Depression

Statement of the problem

There are varied misconceptions on depression as a mental issue, especially in the South African context where multilingualism and multiculturalism exist. Depression is consequently a silent killer due to a number of factors. (1) Stigma and discrimination play an important role to prevent individuals from speaking out and seeking help in society. Stigma is a combination of three features, (a) a limited knowledge on a specific condition (b) negative attitudes, and (c) avoidance or exclusion of behaviours, of which the former feature explains the operational definition of discrimination (Thornicroft, 2006b; Corrigan, 2005; Thornicroft et al, 2007; Thornicroft, 2006). Individuals with depression are therefore afraid of being insulted, rejected, bullied, called names or excluded from social relationships based on their condition. At its extreme, stigma can drive individuals to physical violence. Physical violence is a huge challenge in South Africa due to the countries past history of violence and racial discrimination from the legacies of apartheid and colonialism (Laher, Cockcroft, 2013).

(2) Culture drives individuals with depression to deny help and speaking out in society. Cultural norms on mental health issues are based on gendered roles, in that women are taught to express their feelings and emotions, while men are taught to suppress their feelings and emotions in black South African communities. Culture, in this case, is an unfair and unjust practice on mental health issues.

(3) Education and knowledge of depression as a mental health issue is often limited in underprivileged communities. The varied misconceptions under limited education and knowledge are those of viewing depression as a possession of evil spirits or witchcraft in black South African communities. (Ashforth, 2002; 2004) acknowledged that limited attention on education around HIV/AIDS was given between these years, and (Pöhler, ‎2012) found that more attention on education around HIV/AIDS has widely shifted and educated in black South African communities from 2010-2012. These results have left the gap of education and knowledge on depression, with more focus on HIV/AIDS.

Depression is a global challenge which led a body of empirical research to conclude that unemployment amongst the youth is the leading cause of depression (Dooley, Catalano, Wilson, 1994; Nandi, et al., 2004; Lerner et al., 2015). Statistics South Africa (2005; 2015), reported that depression leads to suicide; that is, a person killing him/herself is as a result of depression. An estimated minimum of at about 23 suicides are caused by the youth between the ages of 20-39 years every hour, who make up 74% of the total unemployed population. The recent incidents of South African celebrities and university students in 2018, respectively are proof that depression is high amongst the youth.

It is therefore important to understand that depression is not related to witchcraft or cultural norms, It is a mental health problem which does not discriminate based on gender, race, ethnicity, sexual orientation, or place of birth, which also requires a multidisciplinary intervention from experienced professionals such as Social Workers, Counselling Psychologists, Clinical Psychologists, General Doctors or Church Pastors in South Africa.

Definition of depression and signs of depression

Depression has been defined in many ways by different authors or mental health professionals, which led depression to be a debatable topic both in the South Africa context and worldwide. According to the Medical Model of Health, depression is a mental health disorder caused by an unexpected change in an individual’s mood. These moods either include or exclude feelings of sadness, hopelessness, worthlessness, anger, frustration, helplessness, suicidal thoughts, loneliness, loss of love, or sense of having failed in life. In a different view of depression, the Psycho-Social-Environmental Model of Health reported that depression can be caused by many factors such as psychological factors, social factors, and environmental factors.
● Psychological factors include those that have already been identified by the medical model of health such as an unexpected change in a person’s mood. In addition, signs of depression can include changes in sleeping habits, weight loss or weight gain, difficulty remembering, paying attention or making decisions or physical symptoms that don’t respond to treatment such as headaches, stomach pain, back pain or chest pains, despite being checked by a doctor.
● Depression can affect a person’s social life. An individual can separate him/herself from friends, family members, church work, and any other significant social relationships. Environmental factors include those that are beyond a person’s control such as a death of a close family member, traumatic events (witnessing a car accident or being involved in a car accident), witnessing a gunshot, unemployment amongst the youth, financial problems, retirement or legal problems.

What are self-help tips?

Self-help tips are those that an individual can use to cope with depressive symptoms. The following are one of the selected self-help tips reported by patients, and self-help tips are different from an individual to an individual.
● Relaxation. In order to ease up the stress either at home, work or school, take a break and relax. Go outside and take a walk.
● Exercise. You don’t need to go to the gym for exercise. Use what you have to exercise and relax when you are under pressure.
● Change of lifestyle. Don’t overwork yourself. Take it easy and try something new that is most exciting for you.
● Balanced diet. Not all individuals have access to a balanced diet due to the high rates of poverty and inequality in South Africa, especially child poverty and malnutrition in South Africa. However, it is advisable to have a balanced diet, limit junk foods and eat well to prevent tiredness and increase energy in the body and mind.
When and where to ask for professional help?
Note: Professional help is multidisciplinary, in that healing from depression requires mental health services from different professionals. If you have been experiencing feelings of depression for more than two weeks, it is a cry for help from the following recommended professionals;

A General Doctor

The main purpose of a general doctor is to admit, assess and diagnose depression. For example, a family history to access the symptoms of depression is done by a doctor. Factors such as medical illness (diabetes, HIV/AIDS, TB, Stroke, or Head Injuries) can cause depression. Having a close family member with depression can trigger the next family member into depression. Certain medications can cause depression or make depression worse. After a medical or family assessment has been made, the doctor is liable to diagnose and prescribe anti-depressants. 80% of people with depression will make a good recovery on antidepressants (SAGAD, 2014). It takes 2-3 weeks to start feeling better. It is very important to adhere to the medication in order to feel better. If the individual does not seem to function or cope with depression given the anti-depressants, patients are referred by doctors to social workers, counselling psychologists or clinical psychologists for further assistance.

One-on-one counselling

Social Workers, Clinical Psychologists, and Counselling Psychologists are available both in local and private clinics and hospitals to empower people with social skills and lifestyle skills to cope with depressive symptoms. Depression is treatable and requires patience and support from family members or close friends. These mental health professionals are trained to intervene with the individual and within the family, strengthen support and make the individual not to feel alone.
Church Pastors are responsible for supporting individuals to tap within their spiritual being and heal from depression. Depending on a person’s socialization in communities, Local Pastors are there to provide counselling and have been proven by patients to be helpful.
Support groups

Keyword ‘support’ groups are a very good way to get support and advice from people who already share the same feelings as you (Call SADAG 0800 21 22 23 for contacts in your area). Don’t give up, you are not alone.
What to do if a family member or friend has depression?

● Observe, observe and check on your family members and friends
● Do not panic, do not shout at them, and always support them by being there for them
● Don’t force them to talk about depression, always remember that they are those people who do not want to talk about their feelings. What to do? Suggest ways on how that person can get help in a caring manner. Always support that person emotionally.
Emergency Helpline Numbers by the South African Depression and Anxiety Group (Non-Profit organization, biggest in mental health intervention).

Suicide Crisis Helpline- 0800 567 567
Dr. Reddy’s Mental Health Helpline- 0800 21 22 23
24hr Substance Abuse Helpline- 0800 33 33 77
Police and Trauma Helpline- 0800 20 50 26
Discovery Medical Student Helpline- 0800 323 323
ADHD Helpline- 0800 55 44 33
For more info: Website: www.sagad.org

Download brochure for more information on depression at
http://www.sadag.org/images/brochures/Depression%20Brochure.pdf

References

Ashforth, A. (2002). An Epidemic of Witchcraft: The Implications of AIDS for the Post-Apartheid State. Abingdon: Carfax Publishing
Ashforth, A. (2004). “AIDS and Witchcraft in Post-Apartheid South Africa” in Anthropology in the Margins of the State. Veena Das Deborah Poole, eds. Santa Fe: School of American Research Press, 141 – 163.
Corrigan P. (2005). On the Stigma of Mental Illness. American Psychological Association: Washington, D.C.
Nandi A., Galea S., Tracy M., Ahern, J., Resnick H., Gershon, R., & Vlahov D (2004). Job loss, unemployment, work stress, job satisfaction, and the persistence of posttraumatic stress disorder one year after the September 11 attacks. National Institutes of Health, 10, 62-105
Laher, S., & Cockcroft, K. (2013). Psychological assessment in South Africa: research and applications. Wits University Press: Johannesburg, South Africa.
Pöhler, L. (2012). HIV and AIDS in the context of South African indigenous religious Discourse.
Stats SA. (2005). Mid-year population estimates 2015. Statistics South Africa, Pretoria.
Stats SA. (2015). Mid-year population estimates 2015. Statistics South Africa, Pretoria.
Thornicroft G. (2006a). Actions Speak Louder: Tackling Discrimination against People with Mental Illness. Mental Health Foundation: London.
Thornicroft G. (2006b). Shunned: Discrimination against People with Mental Illness. Oxford University Press: Oxford.
Thornicroft G. (2007). Most people with mental illness are not treated. Lancet, 370, 807-808.

BY: Nkhensani Baloyi
Qualified Social Worker