Evidence brief: Illness explanatory models of depression among young people in low-resource settings: A qualitative study in Ghana and Zimbabwe

Abstract

Depression among young people is a global public health issue, particularly common in low-resource settings like Ghana and Zimbabwe. Affecting around 10% of young people, depression often emerges between ages 15 and 24 and remains largely untreated due to stigma, limited resources, and cultural beliefs. This study explored the explanatory models of depression among Ghanaian and Zimbabwean young people, from the perspectives of young people, caregivers, healthcare workers, teachers, and community leaders, including policymakers, traditional and faith-based healers, to inform culturally relevant interventions.

Qualitative interviews were conducted in Ghana and Zimbabwe. Using purposive sampling, 133 semi-structured interviews and six focus group discussions were conducted with 53 participants, including young people aged 15–24 with lived experience of depression, high school students, caregivers, community leaders, teachers, and healthcare workers. Data were thematically analysed using NVivo 14 software to identify key patterns and themes.

Young people’s understanding and help-seeking behaviours reflected both emic and etic influences. Emic aspects included culturally shaped explanatory models shared by families, teachers, peers, and communities, including local idioms of distress and spiritual beliefs. Socio-economic stressors like poverty, family conflict, and academic pressure, though universally experienced, were often interpreted through culturally embedded narratives like spiritual causation, thus reflecting emic framing in participants’ accounts and influencing help-seeking in both countries. Etic aspects were evident in symptom descriptions aligning with behavioural (social withdrawal), emotional (sadness), cognitive (suicidal thoughts), and physical (fatigue) categories. Initial support was often sought from spiritual leaders, peers, and school-based resources.

This study provides a culturally grounded understanding of how young people in Ghana and Zimbabwe conceptualise depression, shaped by both emic and etic influences. Participants described depression using local idioms and spiritual explanations, while also recognising biomedical symptoms and socio-economic stressors. These findings underscore the need for interventions that integrate traditional beliefs with evidence-based approaches. Implementing multi-stakeholder approaches that engage families, schools, and spiritual leaders may be critical in reducing stigma, improving care access, and enhancing depression outcomes for young people.

Introduction

Depression among young people is a global public health concern with significant implications for their well-being, academic performance, and future prospects. Depression is among the typically neglected mental health conditions among young people [1], with prevalence rates ranging from 10–20% globally [2–4], and up to 15% in Sub-Saharan Africa [5]. Additionally, Jörns-Presentati and colleagues note that the prevalence of depression varies based on gender and regional sociopolitical conditions [2]. It typically emerges between ages 10 and 24, with females experiencing a 50% higher incidence than males [4]. Depression remains largely untreated in low-income countries, where 95% of those in need lack access to adequate care [6]. This results in hindered productivity, innovation, and the ability to reach educational and social potential. This is particularly critical in African countries, where 60% of the population is under 25 [7,8]. Furthermore, Fusar and colleagues [2024] highlight that the personal experiences of young people with mental health conditions like depression are often ‘siloed’ in academic studies [1]. These studies frequently lack ‘first-person’ insights into young people’s subjective lived experiences [1], potentially leading to the underrepresentation of young people in depression literature and fewer treatment interventions tailored to their unique needs.