Suicidal ideation, depressive symptoms, and mental health care-seeking in Central Mozambique

Abstract

Introduction: To our knowledge there has never been a community assessment of suicidal ideation, depressive symptoms, or care-seeking in Mozambique. Understanding the prevalence of depressive symptoms, suicidal ideation, and care-seeking patterns are needed to inform the development of effective mental health services that meet the burden of disease in the community. Methods: Generalized estimating equations were used to assess factors associated with depressive symptoms, suicidal ideation, and mental health care-seeking among 3,080 individuals surveyed in a representative household survey in Sofala and Manica provinces, Mozambique. Results: 19% of respondents reported depressive symptoms in the past year and 16% reported lifetime suicidal ideation. Only 10% of respondents had ever sought care for mental health, but 27% of respondents who reported depressive symptoms and/or suicidal ideation had sought care. Factors associated with depressive symptoms and suicidal ideation included: female gender, divorced or separated, widowed, and +56 years old. Individuals in the poorest wealth quintile had lower depressive symptoms, and individuals in higher wealth quintiles had higher prevalence of suicidal ideation. Individuals with higher education had lower odds of suicidal ideation. Factors associated with care-seeking included: female gender, rural residence, divorced or separated, 46-55 years old, and +56 years old. Individuals in lower wealth quintiles and with no religious affiliation had lower odds of seeking care. Conclusions: A large number of individuals in Central Mozambique experience depressive symptoms and suicidal ideation, yet rates of care-seeking are very low. These findings highlight the urgent need for mental health implementation science to improve community-level screening and ready access to community-based mental health services. Limited resources could be targeted towards women, those in rural areas, older individuals, those with low education, and those marginalized from society due to divorce, separation, or widowhood.