The meaning(s) and factors influencing treatment seeking behavior for depression among middle-aged and elderly patients at Butabika National Referral Hospital, Uganda

Abstract

Depressive disorders are among the most frequent psychiatric disorders, accounting for up to 30% of primary care service utilization in developing countries. However, delays in seeking treatment, misdiagnosis and non-specific treatments have compromised appropriate care for middle aged and elderly people with depression. This study aimed at exploring the meaning(s), factors influencing treatment seeking and coping strategies for depression among middle aged and elderly patients at Butabika National Referral and Teaching Hospital. This study was guided by the Social Constructivist theory which postulates that reality is socially constructed through lived experiences and the understanding of the meaning of depression has a social inclination based on people’s belief systems which eventually influence their behaviors and; the Health Belief Model (HBM) which postulates that the behavior of people to either fully participate or not in seeking health care is dependent on their perception of the illness and the available ways to handle or curb the prevalence of the disease. This study adopted a qualitative research approach. In-depth interviews were employed to collect data on the meaning(s) and factors influencing health seeking for depression. The interviews also focused on how study participants coped with depression. Eighteen (18) study participants were purposively selected among patients seeking treatment at Butabika National Referral and Teaching Hospital. Because the study used purposeful sampling, only patients receiving medication from Butabika National Referral hospital and those who were assessed as recovered by the medical team at the hospital were sampled. Data analysis was undertaken using thematic content analysis. In terms of meaning of depression, study findings revealed that depression among patients without disruptive behaviors was regarded as a disease of thoughts. Depression with psychotic features was regarded as madness; “clan illness” (eby’ekika) or witchcraft (eddogo). Non –disruptive symptoms were often ignored by the family and perceived as normal features associated with aging. The most commonly identified barriers to effective health care services for both men and women were: stigma, cost of treatment, accessibility and acceptability of health services, knowledge and attitudes to health care seeking. Spirituality or leaving it to God, acceptance and engaging in leisure activities were the major coping strategies adopted by informants. The study concludes that lay people perceive mental health and depression to be largely associated with witchcraft and spiritual attachments. The current study provides evidence that middle aged adults and elderly people have poor access to mental health care services in the study area. To reach universal health coverage, substantial human and financial resources need to be allocated to mental health, coupled with initiatives to improve mental health literacy in the general population.