646 T. Pienkowski et al.


‘That is why people are entering the forest, just stealing [for- est resources], just burning charcoal, collecting firewood in days that are not allowed.’ Hunting and harvesting of forest foods reportedly con-


tributed to diets. Furthermore, income generated from for- est product harvesting was used to purchase food and to meet other needs. However, many respondents also men- tioned the risks of illegal forest use, including corporal pun- ishment, fines and imprisonment. However, no respondents explicitly associated these risks with ‘thinking too much’.


Discussion


Psychological distress in Nyabyeya Parish Many of the reported symptoms of ‘thinking too much’ (e.g. sleep disturbance, fatigue, problems concentrating, changes in weight and appetite, suicidal ideation and the sensation of heart palpitations)were consistent with a stage-based model of poor mental health (APA, 2013; Patel et al., 2018). Furthermore, some respondents described the disruption of their daily activities during periods of ‘thinking too much’, which is consistent with definitions of psychological distress (Drapeau et al., 2012). However, there was apparent variation in the severity and variety of symptoms. For in- stance, some emphasized loss of appetite and weight loss, whereas others highlighted chest discomfort, and some did not explicitly report disruption of daily activities and so- cial functioning. Therefore, in isolation, our study provides only some evidence that ‘thinking too much’ is associated with psychological distress. However,multiple studies inUganda and East Africa have


found both qualitative and statistical associations between ‘thinking toomuch’ and psychological distress and common mental disorders (Kaiser et al., 2015). For example, several studies using qualitative approaches have found evidence linking ‘thinking too much’ to distress and poor mental health amongstUgandan, Kenyan andMalawian populations (Okello&Ekblad, 2006;Velloza et al., 2020;Harrington et al., 2021; Miller et al., 2021). Pienkowski et al. (2022)found a strong positive statistical association between the reported frequency of experiencing ‘thinking too much’ and depres- sion symptom severity within the same area as the current study. More generally, in a review of 60 studies in sub-Saharan Africa, Backe et al. (2021,p. 1) stated that ‘think- ing toomuch is a useful idiomfor understanding rumination and psychiatric distress [...] in clinical settings’.When con- sidering our results in the context of thewider literature, there is good evidence that the term‘thinking toomuch’ is indica- tive of psychological distress. Furthermore, although psycho- logical distress is not a mental disorder, severe distress is indicative of poor mental health and is experienced across a range of severity of commonmental disorders (Drapeau et al.,


2012; Viertiö et al., 2021). Consequently, considered in rela- tion to previous evidence, our results highlight potential risk factors for poor mental health.


Social determinants within a socio-ecological context


Conserved landscapes and ‘thinking too much’ Over recent decades large amounts of forest outside the forest reserves in Uganda appear to have been lost, partly attributed to commercial agricultural expansion (Twongyirwe et al., 2017). In this context, Budongo Forest Reserve appears to con- tribute to the livelihoods of those in the region, particularly those experiencing poverty and food insecurity (Fig. 5). In general, nature conservation seeks to maintain ecosys-


tems and their essential contributions to human well-being (IPBES, 2019). In doing so, conservation may influence social determinants of mental health for many worldwide. For example, forest products are consumed by many pop- ulations globally, sometimes supporting food security (Rasolofoson et al., 2020), which is a well-established deter- minant of mental health (Kinyanda et al., 2011; Lund et al., 2018; Myers, 2020). Thus, conserving forest habitats could maintain the flow of these benefits, potentially supporting mental health. Yet not all interactions with ecosystems are desirable. Several studies describe how interactions with wildlife can be distressing, potentially contributing to the risk of mental illness (Jadhav & Barua, 2012; Barua et al., 2013; Chowdhury et al., 2016). Our findings suggest that liv- ing in proximity to crop-eating wildlife may also be a stressor potentially indirectly linked to experiences of psy- chological distress. This stressor appeared to vary across the study area, with households bordering forest reserves being most affected by crop-eating wildlife, consistent with findings from previous studies (Tweheyo et al., 2005). As such, the full set of social costs and benefits associated with conservation and how they are distributed between groups should be considered when managing landscapes to protect nature. For instance, the post-2020 Global Biodiversity Framework includes plans to nearly double the current extent of protected areas globally by 2030 (CBD, 2021). However, many have argued that these plans have not been based on a thorough assessment of their social impacts (e.g. ICCA Consortium, 2021), which could include impacts on mental health. Uganda has adopted the Sustainable Development Goals,


which include Goal 3 to ‘Ensure healthy lives and promote well-being for all at all ages’ and Goal 10 to ‘Reduce inequal- ity within and amongst countries’ (United Nations, 2015). Perceptions play a central role in people’s subjective evalua- tions of their well-being (Diener, 2009), including their health. Therefore, managing the factors perceived to affect mental health could help promote healthy lives and well- being as subjectively experienced. In the current study


Oryx, 2024, 58(5), 641–649 © The Author(s), 2024. Published by Cambridge University Press on behalf of Fauna & Flora International doi:10.1017/S0030605323001710


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