Old age and depression in Ghana: assessing and addressing diagnosis and treatment gaps

ABSTRACT

Background: There is limited evidence about the prevalence of depression among older people in sub-Saharan Africa, about access to treatment or the potential efficacy of community-based interventions.

Objective: Using nationally representative data from the WHO SAGE survey, we examine the prevalence of and factors associated with depression among people aged 50 and over in Ghana. Compare self-reported diagnosis and a symptom algorithm to assess treatment gaps and factors associated with the size of gap. Assess the feasibility of a small community-based intervention specifically for older people.

Method: Prevalence and treatment data were taken from the WHO SAGE 2007 survey in Ghana, including 4,725 people aged 50 or over. Outcomes of interest were self-reported depression and diagnosis of depression derived from a symptom-based algorithm. The data were subjected to bivariate and multivariate analysis. In parallel, a pilot intervention was conducted with 35 older people, which included screening by a trained psychiatrist and follow-up group sessions of psychotherapy.

Results: The symptomatic algorithm reported an overall rate of 9.2 per cent for the study population, with associations with female sex and older age. The treatment gap for these cases was found to be 83.0 per cent. The implementation of the pilot study was perceived as effective and replicable by stakeholders and there was some evidence of enhanced outcomes for people with mild depression.

Conclusions: Large numbers of older people in Ghana experience depression, but very few have access to treatment. There is an urgent need to develop and validate community-based services for older people experiencing this condition.

KEYWORDS:

• Depression
• prevalence
• feasibility study
• older adults
• mental health
• Africa

Responsible Editor Peter Byass, Umeå University, Sweden

Responsible Editor Peter Byass, Umeå University, Sweden

Acknowledgments

None.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics and consent

Ethical clearance for analysis of SAGE data was not necessary, as these data are in the public domain. Ethical clearance for the feasibility study was granted by the Ghana Health Service Ethics Review Committee (protocol GHSERC004/07/17).

Paper context

Research on depression among older adults in sub-Saharan Africa is very limited. This paper seeks to address this knowledge gap by analysing data from a WHO survey of older people’s health conducted in Ghana. We find that around one in ten people aged 50 or more experienced depression and that almost none had access to effective treatment. The paper also assesses the feasibility and potential impact of s simple, community-based intervention to improve treatment.

Additional information

Funding

The feasibility study and data analysis were funded by the Economic and Social Research Council (grant ES/P003516/1). SAGE data collection was funded by the National Institute of Health (grants OGHA 04034785, YA1323-08-CN-0020 and Y1-AG-1005-0 (R01AG034479)).

Notes on contributors

Peter Lloyd-Sherlock

PLS led the design of the study, as well as the analysis and writing of the paper. Sutapa Agrawal, IL and NM all made substantial contributions to the data analysis and the drafting of the paper. MA-C, Selasie Adom and E A-S made substantial contributions to the planning and analysis of the feasibility study.