Probable depression, its correlates and coping mechanisms among adults exposed to floods in Ntoroko District, Uganda

Abstract

Background: Flooding is one of the most frequent natural disasters contributing to both direct and indirect effects on human health globally. Anthropogenic climate change has contributed to intensified hydrological cycle characteristics, in a nature sufficient to alter the strength and geographical distribution of extreme climate-related weather events. At least 90% of these extremes are weather-water-related exacerbated by increasing intensity of heavy rainfall. In East Africa, rural Ugandan populations experienced floods resulting from the heavy rains of the March-April-May (MAM), and September-October-November-December (SOND) 2024 rainfall seasons. The focus of studies on health consequences of these floods in this region of Sub-Saharan Africa (SSA) has often been directed towards other health outcomes, and less frequently on mental health. Study aim: To determine the prevalence of depressive disorders and their correlates among adults who were exposed to the SOND floods in Ntoroko, Uganda, and determine the different coping mechanisms utilized by these adults post-flood. Methods: A cross-sectional study was conducted to collect data from 360 participants following the extreme flood event of SOND 2024 in Ntoroko. The Patient Health Questionnaire-9 (PHQ-9) tool, General Anxiety Disorder-7 (GAD-7) scale, Perceived Stress Scale (PSS) and Oslo Social Support Scale-3 (OSSS3)were incorporated in a semi-structured online questionnaire to screen for probable depression and its correlates. Total scores on each tool/scale were determined for each participant. These scores were used to report on probable depression status, anxiety, perceived stress and social support. Other measures were used to determine and report on exposure and coping mechanisms. Analysis was performed using methods of descriptive statistics and other methods such as Poisson regression, then presented in summaries such as mean, prevalence ratio (PR), and tabular/graphic selections. Results: The study achieved a 93.51% response rate. Male participants accounted for 56.4% (n=203) of the study. The prevalence of probable depression was 64.7% with most participants experiencing moderate severity (106; 29.4%). Male participants recorded a higher occurrence of probable depression (121; 33.6%) compared to females (112; 31.1%). The correlates of probable depression included anxiety status (p<0.001) (PR= 0.550 95% CI [0.457-0.663] ) and social support level (p=0.033) (Low; PR=1.704 95% CI [1.140-2.548], Moderate; PR= 1.567 95% CI [1.043-2.354]). The final predictive model for depressive status included other variables despite them showing non-significant associations with depression status; sex, age, marital status, primary source of income, flood level, flood impact, former location, community leaders support, flooring material and stress severity. Conclusions: The study found a high prevalence of probable depression as compared to Uganda’s pooled prevalence of 30.2% from a systematic review, moderate severity being the most common. The correlates of probable depression included anxiety status and social support level even though the final predictive model for probable depression status included sex, age, marital status, primary source of income, flood level, flood impact, former location, community leaders support, flooring material and stress severity. The participants suggested needing more coping-focused aid from the government. This study gave recommendations including prioritizing early warning systems, mental health screening, psychosocial first aid, and community-led social support.