scholarly journals Feasibility of WHO mhGAP-intervention guide in reducing experienced discrimination in people with mental disorders: a pilot study in a rural Kenyan setting

2018 ◽  
Vol 28 (2) ◽  
pp. 156-167 ◽  
Author(s):  
V. N. Mutiso ◽  
K. Pike ◽  
C. W. Musyimi ◽  
T. J. Rebello ◽  
A. Tele ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Disorders ◽  
Low Income ◽  
Health Professionals ◽  
Wealth Index ◽  
Health Facilities ◽  
Low Income Countries ◽  
Clinical Psychologist ◽  
Catchment Areas

AimsStigma can have a negative impact on help-seeking behaviour, treatment adherence and recovery of people with mental disorders. This study aimed to determine the feasibility of the WHO Mental Health Treatment Gap Interventions Guidelines (mhGAP-IG) to reduce stigma in face-to-face contacts during interventions for specific DSM-IV/ICD 10 diagnoses over a 6-month period.MethodsThis study was conducted in 20 health facilities across Makueni County in southeast Kenya which has one of the poorest economies in the country and has no psychiatrist or clinical psychologist. We recruited 2305 participants from the health facilities catchment areas that had already been exposed to community mental health services. We measured stigma using DISC-12 at baseline, followed by training to the health professionals on intervention using the WHO mhGAP-IG and then conducted a follow-up DISC-12 assessment after 6 months. Proper management of the patients by the trained professionals would contribute to the reduction of stigma in the patients.ResultsThere was 59.5% follow-up at 6 months. Overall, there was a significant decline in ‘reported/experienced discrimination’ following the interventions. A multivariate linear mixed model regression indicated that better outcomes of ‘unfair treatment’ scores were associated with: being married, low education, being young, being self-employed, higher wealth index and being diagnosed with depression. For ‘stopping self’ domain, better outcomes were associated with being female, married, employed, young, lower wealth index and a depression diagnosis. In regards to ‘overcoming stigma’ domain; being male, being educated, employed, higher wealth index and being diagnosed with depression was associated with better outcomes.ConclusionsThe statistically significant (p < 0.05) reduction of discrimination following the interventions by trained health professionals suggest that the mhGAP-IG may be a useful tool for reduction of discrimination in rural settings in low-income countries.

scholarly journals The Burden of Mental Disorders in the Eastern Mediterranean Region, 1990–2013

2017 ◽  
Vol 41 (S1) ◽  
pp. S156-S157 ◽  
Author(s):  
R. Charara ◽  
A. Mokdad
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Mental Disorders ◽  
Low Income ◽  
Mediterranean Region ◽  
Eastern Mediterranean ◽  
Eastern Mediterranean Region ◽  
Low Income Countries ◽  
Years Of Life Lost ◽  
Life Years

The eastern Mediterranean region (EMR) is witnessing an increase in mental illness. With ongoing unrest, this is expected to rise. This is the first study to quantify the burden of mental disorders in the EMR. We used data from the global burden of disease study (GBD) 2013. DALYs (disability-adjusted life years) allow assessment of both premature mortality (years of life lost–YLLs) and nonfatal outcomes (years lived with disability–YLDs). DALYs are computed by adding YLLs and YLDs for each age-sex-country group. In 2013, mental disorders contributed to 5.6% of total disease burden in EMR (1894 DALYS/100,000 population): 2519 DALYS/100,000 (2590/100,000 males, 2426/100,000 females) in high-income countries, 1884 DALYS/100,000 (1618/100,000 males, 2157/100,000 females) in middle-income countries, 1607 DALYS/100,000 (1500/100,000 males, 1717/100,000 females) in low-income countries. Females had a greater proportion of burden due to mental disorders than did males of equivalent ages, except for those under 15 years. The highest proportion of DALYs occurred in the 25–49 age group. The burden of mental disorders in EMR increased from 1726 DALYs/100,000 in 1990 to 1912 DALYs/100,000 in 2013 (10.8% increase). Depressive disorders accounted for most DALYs, followed by anxiety disorders. Palestine had the largest burden of mental disorders. Nearly all EMR countries had a higher mental disorder burden compared to global level. Our findings call for EMR health ministries to increase provision of mental health services and to address stigma of mental illness. Our results showing the accelerating burden of mental health are alarming as the region is seeing an increased level of instability.

scholarly journals Barriers and opportunities for refugee mental health services: clinician recommendations from Jordan

2021 ◽  
Vol 8 ◽  
Author(s):  
Majd Al-Soleiti ◽  
Mahmoud Abu Adi ◽  
Ayat Nashwan ◽  
Eric Rafla-Yuan
Keyword(s):  
Mental Health ◽  
Health System ◽  
Mental Health Professionals ◽  
Low Income ◽  
Health Professionals ◽  
Mental Health Treatment ◽  
Qualitative Interviews ◽  
Low Income Countries ◽  
Syrian Refugees ◽  
Increased Risk

Abstract Background Jordan has received more than three million refugees from bordering countries during times of conflict, including over 600 000 Syrian refugees between 2011 and 2021. Amidst this humanitarian crisis, a new mental health system for Syrian refugees has developed in Jordan, with most clinical services administered through non-governmental organizations. Prior studies have identified increased risk of psychiatric disorders in refugee populations and significant barriers for Syrian refugees seeking mental health treatment, but few have reviewed the organization or ability of local systems to meet the needs of this refugee population. Methods Qualitative interviews of mental health professionals working with refugees in Jordan were conducted and thematically analyzed to assess efficacy and organizational dynamics. Results Interviewees described barriers to care inherent in many refugee settings, including financial limitations, shortages of mental health professionals, disparate geographic accessibility, stigma, and limited or absent screening protocols. Additional barriers not previously described in Jordan were identified, including clinician burnout, organizational metrics restricting services, insufficient visibility of services, and security restrictions. Advantages of the Jordanian system were also identified, including a receptive sociopolitical response fostering coordination and collaboration, open-door policies for accessing care, the presence of community and grassroots approaches, and improvements to health care infrastructure benefiting the local populace. Conclusions These findings highlight opportunities and pitfalls for program development in Jordan and other middle- and low-income countries. Leveraging clinician input can promote health system efficacy and improve mental health outcomes for refugee patients.

Outcome of common mental disorders in Harare, Zimbabwe

1998 ◽  
Vol 172 (1) ◽  
pp. 53-57 ◽  
Author(s):  
Vikram Patel ◽  
Charles Todd ◽  
Mark Winston ◽  
Essie Simunyu ◽  
Fungisai Gwanzura ◽  
...  
Keyword(s):  
Primary Care ◽  
Mental Disorders ◽  
Low Income ◽  
Common Mental Disorders ◽  
Low Income Countries ◽  
Economic Deprivation ◽  
Poor Outcome ◽  
T1 And T2 ◽  
Illness Model

BackgroundLittle is known about the outcome of common mental disorders (CMD) in primary care attenders in low income countries.MethodTwo and 12 month (T1 and T2) follow-up of a cohort of cases of CMD (n=199) recruited from primary health, traditional medical practitioner, and general practitioner clinics in Harare, Zimbabwe. The Shona Symptom Questionnaire (SSQ) was the measure of caseness.ResultsThe persistence of case level morbidity was recorded in 41% of subjects at 12 months. Of the 134 subjects interviewed at both follow-up points, 49% had recovered by T1 and remained well at T2 while 28% were persistent cases at both T1 and T2. Higher SSQ scores, a psychological illness model, bereavement and disability predicted a poor outcome at both times. Poorer outcome at T1 only was associated with a causal model of witch-craft and an unhappy childhood. Caseness at follow-up was associated with disability and economic deprivation.ConclusionsA quarter of cases of CMD were likely to be ill throughout the 12 month follow-up period. Targeting risk groups for poor outcome for interventions and policy interventions to reduce the impact of economic deprivation may provide a way of tackling CMD in primary care in low income countries.

scholarly journals Nutritional Deficiencies and Maternal Depression: Associations and Interventions in Lower and Middle-Income Countries: a Systematic Review of Literature

2021 ◽  
Author(s):  
Beatrice A. Madeghe ◽  
Wambui Kogi-Makau ◽  
Sophia Ngala ◽  
Manasi Kumar
Keyword(s):  
Mental Health ◽  
Mental Disorders ◽  
Maternal Depression ◽  
Low Income ◽  
Low Income Countries ◽  
Nutritional Deficiencies ◽  
Cross Sectional ◽  
Middle Income ◽  
Nutritional Interventions ◽  
Poor Diet

Abstract Background Nutrition deficiencies are common among pregnant and lactating women in middle- and low-income countries. At the same time, maternal mental disorders, mainly depression is highly prevalent during this period suggesting some connection between the two. The objective of this review is to determine the associations between nutritional deficiencies and maternal depression and identify the role of diet in depression to facilitate further research. Methods A literature search included PubMed databases and Google Scholar search engine published from June 2008 to June 2019 and published in English. Medical subject heading terms was used to identify all relevant studies. All titles and abstracts identified by the search were screened then reviewed the full-text articles which were potentially eligible for inclusion. Results The original search identified 1250 articles but with cascaded elimination, based on quality. Twenty five met the inclusion criteria, of which 13 were cross-sectional, eight were prospective cohort study, and four were intervention studies. Most (95%) of these studies reported positive associations between nutrition deficiencies, poor diet, and maternal depression; thus, only 5% did not show associations between nutrition and depression. Conclusion Our review findings suggest that nutritional interventions are some of the most promising intercessions for mental health illnesses. Not all studies consistently associate poor diet quality with poor maternal and offspring mental health outcomes, and the majority of those that show are cross-sectional. Considering that most of these associations are cross-sectional, studies devoid of exposing causal relationship; thus, longitudinal studies are needed to confirm the associations towards sufficing as a window of opportunity for reducing the risk of mental disorders in mothers and offspring alike.

scholarly journals Prevalence and Stigma of Postpartum Common Mental Disorders in the Gurage Region of Ethiopia: A Mixed-Methods Observational Cohort Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Sophia Monaghan ◽  
Meseret Ayalew Akale ◽  
Bete Demeke ◽  
Gary L. Darmstadt
Keyword(s):  
Mental Health ◽  
Mental Disorders ◽  
Low Income ◽  
Common Mental Disorders ◽  
Common Mental Disorder ◽  
World Health ◽  
Low Income Countries ◽  
Postpartum Women ◽  
Healthcare Staff ◽  
Self Reporting Questionnaire

Objectives: Mental disorders are vastly underdiagnosed in low-income countries that disproportionately affect women. We aimed to evaluate the prevalence of common mental disorders in newly postpartum women, and stigma associated with mental health reporting in an Ethiopian community using a validated World Health Organization survey.Methods: The Self Reporting Questionnaire (SRQ) for psychological distress was administered in Amharic by nurses to 118 women aged 18–37 years who had given birth in the prior 3 months in the Glenn C. Olsen Memorial Primary Hospital in Yetebon. Mental health stigma among the four nursing staff was assessed using Link and Phelan's Components of Stigma.Results: Among 118 women surveyed, 18% had a probable common mental disorder using the SRQ 4/5 cutoff and 2% admitted to suicidal thoughts. Presence of stigma in the healthcare staff was verified, including labeling, stereotyping, separating, and status loss and discrimination.Conclusion: Postpartum mental health disorders as well as stigma against such diagnoses are common in the Yetebon community. There is an urgent need for increased availability of properly trained and supervised healthcare staff in the identification and referral of postpartum women with common mental disorders.

scholarly journals Cost-effectiveness of the Mental Health and Development model for schizophrenia-spectrum and bipolar disorders in rural Kenya

2015 ◽  
Vol 45 (13) ◽  
pp. 2747-2756 ◽  
Author(s):  
V. de Menil ◽  
M. Knapp ◽  
D. McDaid ◽  
S. Raja ◽  
J. Kingori ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Disorders ◽  
Health System ◽  
Low Income ◽  
Bipolar Disorders ◽  
Low Income Countries ◽  
First Year ◽  
Schizophrenia Spectrum ◽  
Health And Development ◽  
The Cost

BackgroundThe treatment gap for serious mental disorders across low-income countries is estimated to be 89%. The model for Mental Health and Development (MHD) offers community-based care for people with mental disorders in 11 low- and middle-income countries.MethodIn Kenya, using a pre-post design, 117 consecutively enrolled participants with schizophrenia-spectrum and bipolar disorders were followed-up at 10 and 20 months. Comparison outcomes were drawn from the literature. Costs were analysed from societal and health system perspectives.ResultsFrom the societal perspective, MHD cost Int$ 594 per person in the first year and Int$ 876 over 2 years. The cost per healthy day gained was Int$ 7.96 in the first year and Int$ 1.03 over 2 years – less than the agricultural minimum wage. The cost per disability-adjusted life year averted over 2 years was Int$ 13.1 and Int$ 727 from the societal and health system perspectives, respectively, on par with antiretrovirals for HIV.ConclusionsMHD achieved increasing returns over time. The model appears cost-effective and equitable, especially over 2 years. Its affordability relies on multi-sectoral participation nationally and internationally.

scholarly journals Risk Factors for Relapse in People with Severe Mental Disorders during the COVID-19 Pandemic: A Multicenter Retrospective Study

Healthcare ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 64
Author(s):  
Antonio José Sánchez-Guarnido ◽  
Paloma Huertas ◽  
Rosario Garcia-Solier ◽  
Miguel Solano ◽  
Beatriz Díez ◽  
...  
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Mental Disorders ◽  
Low Income ◽  
Income Group ◽  
Severe Mental Disorders ◽  
Health Related ◽  
Day Hospitals ◽  
Risk Of Relapse

Background: Evidence suggests that different variables associated with the COVID-19 pandemic may increase the risk of relapse in people with Severe Mental Disorders (SMDs). However, no studies have yet looked closely at the different risk factors involved to determine their influence on the worsening of these patients’ illnesses. Objective: To analyze which variables related to the COVID-19 pandemic have increased the risk of relapse in patients with SMDs. Method: A multicenter retrospective cohort study in which data were collected from 270 patients with mental disorders who had been under follow-up in day hospitals during the year 2020. Results: The proportion of full mental health inpatient admissions was significantly higher in those who lost their employment (40.7% vs. 18.1%; p = 0.01), in those who were not receiving psychotherapy interventions (33.9% vs. 16.6%; p = 0.006), and in those who were not receiving occupational therapy (25.7% vs. 13.6%: p = 0.013). Significant associations were detected between urgent mental health consultations, the number of COVID-19 symptoms (B = 0.274; p = 0.02), and the low-income group (1.2424 vs. 0.4583; p = 0.018). Conclusions: COVID-19 symptoms and certain consequences of the pandemic, such as loss of employment, economic hardship, and loss of interventions, have brought about clinical worsening in people with SMDs. Knowledge of these factors is important for health-related decision-making in future outbreaks or pandemics.

A descriptive study of the prevalence of psychological distress and mental disorders in the Canadian population: comparison between low-income and non-low-income populations

2010 ◽  
Vol 30 (3) ◽  
pp. 148-149 ◽  
Author(s):  
J. Caron ◽  
A. Liu
Keyword(s):  
Mental Health ◽  
Substance Abuse ◽  
Psychological Distress ◽  
Mental Disorders ◽  
Low Income ◽  
Well Being ◽  
Descriptive Study ◽  
Canadian Community Health Survey ◽  
Vulnerable Groups ◽  
High Psychological Distress

Objective This descriptive study compares rates of high psychological distress and mental disorders between low-income and non-low-income populations in Canada. Methods Data were collected through the Canadian Community Health Survey – Mental Health and Well-being (CCHS 1.2), which surveyed 36 984 Canadians aged 15 or over; 17.9% (n = 6620) was classified within the low-income population using the Low Income Measure. The K-10 was used to measure psychological distress and the CIDI for assessing mental disorders. Results One out of 5 Canadians reported high psychological distress, and 1 out of 10 reported at least one of the five mental disorders surveyed or substance abuse. Women, single, separated or divorced respondents, non-immigrants and Aboriginal Canadians were more likely to report suffering from psychological distress or from mental disorders and substance abuse. Rates of reported psychological distress and of mental disorders and substance abuse were much higher in low-income populations, and these differences were statistically consistent in most of the sociodemographic strata. Conclusion This study helps determine the vulnerable groups in mental health for which prevention and promotion programs could be designed.

Self-inflicted injuries: The intersection of mental health and traumatic injury in Malawi

2021 ◽  
pp. 004947552110131
Author(s):  
Brittney M Williams ◽  
Linda Kayange ◽  
Laura Purcell ◽  
Jared Gallaher ◽  
Anthony Charles
Keyword(s):  
Mental Health ◽  
Hospital Mortality ◽  
Low Income ◽  
Retrospective Review ◽  
Primary Outcome ◽  
Trauma Registry ◽  
Traumatic Injury ◽  
Low Income Countries ◽  
Intentional Injury ◽  
Fall From Height

Self-inflicted injury, the most common form of intentional injury, disproportionately affects low-income countries, but is poorly described in this setting. This retrospective review of the 2008–2018 trauma registry at a referral hospital in Malawi included all victims of intentional injury ≥10 years. Self-inflicted injuries were compared to assaults. The primary outcome was in-hospital mortality. Common mechanisms of self-inflicted injuries were fall from height, poisoning, and penetrating injury. In-hospital mortality from self-inflicted injury was 8.8% vs. 1.9% for assault. Those who died from self-inflicted injury were more often older (median 34 vs. 26 years, p < 0.001), male (91.9% vs. 67.8%, p < 0.001), unemployed (32.8% vs. 6.4%, p < 0.001), and most commonly died by hanging (60%). The odds of in-hospital mortality after self-inflicted injury was four times assault (OR 4.0 [95% CI 1.4–11.5], p = 0.01). The trauma registry proved useful for describing self-inflicted injury in this setting.

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