Uplifting guide to tackle depression, the sad, silent killer

WHO says Kenya has the fourth highest number of depressed people in Africa.

WHO says Kenya has the fourth highest number of depressed people in Africa. The approach used in treating depression will determine if the person will get out of the rut. PHOTO | FOTOSEARCH 

IN SUMMARY

  • A 2017 report by the World Health Organisation said Kenya had the fourth highest number of depressed people in Africa.
  • The report said 1.9 million Kenyans had depression-related problems in 2016 when the survey was done.
  • Leading in Africa was Nigeria where more than seven million were affected.

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A month after electronic dance music superstar Jim Bergling (Avicii) died, his family on Tuesday announced plans for his burial, saying his remains will be interred at a private ceremony.

As the Avicii brand fades out, the link between depression and his death is a topic that will be discussed for years to come, because his family had released a statement suggesting that the 28-year-old’s death on April 20 was due to suicide.

DEPRESSION

“Our beloved Tim was a seeker, a fragile artistic soul searching for answers to existential questions...  He really struggled with thoughts about meaning, life, happiness,” the family said in a statement six days after the DJ-cum-producer was found dead in his hotel room in Oman.

“He could not go on any longer,” it added.

That last statement has shocking parallels with one used by a relative of Zipporrah Wangui Wanguhu, a 20-year-old Kenyan woman who committed suicide in the US state of California on April 22.

“She... felt there wasn’t a way out of the pain she was living in,” the relative wrote on GoFundMe, an online fundraising platform.

Ms Wangui, who was a student at Newlight Senior Girls in Kitengela before moving to the US, was found dead in her room just hours after she had shared jovial moments with her nephews and nieces.

And on April 24, the decomposing body of Michael Gikonyo, a second year computer science student at Chuka University, was discovered hanging from a mango tree near the men’s hostel. It was the second suicide at the university in a span of three weeks.

So far-reaching is the law that a parent has no right to get their child’s university transcript without the child’s permission.

That law is being blamed for the December 2016 suicide of 19-year-old Graham Burton at Hamilton College.

The New York Times (NYT) reports that Graham, who hanged himself in his dorm room, had been a worry to his lecturers due to his behaviour, but they never informed his parents about it. They would learn about it from emails exchanged before his death.

Graham’s parents wrote an open letter to the college asking for a mandatory process to notify parents about any concerns on a student’s well-being noticed by anyone at an institution.

Depression is a silent killer in our midst. PHOTO | FOTOSEARCH 

SUICIDE

And on May 7, the High Court in the US state of Massachusetts cleared the Massachusetts Institute of Technology (MIT) of any liability in the 2009 suicide of Han Nguyen, a 25-year-old PhD student.

Mr Nguyen had jumped from a campus building and his family’s lawyers argued that two MIT professors and a dean were bound to stop the student from committing suicide. The court found that the university could do little when Mr Nguyen repeatedly refused offers of help, reports the NYT.

“In these circumstances, as a matter of law, a 25-year-old graduate student’s rights to privacy, autonomy, and self-determination were properly respected,” the court said.

It gets worse because at the University of Pennsylvania, 14 students have committed suicide since 2013, as reported by the New York Times.

Back home, a 2017 report by the World Health Organisation said Kenya had the fourth highest number of depressed people in Africa. The report said 1.9 million Kenyans had depression-related problems in 2016 when the survey was done.

Leading in Africa was Nigeria where more than seven million were affected, followed by Ethiopia with four million then the Democratic Republic of Congo with 2.8 million cases.

With such grim realities, Lifestyle spoke to counsellors and has come up with 10 factors that cause depression, the silent killer in our midst.

One of the counsellors contacted is Mr Lambert Oigara, a psychologist at Cognitive Behavioural Therapy (CBT) Kenya, a firm based in Nairobi’s Kilimani.

We also spoke to Mr Hiram Chomba, a counselling psychologist and physiotherapist at Befrienders Kenya, another organisation that offers counselling.

Ms Dorcas Magai, a clinical and developmental psychologist who is a PhD fellow at the Vrije Universiteit Amsterdam in the Netherlands, also shared her insights.

FINANCIAL WOES

Companies are shutting down every other day, taxes keep rising and, according to the United Nations Children Emergency Fund (Unicef), 42 per cent of the Kenyan population lives below the poverty line. The cost of living has gone so high that even the relatively well-off have to take up two or three jobs to keep pace.

Life, it appears, can only get tougher for the millions of Kenyans battling depression.

“Poverty is a contributing factor, but even people who come from rich backgrounds and high social set-ups are still prone to depression,” says Mr Oigara.

Mr Hiram adds that such factors as unemployment or low job security can also catalyse depression.

In fact, a government-funded study of 9,553 boys and girls aged 14 in the United Kingdom, released two weeks ago, showed that girls from poor families were likely to get depressed by the time they enter adolescence.

The cost of living has gone so high that even the relatively well-off have to take up two or three jobs to keep pace. PHOTO | FOTOSEARCH 

COLLEGE LIFE

From the culture shock a new student experiences to the peer pressure to abuse drugs due to new-found freedom, it appears that institutions of higher learning provide the perfect breeding ground for depression.

Mr Chomba says factors that can lead to depression among college students include loss of the safety net at home, isolation and drop in performance.

Lifestyle reached out to students in four Kenyan universities to get a feel of what causes them distress.

Ms Patrah Murangi, 19, a first year student of spatial planning at Jaramogi Oginga Odinga University, says that besides their own ambitions to excel in life, university students bear other people’s hopes to succeed.

“My friends have taken to drugs to cope with the pressure of these expectations and in the hope of boosting their academic performance,” she says. This leads to hopelessness and suicide becomes the easiest way out, she adds.

Campus relationships, she says, are a dicey affair for all students.

“My female friends go into romantic relationships hoping for a fairy tale. When the relationship goes south, it means the end of the world for them, so they start nursing suicidal thoughts,” she says.

Ms Cecilia Akinyi, 22, a third year education student at Kenyatta University, says that consistent failure in academics tips some students over the edge, especially those who struggle to raise money for school fees.

“It is not always possible to handle the pressure that comes with some courses such as medicine and engineering. Yet students are always expected to put up a brave face and pass,” Ms Akinyi says.

She adds that she has witnessed students take their lives after failing to come out of the rut of overindulgence, prostitution and drug abuse.

“They don’t realise how deep they are into the practice until when it is too late. When self-unworthiness and emptiness creep in, they choose to die,” she says.

For Janet Achieno, 22, a final year education student at the University of Eldoret, an unplanned pregnancy would be unbearable for her. “I can’t take bear a pregnancy, especially if my boyfriend denies responsibility or rejects me,” Ms Achieno says with finality.

DYSFUNCTIONAL FAMILIES

The one place where depression symptoms are likely to be caught is the family. But when there is dysfunction at home, it is likely that the problem will reach dangerous levels.

Mr Oigara says one of the best ways to address depression is to understand the individual, rather than jump into conclusions.

“Support is key, and the kind of support you need to give is that of being there, listening to their side of the story and also having an idea of what might be unusual in this person’s behaviour, being able to know the tell-tale signs,” he says.

“It is important for parents to start getting the basics. And not to ignore the fact that, for sure, children do understand what goes around them,” adds the psychologist.

Ms Magai said the only way depression can be tackled is by starting at the household level.

“Once a mother conceives her baby, the home environment should be peaceful to avoid unnecessary stress hormones being passed to the baby, which may destabilise its stress regulatory system,” she says.

The one place where depression symptoms are likely to be caught is the family. But when there is dysfunction at home, it is likely that the problem will reach dangerous levels. PHOTO | FOTOSEARCH 

LIFESTYLE

A struggle with body weight is one of the reasons known to cause depression all over the world. Some individuals may develop anorexia, an eating disorder, as they struggle to achieve the desired weight.

“It’s estimated around one in five people with anorexia will make at least one suicide attempt. Anorexia is associated with a high risk of suicide,” says NHS Direct Wales, a health advice service for the island country.

Mr Chomba says having less than eight hours of sleep every night will aggravate depression in an individual.

“Your mood is affected by the number of hours you sleep — whether too little or too much,” he says, advising the public to learn healthy sleeping habits.

Staying indoors for long periods, experts say, lowers the body’s serotonin levels, partly due to deficiency of Vitamin D. Waning levels of serotonin, the chemical that sends signals between nerve cells, could trigger depression.

EXPOSURE TO ADVERSITY

The reason why a number of suicides and macabre killings have involved members of the police force, Mr Oigara reasons, is because they are exposed to many ugly happenings in their line of duty.

“The police are exposed to a lot of emotional and psychological trauma. With the kind of job they do, they are always in crime scenes where people have died and such. And they are exposed emotionally and psychologically. And they’re prone to trauma,” he says.

Mr Chomba adds that such factors as having been to a war zone, having served a jail term and working as a doctor, nurse or pharmacist can make one prone to depression. “Another risk is exposure to people with suicidal behaviour, like friends and family,” notes Mr Chomba.

GENETIC DISPOSITION

Mr Oigara says depression can run in the genes, just like some types of diseases. “If there are people who have had depression in a family, some relatives will be prone to depression, the same way as people who have physical ailments like diabetes and high blood pressure who just at some point start developing those symptoms without any particular trigger. They have been having a proper diet but they start having those symptoms because of the genetic disposition,” he says.

“There is also a bit of biology, which is due to a chemical imbalance,” he notes.

But Mr Chomba warns that it is simplistic to argue that there is a suicide gene in instances where depression leads someone to take their own life. “The factors leading to suicide are complex and wide-ranging,” he says.

Swedish DJ Avicii performs at the Sziget Music Festival on the Hajogyar Island of Budapest on August 14, 2015. PHOTO | ATTILA KISBENEDEK | AFP 

FAME

As was the case with Avicii, being in the limelight exposes some individuals to extreme levels of anxiety, which is why alcohol and hard drugs are often misused.

“A documentary released last year, Avicii: True Stories, showed a man plagued with anxiety and stress, pushed to breaking point by his management and booking agency who repeatedly tried to make him play more shows,” The Independent reported in an April 27 story.

It added: “Evidence shows that long touring can take a severe toll on an artiste’s physical and mental health. The accompanying lifestyle neglects the basic human needs — disrupted sleeping patterns, physical distance from friends and family, readily available drugs and alcohol and the pressure of performing in front of large crowds can be a lethal combination.”

Michael Jackson, Whitney Houston, Amy Winehouse are among the big names who struggled with depression as the whirlwind of fame whizzed around them. Their experiences were proof that a person can have lots of money but cannot buy happiness.

ADOLESCENCE

A survey of 533 adolescents in Nyeri and Kiambu counties released in January had this conclusion: “When compared to international standards, prevalence rates of emotional and behavioural problems [in the two counties] are almost twice as high as in children and adolescents in other comparable countries.”

The survey, titled Emotional and Behavioural Problems in Children and Adolescents in Central Kenya, was done by scholars from the Vrije Universiteit Amsterdam in The Netherlands, and Ms Magai was one of the three researchers.

Some 1,022 mothers were interviewed alongside the 533 adolescents in the report published in the Springer journal.

“According to the parent reports, 27 per cent of the children and adolescents had emotional or behavioural problems,” the report said.

It added that 27 per cent of the teens were found to be on the borderline range while 17 per cent were on the clinical range.

Ms Magai tells Lifestyle that if the problems that show up during adolescence are not handled well, the risk later in life will be monumental. “The high emotional and behavioural problems in Kenyan children and adolescents has a huge implication on the country’s future if not addressed,” she says. “Emotional and behavioural problems play a potential role in the high school drop-out rates, criminal behaviour, high number of children on the streets, and school riots and burning of schools.”

The cases of people who kill their spouses and children, she warns, will continue unless teens receive help in handling traumatic life experiences.

Depression is a silent killer in our midst. PHOTO | FOTOSEARCH 

CULTURAL BELIEFS

“People don’t get depressed in Nigeria,” opined Nigerian public health doctor Ike Anya in an August 2012 article in the Granta magazine.

“Many of my classmates, myself included, still look at depression as a largely Western illness,” he said.

Such are the perceptions, Mr Oigara explains, that worsen the state of the depressed.

“We are told that men are not supposed to cry; that men are supposed to be strong. We grow up being conditioned that you are not supposed to do certain things,” he says.

“Because of that, you find that if I am predisposed based on those factors — like if I am biologically predisposed to depression — I will really try to fight that because that is what I’ve always learnt; that I’m not supposed to express myself. And the more I try to repress those emotions, the higher the chances of me having a worse symptomatology or experience of a depressive state,” adds Mr Oigara.

Ms Magai says the culture of labelling children as big-headed creates trouble.

“A quick solution in our culture has been physical punishment while overlooking the possibility that the child might have emotional and behavioural problems that might warrant mental health attention,” she observes.

IMPROPER TREATMENT

When a person decides to get treatment for depression, the approach used will determine if they will get out of the rut.

Mr Oigara speaks highly of a method called cognitive behavioural therapy, where a number of issues about a patient are tacked and follow-ups done.

“After assessment, it is common to find that symptoms are triggered by underlining issues, that have never been attended, thus trigger a negative vicious pattern,” says a message on the website of Mr Oigara’s firm.

Ms Magai calls for more input into managing depression in Kenyan hospitals.

“The public and private sector should prioritise mental health just as they do physical health. It is important to educate and increase the number of psychologists and psychiatrists in health facilities to help with screening and managing children with emotional and behavioural problems,” she says.

“The country’s awareness of child/adolescent mental health problems seems still limited to mainly intellectual disability, autism and Attention deficit hyperactivity disorder (ADHD),” says the report

 

Everyone has a way out of the disease, experts say

No one should underestimate the power of counselling in bringing a depressed person back on track, experts advise.

The good news is that at the moment, there are mobile-based services where a person can call a counsellor and vent out.

Mr Lambert Oigara of CBT Kenya says there is an encouraging trend where young people make the initiative to look for help.

“Maybe it is because of the internet and campaigns to de-stigmatise mental illness,” he said.

Another place where a person can find hope, Mr Oigara said, are places of worship.

“I’m sure churches, mosques and the like have systems in place where someone can go and talk to someone in confidence,” he said.

He added: “Support groups are also available where people can visit and get to talk to those with similar problems and they’re able to be supported.”

Ms Dorcas Magai, a clinical and developmental psychologist, said one solution to depression is by a person learning to open up.

“We should learn to talk about childhood experiences that hurt us, and which we struggle with as adults, to people we trust. When we keep them to ourselves, the issues pile up mentally and will definitely get out of hand,” she said.

Mr Hiram Chomba of Befrienders Kenya said a person can ask a relative to check on them regularly or meet new people by joining a new class or club.

Most importantly, he said, a person should learn to banish the defeatist thinking within themselves.

“You will need to substitute negative thoughts with more balanced perspectives,” he advised.

 

- Elvis Ondieki

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