Studies have found that approximately one-fifth of the population of Sri Lanka (19.4%) has been detected with depression.
Among this, the highest prevalence is reported among young persons (39%). Among adults, older persons, and maternal populations, the prevalence is 8.7%, 18.4%, and 16.9%, respectively. Many of the studies reported several factors associated with depression, including individual attributes and behaviours, socioeconomic circumstances, and broader environmental factors.
This data was published in a research paper authored by University of Peradeniya Department of Community Medicine Lecturer Dr. Inosha Alwis, University of Kelaniya Department of Psychiatry Prof. Miyuru Chandradasa, and Dr. Anuradha Baminiwatta in the German journal Social Psychiatry and Psychiatric Epidemiology, titled ‘Prevalence and associated factors of depression in Sri Lanka: A systematic review and meta‑analysis’.
The research performed a quantitative synthesis of data from 33 studies, reporting the prevalence of depression among 52,778 subjects representing non-clinical samples in Sri Lanka to generate pooled prevalence estimates.
Lead author Dr. Inosha Alwis, elaborating on the study that reviewed 20 years worth of data, noted: “We were interested in identifying the health problems and the issues prevalent in the community as opposed to the problems and issues you may find in technical setups or hospitals. We recently undertook a systematic review regarding the stigma towards mental illness and other health problems or health-related stigma in Sri Lanka. There too we were able to identify the relevant factors.
“Stigma is a significant concern in Sri Lanka and it is important that we identify the factors causing stigma that lead to this issue. We were able to have a 360 degree outlook as to the factors that influence the drivers, determinants, and consequences of stigma in Sri Lanka and we put this into a framework.
“We also undertook an in-depth analysis of the health crisis that we recently experienced, from the angle of the community. We did a thorough analysis on the food insecurity problems as well as the other social issues that emerged during last year, such as intimate partner violence, which is a growing concern in Sri Lanka.”
Key findings
At 39%, the highest prevalence of depression reported among the subgroup of young people was due the fact that many studies were carried out around university students. When the factors causing depression were scrutinised, it was apparent that academic stress was leading to depression among this group.
While studies do not show an association between gender and depression, the reviewed data pointed out that women had consistently demonstrated a greater predilection for depression compared to men.
The studies among younger people also revealed that students in senior grades in schools and senior batches in universities were more likely to show depressive symptoms.
Meanwhile, a World Health Organization (WHO) survey found that the prevalence of self-reported depression among adults above 50 years was lower in Sri Lanka compared to Bangladesh, India, and Nepal. The prevalence of maternal depression in Sri Lanka returned a score of 16.9%.
Several Sri Lankan studies found that unemployment and financial difficulty were associated with depression as well. One Sri Lankan study showed that among people with lower standards of living, underemployment was significantly associated with depression only among men while being employed was associated with depression among women. Therefore, it appears that employment may have different impacts on depression among men and women.
In a few Sri Lankan studies, food insecurity was associated with depression, which is compatible with previous evidence. Currently, Sri Lanka is facing an unprecedented economic crisis with increased food insecurity, especially among less-affluent groups. The rates of depression are likely to increase in this context and urgent measures need to be implemented to protect the vulnerable.
Among Sri Lankans, being widowed, separated, or divorced increased the odds of having depression. Previous studies have suggested similar associations, but marital status, age, gender and depression have shown a complex inter-relationship. Therefore, when screening and treating depression in individuals, researchers suggest that clinicians must carefully consider the existing psychosocial supports while understanding other contextual factors.
The association between chronic diseases and depression is well known and was revealed through several Sri Lankan studies, especially among older adults. Moreover, smoking and alcohol use were associated with depression across the subgroups. Worldwide studies have shown that comorbid substance use, especially alcohol use, is closely associated with depression.
Recommendations
The researchers, following the review of data from the 33 studies, have identified a looming burden that is yet to be fully addressed and have recommended that an integrated, community-based approach involving mental health staff, public health personnel, and community-based organisations be adapted to look at measures to strengthen primary and secondary prevention of depression.
In addition, the researchers have suggested including culturally relevant practices, such as practising mindfulness through meditation and daily affirmations, be included into one’s daily routine to improve help-seeking and acceptability. In the meantime, the State should also consider increasing financing and resource generation for preventive and curative mental healthcare.
Helpline and other measures
When The Sunday Morning asked about the measures that the Sri Lanka College of Psychiatrists (SLCP) had taken to address the issue, SLCP President and National Institute of Mental Health (NIMH) Senior Consultant Dr. Kapila Ranasinghe shared: “Although data suggests that there is a concerning amount of people who experience depression, only a handful would actually seek medical or professional assistance. This is mainly due to illiteracy regarding mental wellness. This creates a treatment gap between the actual number of people who likely suffer from depression and the number of people seeking medical or professional assistance.
“We have opened up a national helpline – 1926 – to provide psychosocial support free to those who reach out. Since its establishment, we have been able to provide advice or save the lives of at least 100,000 people who reached out through the hotline.”
Dr. Ranasinghe also noted that the 1926 hotline has assisted in preventing suicides over the past four years. Moreover, the SLCP has also initiated a school programme where there will be a designated teacher or deputy principal qualified in child and adolescent psychology to provide counselling services to schoolchildren in order to address the mental wellbeing issues they face.
“We would also like to reiterate that private and State media entities as well as civil society organisations can help us with creating awareness about mental wellbeing by creating programmes that can instil a positive outlook in society.
“Nowadays, we see reports of many incidents on news channels that are filled with violence, self-harm, physical and mental abuse, and deaths that occur due to suicide. As much as they are eager to report these incidents, they should also create a space where preventive measures are discussed and a broader understanding about mental wellbeing could be reached through public discourse,” Dr. Ranasinghe emphasised.