Although clinicians only detect depression in about 1% of Kenyan children, the real rate of depression is thought to be closer to 40%. Obviously, there is something wrong with the depression detection and diagnostic system in Kenya if 39 out of every 100 children have depressive symptoms that are not being detected, and therefore not being treated. These numbers are striking. Depression is a debilitating enough disorder in itself, but when we look at the other things that depression can lead to in adulthood – suicidal tendencies, exacerbation of other physical illnesses, other psychiatric illness, etc. – it is all the more important to treat depression early in life and prevent further illness.
A study of adults in Kenya found that 42% of an inpatient and outpatient sample were diagnosed with depression, suggesting that there are similar rates of depression among children and adults. However, I believe that if this mental illness were screened for and treated early in life, we could not only bring down the rate of depression in children, but also have a preventive effect and lower the depression rate in adults as well. In order to have this effect, Kenya needs to drastically change its screening procedures in order to detect depression in the many children whose symptoms go unnoticed.
It is astounding to think that 67% of the world’s cases of depression are located in Sub-Saharan Africa. However, even though the vast majority of cases are located there, an overwhelming majority of diagnosis and treatment occurs in developed nations, such as the United States, where rates of childhood depression are MUCH lower. That does not make any sense. Yes, the United States is a richer country and can afford to spend more money on treatment, but that does not mean that the children in Kenya should suffer from mental illness simply because of a lack of resources.
In my policy memo, I proposed a plan to help increase the amount of children correctly diagnosed with depression by making a change in Kenya’s diagnostic procedures. Currently, children are typically only diagnosed upon entrance to a hospital or doctors office, and therefore those children without other presenting symptoms are not able to receive a diagnosis or proper treatment. Therefore, I think that it should be mandatory to screen for depression in schools across the country. A depression screening tool, the Patient Health Questionnaire-9, has been determined to be both valid and reliable in a sample of Kenyan patients. Therefore, if teachers administered this questionnaire to their students several times a year and assessed the results, they could accurately determine which children are showing depressive symptoms and which are at risk for developing more symptoms in the future. Teachers could then contact the parents of these students and refer them for a clinical diagnosis and treatment.
Although I can understand the idea that exposing children without depressive symptoms to such clinical terminology may be unfair, we must consider the fact that almost half of the children in school have depression and do not know it. They are suffering from this disorder with nowhere to turn and no one to look to for help. By diagnosing their symptoms and referring them to treatment, teachers can help make a huge difference in the lives of many children throughout the country. However, in order for this plan to actually be effective, it is necessary to increase the number of doctors and mental health workers available to treat these children, and I recognize that this is an issue. Therefore, Kenya must actively train more healthcare workers in cognitive behavioral therapy and other treatments for depression in order to lower the prevalence rates of depression in this country. Depression has proven to be a very treatable disorder – we should give Kenya’s children a chance to grow up without this disorder by screening them early and eliminating their depression before adulthood.
References
Ndetei, D. M., Khasakhalam, L. I., Mutiso, V. N., & Mbwayo, A. W. (2009). Recognition of depression in children in general hospital-based paediatric units in Kenya: practice and policy implications. Annals of General Psychiatry, 8 (25).
Ndetei, D. M., Khasakhala, L., Nyabola, L., Ongecha-Owuor, F., Seedat, S., Mutiso, V. et al. (2008). The prevalence of anxiety and depression symptoms and syndromes in Kenyan children and adolescents. Journal of Child and Adolescent Mental Health, 20(1), 33-51.
Depression Screening Tool Works in Resource Poor Countries, Medical News Today. 25 September 2009. http://www.medicalnewstoday.com/articles/140235.php.
Ndetei, D. M., Khasakhala, L. I., Kuria, M. W., Mutiso, V. N., Ongecha-Owuor, F. A. et al. (2009). The prevalence of mental disorders in adults in different level general medical facilities in Kenya: a cross-sectional study. Annals of General Psychiatry, 8(1).
Depression Leads to Worst Health, BBC News. 7 September 2007. http://news.bbc.co.uk/2/hi/health/
6981678.stm
Monahan, P. O., Shacham, E., Reece, M., Kroenke, K., Owino Ong’or, W., Omollo, O., et al. (2008). Validity/Reliability of PHQ-9 and PHQ-2 Depression Scales among adults living with HIV/AIDS in Western Kenya. Journal of General Internal Medicine, 24(2), 189-197.
I am just curious why depression is so common in Kenya? What is causing this? Is it the same for all socioeconomic groups in Kenya?
I do agree that the teachers can play a very important role in the diagnosis of depression. Perhaps teachers should also receive some training to help them better identity mental illness.
I too am curious about the high rates of depression in Kenya – I was astonished when I first read these articles. I would be interested to look at the differences in socioeconomic status, because it has been shown, at least in developing countries, that this has an effect on depression rates. Hopefully more research will be done in this area so that better treatments can be developed.
Thank you for reading my post!
40% of children?! That is completely overwhelming. I know that during our mental health lecture one statistic that stood out for me was the fact that those who suffered severe mental illness lived, on average, 25 years less than their mentally-healthy counterparts. So, for this prevalence to be observed in children seems particularly significant. I know that, when we speak of depression, we don’t always mean a ‘severe mental illness,’ but I wonder if there is a connection at all to other diseases. As our guest lecturer pointed out, depression creates a higher risk for other diseases (such as diabetes, cardiovascular disease, HIV, TB etc). I have to admit, I am a bit skeptical of that ‘fact’ (are we mixing up causation?), but even if there is some truth to that statement, there is some cause for alarm on behalf of Kenyan children.