Elderly Nigerians, especially elderly women, are more susceptible to MDD (major depressive disorder). Levels of urbanization also have an impact on the incidence of MDD among the elderly. Very few MDD patients ever receive any kind of treatment for it in Nigeria, even though the illness is seriously disabling, according to a report published in The Lancet, this week's issue.

Professor Oye Gureje, University of Ibadan, Nigeria and carried out personal interviews with 2,152 people - a representative sample of the general population. They were all over 65 and lived in the Yaroba-speaking regions of the country, which make up just over one fifth of Nigeria's population.

The authors explain that lifetime and previous 12-month prevalence estimates of MDD appeared to be at 26.2% and 7.1% correspondingly. Women have double the risk of developing the disorder, while rising levels of urbanization can up the risk by 40%.

A person who suffers from MDD has impaired quality of life and functioning at home, work and socially. Independent ratings of symptom severity diagnosed MDD in 96•9% of cases.

Of the lifetime cases the researchers came across, only 37% had ever received any treatment, say the authors. On average, it took five years from the onset of symptoms for treatment to begin. MDD sufferers who were poor, or lived in rural areas, were the least likely to receive any treatment.

"Our findings emphasize high unmet need for treatment of depression in this population...the level of impairments that elderly people with major depressive disorder have speaks directly to the need for scaling up of effective medical treatment for those affected," they concluded.

Dr Judith Bass Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA and colleagues, in an accompanying Comment, explain that the effect culture might have on acknowledging and understanding mental illness "cannot be an after-the-fact consideration."

"Understanding local concepts of mental illness and of specific syndromes needs to be the starting place to create locally appropriate study instruments that can be used for measurement of prevalence and incidence of illness and evaluation of the effectiveness of innovative intervention strategies. Without such knowledge, we will continue to be stuck with the 'unsure of cultural appropriateness' caveat as a limitation in research rather than knowing whether we have captured the mental health problems we seek to understand," they conclude.


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