title: Living with sickle cell disease and depression in Lagos, Nigeria: A mixed methods study.
abstract: Sickle cell disorders (SCD) and depression are both chronic illnesses of global significance. Past research on SCD and depression struggles to make sense of statistical associations, essentializes depression within the person with SCD, and treats stigma as an automatic correlate of chronic illness. A mixed methods study (March 2012-April 2014) was undertaken with people living with SCD and depression in Lagos, Nigeria, examining depression-as disease (questionnaires); depression-as-illness-experience (individual depth interviews), and depression-as-societal-sickness (focus groups). 103 people with SCD attending an outpatients clinic were administered the Patient Health Questionnaire-9, and 82 self-identified with some level of depression. Fifteen were subsequently interviewed about their illness experience. Their lives were characterized by being extensively subjected to vicious discriminatory remarks, including from significant others, negative experiences they felt contributed to their depression and even to suicidal thoughts and actions. Contrary to misconceptions of the relational nature of stigma, respondents recognized that stigma resulted not from their SCD but from assumed broken social norms and expectations, norms to do with educability, employability and parenthood. They recounted either that they successfully met such expectations in their own lives, or that they could conceivably do so with reasonable societal adjustments. Ten respondents with SCD and depression further took part in two series of three focus groups with five people in each series of groups. In groups people living with SCD were able to challenge negative assumptions about themselves; to begin to recognize collective social interests as a group, and to rehearse backstage, in discussions between themselves, social actions that they might engage in frontstage, out in wider society, to challenge discriminatory societal arrangements they held to contribute to their depression. To the extent that depression in SCD has social origins, then social interventions, such as anti-discrimination laws and policies, are key resources in improving mental health.
authors.affiliation: Department of Behavioural Medicine, Lagos State University College of Medicine (LASUCOM), Ikeja, P.M.B. 21266 Lagos, Nigeria. Electronic address: wobola@yahoo.com.
authors.forename: Bolanle A
authors.initials: BA
authors.lastname: Ola
authors.affiliation: School of Applied Social Sciences, De Montfort University, Room 0.19a Hawthorn Building, Leicester LE1 9BH, United Kingdom. Electronic address: syates@dmu.ac.uk.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Yates
authors.affiliation: Unit for the Social Study of Thalassaemia and Sickle Cell, De Montfort University, Room 1.27 Hawthorn Building, Leicester LE1 9BH, United Kingdom. Electronic address: sdyson@dmu.ac.uk.
authors.forename: Simon M
authors.initials: SM
authors.lastname: Dyson
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications / Q000523:psychology*; D016000:Cluster Analysis; D003863:Depression / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D009549:Nigeria; D011594:Psychometrics / Q000295:instrumentation / Q000379:methods; D036301:Qualitative Research; D057545:Social Stigma; D011795:Surveys and Questionnaires
keywords: Chronic illness; Depression; Disability rights; Mixed methods; Nigeria; Sickle cell; Stigma