The research behind this page

The study

Title

It is time to think about refugees' mental health: The case of Dzaleka Refugee Camp — Malawi

Authors

Damiano RF, Borges SAM, Jarreta RL, Pereira RAR, Lucchetti G

Journal

Psychiatry Research, Volume 316, October 2022

DOI

10.1016/j.psychres.2022.114783

PubMed ID

36037741

Affiliation

Universidade de São Paulo, Fraternity Without Borders, Federal University of Juiz de Fora

What they did

The researchers assessed 102 individuals living in Dzaleka Refugee Camp using the PHQ-9 (Patient Health Questionnaire-9), a widely used screening tool for depression. The PHQ-9 asks nine questions about symptoms experienced over the past two weeks — things like loss of interest, fatigue, difficulty concentrating, and thoughts of death.

A score of 10 or above is typically interpreted as "probable depression" — meaning the person likely meets clinical criteria, though it is not a formal diagnosis. The study also asked about suicidal ideation and suicide attempts in the 12 months before the assessment.

The headline numbers

What "probable depression" means — and what it doesn't

The PHQ-9 is a screening tool, not a clinical diagnosis. A score of 10+ means the individual probably meets diagnostic criteria for major depressive disorder, but a formal diagnosis requires assessment by a trained clinician. In many refugee camps — including Dzaleka — there is no access to such clinicians, which means we use screening tools as the best available proxy.

The 78% figure should be understood as: in a sample of 102 people assessed in Dzaleka, roughly 4 out of every 5 showed symptoms consistent with clinical depression. It is not a census of the entire camp population of 57,000+, and extrapolation should be done carefully.

Study limitations

This study is the best available evidence for mental health in Dzaleka, but it has significant constraints.

• Small sample size. 102 individuals from a camp of 57,000+. The sample may not be representative of the full population.
• Cross-sectional design. A single snapshot in time. It cannot tell us whether things are getting better, worse, or how long these conditions have persisted.
• Selection bias. The study does not describe its sampling strategy in detail. People who volunteered to be assessed may differ systematically from those who did not.
• Self-report. The PHQ-9 relies on self-report, which can be affected by cultural norms around expressing distress, language barriers, and social desirability bias.
• No control group. There is no comparison with non-refugee populations in the Malawian host community, making it harder to isolate the effects of camp conditions specifically.

The treatment gap

Perhaps the most important implication of this study is what it says about the gap between need and access. If 78% of assessed individuals show probable depression, and only an estimated 2–3% of the camp population accesses any form of psychosocial support, the vast majority of severe distress goes completely untreated.

This gap is not primarily about awareness. As the structural causes page explains, the barriers include language (clinicians speaking English or Chichewa; patients speaking Kinyarwanda, Kirundi, or Swahili), somatic presentation (distress expressed as headache or fatigue rather than "depression"), stigma, and a simple lack of trained staff.

Supporting references