Keywords: Deression, Major Depressive Disorder, neurotransmitters, hormones, Adverse Childhood Experiences, social isolation, Nigeria.
Why Depression is High in Nigeria. What is the rate of depression in Nigeria? Are there Nigerian factors that bring this about?
Depressive disorders are mood disorders that presents with sadness, loss of interest in what one once enjoyed and loss of energy. They negatively affect the way a person feels, behave, and think. It must last at least 2 weeks. And it must affect the person’s function at home, at work/school and socially.
What is the rate of depression in Nigeria?
Depressive disorders in Nigeria affect all people, all genders, all ages, all ethnicity and all socioeconomic status. But it is more among the poor people and uneducated. It affects women more than men. In Nigeria depression is more among married women. The prevalence of depressive disorders in Nigeria is 3.9%. This is with a total Nigerian population of 211,400,708, thus translates to having about 8 million people in Nigeria with depressive disorders, in the general population. Nine percent of 45 million Nigerian adolescents have major depressive disorder. At a university in Zaria, Nigeria, about 58% of students, had depression.
The Nigerian factors in the causes and risk of depression.
The causes are due to the combinations of biological, psychological and social factors.
1. Biological factors:
a. Genetic –
Depression runs in the family. If any or both parents suffer from any of the depressive disorders, the offspring may also suffer from it. There is no single gene that is responsible for depression. It is due to a combination of genes.
b. The neurotransmitters –
These are chemicals in the brain that the neurons (brain cells) use to communicate with each other. Examples of these neurotransmitters are, dopamine, norepinephrine, serotonin, glutamate, Gama amino butyric acid, acetyl choline, etc. In depressive disorders, some of these neurotransmitters levels are low in the brain. For example, serotonin, norepinephrine, dopamine, etc. are low. So when this occur, the communication among the brain cells become reduced.
c. Cortisol –
This is a hormone produced during stress. Under prolonged stress, cortisol will cause destruction of brain neurons and prevent the production and growth of new ones. In a mother who is suffering from depression, cortisol can predispose to damage of the fetal brain cells.
d. Abnormal levels of other hormones –
These include estrogen and thyroid hormones. The reduced level of estrogen seen during menstrual cycle (two weeks before menses), is a risk factor. Low level of estrogen after deliver and during menopause is also a risk factor. So are low levels of thyroid hormones.
e. Abnormalities in certain brain regions –
Certain areas of the brain are abnormal during depression. The amygdale, which is responsible for emotions, becomes enlarged. The hippocampus, which is needed for memory and remembering, becomes smaller. The prefrontal cortex used for thinking, judgment and planning, reduces in size. There are also connectivity problems from one brain area to another.
f. Trauma to certain part of the brain –
Injuries to certain parts of the can predispose someone to have depression. This trauma can occur while the baby is still in the womb, during delivery, during infancy and childhood or adulthood. Traumatic brain injuries are common in Nigeria. Causes include, motor car accidents, falls (from upstairs, career, at home, etc.), hit on the head (assaults), birth trauma, etc. Prolonged labor and child delivery problems, can affect the baby’s brain. This is more probable, when the baby’s head cannot pass through the birth canal. It can also occur during delivery with forceps and vacuum in an inexperienced hands. In Nigeria, there is high percentage of deliveries being carried out by inexperienced personnel. In an accident and emergency section of a teaching hospital in Nigeria, about 40% of all those admitted, had head injuries due to trauma. Head trauma due to road accidents is quite high in Nigeria.
g. Abuse of substances –
Those who abuse substances like cannabis (Indian hemp), cocaine, codeine, alcohol, tobacco, caffeine, are also at risk of suffering depressive disorders. Alcohol and cannabis are the most drugs of abuse in Nigeria. Alcohol abuse among tanker drivers in Lagos, Nigeria, is about 72%.
h. Physical conditions –
Medical conditions such as heart disease, hypertension, diabetes, cancer, HIV, etc. are all risk factors to the development of depressive disorders. And so are cancers, peptic ulcers, asthma, and other chronic conditions. Even the recent COVID 19, is a risk factor for depressive disorders. This is for those currently suffering from it, their relations and those who have recovered from it.
2. Psychological factors:
a. Stress –
The stress from work, school, etc. can predispose someone to any of the depressive disorders. The stress level in Nigeria is quite high. For example, 86% of medical students in one university in Nigeria feel stressed from their course. In general, about 69% of health care workers in Nigeria believe that they are over worked. Even among bankers in Lagos, Nigeria, 67% were moderately stressed, and 25% were highly stressed.
b. Adverse Childhood Experiences (ACEs) –
These occur when the child is physically and psychologically abused and neglected. It also includes child sexual abuse. ACEs include prolonged witnessing of violence in the community. In Nigeria, physical abuse is used as disciplinary methods. These include beating, slapping, knock on the head, etc. Nigerians use psychological abuse such as cursing, belittling, name calling, criticizing, etc. as disciplinary measures. There is high rate of sexual abuse and rape in Nigeria. Up to 38% of child sexual abuse occurs in Nigeria, although majority of the cases are not reported. Witnessing community violence, is one of the ACEs. Recently, there are reports of children being kidnapped from their schools, especially by Boko Haram, a terrorist group. Divorce in Nigeria is also on the increase and can predispose children to depressive disorders. Death of a parent and parental imprisonment, are risk factors. Domestic violence, where a pregnant mother is a victim, can negatively affect the developing brain of the unborn child. And predisposes the child when born and later in life to depressive disorders. As at 2012, the percentage of domestic violence in Nigeria was as high as 31%.
c. Loss –
The loss in any form, like the loss of a loved one, job, property, and even school examination failure are all risk factors.
3. Social and economic factors:
a. Poverty –
About forty percent of Nigerian live below poverty line. This means that approximately 83 million Nigerians live below poverty line. So 83M Nigerians earn less than one hundred and thirty seven thousand, four hundred Naira (N137, 400.00) per year. They spend less than three N376 in a day to feed their families, basic needs, family health, school, etc. One can then easily understand why poverty is a risk factor for depressive disorder. The current figure of unemployment in Nigeria is above 40%. Without earning any money, financial needs cannot be met for the individual, the family and the community. This can lead to depression.
b. Social isolation of the elderly –
Previously, the extended family system was very much practiced in Nigeria, whereby the parents, children, grandparents and other members of the family lived together. But civilization came with urbanization and the young people had to move away from the rest of the family members into the cities. The elderly are thus left behind in the villages. The poor financial situation in the country, has increased the social isolation of the elderly, because the young people can no more meet their obligations. The elderly thus are at high risk of suffering from depressive disorders. Also, there is no functional care policy for the elderly in Nigeria. Retirees in Nigeria face a lot of challenges, which includes losing their social network. This can lead to isolation and depression, with a prevalence rate of about 22%.
c. Others –
Divorce is on the increase as stated above and can predispose the adult to depressive disorders. Marital dissolution is highest in south south and northeastern Nigeria, but lowest in southeastern part. The rate of separations between married couples has increased by 14%.
Intimate Partner Violence, where by women are mostly the victims, occur a lot in Nigeria. This is because in Nigeria, men are viewed as superior and women as inferior. On daily basis in Nigeria, women are beaten and punished for supposed transgressions. In the southeast, the prevalence is as high as 79%.
Wars and strife are the uncertainties that presently plague Nigeria with Boko Haram, farmers/herders conflicts, kidnapping, etc. All these are all risk factors for depression in adulthood.
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