By PATIENCE IVIE IHEJIRIKA, Abuja, ROYAL IBEH Lagos, HEMBADOON ORSAR, Makurdi and HARUNA MUHAMMED, Bauchi
As Nigeria and the rest of the world continue to count their losses to the COVID-19 pandemic, experts are concerned that the pandemic may further increase the risk of anxiety and depression among Nigerians.
The lockdown in particular which saw the closure of public places like worship centres, schools, markets and offices may have impacted on their mental health, LEADERSHIP Sunday learnt.
To make matters worse, checks by our reporters revealed that there are only eight federal government-funded psychiatric hospitals in Nigeria.
A consultant psychiatrist at the Federal Neuropsychiatric Hospital, Enugu, Dr Onu Justus Uchenna, told our correspondent that the pandemic presented all the risk factors for depression, even in a normal population.
Uchenna, who is also a lecturer at the Department of Mental Health, Nnamdi Azikiwe University, Awka, said, “Before now, we had always known that loss events, decreased social support and economic adversities were all risk factors to depression and anxiety and the Covid-19 pandemic presents the same risk factor.
“So, we expect increase in depression and anxiety even in all other mental health disorders. But we don’t have data to state categorically that there is increase in prevalence of depression.”
He noted that whenever there is an increase in social or economic adversity, incidence of depression tends to rise.
Uchenna however noted that most people with depression do not necessarily consider themselves as having mental disorder because behavioural change is not so obvious.
He said, “What people have mostly are sadness and loss of interest in things they used to enjoy but most people will not recognise it as a mental health problem. So, instead of seeing a mental health expert, most of them see other clinicians.
“Maybe if you work in a general hospital or teaching hospital, you will see a lot of depressive disorders but in core psychiatric facilities, people with depression and anxiety don’t tend to see them as a first point of call, when they see other clinicians, those clinicians will refer them to psychiatrists.
“So, we can’t state categorically because we have not taken a survey on the number of people that used to have depression before Covid-19 and the number of people being diagnosed with depression during Covid-19. We have not taken that survey in Nigeria. But a report by the USA census bureau states that the number of people with anxiety and depression symptoms has increased in the country.
“This could also be the case in other parts of the world. This is because COVID-19 presented some unique features. The first of it is that there is a general fear of a deadly disease, so people live with that fear.
“The second thing is information -false information about the disease is being circulated everywhere. There is misinformation in the public and this raises some level of panic.
“The third point that could lead to anxiety and depression is losses. Losses could be in form of anything; it could be life- that is death, it could also be loss of employment, even businesses. These are all losses. It is scientifically proven that life events involving losses posse threat to an individual. For example, somebody during this COVID-19 loses a father; it will put a threat to the person. If you are threatened, you tend to react to anxiety but if you have an event of loss, you tend to respond with depressive symptoms. Most events of loss involve threats, so we have high incidence of comorbid anxiety and depression occurring in the society.”
The mental health expert also identified social support as one of the incidents that could lead to depression as a result of COVID-19.
He said, “Remember that one of the public health measures in reducing the pandemic is physical and social distancing. Our community members have always lived together and supported each other. When we go to church and other congregations or transitional meetings, we share our problems and we tend to support one another but now with the COVID-19 and public health measures, social contact is reducing.
“So, when all the indices of social disadvantage is increasing; loss of job, unemployment, the cushioning effect of social support to stress is also reduced, so this whole factor will cumulate into higher incidences of depression and anxiety”.
Uchenna said despite the rate of mental health disorders in the country, there are very few psychiatrists available in the country.
According to him, the association of psychiatrists in Nigeria in 2019 to 2020 reported that there were about 300 mental health professionals in the country. This means that there is one psychiatrist to 800,000 people, whereas the optimum ratio, according to the World Health Organisation (WHO), is one to 10,000.
“We are not even certain of the 300, we may even be overrating the ratio, it may actually be one to 1,000,000 since we don’t have a track of most of the health experts leaving the country,” he added.
He also stressed the difference in urban/rural distribution of mental health physicians, saying most psychiatrists were practicing in the urban areas whereas at the primary health care centres where the bulk of patients reside, there are no psychiatrists and even psychiatric nurses.
According to him, in Nigeria’s health policy, mental health was incorporated as the 9th component of primary health care. In order words, mental health should actually be delivered in PHC centres, but this is not the case, the integration is just in the paper.
In the same vein, a medical expert in Bauchi, Dr Peter Sule, told our correspondent that although there is no official national documented data on the present prevalence of depression in the country, many physicians will agree with the fact that there is some increase in depression and other mental health diagnosis since last year.
“ln practice, many clinicians will agree with me that with since February 2020 till date the number of patients that have presented to the clinics with various degrees of depression with or without suicidal ideation and/ attempts have increased.
“With the closure of the places mentioned, people’s social interaction was cut off. A lot of businesses experienced losses; others were completely shut down; private organizations laid-off workers in order to save costs; people with blue-collar jobs had nothing to do, and as a result, they soon spent the little savings they had”, he argued.
The medical expert said with unemployment already a challenge in the country, job losses, financial difficulties, idleness, ‘the stay at home’ order from the government months back and the current economic recession, the miseries of Nigerians had unimaginably predisposed many to various degrees of depression.
“Students who are forced to leave school and stay at home for about 10 months now find themselves completely idle, and as the saying goes ‘an idle mind is the devil’s workshop’. Some students have picked up bad habits like drug and substance abuse which is a risk factor for suicide”, he further noted.
He said families where only a spouse was employed and lost their job as a result of the lockdown struggled financially and as a result, some experienced marital conflicts which makes some depressed and gives others suicidal ideation.
Peter said despite the increase in depression, only a few Nigerians pay keen attention to their mental health and that of their loved ones because the average Nigerian family is first concerned with what to eat before bothering about mental health.
He argued further that the Nigerian society is yet to embrace openness, noting that people who try to seek help when they are in some form of dilemma or rough spot are seen to be weak, hence making a lot of people to suffer in silence.
He advised that people should be encouraged to seek mental health counselling when they need one from people they trust and are comfortable to share their challenges with.
Also, a consultant psychiatrist, Dr Yewande Oshodi, said, “Health is something we are concerned about, and when we think about health, it is not just the absence of diseases. It is a state of mental, physical and social wellbeing. So, we must think in holistic and comprehensive health.
“We cannot provide health in section and say all we will do is physical health, because as long as we keep on ignoring mental health, it will keep unburdening us and we can see the incidences of mental illness rising and they will continue to rise if you and I do not take action.”
Speaking on the signs of suicide, Oshodi said, “Any declaration like ‘I just want to die’, ‘I can’t take it anymore’, must be taken seriously. Such statements should not be ignored, but rather, we should encourage such person to seek help from mental health experts.
“If left untreated, mental health disorder can lead to chronic heart diseases.”
Also, mental health physician and psychotherapist, Maymunah Kadiri, said anyone can be depressed at any point in time, adding that most Nigerians are depressed without being aware as recent statistics revealed that one out of every five Nigerians has mental health disorder.
According to her, most Nigerians think people who suffer from mental health disorder are those on the streets.
“The people on the streets represent just one to two per cent of mental health cases in the country. The 98 per cent of mental disorders come from us, not those on the streets. Depression is so high that it cuts across all genders, all socio-economic status etc,” she added.
She however advised those going through depression to get a health system.
“If your friends are not helping you, you would need new friends that can support you. Also, you need to optimize your strengths and minimize your weaknesses,” she added.
She advised the youth to aspire to be great because all humans have a drop of greatness in them.
On his part, director of Advocacy and Communications at PharmAccess Foundation in Nigeria, Dr Olamide Okulaja, said, “We have seen people who will park their cars and jump into the lagoon, we have heard of people committing suicide by taking sniper.
“A lot of people don’t talk about mental health disorder because of the stigma and the government and private sector are not looking in that direction. They are mostly concentrating on diseases like HIV, malaria and Tuberculosis.”
Okulaja urged the government and private sector to turn their attention to mental health issues.
Meanwhile, the founder, Omna Health Nigeria, Abeke Lawal, said the best way to help anyone who is undergoing depression is to encourage that person to seek professional help from a psychologist or a psychiatrist, depending on the severity.
He said psychologists use psychotherapy to treat depression, but if it is severe or occurs with a disorder like psychosis, the person would need anti-depressants which can only be prescribed by a psychiatrist.
She continued: “Mental health issues or illnesses are not something to be ashamed of. Just as your body falls ill, your mind can also fall ill. If you are experiencing any emotional issues whatsoever, please seek help before it is too late.”
She urged the Nigerian government to work with the private sector to provide more mental health facilities for the constantly increasing number of Nigerians with mental health problems.
“They should also sponsor more campaigns geared towards mental health awareness to eliminate the stigma and ignorance currently associated with mental health disorder in Nigeria,” she added.