In light of the prevailing socioeconomic circumstances in the country, more Nigerians are going into depression. In this report by VINCENT KURAUN, medical experts explain why many Nigerians experience mental health conditions that involve the continual feeling of sadness, irritability, hopelessness and recurring thought of suicide.
Depressive disorder (also known as depression) is a common mental disorder that involves a depressed mood, persistent sadness or loss of pleasure or interest in activities for a long period, according to the World Health Organisation (WHO).
Its symptoms include a loss of energy, a change in appetite, sleeping more or less, anxiety, reduced concentration, indecisiveness, restlessness, feelings of worthlessness, guilt, or hopelessness. These symptoms if left untreated could lead to thoughts of self-harm or suicide even though, there is effective treatment for mild, moderate and severe depression
Giving a breakdown of widespreadness of the disorder, the WHO in its report claims that globally, an estimated five per cent of adults suffer from depression with more women being affected than men. In Nigeria, for instance, a 2018 study conducted by the Mind, Behavior, and Development Unit (eMBeD) of the World Bank, gave a disturbing outlook of the health issue in the country. The report shows that one in every five Nigerians is depressed. This figure accounts for an average of 22 per cent of the Nigerian population who are chronically depressed.
“The first signal that tells us there is so much depression is when people become hypertensive, easily irritated, they are unable to control their emotions,” a professor of clinical psychology at the University of Nigeria, Nsukka, Chuka Ifeagwazi, explained to Sunday Tribune while reacting to the question on why many Nigerians are going into depression.
According to him: “Wherever you look, you see people shouting at one another. Sometimes, they get into too many fights in a day over little things that could have been amicably settled.
“When you have these signals, you look at the people and you can tell that nothing interests them in life anymore. It is as if there is a dark cloud hanging all over the horizon. You are not able to picture the future; you are not able to find any reason to be cheerful and you don’t want to celebrate.
“You look at every aspect of life and you don’t seem to know where you can find solace. Not in the church, not in schools, not in the marketplace, not at petrol stations. The more you visit petrol stations, markets, or even church to commune with God, the more your depression heightens. It appears that there is no hope in sight.
“Life becomes a ritual of sleeping and when you wake up, you don’t know why you are waking up, unlike some periods when you wake up and you picture the thing you would achieve during the day with energy and hope.
“Parents cannot explain to their children why they can no longer afford certain things they used to like, including the school fees. The youth who used to depend on family can no longer depend on their earnings or income when they set out on their own. They now look around for their younger ones to help. Your parents will now continue to feed you and your grandchildren,” he said.
In the same vein, a former Deputy Vice Chancellor (Academic) at the Imo State University and a consultant in clinical psychology, Professor Cornelius Uwaoma, told Sunday Tribune that “What gives rise to depression mostly is illogical thoughts, and you can relate this to economic depression or economic recession. This economic recession is not only in Nigeria, but how do individual Nigerians perceive this?
“How do they take it or tolerate this? How do they accept it? If some people lose their jobs as a result of an economic recession, they may not take it easy. They may see it at the end of life. If the wife runs away from the husband or vice versa because things are no longer normal, how does the one left behind take it? The children are no longer going to school or the preferred school of the family, because the man lost his job, how do the individuals take it?
“So, in a nutshell, individuals differ in the way they perceive the economic recession. Some people will look at it as something they can easily overcome while others will look at it as the last bus stop they can’t get out of.
“Many Nigerians also have suicidal thoughts and not just depression because things are not working out the way they have planned. And suicide is an offshoot of depression when the individual feels hopeless and sees a bleak situation ahead of them. And, of course, it is not only economic recession, there is also political instability. If you look at what is happening in Nigeria, people are becoming depressed because the political class is mounting unnecessary pressure on them.
“People’s rights are violated while things are not working very well. People’s votes are being taken away from them. A lot of other things are happening in Nigeria now that you may not look at depression coming from economic recession. We have also had a political recession; we have social recession, and it is all over.
“We come to a time where you have a parent who struggled to train all the children, maybe five of them, through the university system and none of them has a job. This can cause a lot of social distraction. The parent is hopeless and you know in Nigeria and Africa, our major investment is in our children. That represents a collapse, distortion and demolition of somebody’s long-term investment.
“Parents have invested in their children, but when they are supposed to reap from their children or get a little peace or solace from their children, the children don’t have jobs. So it is not only the youth who don’t have jobs that can be affected, but also the parents who trained them, which can lead them into depression.”
A consultant clinical psychologist at the Department of Psychology, Enugu State University of Science and Technology, Agbani, Enugu State, Professor Obiageli Omeje, while speaking with Sunday Tribune, confirmed indeed all the causative factors listed by Uwaoma and Ifeagwazi are etymological roots of depression and include social, economic and psychological.
“It is psychological where the person may have experienced trauma from kidnapping, terror attack, accident, among others. Depression results if the person cannot deal with these challenges and it operates along a continuum through mild, moderate and severe levels,” she emphasised.
“It is social where the individual is faced with interpersonal conflict that is difficult to resolve, death of a loved one and other stressful life events. It is economic where there is a lack of resources to attend to daily needs like food, shelter, clothing and other obligations.”
Confirming the claim that depression is becoming endemic among Nigerians, Chief Executive Director of Empower My Word Foundation, Ms Nwanda Oluka, cited a 2017 WHO report that stated that Nigerians are the most depressed people in Africa, noting that the report was quite surprising because Nigerians were once regarded as the happiest people in the world.
Ms Oluka said: “A lot of Nigerians are depressed as it is. Factors taken into consideration are insecurity, unemployment, drug abuse and high levels of poverty. All these factors contribute to depression in one way or another.
“We have our students graduating from various institutions across the country who have nothing to fall back on. People can barely afford to take care of their necessities and this, in a way, causes depression. We should also not forget that depression is a mental illness which affects one’s mood and the severity of it differs from person to person.”
Oluka added: “How you experience depression might not be the same way I experience depression, but the most important thing is that the mood is always the identifiable factor.
“So, you see someone having mood swings, loss of interest in basic life activities, constantly getting angry, having outbursts. All these triggers are the signs of one who is depressed and you see it everywhere.
“A point in case is when you take public transport in Lagos, you need to see the fight or hear the arguments between conductors/drivers and passengers. Everybody is actually at that very high level of aggression. Even when you are driving your car, you hear how drivers react to minor infractions and that is one sign of depression.
“Unemployment is another major factor. When you are not able to provide for yourself or your family and we live in a patriarchal society where it is expected that a man should provide for his family but now you have a lot of mother-driven homes where the mother has been the major provider in the family. This reversal of rules has led to this change and it is causing depression in women and studies have shown that women are more prone to depression than men.
“And when a woman becomes the breadwinner in a home, the man will start feeling he’s not being needed in the home while the woman on the other hand feels the weight of carrying too much of the burden of the home and this causes a whole lot of frictions that lead to depression among couples.
“Depression also varies. It could be mild, moderate or severe and when it becomes severe, it could lead to suicidal thoughts. Many Nigerians are committing suicide and it is very disheartening to lose lives for something that could be stopped but our economy doesn’t help in any way. So, I agree that Nigerians are depressed.”
Depression or sadness?
A lecturer in the Department of Mental Health at the Obafemi Awolowo University, Ile Ife, Osun State, Dr. Ola Ibigbami, told Sunday Tribune that there is a difference between somebody feeling sad when things are not going right with him or her and someone who has a depressive illness.
According to him: “There are two different things. That somebody failed an exam and is sad is not a depressive illness. It is just sadness to respond to an untoward life event. But when we refer to depression, we are talking about someone who is unusually sad and you can’t even explain why the person is feeling unusually sad. It is a mood disorder.
“There are people that have this disorder, they are unhappy on one side but there are other people who are excited and are extremely happy for no justifiable reason. This is also a mood disorder.
“For depressive illness, it is possible for somebody who has everything going on fine, who has a good job, family and all that you can think of but the person has a depressive illness.
“In that context, what we are talking about is someone whose expression is beyond what is expected for a long duration of time, then it is becoming a depressive illness.
“Somebody could lose his job and that could be what precipitated the depressive illness. They will tell you that they are feeling sad, they lose interest in daily activities and many of them will complain of having decreasing energy even without doing anything. As days go by, their moods improve and their energy comes back a little.
“So, when you see somebody waking up in the morning and starting to feel tired, that could be a depressive illness. An instance where someone who just got married had some issues with the marriage and then decides to jump into a lagoon is more or less like a suicidal attempt in response to a crisis situation.
“Some people find it difficult to cope with the stress of life and feel that the way of escaping from that experience is by killing themselves. Though some of them might be depressed, a lot of them are not actually depressed, they are just having an unpleasant feeling that they cannot cope with.
“Generally, when we talk about mental health, we are talking about the health of the mind. Can that person realise his own potential? Can they work productively? Can the person also cope with the normal stresses of life? And can the person be able to contribute to anything going on around them? So, anybody who is mentally healthy can be able to do all these, but when there is a mental disorder, the person wouldn’t be able to do all that.
“When talking about depression, we are talking about the factors that are associated with it. One of them is that it runs in some families. If you have a mother who suffers from depression, it increases the likelihood of the children having depression. If both parents have a history of depression, it increases the likelihood of the children having depression much more.
“Then people who had experienced traumatic life events in the past, history of sexual abuse, physical abuse, neglect of children when they were small. All these could increase the chances of somebody coming down with a depressive illness.
“Children can also be depressed. They may not express depression like adults, because most of the time children cannot express how they feel, so they tend to act out their feelings of sadness.
“You might see a child becoming withdrawn, not interacting with other children or a child crying for no reason which is what we call weeping spears. You see a child who has issues with concentration, you ask a child a question in class and he or she may not be able to answer absent-mindedness, some will also refuse to go to school, and some will lose their appetite and have problems with sleep.
“Some major life events either on the positive side or negative side can also cause depression. Something good will happen to some people, maybe they just change their environment or job, but the stress of the new job could also precipitate feelings of sadness in them and they become depressed and can’t come out of it.
“One thing about sadness is that if one is sad but has support, people talking to them about the issues and they are able to think about it, they come out of the feeling of sadness, but a depressed person will not be able to come out unless something is done either through medications, support or psychological support.”
How depression affects homes
Many experts believe depression affects family setups in no small measure. They noted that the onset or diagnosis of depression affects the cohesion that is naturally found among members of the family.
According to Professor Ifeagwazi, “depression affects the relationships within members of the family. When the family is happy, it begins with the father who is able to cater for the family and is supported by his wife. Children have cause to run to their parents when they come back from work. They sit down and have quality time together, answer children’s questions and explain things that they do not understand.
“But when your psyche is that of a taxi driver who bought fuel of N10,000 and makes no profit for the day, you don’t sit down to have quality time with your children. You don’t even sit down to have quality time with your wife. Everybody begins to live in isolation, and when the addiction to mobile phones comes in, everybody will be in the house, pressing their phones while trying to find some kind of entertainment or a way to shift the mind away from problems that are supposed to be considered. So, you’ve formed a crowd and you are still lonely in the crowd. No one talks to each other that much.
“When depression hits the family, parents no longer exercise that much control over their family, why? For you to be able to exercise that control over your children, you first of all must be able to provide. If you cannot provide, you cannot dictate for the children. They begin to look outside and that is when the peer pressure begins to take over the process of socialisation.
“Depression also causes sickness in the family and these are times that you don’t even have money that much and you go to hospitals where you are being asked to pay deposits for this and that before anybody talks to you. This situation is critical.”
Alluding to that, Professor Omeje, on her part said, “Just like other mental disorders, depression requires reorganisation of the family setup where activities and schedules are reorganised to accommodate the depressed.”
Dr Ibigbami gave further insight into how depression could destroy the family, noting that someone who is depressed will lose interest in the pleasurable activities he used to engage in with his family members.
“The person loses interest in goals-oriented activities. So, if you have a mother in the family who is depressed, such a mother won’t be able to take care of the children and also take care of herself. She won’t be able to sexually satisfy the husband and will not even have the urge to express herself sexually.
“It would affect the children, the husband, her colleagues at work and every other person. The same happens if it is the man. Some men resort to substance abuse and alcohol which will equally affect their families, finances and relationships with their wives, children and colleagues at work. Depression, if not well taken care of, will affect their performances at work and they may finally lose their jobs. When that happens, it will have negative effects on their families.
“If it is a child that is depressed, the child will not be able to do well in school and will also not be able to relate well with the family and at the end of the day, a lot of negative things will begin to happen to the child irrespective of the gender,” he noted.
Stages and management of depression
The experts also noted that depression develops in stages (which can be managed) some of which are exemplified in the mild, moderate, severe and profound stages of depression.
According to Uwaoma: “We have mild depression and this is very close to normality. For instance, if somebody loses his handkerchief, he may get sad or hopeless or feel bad about it. We have moderate depression; severe depression and the next to it is profound which is the last stage of depression. When one is in this stage, one is hospitalised so that it can be managed and supervised but one can’t come out of it.
“Most Nigerians have mild depression. It is not a clinical depression. Clinical depression is when it begins to interfere with the daily activities of the individual. They can’t talk or eat very well and so on but many people are living with mild depression, they are managing and living with it hoping that one day it will be better.”
While agreeing that depression occurs in stages, Professor Ifeagwazi said the condition can still be “well managed with prescribed medications and by family and religious organisation members who create a support system around the patient. It could be a community where you go and do things in common and your mind is away from the isolation and the urge to do things alone,” adding that taking refuge in alcohol by some sufferers is not the solution. According to him, there is a need for “a national orientation that helps us to moderate our needs where the rich can live simply so that the poor can simply live.”
On her part, Ms Oluka played down the notion that depression is a death sentence.
“There are cures to it from drugs to psychotherapy, you could equally have lifestyle changes, talk therapy.” She underscored the fact that the society needs a better understanding of what depression is all about and how we can help our loved ones who are depressed.
“All they need is love, talk, and acceptance. As for one who suffers from depression, your healing starts with the acceptance of the reality that something is wrong. Accepting your mental health at that point in time matters a lot and there is no stigma to it. People who are depressed need help and we all need to be there for one another.”
Doing away with depression
On how people can avoid depression, Professor Uwaoma advised that they should adopt right- think and determine what they can do to bring happiness into their lives.
“Have hope and sustain a manageable hope. Life is in phases. What you may not get today, you may get tomorrow. You have to relate very well and believe that the system will become nice. Believe that we will have a new and better Nigeria for all of us.”
Dr Ibigbami, on his part, enjoined people to “spend their time with people that they love and are comfortable with. When you have people around you, it helps and when there is a change in your behaviour, the people around you will notice very quickly and they will be able to provide some support.
“Loneliness, boredom and worry come together when somebody does not have people to interact with. Most of the time, people that are mentally ill cannot be able to come out of it without somebody pulling them out of the illness.
“We should also not shy away from the fact that mental illness is like malaria. We should accept the fact that for one reason or another, some people might have mental illnesses. We should reduce the stigma; there is nothing bad about having a mental illness. The bad thing is not treating mental illness. Mental illness is treatable. The only problem is that people are hiding it.
“We should also know that substance abuse is not depression; there is substance disorder on its own. If somebody has an issue with drug abuse, go for rehabilitation, you will get well and everything will be fine,” he admonished.
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