Despite primarily being a health problem, COVID-19 has numerous economic, social and political attributes. The combined effect of the socio-economic problems of the pandemic, in turn, have the potential to raise some other health problems. With stay at home orders, high potential for social crisis, unemployment and perceived threat of losing loved ones during the pandemic, a suitable condition has been created for depression to rise. EBR’s Kiya Ali takes a closer look at the problem.
26 years old Elsa Habtamu, name changed upon her request, vividly remembers the moment her entire life changed for good. Elsa was a happy girl with a resplendent smile for an identifying feature. Being the only child for her parents, she used to be treated in a special way and her family used to do everything they could to make her happy.
However, this cheerful life only lasted until mid-2006. On that day of gloom, her mother forgot to come back with the oranges that she promised to buy. When Elsa realized that her mother didn’t bring them, she started moaning about it. “She apologised and begged me to leave her alone. But I didn’t listen and kept on nagging her. Although she repeatedly promised to buy the oranges after taking some rest, I was stubborn,” Elsa recalls with regret. When her mother decided to shut Elsa up and got out of the house to buy the oranges from the fruit shop across the road, Elsa looked on with triumph from the gate of their compound. When Elsa’s mother was about to cross the asphalt road while holding the plastic bag full of oranges, Elsa was thinking about rewarding her mom with a hug and a kiss. She never guessed a tragic traffic accident would claim her mom’s life. “Everything happened with the speed of an eye blink. Suddenly, a speeding mini-bus hit my mom and turned my whole world upside down,” she sobbed. Elsa watched as a flood of blood drained from her mother’s head on to the asphalt road. “Dyed with blood, the oranges rolled towards me,” she burst into tears.
After the agonizing death of her mother, Elsa suffered a lot mentally. She had nightmares about her mother and daydreams brought the image of her mother lying on the road. As she never ceased to blame herself, she still considers herself the cause of her mother’s death. “When I lost my mom, I felt empty and drowned into darkness,” she says with grief. She later tried to commit suicide. When the issue is brought up, she still says “I wish I didn’t survive.”
People like Elsa are vulnerable to a psychological problem known as Post Traumatic Stress Disorder (PTSD). Its complications usually develop after being exposed to a traumatic event. Such experience can be sexual, emotional or physical abuse and it could be a leading factor to major depressive disorder – the professional way of calling depression. “PTSD could be a major reason to the development of major depressive disorder since both occur frequently following traumatic exposure. However, they can happen as a separate disorder as well,” remarks George Yehisha, a clinical psychologist. He pointed out that death of a loved one, a chaotic, unsafe and dangerous family life, abusive relationship, divorce, loss of a job, financial problem, poverty, social failure, moving to another city, serious trauma such as abuse, neglect, rape, and social isolation could also lead a person to major depressive disorder.
Depression is the leading Mental Health Problem around the world and it is more than just sadness. It is a disorder that is manifested in various ways and causes pain to the patient. While expressing her pain, Elsa remarked: “Routine activities that people carryout simply, such as: taking shower, going to work, eating and socializing with people are a burden for me. Most of the time, I try to pretend that I’m happy in front of people while I’m burning inside. I pretend that I’m comfortable and try to smile but deep down I’m crying.”
People may feel sad or depressed for different reasons. However, depression is different from the usual mood swing since it has its own symptoms. Its duration of grief or morose mood lasts longer than usual. Its symptoms can vary with the type of depression a person has. Nonetheless, thoughts of suicide, sad or empty feeling, constant fatigue, feeling hopeless, changes in appetite, withdrawing from friends and family, agitation, change in sleep habits like either sleeping too much or not sleeping at all and feelings of worthlessness could be mentioned as major symptoms.
“Depression can make socialising exhausting. However, some of these symptoms should persist for two weeks to diagnose someone with major depressive disorder,” Azeb Asamenew, a psychiatrist, explains.
In addition to creating mental and emotional pain, depression can affect the physical parts of a person like the brain, heart and other parts of the body. “One of the most serious side effects of depression is a decrease in brain volume,” George states.
Despite its widely felt impacts, depression is not considered a serious problem in Ethiopia. “Currently, as urbanization and education are expanding, there are some improvements. However, the level of awareness about depression is still low; people don’t know that it can be reliably diagnosed and treated at health centres. Very few people consider it a serious illness and know its symptoms, though it is the leading mental health problem in the country,” noted Atalay Bezabih, a Professor at Addis Ababa University. “The hardest part of depression is it might create a feeling of worthlessness and hide the bright side of the future. In worse cases, it may escalate into attempting and committing suicide,” he added.
Mild, moderate and even the most severe depression can get better with some form of treatment. However, knowing and treating the root causes is very important to find relief from the effects of depression. “The remedies of depression vary depending on the root causes. For instance, biochemical reactions inside the brain and genetic factors could be causes of depression. Sometimes the causes may even remain unknown,” Azebe explained. The World Federation for Mental Health report indicates that the preferred treatment options for major depressive disorder consist of basic psychosocial support combined with antidepressant medication or psychotherapy, such as cognitive behaviour therapy, interpersonal psychotherapy or problem-solving treatment.
However, people who suffer from major depressive disorder sometimes opt for illegal drugs and alcohol to find relief. Elsa is a case in point. Since she lost her mother, communicating and playing with her peers became a challenge to deal with. “I used to only enjoy sitting on the porch and listening to the arguments, laughter, and conversations of my peers. Although I wanted to be a part of their group, I refrained from doing so. Experiencing such a feeling at an early age is so painful,” Elsa recalls.
When she grew up, she started to take marijuana and weed to drift away from her pain. However, she stated, the problems remain when their effect fades quickly. “Alcohol and illegal drugs may give false happiness but they exacerbate the problem underneath it all. If depression is not treated properly, it may cause bipolar disorder. In the worst case, it might also lead to high level mental health problems like schizophrenia. So, victims of depression should avoid illegal drugs and alcohol to find relief from depression and its effects,” George stressed.
Azeb noted that engagement in cultural institutions like Mahiber, Ekub, family, marriage and religious institutions helps, in addition to going to medical centres. She also stated that patients should have at least one person that they can trust and share their problems with. “It is also really vital to avoid judgement and measure others’ problems based on one’s own standards. It is always important to ensure that the person who has major depressive disorder is safe,” Azeb explains. If the patient doesn’t want any help, she went on to remark, it is better not to interfere and they should only be told to ask for help when they feel like it. She also pointed out that apologizing is helpful when confronted with unsolicited interference. “Interference is advisable only when safety becomes an issue. Otherwise, tough love should be avoided,” Azeb advised.
Azebe noted that many people become vulnerable to depression during tough times such as the ongoing Coronavirus pandemic that has disrupted economic activities immensely and forced people (including those who live alone) to stay at home for a long time. “Existing problems may exacerbate the risk of depression particularly for low income families as they may lose their jobs; hence, survival by itself should be celebrated,” Atalay underscored.
9th Year • May.16 – Jun.15 2020 • No. 86