Patients’ and providers’ perceptions of the Swahili words of msongo (stress) and sonona (depression): implications for treating mood disorders among people living with HIV/AIDS, Dar Es Salaam, Tanzania

Abstract

Objectives: People living with HIV/AIDS (PLH) in resource-limited settings have high and often unrecognized prevalence of mood disorders, with adverse implications for medication adherence and engagement in transmission risk reduction behaviors. Working in HIV treatment and care provision, we observed lack of common understandings between PLH and health care workers (HW) of the words msongo and sonona (Swahili) intended to mean stress and depression, respectively. This gap in psychosocial health communication may result in missed opportunities for depression management, which can contribute to altered immune functioning, poor self-care practices, accelerated HIV disease progression, and poor clinical outcomes among PLH. We explored perceptions and experiences in use of the terms msongo and sonona among PLH, to better inform the management of mood disorders among PLH

Methods: A two-phased study which included exploratory mixed methods study including focus group discussions (FGDs), indepth interviews (IDIs) with PLH and HW, and a cross-sectional pilot survey with PLH in Dar es Salaam, Tanzania was conducted from 2012 to 2013. Only the data for phase I was included in this manuscript. Thematic analysis of qualitative data from 86 participants explored PLH and HW experiences with the use of terms msongo and sonona. From these findings, we developed scale items based on PLH’s descriptive idioms for a structured survey questionnaire administered to 318 PLH. Through Principal Component Analysis (PCA) we identified meaningful dimensions for the msongo and sonona scales

Results: Predominant meanings for PLH with mood disorder of the terms included troubling thoughts, emotional and physical symptoms. There were gender and age differences in meanings given to both words. For older PLH, msongo and sonona had similar meanings; the former representing higher severity of sonona. In contrast, younger women perceived sonona as a worse form of msongo, while for some young men sonona was understood as kisonono (gonorrhea). Among PLH with mood disorder, 60% and 80% requested help from a health worker for managing sonona and msongo, respectively. PLH without a mood disorder articulated msongo as normal thoughts not requiring hospital treatment; while sonona was a new word, the meaning of which they did not know. This group reported they did not seek care from a health worker for these concerns. The HW interchanged meanings and symptoms of msongo and sonona, while some thought sonona was a type of psychosis. PCA of the data from PLH revealed five dimensions for the combined sonona and msongo scale, with Cronbach’s alpha estimates of 0.92, a unidimensional msongo scale with Cronbach’s alpha estimates of 0.77 and four dimensions for the sonona scale with Cronbach’s alpha estimates of 0.90

Conclusions: Though PLH overall had a limited understanding of the psychological health implications of msongo and sonona, those with mood disorders understood these words as meaning stress and depression, respectively. HW should raise their awareness and be alerted to possibilities of depressive disorders when PLH express concerns about msongo or sonona or have symptoms in order to facilitate the identification and management of depression in such settings

Keywords: HIV, PLH, msongo, sonona, depression, stress scale, Swahili, Tanzania