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Urbanization increases the risk of major depression in elderly Nigerians: the Ibadan study of aging

Lancet

Major depressive disorder (MDD) is common in elderly Nigerians, particularly women, and its occurrence is related to urbanisation. Despite its seriously disabling nature, few patients with this disorder have ever received treatment, and health care services need to invest in effective treatment programmes for MDD. These are the conclusions of authors of an Article published in this week's edition of The Lancet.

Professor Oye Gureje, University of Ibadan, Nigeria and colleagues conducted face-to-face interviews with a representative sample of 2152 people aged 65 and over, in the Yoruba-speaking areas of Nigeria (representing about 22% of the national population).

The researchers found that lifetime and previous 12-month prevalence estimates of major depressive disorder were 26.2% and 7.1% respectively. Being female nearly doubled the chances of having the disorder, and increasing levels of urbanisation also increased the risk of MDD by 40%.

People with major depressive disorder has impaired quality of life and functioning in home, work, and social roles. Independent ratings of symptom severity confirmed MDD in 96.9% of cases.

Only around 37% of lifetime cases had received any treatment, and there was an average delay of five years from onset of depression to receipt of first treatment. Those patients who were poorest or who lived in rural areas were likely to receive no treatment.

The authors conclude: "Our findings emphasise high unmet need for treatment of depression in this population -- the level of impairments that elderly people with major depressive disorder have speaks directly to the need for scaling up of effective medical treatment for those affected."

In an accompanying Comment, Dr Judith Bass Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA and colleagues say that the impact of culture on understanding of mental illness "cannot be an after-the-fact consideration." They conclude: "Understanding local concepts of mental illness and of specific syndromes needs to be the starting place to creating locally appropriate study instruments that can be used for measurement of prevalence and incidence of illness and evaluation of the effectiveness of innovative intervention strategies. Without such knowledge, we will continue to be stuck with the ‘unsure of cultural appropriateness' caveat as a limitation in research rather than knowing whether we have captured the mental health problems we seek to understand."

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The paper can be accessed through the link below:
http://multimedia.thelancet.com/pdf/press/Ibadan.pdf

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