Hi people, today i  would be sharing m a project done by my older sister, Dr Titilope Sanni, of course with her permission. She still maintains the copyright of the project, and this project should not be copied word for word but should only guide you in your next research project. The project took tears, sweat and blood, and i was played a huge part in the success of it (not to brag or anything…*wink*). I Hope you enjoy and learn a lot from it.

CHAPTER ONE 

INTRODUCTION

1.1     OVERVIEW

Depression has been defined as severe, typically prolonged, feelings of despondency and dejection¹. It is a mental condition characterized by severe feelings of hopelessness and inadequacy, typically accompanied by a lack of energy and interest in life¹

Depression is simply known as a state of feeling sad/dejected. A more comprehensive definition is the one which says that it is a psychoneurotic or psychotic disorder marked especially by sadness, inactivity, difficulty in thinking and concentration, a significant increase or decrease in appetite and time spent sleeping and sometimes suicidal tendencies². Depression has also been viewed simply as a reduction in activity, amount, quality, or force and again as a lowering of vitality or functional activity²

Major depression is known as clinical depression, unipolar disorder, or recurrent depressive disorder³

Clinical depression is a biological, treatable illness that involves abnormal functioning of the brain’s chemicals that affects a person’s emotions, thoughts, energy, sleep, concentration and impairs how they feel about themselves and their relationships and the world⁴.

Major depression is characterized by a combination of symptoms that adversely impact a person’s ability to work, sleep, eat, enjoy once-pleasurable activities, and carry out the functions of everyday life³.

In some cases, it can be continuous, but most of the time it comes in episodes. Some people may only ever experience one episode, while others can battle the condition their entire lives³.

Clinical depression causes a very conspicuous disruption in daily life such as work, school or social activities. It can affect people of any age or sex including children⁵. It has been discovered that there are almost twice as many women as men who suffer from major depressive disorders. This has been attributed to risk factors such as hormonal changes during puberty, menstruation, pregnancy, miscarriage and menopause⁶.

Major depressive disorders have no specific physical findings. Their diagnosis lies in the examination of the history and mental status of the victims. Symptoms of depression include persistent sad and anxious mood accompanied by feelings of hopelessness, worthlessness, guilt, pessimism and helplessness. There is usually social withdrawal and loss of interest in hobbies and activities that were once enjoyed by the victim. These are followed by decreased energy, fatigue, impaired concentration and indecisiveness. Another important symptom is insomnia which is characterised by inability to sleep or experience of difficulty in sleeping or resting. Apart from these an individual might not have initial complaint of low mood; there could be physical symptoms like headache, chronic pain and digestive disorders which are not resolved even after medical treatment has been given. Individuals who suffer from depression are also predisposed to thoughts and attempts of suicide⁷.

Clinical depression is said to exist when at least five of these symptoms persist everyday for more than two weeks⁴. The actual cause of clinical depression is not yet known. A lot of factors could predispose an individual to depression. These include genetic susceptibility, exposure to certain pharmacologic agents such as reserpine or beta blockers and substance abuse. Certain neurologic illnesses such as Parkinson, stroke, MS, Seizure etc also increase the risk of major depressive disorders⁸.

Psychosocial contributors such as stress and interpersonal losses also play a role although major depressive disorders could arise devoid of any precipitating stressors⁸.

1.2       STATEMENT OF THE PROBLEM

Globally, depression poses a substantial health challenge at social, economic and clinical levels.  As at 2012, depression was estimated to affect about 350 million people⁹. In year 2011, it was discovered in the world Mental Health survey conducted in 17 countries that an average of one in every twenty people had depression⁹. Unipolar depressive disorders were ranked as the third leading cause of global burden of disease in 2004 and would move into the first place by year 2030 according to W. H. O.  Life time prevalence rates of depression range from approximately 3 percent in Japan to 16.9 percent in the United States with most countries falling in between 8 and 12 percent⁹.

In developing countries like Nigeria, depression,in the context of ‘mental illness’ is poorly understood.  Owing to this lack of understanding, ignorance and societies’ stigmatization of the victims, depression is not given appropriate attention⁹.

Again, depression is poorly recognized or identified by people when their loved ones experience it. People fail to understand that depression is an illness of the brain and it can be experienced by anybody. They fail to understand that the recognition of depression and the acceptance that it is real are the preliminary steps to treating depression⁹.

A review of mental health problem in developing countries, especially Nigeria reveals a general shortage of Psychiatrists who are the specialists in the field¹¹. In Nigeria, with a population of 120million as at year 2003, there were less than 100 psychiatrists and they were only available at the General and Teaching Hospitals in urban areas while most of the rural areas which had majority of the country’s population had none¹¹. Again in developing countries like Nigeria, primary health care is mostly channelled towards child care, treatment of minor physical ailments and infectious diseases. In past studies conducted, it was discovered that primary health care workers had a very poor knowledge of mental disorders and virtually no mental Health services were provided at the Primary Health care facilities visited¹¹. There is a recognized gap in government funding of the treatment of depression as minimum resources are available for mental health¹⁰.

Though there is possible effective treatment for depression, less than 25 percent of people across the world suffering from it have access to the treatments. The World Health Organization in their recent studies discovered that the median rate for untreated depression is approximately fifty percent owing to dearth of psychiatrists. In Ethiopia according to a recent survey, there were only 26 psychiatrists for approximately 80 million inhabitants¹⁰. Some countries have only one psychiatrist. Also the available Health professionals for effective treatment of depression are limited¹⁰.

It has been predicted that by 2020, depression would be the second leading cause of world disability and by 2030 it is expected to be the largest contributor to disease burden⁹.

Suicide attempts by depressed people are very common. Almost one million lives are lost yearly due to suicide⁹. Studies have shown that about 3000 suicide deaths occur every day⁹. World Health Organization has also speculated that for every person who succeeds in suicide attempt, 20 persons or more may attempt to end their life⁹.

 

1.3       JUSTIFICATION / SIGNIFICANCE OF THE STUDY

This study is being conducted based on observed public’s knowledge gap on depression and the need for the public to be informed about it and about how to handle it.

Past studies show that depression is a major cause of morbidity, mortality and disability and is associated with work place absenteeism, diminished or lost work productivity and increased use of health care resources¹².

It was observed that a lot of people are unable to identify or recognize depression when their loved ones experience it. In developing countries where depression is eventually recognized by the families of the depressed persons they shy away from consulting psychiatrists for fear of the victims being stigmatized or labelled insane persons¹³.

Information from this study can be used to design intervention studies to improve knowledge and attitude to depression.

 

1.4       OBJECTIVE OF THE STUDY

General objectives

The general objective of the study is to determine the knowledge and attitude to depression among community members aged 18-55 in Lagos Mainland Local Government Area.

Specific objectives

1) To assess the knowledge of depression among community members in Lagos Mainland Local Government Area.

2)   To assess the attitude to clinically depressed persons among community members in Lagos Mainland Local Government area.

3) To identify factors influencing knowledge and attitude to depression among community members in Lagos Mainland Local Government area.