Specialisation: Childhood Depression

Childhood Depression in Sub-Saharan Africa

Depression is a mental condition marked by a continuous feeling of loneliness and a lack of motivation. It is different from the daily mood fluctuations that everyone experiences. Adults, teenagers, and children are all affected, making it the most widespread mental disorder. The majority of evidence on depression in Africa comes from adolescents and young adults. Depression, when combined with other cognitive and somatic diseases, can increase the risk of unfavorable consequences and have a detrimental impact on social roles and functional capacity. Furthermore, depression affects many people and has a variety of causes. Individuals and communities alike bear costs as a result of depression’s impacts. These expenses, however, can be controlled through various intervention programs and evaluations.

Causes and Prevalence of Childhood Depression

Depression is a psychological condition caused by a variety of reasons. Mayston et al. (2020) state that physical, mental, or psychological violence is one of the leading causes of childhood depression. Physical abuse at a young age, such as rape, causes dread and stress, which leads to depression in many teenagers. Domestic abuse, poverty, and illnesses such as HIV, according to Hatcher et al. (2019), are risk factors for social and psychological breakdown. Grief or loss is another common cause of depression in children since they may lose a loved one, such as a parent, and become depressed due to their overthinking (Huang et al., 2016). Many youths use recreational drugs and alcohol, leading to depression as a side effect.

Drug and substance addiction is likely to lead to depression if the substances are unavailable. However, Huang et al. (2016) argue that if a child has a family history of depression, especially if a parent experienced the condition as a child, they are more likely to have childhood depression. Once a child has had a major depressive episode, they are more likely to have another in the next five years. Depression can affect a person’s ability to perform and enjoy life for a long time or repeatedly. According to Hatcher et al. (2019), kids with co-morbid depression originate from broken families and suffer from severe drug misuse problems. Depression has been linked to youth suicide conduct, a big issue in many countries and the third largest cause of mortality among teenagers.

Depression is the most frequent of all mood disorders widely spread in Sub-Saharan Africa. Based on Mayston et al. (2020), depression has been marked with a prevalence of 4.4 percent and a high rate in females than males. It is generally accompanied by indifference, poor spirits, and sorrow. According to the study by Mayston et al. (2020), there is a variation in the prevalence rate between boys and girls. Boys have increased rates of behavioral disorders, while girls have higher rates of emotional illnesses. Males and females are similarly affected during childhood, according to Mayston et al. (2020), but the female to male ratio shifts to around 3:1 by adolescence, mirroring prevalence in adulthood. Jörns-Presentati et al. (2021) found similar prevalence rates in rural and urban areas but much higher in slum areas, implying that poverty or crime plays a significant role. According to Huang et al. (2016), the prevalence of depression is higher for participants with unemployed guardians and lower for those with professional guardians. Furthermore, the high frequency of depression imposes high costs on affected individuals and society.

Costs of Childhood Depression

Depression and other childhood psychological disorders are becoming increasingly common among African children. According to Sterling et al. (2018), depression in early childhood places a significant load on individuals, relatives, and society by increasing hospitalization and fatality and negatively impacting the quality of life during periods of severe depression. Depression is one of the leading causes of disability worldwide, accounting for 4.3 percent of the global burden of disease (Sterling et al., 2018). It has long-term economic consequences in adulthood for people who had psychological problems as children. Increased difficulties in working, trouble finding or retaining a spouse, and a reduced earning potential of one’s ultimate mate are three crucial mechanisms through which these psychological issues appear to affect adult earnings (Sterling et al., 2018). The prevalence of widespread unmeasured family and local influences is not the primary cause of these high economic costs. Children and teenagers with depression have higher support expenditures than those with other mental diseases.

Costs are incurred when services are used over a set length of time such as quarterly outpatient visits, a certain number of days as an inpatient, weekly health and social care contracts, or participation at a particular school unit (Sterling et al., 2018). Treatment costs increase for low-income families who have depressed patients; therefore, society steps in to help. According to Sterling et al. (2018), the occurrence of mental health issues is associated with an increased overall healthcare cost of $2,631 per child per year. Prescription drugs, emergency treatment, and office visit costs were around two times greater for children with mental illnesses than for children without mental illnesses. The total expenses of depression, according to Sterling et al. (2018), may include consideration of the illness’s comorbidity costs with several other disorders. Reduced quality of life for sufferers and increased out-of-pocket costs as a result of the illness’s effects, notably those connected to household services. In light of the negative effects of depression and the limited ability in the treatment choices, intervention and prevention are essential.

Intervention Program on Childhood Depression

Young people all across the world are affected by depression. According to Beames et al. (2021), this condition is widespread and long-lasting, creating stress as young individuals enter maturity. Detection and early assessment measures are essential to lower the clinical cost of depression in youths. Beames et al. (2021) found that the most prevalent technique for depression treatment for teenagers is cognitive-behavioral group therapy. The fundamental concept of cognitive-behavioral therapy is that ideas influence emotions, which influence behavior. Cognitive restructuring skills, which support participants in detecting and confronting their negative, unconstructive thinking, are often taught in cognitive-behavioral techniques (Beames et al., 2021). Primary prevention strategies aim to prevent the occurrence of depression in large groups of people or lower the general incidence of depression in the community. Behavioral therapy incorporates behavioral approaches, progressive relaxation, problem-solving therapy, and ways to strengthen social support and can be utilized individually or as a group.

In high-risk patients, cognitive-behavioral intervention seeks to prevent or delay the onset of symptoms. This intervention avoids stigmatization and has higher participation rates, lower dropout rates, and a wider reach, capturing individuals who would otherwise go untreated and preventing healthy children from becoming at-risk (Beames et al., 2021). Furthermore, evaluation results show that participants who begin with elevated symptoms of depression improve the most from cognitive-behavioral therapies. Beames et al. (2021) advocated creating a new plan for preschool-aged children and their parents that would empower the community and successfully respond to depression using the findings. This new program is a universal program with a parent component that may be administered by certified teachers in kindergarten and preschool settings. The curriculum incorporates skill development for children, parents/caregivers, teachers, and critical psycho-education for parents and teachers about mental health signs, management, and referral.

Effective patient outcome monitoring and evaluation is a critical tool for guiding treatment decisions. According to Beames et al. (2021), evaluation aids in identifying the need for extra professional education and training and assists patients in recognizing their progress. A combined effort between mental homes is important to ensuring that psychological issues in youths are spotted early, reduced, and treated appropriately (Beames et al., 2021). The program exemplifies several of the framework’s principles by putting research into practice, improving care pathways, and discovering more about how to detect, recognize, and respond to young people with mental health problems in the community early, effectively, and cooperatively. Regular follow-up interactions and symptom assessment are required for efficient care of depressed patients. Beames et al. (2021) assessed the Patient Health Questionnaire-9 (PHQ-9), which is a standard instrument for detecting depression in primary care. It is applicable for response to therapy, repeatability, and minimal clinically meaningful difference.


Adverse childhood experiences can disrupt children’s important physical, interpersonal, and social growth, putting them at risk for mental health challenges. Early intervention and prevention measures are necessary and successfully minimize the burden associated with internalizing symptoms in children, at least in the short term. In programs focuses at children or parents, continuous training programs in cultural, psychological, and behaviour capacity appear to be the most beneficial. While the initiatives evaluated here provide hopeful evidence of the effectiveness of early childhood preventive interventions, more detailed research investigations are necessary. These include a longer-term randomized controlled trial with multiple reporters and evaluations of sociocultural, psychological, intellectual, and biological variables administered evenly throughout the sample with all confounds controlled.


Beames, J., Kikas, K., & Werner-Seidler, A. (2021). Prevention and early intervention of depression in young people: an integrated narrative review of affective awareness and Ecological Momentary Assessment. BMC Psychology9(1). https://doi.org/10.1186/s40359-021-00614-6

Du Rietz, E., Jangmo, A., Kuja‐Halkola, R., Chang, Z., D’Onofrio, B., & Ahnemark, E. et al. (2020). Trajectories of healthcare utilization and costs of psychiatric and somatic multimorbidity in adults with childhood ADHD: a prospective register‐based study. Journal of Child Psychology and Psychiatry61(9), 959-968. https://doi.org/10.1111/jcpp.13206

Hatcher, A., Gibbs, A., Jewkes, R., McBride, R., Peacock, D., & Christofides, N. (2019). Effect of childhood poverty and trauma on adult depressive symptoms among young men in peri-urban South African settlements. Journal of Adolescent Health64(1), 79-85. https://doi.org/10.1016/j.jadohealth.2018.07.026

Huang, K., Abura, G., Theise, R., & Nakigudde, J. (2016). Parental depression and associations with parenting and children’s physical and mental health in a Sub-Saharan African setting. Child Psychiatry &Amp; Human Development48(4), 517-527. https://doi.org/10.1007/s10578-016-0679-7

Jörns-Presentati, A., Napp, A., Dessauvagie, A., Stein, D., Jonker, D., & Breet, E. et al. (2021). The prevalence of mental health problems in sub-Saharan adolescents: A systematic review. Plos One16(5), e0251689. https://doi.org/10.1371/journal.pone.0251689

Mayston, R., Frissa, S., Tekola, B., Hanlon, C., Prince, M., & Fekadu, A. (2020). Explanatory models of depression in sub-Saharan Africa: Synthesis of qualitative evidence. Social Science &Amp; Medicine246, 112760. https://doi.org/10.1016/j.socscimed.2019.112760

Sterling, S., Chi, F., Weisner, C., Grant, R., Pruzansky, A., & Bui, S. et al. (2018). Association of behavioral health factors and social determinants of health with high and persistently high healthcare costs. Preventive Medicine Reports11, 154-159. https://doi.org/10.1016/j.pmedr.2018.06.017