Agreement on diagnoses of mental disorder in the primary health care of Turku, Finland

1995 ◽  
Vol 10 (1) ◽  
pp. 11-16 ◽  
Author(s):  
V Lehtinen ◽  
M Joukamaa ◽  
H Karlsson ◽  
E Rouhe
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Primary Health Care ◽  
Mental Disorders ◽  
Mental Disorder ◽  
General Practitioners ◽  
Health Centre ◽  
Mental Health Issue ◽  
Psychiatric Interview ◽  
Primary Health

SummaryPrimary health care is in the central position in the general sphere of mental health services. This article deals with, as a part of a joint Nordic project, the occurrence of mental disorders of patients in primary health care as based on the material (n = 1,000) collected in the health centre of Turku. The relation of the occurrence of mental disorders as diagnosed by means of a standardized psychiatric interview method (PSE) to the disorders, recognized by general practitioners (GPs) working in the health centre is also observed. It was found that one fourth of the patients had a clear mental disorder that required treatment, while studies in the general population, using the same method, reveal only 10% as having some kind of mental disorder. Three quarters of the evident mental disorders recognized by GPs were diagnosed as such also by the PSE, but the GPs were capable of recognizing only 43% of the cases identified by the PSE. On the basis of these results, the importance of the mental health issue in the basic and postgraduate training of the general practitioners must be emphasized.

scholarly journals Common mental disorders among those attending primary health clinics and traditional healers in urban Tanzania

2003 ◽  
Vol 183 (4) ◽  
pp. 349-355 ◽  
Author(s):  
Mdimu Charua Ngoma ◽  
Martin Prince ◽  
Anthony Mann
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Primary Health Care ◽  
Mental Disorders ◽  
Mental Disorder ◽  
Health Care Services ◽  
Common Mental Disorders ◽  
Common Mental Disorder ◽  
Traditional Healers ◽  
Primary Health

BackgroundTraditional healers provide a popular and accessible service across the African continent. Little is known of the characteristics or mental health status of those using these services.AimsTo determine and compare the prevalence of common mental disorder among, and the characteristics of, those attending primary health care clinics (PHCs) and traditional healer centres (THCs) in Dar-es-Salaam.MethodThe Clinical Interview Schedule – Revised was used to determine the prevalence of mental disorders in 178 patients from PHCs and 176 from THCs, aged 16–65 years.ResultsThe prevalence of common mental disorders among THC patients (48%) was double that of PHC patients (24%). Being older, Christian, better educated, and divorced, separated or widowed were independently associated with THC attendance. None of these factors explained the excess of mental disorder among THC attenders.ConclusionsThe high prevalence of mental disorders among THC attenders may reflect the failure of primary health care services adequately to detect and treat these common and disabling disorders. Traditional healers should be involved in planning comprehensive mental health care.

scholarly journals Performance of Primary Health Care Workers in Detection of Mental Disorders Comorbid with Epilepsy in Rural Ethiopia

2021 ◽  
Author(s):  
Ruth Tsigebrhan ◽  
Abebaw Fekadu ◽  
Girmay Medhin ◽  
Charles R. Newton ◽  
Martin J. Prince ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Mental Disorders ◽  
Mental Disorder ◽  
Predictive Value ◽  
Rural Ethiopia ◽  
Primary Health ◽  
Clinical Records ◽  
Comorbid Mental Disorders ◽  
Screening Scale

Abstract Background: Timely detection and management of comorbid mental disorders in people with epilepsy is essential to improve outcomes. The objective of this study was to measure the performance of primary health care (PHC) workers in identifying comorbid mental disorders in people with epilepsy against a standardised reference diagnosis and a screening instrument in rural Ethiopia.Methods: People with active convulsive epilepsy were identified from the community, with confirmatory diagnosis by trained PHC workers. Documented diagnosis of comorbid mental disorders by PHC workers was extracted from clinical records. The standardized reference measure for diagnosing mental disorders was the Operational Criteria for Research (OPCRIT plus) administered by psychiatric nurses. The mental disorder screening scale (Self-Reporting Questionnaire; SRQ-20), was administered by lay data collectors. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of PHC worker diagnosis against the reference standard diagnosis was calculated. Logistic regression was used to examine the factors associated with misdiagnosis of comorbid mental disorder by PHC workers. Results: A total of 237 people with epilepsy were evaluated. The prevalence of mental disorders with standardised reference diagnosis was 13.9% (95% confidence interval (CI) 9.6%, 18.2%) and by PHC workers was 6.3% (95%CI 3.2%, 9.4%). The prevalence of common mental disorder using SRQ-20 at optimum cut-off point (9 or above) was 41.5% (95% CI 35.2%, 47.8%). The sensitivity and specificity of PHC workers diagnosis was 21.1% and 96.1%, respectively, compared to the standardised reference diagnosis. In those diagnosed with comorbid mental disorders by PHC workers, only 6 (40%) had SRQ-20 score of 9 or above. When a combination of both diagnostic methods (SRQ-20 score ≥9 and PHC diagnosis of depression) was compared with the standardised reference diagnosis of depression, sensitivity increased to 78.9% (95% (CI) 73.4, 84.4%) with specificity of 59.7% (95% CI 53.2, 66.2%). Only older age was significantly associated with misdiagnosis of comorbid mental disorders by PHC (adjusted odds ratio, 95% CI= 1.06, 1.02 to 1.11).Conclusion: Routine detection of co-morbid mental disorder in people with epilepsy was very low. Combining clinical judgement with use of a screening scale holds promise but needs further evaluation.

Expanding the Role of Primary Health Care in the Provision of Mental Health Services to the Population of the Kyrgyz Republic

2017 ◽  
Vol 41 (S1) ◽  
pp. S606-S606
Author(s):  
T. Galako
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Primary Health Care ◽  
Mental Health Services ◽  
Mental Disorders ◽  
Health Services ◽  
Mental Health Care ◽  
Kyrgyz Republic ◽  
Family Doctors ◽  
Primary Health

Providing comprehensive, integrated services in the field of mental health in primary health care (PHC) is a component of the state mental health program for the population of the Kyrgyz republic (KR) in the 2017–2030 biennium. In order to develop an action plan in this area a situational analysis of resources of psychiatric care at PHC level was carried out. There was revealed a significant deficit of specialists, such as family doctors, mental health care professionals. In spite of the need for 3,300 family doctors, only 1706 work, and 80% of them are of retirement age.The results of a research showed a low level of knowledge and skills of family physicians for the early detection of mental disorders and provision of appropriate medical care. There are also a limited number of psychiatrists, especially in rural regions (77% of the required quantity).During recent years, there have been implemented significant changes in the system of mental health services, aimed at improving its quality, the approach to the place of residence of the patient and the prevalence of psychosocial services.Since 2016 in 8 southern regions in the Kyrgyz Republic has been introduced a new model for the provision of comprehensive health care services. Piloting this model involves psychosocial rehabilitation of patients with mental disorders, the help of mobile teams at the place of patient residence, as well as psychoeducation, training, and support to family doctors. These and other measures will help to optimise mental health care at PHC level.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

Determinants of Common Mental Disorders Detection by General Practitioners in the Primary Health Care in Brazil

2011 ◽  
Vol 41 (1) ◽  
pp. 3-13 ◽  
Author(s):  
Daniel A. Gonçalves ◽  
Sandra Fortes ◽  
Luís Fernando Tófoli ◽  
Mônica Rodrigues Campos ◽  
Jair De Jesus Mari
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Mental Disorders ◽  
General Practitioners ◽  
Common Mental Disorders ◽  
Psychiatric Morbidity ◽  
Physical Symptoms ◽  
Detection Accuracy ◽  
Detection Rates ◽  
Primary Health

Objective: Common Mental Disorders (CMD) are highly prevalent among patients attending primary care. Many of these disorders remain unrecognized by general practitioners (GPs), with the detection rates varying from 30 to 60%. This study aims to evaluate the CMD detection rates by Primary Heath Care (PHC) practitioners in Brazil—and factors that affect CMD detection. Methods: A cross sectional study was conducted with users of five PHC units in the city of Petrópolis. The CMD prevalence of psychiatric morbidity was estimated by the General Health Questionnaire-12, and the physician's CMD detection was evaluated by a questionnaire completed by GPs after each consultation. Results: Seven hundred and fourteen subjects participated of the study, and 400 (56%) were screened positive using GHQ-12 cut-off point of 2/3. GPs diagnosed 379 people with CMD (53.1%), and 256(36%) subjects were detected by both GHQ and the GPs with an OR of 3.04 (95%CI 2.23–4.13). CMD detection accuracy by GPs was 65%. There was a strong association between the detection of CMD and the report of medically unexplained physical symptoms by GPs. Being female, married, and a frequent service user was also related to higher detection rates. Conclusion: CMD detection rate was similar to those reported worldwide, but contrary to other studies, the presence of MUS increased detection rates. The high frequency of CMD in Primary Health Care highlights the need for improving GP and health worker's training in order to enable them to accurately recognize and treat psychological distress with evidence-based interventions.

Mothers’ perceptions of primary health-care providers: thematic analysis of responses to open-ended survey questions

2015 ◽  
Vol 21 (1) ◽  
pp. 58 ◽  
Author(s):  
L. Corr ◽  
H. Rowe ◽  
J. Fisher
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Primary Health Care ◽  
Health Care Providers ◽  
Family Health ◽  
Care Providers ◽  
Psychiatric Interview ◽  
Early Parenting ◽  
Primary Health ◽  
Maternal Child

General practitioners and maternal, child and family health nurses have a central role in postpartum primary health care for women and their infants. Positive client-provider relationships are particularly important for women experiencing mental health problems or unsettled infant behaviour. However, little is known about their experiences of postnatal primary health care. The study aimed to describe views of postnatal primary health care among women completing a residential early parenting programme and to identify potential strategies to enhance provider-patient interactions. Participants (n = 138) were women admitted with their infants to a private or a public early parenting service in Melbourne, Australia. Women completed a detailed self-report survey, including open-ended questions about experiences of primary health-care services, and a structured psychiatric interview to diagnose anxiety and depression. Survey responses were analysed thematically. Womens’ experiences of primary health care were influenced by their perceptions of provider competence and the quality of interactions. While similar positive characteristics of doctor and nurse care were valued, medical and nursing practices were judged in different ways. Women described GPs who listened, understood and were thorough as providing good care, and maternal, child and family health nurses were valued for providing support, advice and encouragement. Threats to therapeutic relationships with doctors included feeling rushed during consultations, believing that GPs were not mental health-care providers and the clinician not being ‘good’ with the infant; with nurses, problems included feeling judged or given advice that was inconsistent or lacked an evidence-base. Postpartum primary health care will be improved by unhurried consultations, empathic recognition, encouragement, evidence-informed guidance and absence of criticism.

scholarly journals The Effect of Mental Health Training on Attitudes and Knowledge of Cadres in Early Detection of Mental Disorders in Tanjungsari Sub-district, Gunungkidul Regency

2018 ◽  
Vol 1 (3) ◽  
pp. 136
Author(s):  
Nur Alifa Istiani ◽  
Adi Heru Sutomo ◽  
Mahar Agusno
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Primary Health Care ◽  
Mental Disorders ◽  
Early Detection ◽  
Wilcoxon Test ◽  
Mental Health Training ◽  
Health Training ◽  
Primary Health ◽  
Attitudes And Knowledge

ABSTRACTBackground: In developing countries, the proportion of undetected mental disorders is still high. This is due to the lack of time and skill of primary health care providers in early detection and therapy. Community empowerment through cadres plays an important role in improving the early detection of mental disorders. Attitudes and knowledge of cadres are influenced by several factors such as the level of formal education, employment status, economic status and the level of knowledge gained through training.Objectives: This study aimed to determine the effect of mental health training on the attitude and knowledge of cadres in the early detection of mental disorders.Methods: This study was a quasi-experimental research with a pre and posttest design. The population in this research was all (posyandu) volunteer cadres in the working area of the Community and Primary Health Care Center Hargosari, Tanjungsari, amounting to 45 people. The sampling technique used in this study was total sampling. The research instrument used was the questionnaire. Data analysis used the Wilcoxon test for comparison of scores (p<0.05).Results: The results of the mean value for pretest of knowledge = 13.44 and posttest = 17.38. Wilcoxon test showed there was a significant change in knowledge with the value p=0.0000 (<0.05). The results of the average value of pretest attitude = 36.71 and posttest = 45.20. Wilcoxon test showed there was a significant change in attitude with the value p = 0.0000 (<0.05).Conclusion: In conclusion, there was a significant influence by providing health training on the attitude and knowledge of cadres in the early detection of mental disorders in Tanjungsari District, Gunungkidul Regency.

scholarly journals Adherence to clinical guidelines in integration of mental health services into primary health care in Mbarara, southwestern Uganda: a medical records review

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Edith K. Wakida ◽  
Moses Ocan ◽  
Godfrey Z. Rukundo ◽  
Samuel Maling ◽  
Peter Ssebutinde ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Primary Health Care ◽  
Mental Health Services ◽  
Mental Disorders ◽  
Health Services ◽  
Clinical Guidelines ◽  
Common Mental Disorders ◽  
Primary Health ◽  
Southwestern Uganda

Abstract Background The Ugandan Ministry of Health decentralized mental healthcare to the district level; developed the Uganda Clinical Guidelines (UCG); and trained primary health care (PHC) providers in identification, management, and referral of individuals with common mental disorders. This was intended to promote integration of mental health services into PHC in the country. ‘Common mental disorders’ here refers to mental, neurological and substance use conditions as indicated in the UCG. However, the extent of integration of mental health into general healthcare remains unknown. This study aimed to establish the level of adherence of PHC providers to the UCG in the identification and management of mental disorders. Methods This was a prospective medical record review of patient information collected in November and December 2018, and March and April 2019 at two health centers (III and IV) in southwestern Uganda. Data (health facility level; sex and age of the patient; and mental disorder diagnosis, management) was collected using a checklist. Continuous data was analyzed using means and standard deviation while categorical data was analyzed using Chi-square. Multivariable logistic regression analysis was performed to establish predictors of PHC provider adherence to the clinical guidelines on integration of mental health services into PHC. The analysis was conducted at a 95% level of significance. Results Of the 6093 records of patients at the study health facilities during the study period, 146 (2.4%) had a mental or neurological disorder diagnosis. The commonly diagnosed disorders were epilepsy 91 (1.5%) and bipolar 25 (0.4%). The most prescribed medications were carbamazepine 65 (44.5%), and phenobarbital 26 (17.8%). The medicines inappropriately prescribed at health center III for a mental diagnosis included chlorpromazine for epilepsy 3 (2.1%) and haloperidol for epilepsy 1 (0.7%). Female gender (aOR: 0.52, 95% CI 0.39–0.69) and age 61+ years (aOR: 3.02, 95% CI 1.40–6.49) were predictors of a mental disorder entry into the HMIS register. Conclusion There was a noticeable change of practice by PHC providers in integrating mental health services in routine care as reflected by the rise in the number of mental disorders diagnosed and treated and entered into the modified paper based HMIS registers.

Interventions in the Health and Non-health Sectors Aimed at Promoting Mental Health

2017 ◽  
Vol 41 (S1) ◽  
pp. S8-S8
Author(s):  
H. Herrman
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Human Rights ◽  
Primary Health Care ◽  
Early Intervention ◽  
Mental Disorders ◽  
Women’S Mental Health ◽  
Women's Mental Health ◽  
Primary Health ◽  
The Impact

The impact of social determinants on women's mental health is becoming clearer worldwide. Poverty, violence and communal insecurity are among the main challenges to women's mental health and the health of their families. Depression is one of the most common mental disorders experienced by women. It typically has an early onset in life and is more frequently found in women made vulnerable by trauma.Improving mental health for women and girls requires early intervention for depression and other mental disorders; with gender sensitive clinical care and support for recovery in primary health care, and mother, child and reproductive health settings. Early intervention in primary health care and collaboration with patients and family carers encourage integration of mental health with the health care system, in turn protective of human rights.In addition, gender equity and observance of human rights need to be embedded in policy and practice in health and non-health sectors to ensure that women's mental health is promoted and mental illnesses adequately prevented and treated. Effective promotion of mental health and prevention of mental disorders is possible in countries of all income levels.Disclosure of interestThe author has not supplied his declaration of competing interest.

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