You are the coordinator of an international nutrition program in refugee camps, including a
refugee camp in Tanzania. Most of the refugees in this camp have fled violence from the
Democratic Republic of the Congo, and the size of the camp is increasing because of the
intensification of armed violence there. The nutrition organization that you have been
working for has been implementing programs to promote breastfeeding, and appropriate
infant and young child feeding practices. You have been told that program staff are facing
difficulties, and you decide to visit the site to see for yourself what is going on. In your
meeting with some of the community health workers who are implementing the program, you
hear of women living in very challenging circumstances. A group of women seems to be very
tired and have lost the energy to engage with daily routines. You suspect that mental health
may play a role, and decide to ask further questions and write a report about this to your
organization’s headquarters.
Question 1 (750 word maximum)
Recognizing depression: What would you ask the community health workers in order to
identify if maternal depression may be an important factor in this scenario? Name at least five
types of problems that depressed women may describe. Also, provide an example – based on
the lectures or other experiences - of how emotional difficulties may be experienced
differently across cultures.
The maternal depression is one of common public health problem that spread widely. In
given scenario many risk factors that could cause maternal depression for women within this
camp. Most important risk factor is being a refugee, as well as no or low-income women and
women with low levels of education. Also women feel insecure and unsafe environment they
live in consider a risk factor for maternal women to get maternal depression. However,
The burden of depression: Citing existing evidence on the global burden of depression from
lectures 1 and 2, describe why thinking of depression makes sense in this scenario.
Relations with functioning: Describe how depression may interfere with daily functioning in
this camp. Discussing findings on the natural history of depression, what is one reason why
depression has such a large impact on people’s functioning?
Question 2 (750 word maximum)
You have conducted further assessments and found that maternal depression is indeed a
major factor that impacts women. Your organization responds positively to your report, and
provides additional resources to address maternal depression as part of your nutrition
program.
Describe how you would develop an intervention, based on the following considerations:
 Emic perspectives: Which qualitative research methods could you use to understand
the causes and consequences of emotional difficulties from the camp’s inhabitants
perspectives?
 Etic perspectives: What are some of the studied risk factors for depression that
women may face in this scenario (name at least 2)?
 Protective factors: What are some of the studied protective factors for depression that
women may benefit from in this scenario (name at least 2)?
 Intervention options: Name a treatment that has been shown to effectively reduce
(maternal) depressive symptoms. Who in the camps could potentially be trained to
deliver the intervention?
If depression would indeed be a major concern, what types of interventions would be
available?
You have been assigned a new position in the agency DepressionCare, a non-governmental
organization with the goal of expanding and improving diagnosis and treatment of depression
in a disadvantaged community setting. You have limited resources, but numerous options.
You can invest all your resources in (1) a public campaign to de-stigmatize treatment seeking
for depression, (2) an initiative to improve detection and treatment of major depression in
primary care settings, or (3) an initiative to improve the quality of care for patients with
depression treated in specialty mental health clinics and hospitals.
Question 1 (750 word maximum)
Which one of these initiatives will you choose? Remember, you cannot choose more than
one. Describe your program in some detail. Justify your choice of program by giving at least
two reasons based on the lectures in the course, scientific literature, and/or your relevant
experiences. Be sure to identify the information sources you used to inform your decision.
Your justifications could relate to the cost of the program, the type and number of individuals
who would most benefit from the program, or the outcomes of similar initiatives used for
depression or other health conditions in the past. You must also justify why you decided
NOT to select the other two alternatives, again based on cost, type of individuals, or
outcomes.
Question 2 (750 word maximum)
What health, mental health or social outcomes linked to depression did you consider when
choosing one initiative over another? How would you go about measuring and monitoring to
see if your initiative has had the desired outcome? Use what you have learned from the
lectures, scientific literature, or past experience to choose an outcome measure and a research
design to measure and monitor the outcome. Identify one potential outcome that would not
serve as a good indicator of program success and justify your decision to exclude this
outcome. Again, be sure to identify the information sources (lectures, scientific literature,
and/or relevant experience) that you have used to inform your decision.