Department of Medicine, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK.
Newcastle University, Newcastle Upon Tyne, UK.
Int Psychogeriatr. 2019 Oct;31(10):1473-1481. doi: 10.1017/S1041610218002016.
Depression in older people is likely to become a growing global health problem with aging populations. Significant cultural variation exists in beliefs about depression (terminology, symptomatology, and treatments) but data from sub-Saharan Africa are minimal. Low-resource interventions for depression have been effective in low-income settings but cannot be utilized without accurate diagnosis. This study aimed to achieve a shared understanding of depression in Tanzania in older people.
Using a qualitative design, focus groups were conducted with participants aged 60 and over. Participants from rural villages of Kilimanjaro, Tanzania, were selected via randomized sampling using census data. Topic guides were developed including locally developed case vignettes. Transcripts were translated into English from Swahili and thematic analysis conducted.
Ten focus groups were held with 81 participants. Three main themes were developed: a) conceptualization of depression by older people and differentiation from other related conditions ("too many thoughts," cognitive symptoms, affective and biological symptoms, wish to die, somatic symptoms, and its difference to other concepts); b) the causes of depression (inability to work, loss of physical strength and independence, lack of resources, family difficulties, chronic disease); c) management of depression (love and comfort, advice, spiritual support, providing help, medical help).
This research expands our understanding of how depression presents in older Tanzanians and provides information about lay beliefs regarding causes and management options. This may allow development of culturally specific screening tools for depression that, in turn, increase diagnosis rates, support accurate diagnosis, improve service use, and reduce stigma.
随着人口老龄化，老年人的抑郁问题可能成为一个日益严重的全球健康问题。不同文化对抑郁的观念（术语、症状和治疗方法）存在显著差异，但撒哈拉以南非洲的数据却很少。针对抑郁的低资源干预措施在低收入环境中已被证明是有效的，但如果没有准确的诊断，这些干预措施就无法使用。本研究旨在让坦桑尼亚老年人对抑郁有一个共同的理解。
采用定性设计，对坦桑尼亚基利马尼洛县的 60 岁及以上的老年人进行焦点小组讨论。采用人口普查数据，通过随机抽样选择农村村庄的参与者。制定了主题指南，包括当地制定的病例简介。从斯瓦希里语翻译成英语并进行主题分析。
共进行了 10 次焦点小组讨论，有 81 名参与者。确定了三个主要主题：a）老年人对抑郁的概念化及其与其他相关疾病的区别（“想法太多”、认知症状、情感和生物症状、想死、躯体症状以及与其他概念的区别）；b）抑郁的原因（无法工作、失去体力和独立性、缺乏资源、家庭困难、慢性疾病）；c）抑郁的管理（爱与安慰、建议、精神支持、提供帮助、医疗帮助）。
这项研究扩展了我们对坦桑尼亚老年人抑郁表现的理解，并提供了有关其发病原因和管理方法的文化观念。这可能有助于开发针对抑郁的文化特异性筛查工具，从而提高诊断率、支持准确诊断、提高服务利用率并减少耻辱感。
