard in order to administer assessments accurately. Sometimes depression may have more than one description by tribe or language. For example words like; Tuo paa/para (disease of extreme thoughts) among the Acholi tribe, Tam-a-tut (deep thoughts)/Tuo para among the Langi, oburwaire bw’ebitekerezo (disease of thoughts) among the Batooro, Okwennyamila (low mood) among the baganda, Aturur (state of extreme sadness) among the Itesot, Par Madwong (many thoughts) among the Alur among others. Therapists battle with the fact that they have to employ cultural sensitivity in their daily work while they endeavour to understand the diverse descriptions of depression based on their client’s context. It requires vigilance to understand what the patients mean during assessment and also what to communicate to the patient in the session in relation to their language, and cultures. This is a skill that a therapist will have to pick based on the context they are exposed to. Otherwise, it may not be taught in school since it is difficult to exhaust issues of diversity.

Depression is more common in poverty-stricken areas. If the cause of depression is poverty related, the therapist embarks on effective referral of the patient to other service providers for economic support. However, the chances that the patient will access this support are very minimal, since it’s provided mostly by NGOs which run based on targets. This pushes the therapist further to explore clients’ capabilities to perhaps start an Income Generating Activity (IGA) to empower them economically. This, as well, must be contextual and culture (including religion) appropriate. The therapist should be well informed of the viable IGAs in the area and whether they suit the patient culturally. The appropriateness of this IGA should be noted, based on the community they interact with as well as their beliefs in that regard. The risks have to be discussed since the idea is aimed at helping reduce on depression. Risks may include choices that may expose them to stigma and failing with their IGA.

As usual, at the end of the sessions, the patients often ask the therapist questions like; will I ever get back on my feet and function as I used to? Please tell me, help me out of this. The feeling that the therapist has to give answers makes it seem like they are the determinant of the client’s wellness. Yes, that would be the goal but the patient too has a greater role to play in this and this response is often provided to them in a culturally appropriate manner.

To understand depression better in Uganda, it is important to consider context. Professionals should endeavour to know the cultures of the populations they serve so as to provide appropriate services.

Uganda Suicide Hotline: 0800 200 600  (Mon. – Fri, 8am to 7pm)

[1] Kinyanda E, Woodbum P, Tugumisirize J, Kagugube J, Ndyanabangi S, Patel V. Poverty, Life Events and the Risk for Depression in Uganda. PMC. 2011.