If you have been experiencing a persistently sad or anxious mood, feeling restless and irritable, sleeping and eating too little or too much, and have difficulty concentrating, you may be suffering from depression. This illness is also characterized by constant fatigue, feelings of guilt, a loss of interest in activities that were formerly enjoyed, thoughts of suicide and in some cases, physical symptoms that do not respond to treatment. There are various types of depression ranging from dysthymia (which is a milder chronic form, to major depression) but what is important to remember is that it is an illness that can be treated.
Although the prevalence of depression amongst black South Africans is largely uninvestigated due to problems relating to language and cultural differences, the studies that have been done indicate that the numbers are seriously high, with approximately 18% of black patients presenting at primary health care facilities being found to be suffering from depression. This may even be an underestimation of the figures, as it has been found that GP's fail to detect between 33% to 50% of depressive disorders in patients presenting to them. Dr Sebolelo Seape stated that “ most black patients tend to focus on the physical symptoms of depression rather than reporting how they feel emotionally”.
Depression does not discriminate on the basis of race. A person's cultural background may however play a large role in the way symptoms are reported and interpreted, and in how and if depression is recognised and appropriately treated. Prof. Dan Mkize believes that “for a long time, depression has been thought not to exist in and around Africans. The community needs to acquire tremendous knowledge concerning this disorder”.
Sometimes depression is mistakenly viewed as "normal" for certain groupings of people, for example older people, menopausal women, and people with chronic or terminal illnesses such as TB, cancer or AIDS. This incorrect assumption results in the unnecessary endurance of emotional pain for many people who might otherwise be successfully treated. In the past, many assumed that suffering is something that is intricately connected to being black. Informal urbanisation and political uncertainty in the preceding years have led to an increase in poverty, violence and disturbed marital and social relations amongst this population.
Studies have shown that there are certain factors that can predispose someone to developing depression, such as high amounts of environmental stress and a lower socioeconomic level. Although there are a number of other factors that are implicated, these two alone could account for much of the elevated prevalence of depression in the black community. The disadvantaged position of the majority of black South Africans as a result of previous discriminatory socioeconomic policies, is still a major social problem with dire consequences, one of which is the escalated occurrence of mental illness.
There are also certain cultural barriers that tend to predispose the black population in particular to depression. These include a mistrust of medical health professionals and a community reliance on the support of family during periods of emotional distress. This can cause a delay in diagnosis and consequently a delay in appropriate treatment, which can cause the depression to worsen and further complicate later recovery. This highlights the importance of the role of support groups, like the Depression and Anxiety Support Group, which can be reached on (011) 783-1474/6, in the bridging of this gap between community and mental health services.
Another function that support groups play in the fight against mental illness is one of education. It has been found that many believe depression to be merely " the blues" or a sign of personal weakness, rather than an illness. This attitude is especially prevalent in the black community, and especially where women are concerned. Black women are viewed as nurturers, caretakers and healers of other people, and are supposed to be strong. When a black woman is suffering from a mental illness the overwhelming opinion is that she is weak. This has serious implications, especially when one considers the fact that depression is found in women twice as often as in men, and that according to the American National Mental Health Association, the rate is 50% higher in African women than in Caucasian women.
Studies have also found that there is a high co-occurrence of depression and anxiety disorders, like generalized anxiety disorder, panic disorder and post-traumatic stress disorder. Increased psychic anxiety and a history of recent panic attacks have been demonstrated to be predictors of suicide in depressed patients. Symptoms of anxiety include worrying a lot, irritability, difficulty relaxing, insomnia, an exaggerated startle response and a variety of physical symptoms such as headaches, abdominal distress, a dry mouth, trembling, dizziness, sweating, urinary frequency and diarrhea. In a 1994 study conducted by Joubert, van Rensburg, Gagiano and Joubert, a strong link between PTSD and major depression was found. People who had experienced or witnessed catastrophies that were deemed to be outside the range of normal human experience, like gruesome minibus accidents, the burning of property, political street violence and intimidation, had a higher chance of developing depression.
They also found that depression is found mostly in young females who often present with various physical symptoms. This they attributed to the escalated levels of rape and social violence. Most of these women were found to be suffering from an anxiety disorder as well as depression.
All of this highlights the need to take cultural differences into account when considering a diagnosis of depression. A person's perception of an event is of utmost importance, for example, the death of a husband in western culture may not be considered an event that is outside of normal experience, while in this population it may easily mean hunger, poverty, insecurity and homelessness.
If you have a friend who is suffering from depression or feel you may be suffering yourself, speak to somebody. Many people find strength and support through their religious and spiritual communities or through a support group, but remember only a doctor or mental health professional can diagnose clinical depression and prescribe medication. Anti-depressant medications are not habit-forming and can provide relief. Remember not to stop your medication as soon as you feel better, since some medications can cause problems if stopped abruptly. Help is available and a better quality of life is within reach.