Sexual violence: Leading cause of female depression

“Back home, I did not seem to fit. I later left to be with friends and only returned to sit A-Level, but I never finished,” Ndagire says with a far off look. “I was in and out of relationships, desperately needing someone to listen to me or accept me without judging.”
The last relationship was abusive and despite feeling attached, she eventually decided to let go. “All this, coupled with the failure to fit in with my family, left me lost. I distanced myself from people and things.”

Tired of it all
She gave away all her belongings and switched off her phone for three years. “I had had enough of what the world offered! The only thing I held on to was reading. I read many self-help and spiritual books, looking for answers. I also developed voices in my head that I preferred to listen to than people.”

One night, while reading at her home alone, Ndagire felt like she was losing her mind. With a book, pen and writing pad in tow, she went to a bar in the hope that if anything happened, she would not be alone. A man approached her. Despite telling him off several times, he persisted and eventually they had a long chat. He was Joseph Atukunda. He invited her to a group of mental health champions, Heart Sounds Uganda. He said there was a library from which she could borrow books anytime.

“I did not think or know that I needed help,” Ndagire lets on, “I remember this was a time I felt like I was standing on a cliff, eyes closed and ready to jump! I had given up.”

At Heart Sounds, she felt a sense of belonging; there was no judgment or criticism. She began to get the reins of her life back.
“The people I met at this centre have become family to me,” Ndagire shares, “We are now at Butabika Recovery College at Butabika Hospital under a project called Brain Gain II funded by THET under UK Aid.” The projects have seen Ndagire change from being at the receiving end of help to becoming a giver of help.

While she never warmed up to medication because of a history of asthma, Ndagire embraced reading and other therapies that helped her. She owes a lot to Rachel Lassman, an occupational therapist now at Kyaninga Child Development Centre in Fort Portal, who took her through therapy sessions and taught her how to make paper beads.

“Beading brought colour back to my life,” Ndagire says with a smile. “I shared the skill with my peers and together we are
rediscovering purpose in life. They now teach a group of other people at the Butabika Recovery College. This team has restored my sense of responsibility and accountability. Having had an addiction to alcohol, I would drink, shut down even more and go days without bathing. Now with people waiting on me and the need to work with people for both my good and theirs, I am a better person.”

Road to rehabilitation
“I have also learned yoga, and I am now a teacher trained by Nicky Zammit,” Ndagire says rather triumphantly. “I have learned to relax, enabling harmony and balance to return to my body and mind. It was five years of detachment, and many things that happened within that time are blurred. I had to re-learn some skills such as crossing the road because the noise is too much, but the corner has been turned and the future is bright,” Ndagire concludes.

Women prone to depression
While depression affects both males and females, the burden of depression is 50 per cent higher for females than males, according to a 2012 report by World Health Organisation (WHO). The report further reveals that depression is the leading cause of disease burden for women globally.

Dr Henry Nsubuga, the Director of the Counselling and Guidance Centre, Makerere University, Kampala, says: “Women take things seriously. They attach a lot of meaning, emotion and attention to things, which is good in itself. However, if it is negative, they get wounded more.”

What is depression?
Depression is a common and serious medical illness that negatively affects how you feel, think and act. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at optimum.

“Depression is a mood disorder that affects everyone; children and adults but studies we have done have shown that it occurs more among women,” Dr Juliet Nakku, a senior consultant psychiatrist and Deputy Executive Director at Butabika Hospital explains, “Depression causes one to be persistently sad over a long period of time; two weeks or more. However, by the time someone seeks help, they have been sad for months.”

Depression causes people to withdraw from society and keep to themselves. It also causes biological changes such as loss of appetite, impaired sleep (or lack of sleep). Once in a while, they might sleep excessively. Sufferers often see suicide as the best escape. Sometimes, it may cause them to want to kill others; for women, it is usually their children. This may be followed by self-blame, guilt and low self-esteem.

Forms of depression
Bipolar depression; causing mood swings, between very low to a very upbeat mood (mania). People with this disorder are genetically predisposed.

“Some people are born with a genetic vulnerability to be depressed and things that trigger it are often general occurrences, especially negative ones,” Dr Nakku explains. “They may even develop depression when there are no stressors. For example, a scenario that one would normally deal with easily may seem overwhelming to one who is genetically predisposed.”
Circumstantial depression; this happens as a result of secondary situations around an individual.

Causes of depression in women
Caring role: Due to the caring role of women, they tend to go through a lot of stressful situations. That is especially common when very young children are involved.
Juggling duties: Apart from working, women have domestic roles that men may not go through. That feeling of being overwhelmed can lead to depression.
Lack of support: A working woman raising little children, especially under five years, with no support mainly from their spouse, tends to feel overwhelmed.
Marital difficulties and other conflicts with friends, peers, parents and even children.
Feelings of uncertainty about the future.

Death of loved ones; while these may stress everyone, women tend to get affected more.
Menstruation: Some women have pre-menstrual syndrome (PMS) with symptoms such as irritability, joint and back pains. For some, it may take a short time and they can handle it really well. However, when it starts affecting the various activities in their lives such as work, then it gets stressful and difficult to manage.

Causes of depression
Childbirth (post-natal depression): The changes in hormones within the body due to pregnancy and child birth affect the chemicals within the brain, especially a neurotransmitter called serotonin. This usually results into depression particularly after delivery.

“Though affecting close to 20 per cent of women who have had a baby, it is often not identified,” Dr Nakku explains. It can also happen among women who have had a miscarriage.

After birth, a crying baby, inexperience and several sleepless nights can overwhelm a mother.
Menopause may come early and coupled with the hormonal changes such as reduced oestrogen, can really stress a woman.
Unresolved issues: such as sexual and physical abuse and emotional problems.

“Violence is one of the commonest causes of depression,” Dr Nakku reveals, “sexual violence in particular is notorious for causing depression as it causes psychological trauma.”

Illnesses such as HIV/Aids: “These days we see a lot of depression cases in the context of HIV/AIDS,” Dr Nakku reveals, “When a woman tests positive for HIV/Aids, it has a lot of implications, for example on their intimate relationships and families, more so the children.”

Other diseases include cancers and any other chronic illness.
Disfiguring conditions: A woman’s appearance is very important. It defines you and what you represent. It could be hair loss, an amputated limb, scars, or a face disfiguring condition.

“Women who have had acid attacks almost invariably go through depression,” Dr Nakku says.
Work: “For example, failure to get into the senior roles due to gender can cause her (a woman) to get really stressed because she is putting in a lot yet with minimal results,” says Dr Norbert Bwana of the Physic Clinic, Kamwokya.

Managing depression
Talk: “The first line of dealing with depression is finding someone trustworthy to talk to; a trusted friend that you can share your problems with. This will help you to understand why you are going through certain things, hence come up with a plan on how to manage the situation,” Dr Bwana says.

Prioritise: If you are overwhelmed with work, Dr Bwana suggests writing out your day’s duties and setting priorities. That will help you not to feel anxious as you go through the day.
Journaling: If you are performing a duty yet feeling irritable, Dr Bwana says writing is as good as talking to a friend. This lowers your anxiety levels.

See a trusted psychotherapist or trained counsellor: They will help you identify what is stressing you. Through cognitive therapy, medical personnel will be able to tell that you are stressed or depressed by looking at your behaviour.

Therapy
Between the depressed person and a trusted psychotherapist or trained counsellor; the person tells you what they are going through, you listen and teach them how to manage.
Involving a partner or trusted friend; this is to help them through the process or group therapy.
However, in the case of sexual violence, it may be difficult to counsel them in a group setting. Involve the family, so they can know about the problems and aid them in overcoming the depression.

Prevalence of spousal and sexual violence in Uganda
Findings from the Uganda Demographic and Health Survey (UDHS), show that in 2006, more women (68 per cent) than men (43 per cent) had ever experienced spousal violence. Results revealed that 55 per cent of the women and 30 per cent of the men had experienced spousal violence in the last 12 months to the survey.

In 2011, more women (60 per cent) than men (42 per cent) had ever experienced spousal violence. Findings indicated that 45 per cent of the women and 33 per cent of the men had experienced spousal violence in the last 12 months to the survey.

Spousal violence was more wide spread in rural than urban areas with more women reportedly having experienced at least one form of spousal violence in rural areas (70 per cent in 2006 and 61 per cent in 2011) as compared to urban areas (55 per cent in 2006 and 53 per cent in 2011).

According to UN women’s Global Database on violence against women, the prevalence rate for lifetime physical and sexual intimate partner violence stands at 51 per cent. This refers to the proportion of ever-partnered women aged 15-49 years experiencing intimate partner physical and/or sexual violence at least once in their lifetime. Source: Uganda Bureau of Statistics (UBOS) and ICF International Inc., 2012.

While the prevalence rate for Physical and/or Sexual Intimate Partner Violence in the last 12 months stood at 35 per cent. This referred to proportion of ever-partnered women aged 15-49 years experiencing intimate partner physical and/or sexual violence in the last 12 months.

The prevalence rate for Lifetime Non-Partner Sexual Violence stood at 4 per cent. This refers to Proportion of women aged 15–49 years experiencing sexual violence perpetrated by someone other than an intimate partner at least once in their lifetime.
Source: Uganda Bureau of Statistics (UBOS) and ICF International Inc., 2012.