A new study in Nigeria shows that depression is associated with a lower labor force participation and reduced investments in children’s schooling. How Depression In recent years, Nigeria has suffered from security crises caused by conflicts between ethnic groups, Affects Welfare in a farmers, and herdsmen. Some of the more egregious incidents have been committed by Boko Haram, Context of Conflicts which is responsible for terrorist attacks including the abduction of more than 200 schoolgirls in 2014, and an estimated 30,000 deaths since 2011. While Depression is a common illness that affects more the effects of adverse events (which we define as than 300 million people worldwide. Unfortunately, conflicts, shocks, and/or deaths) on physical loss tend its implications and those of other mental health to be easier to measure, very little is usually known problems are often neglected in public health policies, about their psychological effects and implications for particularly in developing country settings where decision-making. more visible health issues get prioritized. In light of the need to understand the economic impact of these events in this context, the Nigerian National Bureau of Statistics, in collaboration with The Project the World Bank, collected a nationally representative sample via a new round of the General Household Survey Panel conducted in 2015-2016. In addition A new study by the World Bank looks at the first to the standard welfare measures and information nationally representative estimates of depression about adverse events, the survey included a measure in Nigeria to shed light on how it may be linked to of depression of the respondent using the Center economic outcomes, such as labor market and human for Epidemiological Studies Depression scale (CESD). capital investments, especially in heavy-conflict areas Versions of this scale have been widely used and tested or for individuals or communities who have experienced in various settings as population-based measures for shocks or deaths. self-reported depression. The Results adverse events affecting these households add another 10 percentage points to the probability of the respondent having depressive symptoms. Poverty and shocks go hand in hand. One in five Nigerian respondents have depressive symptoms. Having representative statistics of mental health at the national level is rare, so while these results are not surprising, they are telling. On average, 22% of Nigerian respondents - 74% who are household heads, 27% who are female - have depressive symptoms. There is a strong correlation between depression and labor market outcomes. Specifically, a respondent who has depressive symptoms has an eight percentage points lower probability of participating in the labor market. While the overall effects are similar by gender, depression drives lower labor market participation in agricultural activities Depression is strongly associated for men and in non-farm self-employment for women with adverse events, especially conflict. (which is mainly driven by gender sectoral distribution). As expected, these events are positively associated In our sample of workers, there is no correlation in with depression. Still, their effects vary. For example, less terms of number of hours worked. than 30% of respondents who are affected by a family death or a community shock (such as droughts) have depressive symptoms. This contrasts with more than 50% for respondents affected by conflicts; this rate of depression is more than twice the national average. Finally, depression also affects child investments. For example, families with a parent who has depressive symptoms spend nearly 30 US$ (in current terms) less in educational expenses annually, driven by lower investments among older girls between 12 and 18 years As expected, there are strong socio-economic of age. In addition, younger children (particularly girls) gradients at play with respect to depression. between 5 and 11 years of age who live with a parent Being in the bottom 30% of the income distribution is with depressive symptoms are 2.5 percentage points positively associated with depression. Even worse, more likely to work. Policy Implications Taken together, these findings suggest that depression the potential amplified costs of adverse events into is likely to have both short- and long-term effects account when making these decisions. Last, it is of utmost on welfare in Nigeria. It also seems to be affecting importance to integrate solutions in mental health policies intra and inter-generational to provide psychological support to channels of upward mobility. affected populations. These policies With almost two out of every With almost two out of every five may include implementing mental Nigerian households affected by five Nigerian households affected health and psychosocial programs shocks, deaths, and/or conflicts by shocks, deaths, and/or conflicts which have been tested in similar (key drivers of depression), settings, and changing the social further understanding these (key drivers of depression), further norms related to communication costs and linkages is essential. understanding these costs and about and treatment of depression Conflict- and shock-mitigating linkages is essential. and depressive and stress symptoms. policies (related, for example, to By directly treating and minimizing insurance, prices, and security) may the effects of depression experienced by victims of have far higher economic impacts than what is conflicts, deaths and shocks, we may help mitigate these traditionally measured. Thus, policy makers should take incidents’ overall economic impact in society. About eMBeD The Mind, Behavior, and Development Unit (eMBeD), the World Bank’s behavioral science team in the Poverty and Equity Global Practice, works closely with project teams, governments, and other partners to diagnose, design, and evaluate behaviorally informed interventions. By collaborating with a worldwide network of scientists and practitioners,  the eMBeD team provides answers to important economic and social questions, and contributes to the global effort to eliminate poverty and enhance equity. Stay Connected eMBeD@worldbank.org #embed_wb worldbank.org/embed bit.ly/eMBeDNews Last Update: April 10, 2018