In Her Lifetime Female Morbidity and Mortality in Sub-Saharan Africa (1996) / Chapter Skim
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6 Mental Health Problems
6 Mental Health Problems
Pages 136-151
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From page 136... ...
The aim of this chapter is to provide a review of the current state of knowledge about women and psychiatric disorders in African countries, underlining the similarities and differences between the two sexes in the rate, phenomenology, course, and outcome of these disorders. With respect to the rates of occurrence, it is their similarity in the two sexes that is remarkable: as Table 6-1 indicates, the only psychiatric disorders that appear to impose a disproportionate and, in this instance, unique burden on Sub-Saharan females are those associated with pregnancy and the puerperium.
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From page 137... ...
A better understanding of changing rural lifestyles further helped to dispel the notion that African populations are free of stress and that their culture somehow protects them from the pressures that normally affect others. Despite this wider awareness, until recently many European and American observers held on to the notion that stressful situations have different, generally milder, consequences among African women than among women elsewhere.
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From page 138... ...
Several well-conducted epidemiologic studies from outside Africa have indeed shown that there are remarkable differences in the rates of occurrence of various mental disorders between the two sexes, with females generally showing higher incidence and prevalence rates compared with males. This result has been confirmed in a number of reviews (Dohrenwend and Dohrenwend, 1969, 1974; Goldman and Ravid, 1980; Gove and Tudor, 1973; Weissman and Klerman, 1977~.
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From page 139... ...
. On the whole, from epidemiologic studies carried out in a variety of countries and sociocultural settings throughout the world, it appears that there are significant gender differences in the rate of selected mental disorders when these are sorted by type, with an excess of males for some disorders and an excess of females for others.
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From page 140... ...
(The short report on the study does not specify how many people were actually interviewed.) The author found an overall prevalence rate for most common psychiatric disorders of 6.3 percent; females outnumbered males almost 4:1.
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From page 141... ...
While one analysis of the Ugandan data showed a significant excess of women with depressive disorders, however, this was largely accounted for by the exclusion from that analysis of subjects over 65 years of age: four of the eight men over age 65 in the group had a depressive disorder, but none of the seven women did. Adding the four men to the "depressed" sample served to narrow the gender gap, although the predominance of depressive symptoms among women persisted.
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From page 142... ...
Despite the possibility advanced by the authors that the rate was artificially low because of methodological limitations of the study, it is still the case that the Nigerian site reported more very acute onsets of schizophrenia than sites in developed countries, and many of these did not appear to have been related to stressful life events. This distinctive pattern remains to be investigated.
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From page 143... ...
When centers in developed and developing countries were taken separately, however, some suggestion of gender differences appeared. As shown in Table 6-2, females in the Ibadan site outnumbered males in the group with the best course (that is, single psychotic episode followed by complete remission; 60.5 percent versus 43.6 percent', while there was a relative predominance of males with poor course (two or more psychotic episodes with incomplete remissions between most of them; 16.4 percent versus 2.3 percent)
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From page 144... ...
also found a statistically significant excess of psychiatric morbidity among females compared with males, although it did not provide the actual numbers. In one study, the rate was exactly the same for the two sexes; in another three studies in the police force hospital, mentioned in the paper by Giel and Van Luijk (19691; in the study by Binitie (1981~; and in the WHO multisite study (Sartorius et al., 1993)
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From page 145... ...
145 Cal .
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From page 146... ...
The weighted prevalence rate for all psychiatric disorders mentioned above is much lower than the weighted rate of 27.8 percent reported from an earlier study conducted in a primary care clinic in Ibadan, and in which identical instruments for case detection were used (Gureje et al., 1992~. A number of factors may be responsible for this discrepancy.
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From page 147... ...
, who had found an association between psychiatric morbidity and marital separation; in their sample, 24 percent of pregnant Baganda women showed conspicuous psychiatric morbidity. In another careful investigation, 240 pregnant women consecutively attending an antenatal clinic in Nigeria over a period of eight weeks were assessed by a two-stage procedure, using the 30-item General Health Questionnaire (GHQ-30)
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From page 148... ...
Considerations of age aside, the limited data available seem to point to two conclusions: (1 J the magnitude of psychiatric morbidity in Africa is substantial and comparable to that found in developed countries; and (2) African women, despite their substantial burdens in various settings, do not seem to show the excess in rates of defined psychological disorders compared with males that have been recorded for women in developed countries.
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From page 149... ...
· There is a need to further investigate why women in Africa have the same, or perhaps fewer, psychiatric disorders, including depression, than men in Africa. It is still unclear whether this is the result of African men suffering from an excess of the disorder when compared with men in the developed world, or whether African women are somehow protected from mental disorders more than their counterparts in developed countries.
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From page 150... ...
1981. Psychiatric disorders of the puerperium in South African women of Nguni origin.
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From page 151... ...
1979. Psychiatric disorders in two African villages.
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