Results from a survey carried out in a densely populated suburb of Harare showed that 30% of women from a random community sample had suffered a depressive illness in the year before interview. The average length of depression was 5 months. 25% of depressed women had attempted or seriously considered suicide. The commonest events precipitating depression were marital disputes, crisis in other relationships and deaths of close relatives. Housing and financial difficulties were as common in the non-depressed women as amongst the depressed ones. A second survey in Primary Health Care Units showed that the highest proportion of psychiatric morbidity occurred amongst patients who repeatedly referred themselves to the clinic. In this subgroup over 20% had either depression or anxiety although they had commonly presented with multiple pains, sleep disturbances and "thinking too much".

Recommendations:

• Design a "Multiple Symptoms Card" for decision making at Primary Health Care facilities
• Develop a 7-step plan for the management of depression
• Design a pamphlet for community groups
• Introduce the diagnostic and therapeutic guidelines in Health Facilities
• Include diagnosis and treatment of depressions in continuous training programmes

• "Multiple Symptoms Card" + "7-step treatment plan" printed and distributed
• Feedback workshops with communities conducted
• Workshop results documented
• Depressed patients referred to self-help groups

Shortcomings:

• Qualified therapy not possible due to lack of psychiatric manpower
• Advice on social welfare and legal matters difficult to get