Depressive symptoms, suicidal ideation, and mental health care-seeking in central Mozambique
There is scant research on depressive symptoms (DS), suicidal ideation (SI), and mental health care-seeking in Mozambique.
Generalized estimating equations were used to assess factors associated with DS, SI, and mental health care-seeking among 3080 individuals interviewed in a representative household survey in Sofala and Manica provinces, Mozambique.
19% (CI 17–21%) of respondents reported DS in the past year and 17% (CI 15–18%) lifetime SI. Overall, only 10% (CI 8–11%) of respondents ever sought any care for mental illness, though 26% (CI 23–29%) of those reporting DS and/or SI sought care. 90% of those who sought care for DS received treatment; however, only 46% of those who sought care for SI received treatment. Factors associated with DS and SI include: female gender, divorced/separated, widowed, and > 55 years old. Respondents in the bottom wealth quintile reported lower DS, while those in upper wealth quintiles reported higher prevalence of SI. Individuals with DS or SI had significantly elevated measures of disability—especially in doing household chores, work/school activities, standing for long periods, and walking long distances. Factors associated with care-seeking include: female gender, rural residence, divorced/separated, and > 45 years old. Individuals in lower wealth quintiles and with no religious affiliation had lower odds of seeking care.
DS and SI are prevalent in central Mozambique and treatment gaps are high (68% and 89%, respectively). An urgent need exists for demand- and supply-side interventions to optimize the delivery of comprehensive community-based mental healthcare in Mozambique.
KeywordsMozambique Mental health Depressive symptoms Suicidal ideation Care-seeking
This work was supported by the African Health Initiative of the Doris Duke Charitable Foundation. INCOMAS Study Team includes: Falume Chale; Alfredo Covele; Fatima Cuembelo; Stephen Gloyd; Catherine Henley; Leecreesha Hicks; Joaquim Lequechane; Arlete Mahumane; Nelia Manaca; Cathy Michel; Alberto Muanido; Miguel Nhumba; James Pfeiffer; and Lucia Vieira.
BHW, KA, and SH conceived the idea. BHW, OA, SG, KS, KA and the INCOMAS Study Team collected the data. KA and SH designed the analysis with input from BHW. SH wrote the first draft of the manuscript under mentorship of KA and creative input from BHW. All authors read and approved the final manuscript.
This study was supported by the Doris Duke Charitable Foundation’s African Health Initiative. Bradley H. Wagenaar was supported by Grant number K01MH110599 from the US National Institute of Mental Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Compliance with ethical standards
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Ethical approval and consent to participate
The study was approved by the Institutional Bio-ethics Committee of the National Institute of Health in Mozambique. All survey respondents provided written informed consent. In cases where participant could not read or write, s/he provided a thumbprint.
Statement of Originality
The authors attest that all work is original and that it has not been published or submitted anywhere other than to Social Psychiatry and Psychiatric Epidemiology.
- 6.Kessler RC, Birnbaum HG, Shahly V, Bromet E, Hwang I, McLaughlin KA, et al. Age differences in the prevalence and co-morbidity of DSM-IV major depressive episodes: results from the WHO World Mental Health Survey Initiative. Depress Anxiety [Internet]. 2010;27(4):351–64. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20037917%5Cnonlinelibrary.wiley.com/store/10.1002/da.20634/asset/20634_ftp.pdf?v=1&t=hiebojc9&s=73d7e920588e5c5a1a67d9826a671a02d49df746
- 7.Guerra M, Prina AM, Ferri CP, Acosta D, Gallardo S, Huang Y et al (2016) A comparative cross-cultural study of the prevalence of late life depression in low and middle income countries. J Affect 190:362–368Google Scholar
- 8.Kessler RC, Bromet EJ (2013) The epidemiology of depression across cultures. Annu Rev Public Health 34(1):119–138. https://doi.org/10.1146/annurev-publhealth-031912-114409 CrossRefPubMedPubMedCentralGoogle Scholar
- 9.World Health Organization. Depression and other common mental disorders: global health estimates. 2017Google Scholar
- 13.Vijayakumar L, John S, Pirkis J, Whiteford H. Suicide in developing countries (2): risk factors. Crisis. 2005;26(3):112–9. Available from: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16276753
- 14.Vijayakumar L, Rajkumar S (1999) Are risk factors for suicide universal? A case–control study in India. Acta Psychiatr Scand 99(6):407–411. https://doi.org/10.1111/j.1600-0447.1999.tb00985.x CrossRefPubMedGoogle Scholar
- 20.Institute for Health Metrics and Evaluation (IHME) (2016) GBD compare data visualization. IHME, University of Washington, SeattleGoogle Scholar
- 21.Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, Abdulkader RS et al (2017) Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 390(10100):1260–1344Google Scholar
- 22.World Health Organization (WHO) (2018) Global health observatory data: suicide rates per 100,000 populationGoogle Scholar
- 26.Sherr K, Cuembelo F, Michel C, Gimbel S, Micek M, Kariaganis M et al (2013) Strengthening integrated primary health care in Sofala, Mozambique. BMC Health Serv Res 13(2):4Google Scholar
- 27.The World Bank. The world bank: Mozambique [Internet]. Available from: https://data.worldbank.org/country/mozambique
- 28.United States Central Intelligence Agency. CIA world factbook: Mozambique [Internet]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/print_mz.html
- 29.National Statistics Institute (2017) Mozambique 2017 census. Maputo, MozambiqueGoogle Scholar
- 30.Mozambican Ministry of Health. Inquérito de Indicadores de Imunização, Malária e HIV/SIDA em Moçambique (IMASIDA). 2016Google Scholar
- 31.UNICEF. Monitoring the Situation of Children and Women: Mozambique [Internet]. Available from: https://data.unicef.org/country/moz/
- 32.Moçambique demographic and health survey. 2011Google Scholar
- 33.Wagenaar BH, Augusto A, Asbjornsdottir K, Akullian A, Manaca N, Chale F, Muanido A, Covele A, Michel C, Gimbel S, Radford T, Girardot B, Sherr K (2018) Developing a representative community survey sampling frame using satellite imagery in Mozambique. Int J Health Geogr 17:37PubMedPubMedCentralGoogle Scholar
- 34.Hartung C, Anokwa Y, Brunette W, Lerer A, Tseng C, Borriello G (2010) Open data kit: tools to build information services for developing regions. Proc Int Conf Inf Commun Technol DevGoogle Scholar
- 35.O’Donnell O, van Doorslaer E, Wagstaff A, Lindelow M (2008) Analyzing health equity using household survey data: a guide to techniques and their implementation. Health Equity using, Pp. 69–82Google Scholar
- 37.World Health Organization (WHO) (2010) Measuring health and disability: manual for WHO disability assessment schedule WHODAS 2.0Google Scholar
- 38.Tomlinson M, Grimsrud AT, Stein DJ, Williams DR, Myer L (2009) The epidemiology of major depression in South Africa: results from the South African Stress and Health study. South African Med J 99(5):368–373Google Scholar
- 39.Adewuya AO, Ola BA, Coker OA, Atilola O, Zachariah MP, Olugbile O et al (2016) Prevalence and associated factors for suicidal ideation in the Lagos state mental health survey, Nigeria. Br J Psychiatry 2(6):385–389Google Scholar
- 40.Johnson K, Asher J, Rosborough S, Raja A, Panjabi R, Beadling C et al (2008) Association of combatant status and sexual violence with health and mental health outcomes in postconflict liberia. JAMA, J Am Med Assoc 300(6):676–690Google Scholar
- 46.Newitt M. A short history of Mozambique. 2017Google Scholar
- 54.Mendenhall E, De Silva MJ, Hanlon C, Petersen I, Shidhaye R, Jordans M et al (2014) Acceptability and feasibility of using non-specialist health workers to deliver mental health care: stakeholder perceptions from the PRIME district sites in Ethiopia, India, Nepal, South Africa, and Uganda. Soc Sci Med 118:33–42PubMedPubMedCentralGoogle Scholar
- 55.World Health Organization (2010) mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings: mental health gap action programme (mhGAP). pp 1–121Google Scholar
- 60.Vijayakumar L (2015) Suicide in women. Indian J Psychiatry 57(Suppl 2):233–238Google Scholar
- 71.Magaard JL, Seeralan T, Schulz H, Levke A, Tt B (2017) Factors associated with help-seeking behaviour among individuals with major depression: a systematic review. PLoS ONE 12(5):1–17Google Scholar
- 72.Abaerei AA, Ncayiyana J, Levin J (2017) Health-care utilization and associated factors in Gauteng province, South Africa. Glob Health Action 10:1305765Google Scholar