In 2017, it was estimated that there were 322 million people living with depression globally with the highest prevalence (as % of population) being in the African region (WHO, 2017). Many past studies worldwide have found that depression is almost twice as likely to affect women, compared to men, (Nazroo et al. 1998) and this has remained the same in more recent studies (Yu, 2018). Although there are some biological factors that can contribute to this, such as hormonal and reproductive differences, (Mental Health America, 2019) it is also important to take into account the many social risk factors that are enhanced by gendered inequalities. According to the Global Report by Equal Measures 2030 (2019), Uganda scored 50.6 on the Gender Index score, ranking at 107 of 120 countries. Although rates of depression in transgendered women are as high as 62% (Hoffman, 2014) and generally more prevalent in the LGBTQ+ community (Witcomb et al. 2018), there is a lack of data and research in this area - especially on non-binary genders.
Education has been seen as a protective factor against developing depression (Bauldry, 2016), and in Uganda, this is the case for both males and females (Kinyanda et al. 2012). The likelihood for females to get a higher level of education is lower than for males, due to cultural norms and positions in society. However, there has been no significant trend between different levels of education and employment in women in Uganda (The Uganda Bureau of Statistics (UBOS), 2018), possibly due to the general levels of unemployment in this context. This data also does not differentiate between formal, unformal, paid and unpaid jobs, whereas discrepancies in these between higher and lower educated women can contribute to the risk of depression.
Socio-Economic Status
Interactions of education with the socio-economic status of the family seems to further increase inequalities between girls and boys. UBOS (2018) illustrates in the DHS 2016 that there is a huge gradient seen across wealth quintiles – with women in the lower quintiles being significantly less likely to finish secondary education. One explanation for this could be the practice of early marriage in Uganda, both as a means to increase family income, and as a cultural norm (Lovell, 2010). Furthermore, it has been seen in Kamuli, Uganda, that in families with economic hardship, they prioritise boys’ educations as they perceive this to bring in the most benefits (Atekyereza, 2001).
Cultural Beliefs and Family Expectations
There are many different norms associated with girls within the family construct – especially those of domestic work. In Northern Uganda, it was shown that young girls performed 85% of domestic chores, as opposed to 5% by young boys (Amone et al. 2013). The attendance of girls at school could be seen as hindering towards their domestic responsibilities, or less valuable, as their future is perceived to lie more heavily in their roles as mothers and wives. A study by Nalugya-Sserunjogi et al. (2016) in Central Uganda found that depressive symptoms in children ages 14-16 that were enrolled in school were already double in females, suggesting that risks for developing depression start while still in education. However, this study was undertaken in a rural community and therefore cannot be generalised.
Decolonial Theories
It is important to look at the gendered impacts of colonialism in terms of the lack of access to education and employment opportunities of women in post-colonial settings. In Africa during the colonial period, there was an increasing emphasis on women to be responsible mostly for domestic duties (Fofack, 2013). It was shown in Kampala, Uganda, that there were huge gaps in literacy between men and women, with women developing much slower, as well as men engaging in more “white collar jobs” (zu Selhausen & Weisdorf, 2015). Although recent data illustrates that these gaps have narrowed, they have not been eliminated, possibly due to the prevalence of male-dominated policies and the institutional reinforcement of mainstream gender structures. This lessened opportunity for formal employment in women may have decreased incentives for them to get an education, as there were less economic benefits of doing so. However, there is a complete lack of data surrounding pre-colonial times in Uganda and therefore it is hard to compare the changing of gender structures between the two periods.
The framework used to determine depression differed in almost all of the studies and as these have been developed in different contexts to the ones studied, it’s unsure whether they can adequately assess and diagnose depression among Ugandans. Definitions of depression and depressive symptoms can vary across languages and may cause misunderstandings and inaccurate data. As many of the determinants and gender inequalities pertaining to depression are interlinked, it is hard to see the effect of one determinant independently of other, causing very little definitive links to be made. Care-seeking behaviour around mental health tends to be less in men, and therefore they can be underrepresented in the statistics. Although there is increasing data around the social factors influencing NCDs, more research needs to be done in the area. There needs to be increasing research into the intersectionality of gender, as many other influences such as race and social class also have huge effects on depression and other NCDs.
References
Amone, C., Okwir, A. J. & Akot, D. (2013). Culture and girl-education in Northern Uganda. Prime Research on Education, 3(6), pp. 570-578.
Aterkyereza, P. (2001). The education of girls and women in Uganda. Journal of Social Development in Africa, 16(2), pp. 115-146.
Bauldry, S. (2016). Variation in the Protective Effect of Higher Education Against Depression. Society and mental health, 5(2), pp. 145-161.
Equal Measures 2030. (2019). Harnessing the Power of Data for Gender Equality: Introducing the 2019 EM2030 SDG Gender Index. Available at: https://data.em2030.org/2019-global-report/
Fofack, H. (2013). A Model of Gendered Production in Colonial Africa and Implications for Development in the Post-Colonial Period. Washington, DC: World Bank. Available at: https://openknowledge.worldbank.org/handle/10986/15579
Hoffman, B. (2014). An Overview of Depression among Transgender Women. Depression Research and Treatment, 2014, 394283.
Kinyanda, E., Woodburn, P., Tugumisirize, J., Kagugube, J., Ndyanabandi, S. & Patel, V. (2012). Poverty, life events and the risk for depression in Uganda. Social Psychiatry and Psychiatric Epidemiology, 46(1), pp. 35-44.
Lovell, N. (2010). Life experiences and expectations of young women in Uganda. Journal of Health Organisation and Management, 24(5), pp. 505-511.
Mental Health America. (2019). Depression in Women. Available at: https://www.mentalhealthamerica.net/conditions/depression-women
Nalugya-Sserunjogi, J. Rukundo, G. Z., Ovuga, E., Kiwuwa, S. M., Musisi, S. & Nakimuli-Mpungu, E. (2016). Prevalence and factors associated with depression symptoms among school-going adolescents in Central Uganda. Child and Adolescent Psychiatry and Mental Health, 10(39), 3260.
Nazroo, J. Y., Edwards, A. C. & Brown, G. W. (1998). Gender differences in the prevalence of depression: artefact, alternative disorders, biology or roles. Sociology of Health & Illness, 20(3), pp. 312-330.
Uganda Bureau of Statistics (UBOS) & ICF. (2018). Uganda Demographic and Health Survey 2016. Kampala, Uganda and Rockville, Maryland, USA: UBOS and ICF.
Witcomb, G. L., Bourman, W. P., Claes, L., Brewin, N., Crawford, J. R. & Arcelus, J. (2018). Levels of depression in transgender people and its predictors: Results of a large matched control study with transgender people accessing clinical services. Journal of Affective Disorders, 235, pp. 308-315.
World Health Organisation. (2017). Depression and Other Common Mental Disorders: Global Health Estimates. Geneva: World Health Organisation.
Yu, S. (2018). Uncovering the hidden impacts of inequality on mental health: a global study. Translational Psychiatry, 8(1), 98.
Zu Selhausen, F. M. & Weisdorf, J. (2015). A colonial legacy of African gender inequality? Evidence from Christian Kampala, 1895–2011. The Economic History Review, 69(1), doi: 10.1111/ehr.12120.