Manifestations of affective disturbance in sub-Saharan Africa: key themes.

Background: Affective disorder, once seen as rare in sub-Saharan Africa, is now viewed as more common. There are however challenges in assessing rates of depression, exploring manifestations of depression, and understanding risk factors for depression, especially those related to gender.

Aim: To identify key themes and new directions for research on affective disorder in sub-Saharan Africa, with particular reference to gender issues.

Methods: Interpretive review of selected literature, and theoretical analysis.

Results: There are gender differences in manifestations and rates of depression in sub-Saharan Africa, and there are forms of presentation (largely somatic, based on interpersonal relationships, or spiritual in nature) which may obscure the detection of depression. Studies are consistent however that when depressive symptoms are sought and are present, these are reasonably easy to elicit.

Limitations: This was not a systematic review, and the substantial grey literature from sub-Saharan Africa was not reviewed. For many countries, there are no data available.

Conclusions: Affective disorder, when properly sought for through both qualitative and quantitative methods, has been found to be common in sub-Saharan Africa. There is a paucity of research on interventions with affective disorder in this region.