Navigating the Therapeutic Landscape: An investigation of social capital and responses to depression among women in western Kenya

Globally, depression is the leading cause of disease burden among women of childbearing age. Yet in many places, very little is known about the available forms of health provision for depression and about how women make use of those forms.  The purpose of this research is to identify resources available to women suffering from depression in rural western Kenya and to describe how they navigate this therapeutic landscape.  A series of three in-depth interviews were conducted with women suffering from depression (n=14). Group discussions (n=3) and additional interviews with healthcare providers, indigenous and faith healers, religious leaders, community group leaders and elders (n=20) provided contextual information about the therapeutic landscape.  All interviews were transcribed and translated to English.  Inductive coding was used to identify themes in the data.  The data reveal a therapeutic landscape that is exceedingly inadequate. “Modern” health systems do not accommodate depression while “traditional” systems undermine social cohesion through witchcraft.  Faith communities vary in response: some blame spirit possession and prescribe prayer, others blame the woman and her “bad deeds”.  Jealousy and competition over scarce resources place tremendous strain on traditional social networks and impact the availability of social support.  Out of this landscape, self-organizing community groups have emerged to address the material and mental health needs of women.  These groups represent a promising alternative to traditional forms of social capital.  Public health professionals must recognize these groups as resources for promoting mental health and search for appropriate ways to bolster the work of these groups.