Depression in context: PhD Students, Youth & Low and Middle Income Countries
I can hardly pin-point the start or trigger of my interest and passion for global health. I frequently refer to a point when I was about 7 where I witnessed the impact of my father’s work with HIV/AIDS on people in Cameroon (my home country). Or, to a point when I was 16 and I spent a week travelling to 3 of the most socio-economically deprived regions in Ghana visiting various Anti-retroviral (ART) centres with himself as UNAIDS country coordinator for Ghana alongside the country coordinator of Society of Women Living with AIDS in Africa (SWAA).Currently in the final year of my PhD in infectious Disease and Global Health at the University of Liverpool, and the starting point on this journey seems quite distant and somewhat irrelevant. It is safe to say whatever it was, the yearning for more education and solutions is deep-seated, profound and constantly enlarging with time, experiences and the current social climate we live in.
The reminder of World Health Day flooded many themes to mind as I contemplated what to focus this article on. Upon further research and learning this year’s theme – “Depression – let’s talk about it”, I instantly found the theme I will go on to address.
Considering my background and current position, I will focus on mental health problems in PhD students and youth, as well as depression in people in low and middle income countries (specifically Sub-Saharan Africa). I must admit, when I initially thought of my areas of interest in health, mental health was seldom at the top of my list. This is therefore unchartered territory for me but one that has seized my attention and led me into another dimension on this journey and interest in global health.
Mental health problems in PhD students and youth
A doctorate in philosophy (PhD) is still one of the highest academic qualifications attainable. It is therefore interesting to note, a study based on 12 mental health symptoms showed 32% of PhD students are at risk of having or developing a common psychiatric disorder especially depression. Yet, national figures in the United Kingdom for example in 2012 showed approximately 1 in 500 individuals reporting a mental health problem to their university. The fear of stigma and adverse effects on a future career has led to a reluctance to seek help.
The number of new PhDs (recipients of doctorate degrees) grew from 158,000 in 2000 to 247,000 in 2012; an increase of 56%. This increase was accompanied by budget cuts and increased competition for research resources. The laws of mathematics and demand and supply will agree on the inability to marry the number of PhD students produced by various institutions, with future academic careers following research budget cuts.
What has become the “norm” is the idea of spending on average 4 years (in most European countries) doing a PhD with no job security or specific knowledge on how to navigate from point A (end of PhD) to point B (desired career). This effect has somewhat diluted the sense of achievement upon completion of a PhD into looking for the next best opportunity. This process is frequently accompanied by various stresses such as; fear of failure, funding running out, thesis writing and making future career decisions in a heavily saturated field. This situation is made furthermore difficult for international students contemplating future career options due to the sponsorship requirements for job hiring.
Highlighting this in PhD students doesn’t detract away from this as a phenomenon currently plaguing many youths in both the developed and developing world. In 2016, it was reported within the UK, drinking, smoking, drug taking and teen pregnancies are at their lowest but depression and anxiety have increased by 70% in the past 25 years in teenagers. The question stands, how has society managed to produce a generation with such prevalent mental health problems? While this could be attributed to a number of factors, I believe one of them is – uncertainty of the future.
Another article recently stated, Millenials are the most educated generation in U.S history but yet struggle to attain professional success. Realities are; 39% of people under 25 are unemployed or underemployed. There is an imbalance which needs to be addressed between the education system, skill set, job creation and thus professional success. It is the responsibility of the institutions and governments to create prosperity and ensure employment of youth and in the specific case of PhD students, balance the demand and supply in academia and in industry. These will go a long way to solve some mental health problems especially depression stemming from a job insecurity and other issues which go alongside this such as quality of life.
Depression in low and middle income countries (specifically Sub-Saharan Africa)
In Sub-Saharan Africa, depression is an important but frequently neglected public health problem exacerbated by different circumstances. The prevalence of depression in Sub-Saharan Africa (SSA) is at about 5.5% but in people living with HIV (PLHIV) it is about 8%. Some of the challenges faced include; coping with diagnosis, social rejection, co-existing poverty and relationship crises to name a few. Depression in post-natal mothers reports higher figures. A study carried out by the Harvard Chan School of Public Health highlighted a significantly higher level of maternal depression in low and middle income countries compared to higher income countries. Several risk factors include; partner violence, low maternal education attainment and socioeconomic status. The common thread amongst all the risk factors of depression regardless of the group examined at any one time is; socio economic status, lack of education and gender inequality. It is therefore no surprise that several factors which play crucial roles in prevention of depression include; alleviating poverty, improving education, reducing violence and gender equality. These factors all feed in one way or the other to the sustainable development goals (SDGs).
The SDGs have a duty to go beyond reducing poverty but also creating prosperity, to go beyond encouraging education but creating a society able to absorb and value this education, to go beyond motivating Youth but empowering and ensuring sustainability and continuity. As of 2015, unemployment rates in Africa compared to the rest of the world were 7.44% and 6.00% respectively. The total youth unemployment reached 30.4% in North Africa and 48.1% in Sub-Saharan Africa. In Sub-Saharan Africa, 61.4% of youth lack the level of education expected to make them productive on the job.4 These figures are at an all time high, it is therefore unpractical to think there is no direct link between education/employment and the level of health. The expectations placed on understanding the need for access to healthcare and obtaining frequent tests for sexually transmitted diseases are unfair with increase unemployment, lack of security and somewhat limited knowledge on disease transmission at all levels within the community. It is impractical to expect an individual to consider long-term effects (such as mental health in this case) when the short-term needs (food and shelter) are not met via high unemployment rates and low socioeconomic status . In order to facilitate an improvement in the status quo, a positive change in the employment/education landscape alongside a change in the health sector is needed.