Cultural explanatory models of depression i Uganda

Background: Depressive disorders are among the most frequent psychiatric disorders, accounting for up to 30% of primary care service utilisation in developing countries in general, and Uganda in particular. However, delays in seeking treatment, misdiagnosis and non-specific treatments have compromised appropriate care for people with depression. The general aim of this thesis is to explore and describe how depressive symptoms are conceptualised and communicated by the Baganda and how this conceptualisation may influence their help-seeking behaviour and processes. The research questions that the studies aimed to answer were: i) How do the Baganda understand, talk about and cope with depression? ii) What is perceived as effective treatment and how severe must symptoms be to warrant treatment? iii) Are the sub-types of depression seen as constituting one illness? Methods: The thesis consists of four exploratory papers employing qualitative methods of individual interviews and Focus Group Discussions. Paper I reports preliminary results of a pilot study on lay explanations of causes, effects and help-seeking behaviour for depression among the Ganda cultural group. Twenty-nine adults participated in four focus group discussions and four individual interviews. Paper II reports results of an interview study among 25 adults receiving treatment for depression, regarding their personal and social meaning of depression, their beliefs on causes and consequences of depression, and what triggered seeking psychiatric help. Paper III reports results of the study that aimed to explore the Baganda's conceptualization of psychotic depression in terms of illness identity, causes and treatment. Members of the general population participated in 31 individual interviews and 12 focus group discussions. Unlabelled case vignettes based on DSM-IV criteria for psychotic depression were used as stimulants for discussion. Paper IV reports results of a study exploring traditional healers' explanatory model of depression without psychotic features. Interviews were conducted with 22 traditional healers. Results: Depression without psychotic features was regarded as illness of thoughts. Depression with psychotic features was regarded as a "clan illness" (eByekika), arising from poor relationships between the living and the dead. Both illnesses were perceived as not requiring Western medication but culturally accepted corrective traditional therapies. Patients' illness behaviours, particularly those defined as socially disruptive, were important determinants of entry to psychiatric care. Non-disruptive symptoms were often ignored, misdiagnosed or treated as physical problems by health-care providers. Concluding remarks: Conceptualisation of depression among the Baganda differs from the Western biomedical model of depression in terms of cause and treatment. Psychiatric help was sought if patients' behaviour became socially disruptive. There are similarities in the conceptualisation of depression between lay people and traditional healers who are the alternative care providers. Implications for clinical practice: It may be important to review the way depression is managed in the Western form of psychiatry when the patients reach mental health services in hospitals. The noted similarity between the alternative care providers and the users of their service has clinical implications for therapeutic approaches such as psychotherapy, where the agreement between the care provider and care receiver is key in a therapeutic relationship. These results have policy, research and training implications

Human Papillomavirus (HPV) Vaccination and Adolescent Girls' Knowledge and Sexuality in Western Uganda: A Comparative Cross-Sectional Study.

The purpose of the study was to investigate the influence of human papillomavirus (HPV) vaccination on adolescent girls' knowledge of HPV and HPV vaccine, perception of sexual risk and intentions for sexual debut. This cross-sectional comparative study was conducted in Ibanda and Mbarara districts. Data was collected using a standardized self-administered questionnaire and analyzed using the Statistical Package for the Social Sciences computer software. Univariate, bivariate, and logistic regression analyses were conducted with significance level set at p < .05. Results showed that HPV vaccination was associated with being knowledgeable (Crude OR: 5.26, CI: 2.32-11.93; p = 0.000). Vaccination against HPV did not predict perception of sexual risk. Knowledge was low (only 87/385 or 22.6% of vaccinated girls were knowledgeable), but predicted perception of a high sexual risk (Adjusted OR: 3.12, CI: 1.37-3.63; p = 0.008). HPV vaccination, knowledge and perceived sexual risk did not predict sexual behaviour intentions. High parental communication was associated with adolescent attitudes that support postponement of sexual debut in both bivariate and multiple regression analyses. In conclusion, findings of this study suggest that HPV vaccination is not likely to encourage adolescent sexual activity. Influence of knowledge on sexual behaviour intentions was not definitively explained. Prospective cohort studies were proposed to address the emerging questions

Predictors of perceived sexual risk derived by logistic regression analysis.

<p><b>Note</b>:</p><p>** Significant at <i>p</i> ≤ 0.01</p><p>Predictors of perceived sexual risk derived by logistic regression analysis.</p

Background characteristics of respondents by attitudes towards postponement of sexual debut (PSD).

<p><b>Notes</b>:</p><p>¹ Vaccinated represents the sample from Ibanda; unvaccinated represents the Mbarara sample.</p><p>⁺Figures do not add up to 357 due to a missing case.</p><p>Background characteristics are the predictors while attitude towards postponement of sexual debut is the outcome.</p><p>For all background or predictor variables, 2^nd column odds are divided by 3^rd column odds.</p><p>Significance is at <i>p</i> ≤ 0.05.</p><p>Background characteristics of respondents by attitudes towards postponement of sexual debut (PSD).</p

Background characteristics of respondents by level of perceived sexual risk.

<p><b>Notes</b>:</p><p>¹ Vaccinated represents the sample from Ibanda; unvaccinated represents the Mbarara sample.</p><p>Background characteristics are the predictors while perceived risk for HIV and other STIs infection is the outcome.</p><p>For all background or predictor variables, high risk odds are divided by low risk odds.</p><p>Significance is at <i>p</i> ≤ 0.05.</p><p>Background characteristics of respondents by level of perceived sexual risk.</p

Predictors of attitudes towards postponement of sexual debut (PSD) derived by logistic regression analysis.

<p><b>Notes:</b> Number of observations = 645.</p><p>*Significant at <i>p</i> ≤ 0.05.</p><p>Predictors of attitudes towards postponement of sexual debut (PSD) derived by logistic regression analysis.</p