Background information

The family is the most basic institution in any society. People are born into a family, live much of their lives within a family, and consider it to be a high priority in their value systems ₁ . The concept of a family or the role of the family has been universally agreed to vary from a group of intimate individuals with a history and a future; to a nuclear family with father, mother and progeny; to people living under the same roof and sharing physical and economic arrangements ₁ . In Nigeria and indeed most West African countries, a family is traditionally extended vertically to include other generations, such as grandparents; and horizontally to include other relatives, such as brothers or sisters who do not live with them. The nuclear family may also be extended through the acquisition of more than one spouse (polygamy), or through the common residence of two or more married couples and their children, or of several generations connected in the male and female lines.

The primary function of a family is the provision of nurturance and support for psychosocial growth and development of its member. Family members, particularly a spouse, appear to be most important source of social support and account for most of the association between social support and health. ₂ There is evidence that support from sources outside the family cannot compensate for what is missing from within the family. ₃ Family support is crucial in the recovery and return to well-being of a depressed individual. The family offers emotional support which involves listening without judging, demonstrating understanding, patience, affection and encouragement. However, societies, the world over are bemoaning the decline of family. In most West African communities, as in many parts of the world, the ties of kinship binding individuals to their families are progressively weakened by increasing urbanization. ₂

Furthermore, a large body of research has shown a strong and consistent relationship between social relationships, especially the perception of social support, and overall morbidity and mortality. ₃ Health outcomes associated with good social support include lower susceptibility to disease, lower cardiovascular reactivity, enhanced immune function, better adjustment to recovery from illness, lower rates of mortality, and increased psychological well-being. ₃ Social support has been conceptualized in terms of its structure and function ₁ . Structural social support or social networks was explained as the web of social ties that surrounds the individual. Functional social support was defined as the emotional, instrumental and financial aid obtained from one's social network ₁ . Building on this line of thinking, Sarafino ₄ classified functional social support into emotional support which is the expression of caring, concern and empathy towards a person; esteem support as the expression of positive regard for a person; tangible or instrumental support as giving direct assistance during the time it is needed and information support as giving advice, suggestions or feedback about how a person is doing. There is evidence that lack of social supports, whether perceived or received, may increase the risk of depression ₄ . Low socioeconomic status might also decrease a person's ability to engage in social activities. Unplanned urbanization has and is posing great strains on traditional social support systems across the developing world. The lack of social support and the breakdown of kinship structures is probably the key stressor for the millions of migrant labourers to the urban centers of Africa leaving behind millions of dependants in the rural areas whose only hope of survival are the remittances their relatives will send from distant cities. Fujita and co-worker ₅ , in their seminal work on the social origins of depression, identified factors such as having no one to confide in as one of the vulnerability factors for depression.

Materials and methods

Study population and setting

Ethical consideration

Testing Procedure

Results

Figure 1

Table 1: Socio-demographic characteristics of study subjects

Table 1 shows that majority (69.6%) of the study subjects were currently married. It also shows that most of the subjects (57.2%) were self-employed. Majority belonged to the Christian faith (88.4%) and only 0.8% gave positive family history of psychiatric illness.

Figure 2

Figure 1: Bar Chart depicting Zung's SDS rating of depression in study subjects

(Subjects' depression rating was categorized based on validated thresholds of Zung's scale).

Figure 1 shows Zung's SDS rating of depression in study subjects: one hundred and one subjects (40.4%) had no depression, 42.8% of subjects had mild depression, 16% had moderate depression while only 0.8% had severe depression.

Figure 3

Table 2: Relationship between level of income and depression rating among study subjects

Table 2 shows that 70.8 percent of depressed subjects lived below poverty level. There was a statistical association between depression rating and poverty level.

Figure 4

Table 3: Relationship between family support and depression rating among study subjects

Table 3 shows that depression was significantly more common among subjects (65.2%) who had weak or no family support, compared with subjects (50.0%) with strong family support. Subjects with weak or no family support were 1.87 times more likely to have depression than subjects with good family support.

Discussion

The demographic distribution of subjects in this study is characteristic of a young population which is a common phenomenon in most developing countries of West African sub-region. This demographic structure as well as social, economic and political environments in the sub-region places great stress on families ₁,₂,₃ . The average family size is shrinking due to dispersal of family members. This affects the rhythm of family cycle, family-centered socialization and care of young children as well as ageing adults. Other factors that fuel this include rapid urbanization, increasing prevalence of nuclear family, low levels of education and high prevalence of extreme poverty. The result of this trend is the acquisition of new lifestyles related to urbanization, rapid rise in infectious diseases and increasing burden of mental illness like depression which is an important cause of disability, particularly among women, adolescents and youths ₁,₂ .

In this study, one hundred and forty nine subjects (59.6%) were found to have significant depressive symptoms: mild depression-42.8%; moderate depression-16% and severe depression -0.8%. This prevalence of 59.6% was high when compared with 49% reported by Ohaeri and Jegede ₁₂ in 1990 from Ibadan, South Western Nigeria but lower than 40% reported by Patel et al ₁₃ from Zimbabwe, a Southern African country. More recently, Dolittle and Farrell ₁₄ reported a slightly higher prevalence rate of 62% among urban poor in United States, the breakdown of which showed that 38% of their subjects were not depressed; 30% had mild depression; 22% had moderate depression and 11% had severe depression. Differences between the observed prevalence from this study and the values cited from US and Zimbabwe studies may be reflective of variation in local rates of predisposing factors to depression in the various communities as similarly suggested by Judd et al ₁₅.

Plausible reasons for these differences beyond location and times of study include the effects of severely depressed national economy on psychological state of the populace. There is a general decline in per capita income from $1000 in 1988, the period when Ohaeri et al ₁₂ conducted their studies; to $260 in 1998, and a subsequent re-classification of Nigeria from middle to a low-income country ₁₀ . Nigeria's GDP for 2004 was $64.1 billion, which could make the country one of the richest countries in Africa after South Africa. However, due to Nigeria's high population, this translates to $390 per capita, making the country one of the poorest in the continent ₁₀ . There is also a widespread and rising level of poverty in Nigeria. According to Mustapha, “the percentage of people living below the poverty line increased from 41% in 1992 to 80% in 1998” [[[16.]]] . Furthermore, WHO has cited poverty as a recognized factor in the increasing prevalence of depression worldwide ₁₀ . This may explain the high prevalence rate reported in this study. Similarly, the US study was conducted among people who were daily exposed to stressors like increased rates of poverty, crime and chronic illness ₁₄ .

A significant negative association existed between total income and depression in this study (p=0.002). This is consistent with findings of other studies ₁₇,₁₈,₁₉ . There was also a significant association between level of family support and depression (p=0.018). Majority of subjects with weak or no family support had depression. This agrees with findings of other studies that investigated the effects of family support on the maintenance and promotion of health of depressed individuals ₅,₂₀ . Fujita et al ₅ reported that the higher the level of perceived support provided by families and friends, the less the stress due to disease, leading to good outcomes in secondary prevention and prognosis of depressive symptoms. This was supported by De Leeuw and De Graeff ₂₀ in Netherlands who established in a cohort of cancer patients that the relationship between family support and depressive symptoms was especially apparent in patients with few general health complaints. In Africa generally and West Africa in particular, people are shielded from untoward effects of circumstances by supports from families, friends and significant others, but more recently, western culture has led to increasingly isolated nuclear families causing a breakdown in this protective kinship structure ₂ . This may explain why a large proportion of subjects with depression had weak or no family support.

It is therefore important that the family support system is resuscitated to cater for health of its members. This becomes imperative in view of the prevailing poor social welfare engendered by political misrule in developing countries like Nigeria. Many different stakeholders in the community, such as religious and social groups may contribute to the social support networks needed to strengthen the roles of family in promoting and protecting mental health of its members.