Prevalence and Associated Factors of Common Mental Disorders Among Adult Residents in Silte Zone, Southern Ethiopia

1. INTRODUCTION

Common mental disorders are a group of distress states manifesting with anxiety, depressive and unexplained somatic symptoms that typically come up in the community and primary care setting and also frequently occur together with a shifting combination of symptoms over time indicating emotional or mental abnormality [1, 2] Mental disorders have been recognized as the most public health important globally, around 450 million people currently suffer from such conditions, placing mental disorders among the leading causes of ill-health and disability worldwide [3].

The global prevalence of common mental disorders from 1980–2013 was approximately 1 in 5 people experienced during the 12-month preceding assessment [4]. Adult mental disorders are found to be associated with high role impairment and economic burden [5, 6]. According to the World Economic Forum, mental illness will account for more than half of the economic burden of disease over the next two decades – more than cancer, diabetes and chronic respiratory diseases combined. About 54% of the economic burden of disease falls to low- and middle-income countries [7]. Mental health problems appear to be increasing in importance in Africa. Mental and substance use disorders were the leading cause of YLDs (yearly lived with disability) in Sub-Saharan Africa [8].

Evidence from previous studies shows that mental disorders are common in all countries, there is a considerable variation in the prevalence of these disorders. In developed worlds, the past 12-month prevalence of mental disorders was found 14% in Greece [9] and 44% in a review of Bangladesh, India, and Pakistan [10]. In Africa, the past 12-month prevalence of common mental disorders was found between 10.3%- 33.6% [11-14]. This can be explained by deference in sociocultural factors across countries. Mental problems are influenced by social factors such as gender, social class, race and ethnicity, household patterns, poverty, violence, and other stressful social environments. They are not unique to any part of the globe [15, 16].

Myths and misconceptions about mental illness contribute to the stigma, which leads many people to be ashamed and prevents them from seeking help. Generally, people who have mental disorders are considered lazy, unintelligent, worthless, stupid, unsafe to be with, violent, always in need of supervision, possessed by demons, recipients of divine punishment, unpredictable, unreliable, irresponsible, without conscious, incompetent to marry and raise children, unable to work, affect rich people, increasingly unwell throughout life, and in need of hospitalization [17].

Researchers found that Khat use is directly linked to common mental disorders [18]. Khat is a flowering plant that contains the alkaloid cathinone, which is said to cause excitement [19], which is common in Horne of Africa in including study area. According to the 2016 Ethiopia Demographic and Health Survey report, 12% of women and 27% of men reported the use of Khat [20]. The presence of khat in the study area may increase the burden of common mental disorders.

The majority of the global burden of mental disorders is located in low and middle-income countries [21]. Therefore, integration of mental health in primary health care in resource-limited settings is more important for two reasons. The first reason is mental health resources are unlikely to be adequate to address the burden of mental disorders in low and middle-income countries. The second reason is most patients with mental disorders, particularly less severe disorders, prefer to seek care from their own family or primary health care settings [22]. Evidence from previous studies shows that mental disorders are common in all countries, there is a considerable variation in the prevalence of these disorders. Apart from methodological factors, the most acceptable explanation for this wide variation is likely to be the fact that socio-cultural factors are major determinants of mental disorders. Therefore a mental disorder has to be understood in a specific setting to develop effective and tailored interventions. Hence, this community-based study was intended to determine the prevalence and associated factors of common mental disorders among adult residents in the study area.

2. METHODS

3. RESULTS

4. DISCUSSION

The aim of this study was to assess the prevalence of common mental disorders and their associated factors. The results showed that 39.7% of the adults had common mental disorders. Our result is comparable with a study carried out in another area of Ethiopia and a review done in three countries of Europe (Bangladesh, India, and Pakistan), where it was estimated at 33.6% [11] and 44% [10], respectively. On the other hand, our finding is higher than those of two area studies of Ethiopia, namely in Harari 14.9% (25), a review in Ethiopia 21.58% [29]. Our finding is also higher compared to two studies conducted in Kenya, and a study in Greece reported 10.3% [13], 10.8% [12] and 14% [9], respectively. The variation might be due to distinctions in the measurement tools, and the socio-culture distinctions between Ethiopia and the other counties.

Regarding factors, we found a highly increased prevalence in women compared to men; CMDs were 9 times higher among female respondents compared to males. This finding is supported by other studies [11, 30]. It may be attributed to gender-specific risk factors for common mental disorders that disproportionately affect women including gender-based violence, socioeconomic disadvantage, low income and income inequality, low or subordinate social status and rank and unremitting responsibility for the care of others [31]

Older age is also positively associated with CMDs, older age increases the likelihood of CMDs. This result is consistent with that of previous studies done in Ethiopia and Kenya [11, 25, 32]. There may be multiple risk factors for mental health problems at any point in life. Older people may experience life stressors common to all people; stressors may be more common in later life, like a significant ongoing loss in capacities and a decline in functional ability lead to common mental disorders.

Adults who had poor social support were 2 times more likely to develop CMDs compared to those who had good social support. Evidence showed that the impact of social support on mental health can occur through two mechanisms: either as a main effect influence in which social support has a beneficial effect on mental health regardless of whether or not the individuals are under stress, or social support improves the wellbeing of those under stress by acting as a buffer or moderator of that stress [33].

In the current study, a strong association between stressful life events and common mental disorders was observed. Stressful life event increases the likelihood of having common mental disorders. This could be explained by hormones, neuroendocrine mediators, peptides, and neurotransmitters involved in the body's response to stress. Many disorders originate from severe and prolonged stress that leads to mental disorders [34, 35]

CONCLUSION

In the study, the magnitude of the common mental disorder remains high in the study area. Older age, being female, increased family size, poor social support, and stressful life event were significantly associated with common mental disorders. Based on our findings, we would like to forward the following recommendation; mental health screening and counseling should be strengthened in health facilities; due attention should be given to the mental health aspect of those older adults, women, adults who have poor social support. Future research could beneficially include consideration of the severity and impairment of activities of daily living caused by CMD and would contribute to an understanding of the impact of CMDs on the lives of this population.

REFERENCES