Saturday, November 27, 2021

Are the kids alright? Botswana does not know

In Botswana, the health of kids is supposed to be a big deal, apparently. After all enquiries about the health of children (bana ba tsogile jang?) almost always comes up after “how are yous” whenever parents meet and greet.

Most Batswana parents tend to think they know how their children are doing and can spot even signs of depression in their kids. Unfortunately, it isn’t always the case. While many parents bring their child in for help shortly after depression begins, the opposite is far more common than we think.

In fact, research has revealed that even Botswana’s leaders and policy makers do not know how depressed their citizens are. A recent study: Mental health research in Botswana: a semi-systematic scoping review by Philip R. OpondoAnthony A. Olashore and, Keneilwe Molebatsi carried out in 2020 “identified a relative scarcity of mental health-related research in Botswana. The few studies identified were mostly cross-sectional and covered only a few aspects of mental health, such as HIV and mental health, and substance use.” According to the researchers, “the findings suggest a need to strengthen the research capacity of individuals working in the mental health field. There is a need to develop a national database of research on mental health in Botswana and to set out research priorities. This would help to guide the mental health research agenda. To the best of our knowledge, this is the first study to review the extent of mental health research in Botswana. It thus forms a baseline for further reviews and priority-setting in mental health research in Botswana.”

This observation is shared by another study: Psychiatric epidemiological survey of university students in Botswana: rationale and methods of the Youth Mental Health Study (YMHS) by Maphisa Maphisa, Opelo Petunia Mogotsi, Olorato Khumo Machola, Keamogetse Metlha Maswabi, Tiro Bright Motsamai and Boitshepo Mosupiemang which states; “ While the burden of disease attributable to mental disorders in low/middle-income countries (LMICs) is lower than high-income countries, there is recognition that the dearth of evidence from the LMICs may underestimate the actual prevalence and burden associated with mental disorders. Such is likely the case for Botswana where there has been no nationally representative data on the prevalence of symptoms of mental disorders or even a subgroup estimation of mental disorders in the country.”

The study further observed that, “there is no nationally representative data on the prevalence of symptoms of mental disorders in Botswana, nor is there a subgroup estimation of mental disorders in the country.

The more robust of the available studies is a cross-sectional population study which investigated depressive symptoms among a sample of 1268 participants from five of the 17 districts in the country. The study found a 28% prevalence of significant depressive symptoms as measured by the Hopkins Symptom Checklist for Depression. Other available studies in Botswana are mostly disorder specific—mostly depressive symptoms; are restricted to specific clinical populations—mostly HIV; and offer a cross-sectional formulation of symptoms of mental disorders—for example, proximal psychological variables.”

This lack of knowledge on the mental state of Botswana’s young adults runs from the top of government right down to the family unit.

Telling the difference between a child’s normal ups and downs and something bigger is among the top challenges’ parents face in identifying youth depression. Most parents struggle to differentiate between normal mood swings and signs of depression, while some say their child is good at hiding feelings. In many families, the preteen and teen years bring dramatic changes both in youth behaviour and in the dynamic between parents and children. These transitions can make it very challenging to get a read on child’s emotional state and whether there is possible depression.

Parents dismiss depression in their children by thinking they are going through a phase, and it won’t last. They think “my child looks fine to me, everything seems fine, so we move on”. Parents are also guilty of not listening, most parents are busy, and don’t pick up the cue to put down what we they are doing and tune in. Even though they spend more time with their children than ever before, they are also more often distracted. Children whether young or old try to protect their parents. They can see when their parents are struggling and avoid telling them how they are doing. They don’t want to overload their parents. This is often evident in elder children, who will protect their parents even as they take on the caretaking role for others in the family. It is also seen in younger children who have taken on the family role as “laid back,” or the happy one.

But having depression is more than just being sad. Depression affects the way we think, and how we see ourselves and our future. Along with feeling sad or irritable, it may seem that nothing is worthwhile and that things will never get better. Depression is hard to diagnose because it is not always obvious. Parents may not believe in an illness they don’t see. Parents need to be educated that some illnesses exist and cause suffering even if they can’t always see it.

Senior Social Work lecturer at the University of Botswana, Dr Poloko Ntshwarang says, “Sometimes depression is triggered by difficult event, such as parents separating, a bereavement or problems with school or other children. Often, it’s caused by a mixture of things. For example, your child may tend to get depression and experienced some difficult life events. Loneliness and social isolation are some of the biggest challenges a depressed young adult may face. More severe challenges include self-harm, suicidal feelings and failing to take medication and/or go to therapy.  Parents need to tease out what’s depression and what’s typical stress. One of the hallmarks of depression is the way it cuts us off from meaningful connections. It’s important to take notice when parents feel that their connection with a child fades in a way that continues for more than a week or two.”

Dr Sophie Moagi, clinical psychologist in Gaborone says, “Depressed individuals often have difficulties in school, interpersonal relationships, and occupational adjustments in general. They also tend to dabble in increased tobacco and substance abuse; and even suicide ideation and attempts. Academic failure and work issues are particularly important consequences for young adults these events can result in them feeling isolated hence diverting from a normal developmental trajectory. Symptoms of depression in young people include feeling grumpy, having trouble sleeping, feeling worthless or guilty, eating more or less than usual and gaining or losing weight. Life situations can contribute to depression in young people but sometimes there seems to be no reason. Encourage young people to talk about how they feel with someone they know and trust such as a parent, teacher, school counsellor, family member or friend. Depression is one of the major risk factors for suicide and self-harm. If a young person is self-harming or talking about suicide, it is important that they talk with close and trusted people in their lives, such as family or friends.”

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