Knowledge of Depression and Self-Reported Capacity to Recognize and Manage DepressionAmong Primary Healthcare Workers in Osun State, Nigeria: A Cross-Sectional Study

<title>Abstract</title> <p>Background Depression is a leading cause of disability worldwide, yet it remains substantially under-recognized and under-treated in primary healthcare settings, particularly in low- and middle-income countries. Primary healthcare workers (PHCWs) are often the first point of contact for individuals with mental health needs, and their knowledge, attitudes, and self-reported capacity are central determinants of the quality-of-care patients with depression receive. This study assessed the knowledge of depression and the self-reported capacity of PHCWs to recognize and manage depression in Osun State, Nigeria, and identified factors associated with this capacity. Methods A descriptive cross-sectional study was conducted among 389 PHCWs selected from four local government areas in Osun State using a multi-stage sampling technique. Data were collected with a pre-tested, structured, self-administered questionnaire covering socio-demographic characteristics, knowledge of depression, attitudes (using the Revised Depression Attitude Questionnaire, R-DAQ), and self-reported capacity to recognize and manage depression. Knowledge and attitude scores were dichotomized around the mean as good/poor and positive/negative respectively, while self-reported capacity was categorized into not confident, moderately confident, and highly confident using percentile cut-offs. Associations between categorical variables were tested using the Pearson chi-square test, with statistical significance set at p &lt; 0.05. Results The mean age of respondents was 35.3 years, and 91.5% were female. Most respondents (91.0%) had heard of depression, and 60.7% demonstrated good overall knowledge of depression; however, only 13.9% were aware of a standardized tool for classifying depression, and 17.5% still attributed depression to witchcraft, charms, or evil spirits. Overall, 55.3% of respondents held a negative attitude towards depression, although professional confidence (71.5% positive) and generalist perspective (63.8% positive) sub-scales were more favourable than therapeutic optimism (51.4% positive). Regarding self-reported capacity, 34.7% of PHCWs were not confident, 33.4% were moderately confident, and 31.9% were highly confident in recognizing and managing depression. Age, gender, marital status, duration of practice, profession, highest level of education, years of mental health training received, and overall attitude were all significantly associated with self-reported capacity (p &lt; 0.05). Conclusion While a majority of PHCWs in Osun State demonstrated good baseline knowledge of depression, negative attitudes and limited confidence in recognizing and managing depression remain widespread, particularly among younger, less experienced, and less trained cadres. Targeted, competency-based training that integrates knowledge enhancement with attitude change is needed to strengthen the capacity of primary healthcare workers to close the depression treatment gap in Nigeria.</p>