Common Mental Disorders and Risk Factors in Urban Tanzania
Abstract
:1. Introduction
2. Methods
2.1. Sites
2.2. Sample
2.3. Procedure
2.4. Instruments
2.5. Analysis
2.6. Ethics Approval
3. Results
3.1. Response Rate
3.2. Differences between Areas
3.3. Predictors of Common Mental Disorder
4. Discussion
4.1. Main Findings
4.2. Comparison with Other African Prevalence Studies
4.3. Social Determinants of CMD
4.4. Life Events and CMD
4.5. Social Support and CMD
4.6. Limitations of the Study
5. Conclusions
Acknowledgments
References
- United Nations. The Millennium Development Goals Report; United Nations: New York, NY, USA, 2007. [Google Scholar]
- The World Bank. African Development Indicators 2005; The World Bank: Washington, DC, USA, 2005. [Google Scholar]
- Government of Tanzania. Development Vision 2025; Government Printer: Dar es salaam, Tanzania, 1997. [Google Scholar]
- Government of Tanzania. National Strategy for Growth and Reduction of Poverty (2005–2010); Government Printer: Dar es salaam, Tanzania, 2005. [Google Scholar]
- Government of Tanzania. Tackling Vulnerability: An Approach to Poverty Reduction; Government Printer: Dar es salaam, Tanzania, 2004. [Google Scholar]
- The Global Burden of Disease: 2004 Update; World Health Organisation: Geneva, Switzerland, 2008.
- Mbatia, J; Jenkins, R; Singleton, N; White, B. Prevalence of Alcohol, Nicotine and other substance use and hazardous alcohol use in Urban Tanzania, and Their Associated Risk Factors. Int. J. Environ. Res. Public Health 2009, 6, 1991–2006. [Google Scholar]
- Kitange, HM; Machibya, H; Black, J; Mtasiwa, DM; Masuki, G; Whiting, D; Unwin, N; Moshiro, C; Klima, PM; Lewanga, M; Alberti, K; McLarty, DG. Outlook for survivors of childhood in sub-Saharan Africa: adult mortality in Tanzania. BMJ 1996, 312, 216–220. [Google Scholar]
- Unwin, N; Mugusi, F; Aspray, T; Whiting, D; Edwards, R; Mbanya, JC; Sobgnwi, E; Rashid, S; Alberti, K. Tackling the emerging pandemic of non-communicable diseases in sub-Saharan Africa: The essential NCD health intervention project. Public Health 1999, 113, 141–146. [Google Scholar]
- Ministry of Health and AMMP Team. Policy Implications of Adult Morbidity and Mortality, End of Phase 1 Report Summary; Technical Report No. 1; Tanzania Ministry of Health: Dar es Salaam, Tanzania, 1997. [Google Scholar]
- Ministry of Health. Adult Morbidity and Mortality Project (AMMP) The Policy Implications of Tanzania’s Mortality Burden, Volume 1 A Ten-Year Community-Based Perspective; Tanzania Ministry of Health: Dar es Salaam, Tanzania, 2002. [Google Scholar]
- Lewis, G; Pelosi, A; Araya, RC; Dunn, G. Measuring psychiatric disorder in the community: a standardised assessment for use by lay interviewers. Psychol. Med 1992, 22, 465–489. [Google Scholar]
- Bebbington, PE; Nayani, T. The psychosis screening questionnaire. Int. J. Methods Psychiatr. Res 1995, 5, 11–20. [Google Scholar]
- Saunders, JB; Aasland, OG; Babor, TF; de la Fuente, JR; Grant, M. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption II. Addiction 1993, 88, 791–804. [Google Scholar]
- Jenkins, R; Mbatia, J; Singleton, N; White, B; Whiting, D. Psychotic symptoms and risk factors in Tanzanian urban surveillance sites of varying levels of poverty. Int J Environ Res Public Health 2010, (in press).. [Google Scholar]
- Lewis, G. Computerized assessments of psychiatric disorder using PROQSY. J. R. Soc. Med 1992, 85, 403–406. [Google Scholar]
- Jenkins, R; Bebbington, P; Brugha, T; Farrell, M; Gill, B; Lewis, G; Meltzer, H; Petticrew, M. The National Psychiatric Morbidity Surveys of Great Britain—Strategy and methods. Psychol. Med 1997, 27, 765–774. [Google Scholar]
- Meltzer, H; Gill, B; Petticrew, M; Hinds, K. OPCS Survey of Psychiatric Morbidity: Report 1. The Prevalence of Psychiatric Morbidity among Adults Ages 16–64 Living in Private Households in Great Britain; HMSO: London, UK, 1995. [Google Scholar]
- Singleton, N; Bumpstead, R; O’Brien, M; Lee, A; Meltzer, H. Psychiatric Morbidity among adults living in private households, 2000. Int. Rev. Psychiatry 2003, 15, 65–73. [Google Scholar]
- Patel, V; Kirkwood, BR; Pednekar, S; Weiss, H; Mabey, D. Risk factors for common mental disorders in women: Population-based longitudinal study. Br. J. Psychiatry 2006, 189, 547–555. [Google Scholar]
- Patel, V; Mann, A. Etic and emic criteria for non-psychotic mental disorder: a study of the CISR and care provider assessment in Harare. Soc. Psychiatry Psychiatr. Epidemiol 1997, 32, 84–89. [Google Scholar]
- Wickramasinghe, SC; Rajapakse, L; Abeysinghe, R; Prince, M. The Clinical Interview Schedule-Revised (CIS-R): modification and validation in Sri Lanka. Int. J. Methods Psychiatr. Res 2002, 11, 169–177. [Google Scholar]
- Ngoma, MC; Prince, M; Mann, A. Common mental disorders among those attending primary health clinics and traditional healers in urban Tanzania. Br. J. Psychiatry 2003, 183, 349–355. [Google Scholar]
- World Health Organization. International Statistical Classification of Diseases and Related Health Problems. Tenth Revision; World Health Organization: Geneva, Switzerland, 1993. [Google Scholar]
- Jenkins, R; Lewis, G; Bebbington, P; Brugha, T; Farrell, M; Gill, B; Meltzer, H. The National Psychiatric Morbidity Surveys of Great Britain—Initial Findings from the Household Survey. Psychol. Med 1997, 27, 775–790. [Google Scholar]
- Singleton, N; Meltzer, H; Gatward, R; Coid, J; Deasy, D. Psychiatric Morbidity among Prisoners in England and Wales: A Survey Carried Out in 1997 by the Social Survey Division of ONS on Behalf of the Department of Health; The Stationery Office: London, UK, 1998. [Google Scholar]
- Breeze, E; Maidment, A; Bennett, N; Flatley, J; Carey, S. Health Survey for England, 1992; HMSO: London, UK, 1994. [Google Scholar]
- Singleton, N; Bumpstead, R; O’Brien, M; Lee, A; Meltzer, H. Psychiatric Morbidity among Adults Living in Private Households, 2000; TSO: London, UK, 2001. [Google Scholar]
- Brugha, T; Bebbington, PE; MacCarthy, B; Potter, J; Sturt, E; Wykes, T. Social networks, social support and the type of depressive illness. Acta Psychiatr. Scand 1987, 76, 664–673. [Google Scholar]
- Brugha, T; Wing, J; Brewin, C; MacCarthy, B; Lesage, A. The relationship of social network deficits with deficits in social functioning in long-term psychiatric disorders. Soc. Psychiatry Psychiatr. Epidemiol 1993, 28, 218–224. [Google Scholar]
- Statistical Package for Social Sciences; , Windows 15; SPSS Inc: Chicago, IL, USA, 2006.
- Institute of Medicine. Neurological, Psychiatric, and Developmental Disorders: Meeting the Challenge in the Developing World; National Academy Press: Washington, DC, USA, 2001. [Google Scholar]
- Kessler, R; Angermeyer, M; Anthony, J; De Graaf, R; Demyttenaere, K; Gasquet, I; De Girolamo, G; Gluzman, S; Gureje, O; Haro, J; Kawakami, N; Karam, A; Levinson, D; Medina Mora, M; Oakley Browne, M; Posada-Villa, J; Stein, D; Tsang, c; Aguilar-Gaxiola, S; Alonso, J; Lee, S; Heeringa, S; Pennell, B; Berglund, P; Gruber, M; Petukhova, M; Chatterji, S; Üstün, T. Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization’s World Mental Health Survey Initiative. World Psychiatry 2007, 6, 168–176. [Google Scholar]
- Gureje, O; Lasebikan, VO; Kola, L; Makanjuola, VA. Lifetime and 12-month prevalence of mental disorders in the Nigerian Survey of Mental Health and Well-Being. Br. J. Psychiatry 2006, 188, 465–471. [Google Scholar]
- Amoran, O; Lawoyin, T; Lasebikan, V. Prevalence of depression among adults in Oyo State, Nigeria: A comparative study of rural and urban communities. Aust. J. Rural Health 2007, 15, 211–215. [Google Scholar]
- Jenkins, R; Bebbington, P; Brugha, TS; Farrell, M; Lewis, G; Meltzer, H. British Psychiatric Morbidity Survey. Br. J. Psychiatry 1998, 173, 4–7. [Google Scholar]
- Lima, MS; Beria, JU; Tomasi, E; Conceicao, AT; Mari, JJ. Stressful life events and minor psychiatric disorders: an estimate of the population attributable fraction in a brazilian community-based study. Int. J. Psychiatry Med 1996, 26, 211–222. [Google Scholar]
- Patel, V; Todd, C; Winston, M; Gwanzura, F; Simunyu, E; Acuda, W; Mann, A. Common mental disorders in primary care in Harare, Zimbabwe: associations and risk factors. Br. J. Psychiatry 1997, 171, 60–64. [Google Scholar]
- Tafari, S; Aboud, FE; Larson, CP. Determinants of mental illness in a rural Ethiopian adult population. Soc. Sci. Med 1991, 32, 197–201. [Google Scholar]
- Havenaar, JM; Geerlings, MI; Vivian, L; Collinson, M; Robertson, B. Common mental health problems in historically disadvantaged urban and rural communities in South Africa: prevalence and risk factors. Soc. Psychiatry Psychiatr. Epidemiol 2008, 43, 209–215. [Google Scholar]
- Patel, V; Araya, R; de Lima, M; Ludermir, A; Todd, C. Women, poverty and common mental disorders in four restructuring societies. Soc. Sci. Med 1999, 49, 1461–1471. [Google Scholar]
- Bondestam, S; Garssen, J; Abdulwakil, AI. Prevalence and treatment of mental disorders and epilepsy in Zanzibar. Acta Psychiatr. Scand 1990, 81, 327–331. [Google Scholar]
- Gureje, O; Obikoya, B; Ikuesan, BA. Prevalence of specific psychiatric disorders in an urban primary care setting. East Afr. Med. J 1992, 69, 282–287. [Google Scholar]
- Dhadphale, M; Ellison, RH. The frequency of mental disorders in the outpatients of two Nyanza hospitals. Cent. Afr. J. Med 1983, 29, 29–32. [Google Scholar]
- Ndetei, DM; Muhangi, J. The prevalence and clinical presentation of psychiatric illness in a rural setting in Kenya. Br. J. Psychiatry 1979, 135, 269–272. [Google Scholar]
- Husain, N; Creed, F; Tomenson, B. Depression and social stress in Pakistan. Psychol. Med 2000, 30, 395–402. [Google Scholar]
- Hamad, R; Fernald, LCH; Karlan, DS; Zinman, J. Social and economic correlates of depressive symptoms and perceived stress in South African adults. J. Epidemiol. Community Health 2008, 62, 538–544. [Google Scholar]
- Brugha, T; Jenkins, R; Bebbington, P; Meltzer, H; Lewis, G; Farrell, M. Risk factors and the prevalence of neurosis and psychosis in ethnic groups in Great Britain. Soc. Psychiatry Psychiatr. Epidemiol 2004, 39, 939–946. [Google Scholar]
- Patel, V; Kleinman, A. Poverty and common mental disorders in developing countries. Bull. World Health Organ 2003, 81, 609–615. [Google Scholar]
- Baingana, F; Dabalen, A; Menye, E; Prywes, M; Rosholm, M. Mental Health and Socio-Economic Outcomes in Burundi, HNP Discussion paper; The World Bank: Washington, DC, USA, 2004. [Google Scholar]
- Abeyasekera, S; Ward, P. Models for Predicting Expenditure per Adult Equivalent (for AMMP surveillance sentinel sites); Tanzanian Ministry of Health: Dar es Salaam, Tanzania, 2002. [Google Scholar]
- Broadhead, JC; Abas, MA. Life events, difficulties and depression among women in an urban setting in Zimbabwe. Psychol. Med 1998, 28, 29–38. [Google Scholar]
- Bebbington, P; Wilkins, S; Jones, P; Foerster, A; Murray, R; Toone, B; Lewis, S. Life events and psychosis. Initial results from the Camberwell Collaborative Psychosis Study. Br. J. Psychiatry 1993, 162, 72–79. [Google Scholar]
- Das, J; Do, Q-T; Friedman, J; McKenzie, D; Scott, K. Mental health and poverty in developing countries: Revisiting the relationship. Soc. Sci. Med 2007, 65, 467–480. [Google Scholar]
- Lund, C; Breen, A; Flisher, AJ; Kakuma, R; Corrigall, J; Joska, JA; Swartz, L; Patel, V. Poverty and common mental disorders in low and middle income countries: A systematic review. Soc Sci Med 2010, (in press). [Google Scholar]
- Broadhead, J; Abas, M; Sakutukwa, G; Chigwanda, M; Garaura, E. Social support and life events as risk factors for depression among women in an urban setting in Zimbabwe. Soc. Psychiatry Psychiatr. Epidemiol 2001, 36, 115–122. [Google Scholar]
- Sproston, K; Nazroo, J. In Ethnic Minority Psychiatric Illness Rates in the Community (EMPIRIC)—Quantitative Report; National Centre for Social Research, Department of Epidemiology and Public Health, the Royal Free and University College Medical School. London, UK, 2002. [Google Scholar]
Saba Saba n = 418 (%) | Ilala n = 481 (%) | Unadjusted odds ratio (95% CI) | P value (χ2) | |
---|---|---|---|---|
Gender | ||||
Male | 44 | 43 | 1.00 | |
Female | 56 | 57 | 1.04 (0.80–1.36) | 0.760 |
Age | ||||
16–24 | 32 | 29 | 1.00 | |
25–34 | 34 | 34 | 1.11 (0.80–1.54) | |
35+ | 34 | 37 | 1.21 (0.88–1.68) | 0.508 |
Marital status | ||||
Married/cohabitating | 55 | 56 | 1.00 | |
Single | 38 | 36 | 0.93 (0.71–1.23) | |
Widowed/divorced/separated | 8 | 9 | 1.16 (0.71–1.89) | 0.687 |
Relationship to household head | ||||
Head | 35 | 45 | 1.00 | |
Spouse/partner | 32 | 33 | 0.81 (0.59–1.11) | |
Other | 34 | 23 | 0.52 (0.38–0.73) | <0.001 |
Ethnic group | ||||
Black African | 98 | 88 | 1.00 | |
Other | 2 | 12 | 7.6 (3.47–17.09) | <0.001 |
Employment status | ||||
Working | 32 | 39 | 1.00 | |
Unemployed | 9 | 3 | 0.26 (0.13–0.51) | |
Economically inactive | 59 | 58 | 0.81 (0.60–1.08) | <0.001 |
Own/rent accommodation | ||||
Owns | 49 | 41 | 1.00 | |
Rents | 48 | 55 | 1.35 (1.03–1.77) | |
Rent free | 2 | 4 | 1.99 (0.90–4.38) | 0.036 |
Type of accommodation | ||||
Whole house | 46 | 41 | 1.00 | |
Rooms/flat/other | 54 | 59 | 1.24 (0.95–1.62) | 0.107 |
Age left full time education | ||||
13 or under/Never went | 8 | 5 | 1.00 | |
14–16 | 38 | 38 | 1.69 (0.94–3.07) | |
17 or 18 | 24 | 24 | 1.69 (0.91–3.12) | |
19+ yrs | 20 | 27 | 2.32 (1.25–4.30) | |
Still at school | 10 | 6 | 1.02 (0.49–2.11) | 0.012 |
Income | ||||
Yes | 44 | 41 | 1.00 | |
No | 55 | 59 | 1.14 (0.87–1.50) | 0.349 |
Perceived social support | ||||
Severe lack | 21 | 21 | 1.00 | |
Moderate lack | 37 | 34 | 0.94 (0.65–1.38) | |
No lack | 41 | 44 | 1.08 (0.75–1.56) | 0.708 |
Size of Primary Social support group | ||||
0–3 | 14 | 15 | 1.00 | |
4–8 | 42 | 49 | 1.12 (0.75–1.67) | |
9 or more | 44 | 36 | 0.79 (0.53–1.18) | 0.408 |
Number of life events | ||||
None | 56 | 72 | 1.00 | |
1 | 26 | 21 | 0.61 (0.44–0.84) | |
2 | 12 | 6 | 0.37 (0.23–0.61) | |
3+ | 7 | 3 | 0.28 (0.14–0.56) | <0.001 |
Prevalence (Per 1,000 in last 6 months) | Temeke | Ilala | Combined |
---|---|---|---|
Men | 38 | 14 | 25 |
Women | 43 | 29 | 36 |
All Adults | 41 | 23 | 31 |
Sample size | Prevalence of CMD (%) | Unadjusted odds ratio (95% CI) | Adjusted odds ratio (95% CI) | |
---|---|---|---|---|
Gender | ||||
Male | 393 | 2.5 | 1.00 | |
Female | 506 | 3.6 | 1.41 (0.65–3.10) | |
Age | ||||
16–24 | 275 | 4.7 | 1.00 | |
25–34 | 308 | 3.2 | 0.68 (0.29–1.57) | |
35+ | 316 | 1.6 | 0.32 (0.11–0.92) | |
Marital Status | ||||
Married/cohabitating | 495 | 2.4 | 1.00 | |
Single | 327 | 4.0 | 1.67 (0.75–3.70) | |
Widowed/divorced/separated | 75 | 4.0 | 1.68 (0.46–6.09) | |
Relationship to household head | ||||
Head | 359 | 0.6 | 1.00 | |
Spouse/partner | 290 | 4.5 | 8.38 (1.88–37.43)* | |
Other | 250 | 5.2 | 9.79 (2.19–43.78)* | |
Ethnic group | ||||
Black African | 834 | 3.1 | 1.00 | |
Other | 63 | 3.2 | 1.02 (0.24–4.39) | |
Employment status | ||||
Working | 300 | 1.7 | 1.00 | |
Unemployed | 49 | 10.2 | 6.71 (1.87–24.10)* | |
Economically inactive | 496 | 3.6 | 2.22 (0.82–6.05) | |
Own/rent accommodation | ||||
Owns | 403 | 4.0 | 1.00 | |
Rents | 463 | 2.6 | 0.64 (0.30–1.38) | |
Rent free | 29 | 0.0 | – | |
Type of accommodation | ||||
Whole house | 386 | 3.4 | 1.00 | |
Rooms/flat/other | 510 | 2.9 | 0.87 (0.41–1.85) | |
Age left full time education | ||||
13 or under/Never went | 52 | 1.9 | 1.00 | |
14–16 | 337 | 3.0 | 1.56 (0.20–12.44) | |
17+ years | 420 | 2.9 | 1.5 (0.91–11.78) | |
Income | ||||
Yes | 354 | 4.5 | 1.00 | |
No | 476 | 2.3 | 0.50 (0.23–1.09) | |
Perceived social support | ||||
Severe lack | 173 | 2.1 | 1.00 | |
Moderate lack | 288 | 3.1 | 1.36 (0.41–4.49) | |
No lack | 341 | 4.1 | 1.81 (0.59–5.58) | |
Size of Primary Social support group | ||||
0–3 | 130 | 1.5 | 1.00 | |
4–8 | 411 | 2.9 | 1.92 (0.43–8.71) | |
9 or more | 358 | 3.9 | 2.6 (0.58–11.62) | |
Number of life events | ||||
None | 576 | 0.7 | 1.00 | 1.00 |
1 | 206 | 4.9 | 7.30 (2.26–23.53)* | 7.22 (2.24–23.28)* |
2 | 46 | 6.6 | 10.07 (2.64–38.37)* | 9.91 (2.60–37.80)* |
3+ | 41 | 22.0 | 40.22 (11.75–137.66)** | 39.83 (11.06–136.78)** |
Sample size | Prevalence of CMD (%) | Unadjusted odds ratio (95% CI) | Adjusted odds ratioa (95% CI) | |
---|---|---|---|---|
Health risks | ||||
No | 815 | 2.7 | 1.00 | |
Yes | 84 | 7.1 | 2.77 (1.09–7.04)* | |
Relationship problems | ||||
No | 851 | 2.1 | 1.00 | 1.00 |
Yes | 48 | 20.8 | 12.18 (5.27–28.17)*** | 8.39 (3.39–20.76)*** |
Income instability | ||||
No | 805 | 1.7 | 1.00 | 1.00 |
Yes | 94 | 14.9 | 9.89 (4.55–21.48)*** | 6.63 (2.91–15.12)*** |
Death of a loved one | ||||
No | 702 | 2.1 | 1.00 | 1.00 |
Yes | 197 | 6.6 | 3.24 (1.51–6.92)** | 2.31 (1.01–5.25)* |
Legal issues | ||||
No | 859 | 2.7 | 1.00 | |
Yes | 40 | 12.5 | 5.19 (1.86–14.47)** |
Country | Author | Setting | Number | Measure | Prevalence |
---|---|---|---|---|---|
Lesotho | Hollifield et al. 1990 | Rural | 356 | DIS | 23.5% F 14.7% M |
Zimbabawe | Abas & Broadhead, 1997 | Urban | 172 | SSQ | 15.7% F 1 month, 30.8% F 1 year |
South Africa | Haavenaar et al. 2008 | Periurban | 209 | SRQ | 34.9% M and F |
South Africa | Haavenaar et al. 2008 | Rural | 222 | SRQ | 27.0% M and F |
South Africa | Hamad et al. 2008 | Urban | 257 | CES-D | 64.5% F, 50.4 % M |
Nigeria | Gureje et al. 2006 | Probability sample of 8 states | 4,984 | CIDI | 12.1% life time; 5.8% 12 month prevalence M and F |
Ethiopia | Tafari et al. 1991 | Rural | 2,000 | SRQ | 11.2% M and F |
Uganda | Orley and Wing 1979 | Rural | PSE | ||
Sudan | Rahim and Cederblad | Urban | SRQ/DSM III | 16.6% M and F |
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Jenkins, R.; Mbatia, J.; Singleton, N.; White, B. Common Mental Disorders and Risk Factors in Urban Tanzania. Int. J. Environ. Res. Public Health 2010, 7, 2543-2558. https://doi.org/10.3390/ijerph7062543
Jenkins R, Mbatia J, Singleton N, White B. Common Mental Disorders and Risk Factors in Urban Tanzania. International Journal of Environmental Research and Public Health. 2010; 7(6):2543-2558. https://doi.org/10.3390/ijerph7062543
Chicago/Turabian StyleJenkins, Rachel, Joseph Mbatia, Nicola Singleton, and Bethany White. 2010. "Common Mental Disorders and Risk Factors in Urban Tanzania" International Journal of Environmental Research and Public Health 7, no. 6: 2543-2558. https://doi.org/10.3390/ijerph7062543