Performance of primary health care workers in detection of mental disorders comorbid with epilepsy in rural Ethiopia

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.

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

10.21203/rs.3.rs-252322/v1 ◽

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.

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Comorbid mental disorders and quality of life of people with epilepsy attending primary health care clinics in rural Ethiopia

PLoS ONE ◽

10.1371/journal.pone.0238137 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0238137

Author(s):

Ruth Tsigebrhan ◽

Abebaw Fekadu ◽

Girmay Medhin ◽

Charles R. Newton ◽

Martin J. Prince ◽

...

Keyword(s):

Quality Of Life ◽

Health Care ◽

Primary Health Care ◽

Mental Disorders ◽

Seizure Frequency ◽

Functional Disability ◽

Social Outcomes ◽

Primary Health ◽

Comorbid Mental Disorders

Background Evidence from high-income countries demonstrates that co-morbid mental disorders in people with epilepsy adversely affect clinical and social outcomes. However, evidence from low-income countries is lacking. The objective of this study was to measure the association between co-morbid mental disorders and quality of life and functioning in people with epilepsy. Methods A facility-based, community ascertained cross-sectional survey was carried out in selected districts of the Gurage Zone, Southern Ethiopia. Participants were identified in the community and referred to primary health care (PHC) clinics. Those diagnosed by PHC workers were recruited. Co-morbid mental disorders were measured using a standardised, semi-structured clinical interview administered by mental health professionals. The main outcome, quality of life, was measured using the Quality of Life in Epilepsy questionnaire (QOLIE-10p). The secondary outcome, functional disability, was assessed using the 12-item World Health Organization Disability Assessment Schedule (WHODAS-2). Results The prevalence of comorbid mental disorders was 13.9%. Comorbid mental disorders were associated with poorer quality of life (Adjusted (Adj.) β -13.27; 95% CI -23.28 to-3.26) and greater disability (multiplier of WHODAS-2 score 1.62; 95% CI 1.05, 2.50) after adjusting for hypothesised confounding factors. Low or very low relative wealth (Adj. β = -12.57, 95% CI -19.94 to-5.20), higher seizure frequency (Adj.β coef. = -1.92, 95% CI -2.83 to -1.02), and poor to intermediate social support (Adj. β coef. = -9.66, 95% CI -16.51 to -2.81) were associated independently with decreased quality of life. Higher seizure frequency (multiplier of WHODAS-2 score 1.11; 95% CI 1.04, 1.19) was associated independently with functional disability. Conclusion Co-morbid mental disorders were associated with poorer quality of life and impairment, independent of level of seizure control. Integrated and comprehensive psychosocial care is required for better health and social outcomes of people with epilepsy.

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

European Psychiatry ◽

10.1016/0767-399x(96)80070-8 ◽

1995 ◽

Vol 10 (1) ◽

pp. 11-16 ◽

Cited By ~ 9

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.

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

The British Journal of Psychiatry ◽

10.1192/bjp.183.4.349 ◽

2003 ◽

Vol 183 (4) ◽

pp. 349-355 ◽

Cited By ~ 96

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.

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Primary Health Care and the ICD-11

Die Psychiatrie ◽

10.1055/s-0038-1670835 ◽

2013 ◽

Vol 10 (01) ◽

pp. 33-37 ◽

Cited By ~ 2

Author(s):

M. Klinkman ◽

D. Goldberg

Keyword(s):

Health Care ◽

Primary Health Care ◽

Mental Disorders ◽

Medical Care ◽

Special Needs ◽

Field Trials ◽

Primary Medical Care ◽

Dsm 5 ◽

Primary Health ◽

Icd 10

SummaryThis paper describes the necessity of adapting the major classifications of mental disorders exemplified by the ICD-11 and the DSM-5 for the special needs of primary medical care. An earlier version of the classification – the ICD-10-PHC – is described, and the process of adapting it is described in detail. The new 28 item version of the classification is described, and the procedures to be adopted in the Field Trials to be held during 2013 are set out, together with the specific problems these field trials will address.

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Childhood Mental Disorders in Primary Health Care: Results of Observations in Four Developing Countries

PEDIATRICS ◽

10.1542/peds.68.5.677 ◽

1981 ◽

Vol 68 (5) ◽

pp. 677-683

Author(s):

R. Giel ◽

M. V. de Arango ◽

C. E. Climent ◽

T. W. Harding ◽

H. H. A. Ibrahim ◽

...

Keyword(s):

Health Care ◽

Developing Countries ◽

Primary Health Care ◽

Mental Disorders ◽

Health Workers ◽

Health Care Facilities ◽

Primary Health ◽

Care Facilities ◽

Research Procedure ◽

Primary Health Care Facilities

To ascertain the frequency of mental disorders in Sudan, Philippines, India, and Colombia, 925 children attending primary health care facilities were studied. Rates of between 12% and 29% were found in the four study areas. The range of mental disorders diagnosed was similar to that encountered in industrialized countries. The research procedure involved a two-stage screening in which a ten-item "reporting questionnaire" constituted the first stage. The study has shown that mental disorders are common among children attending primary health care facilities in four developing countries and that accompanying adults (usually the mothers) readily recognize and report common psychologic and behavioral symptoms when these are solicited by means of a simple set of questions. Despite this, the primary health workers themselves recognized only between 10% and 22% of the cases of mental disorder. The results have been used to design appropriate brief training courses in childhood mental disorders for primary health workers in the countries participating in the study.

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Optimal diagnostic accuracy of quantitative faecal immunochemical test positivity thresholds for colorectal cancer detection in primary health care: A community-based cohort study

United European Gastroenterology Journal ◽

10.1177/2050640620949714 ◽

2020 ◽

pp. 205064062094971 ◽

Cited By ~ 1

Author(s):

Noel Pin-Vieito ◽

Laura García Nimo ◽

Luis Bujanda ◽

Begoña Román Alonso ◽

María Ángeles Gutiérrez-Stampa ◽

...

Keyword(s):

Colorectal Cancer ◽

Health Care ◽

Cohort Study ◽

Primary Health Care ◽

Negative Predictive Value ◽

Predictive Value ◽

Clinical Laboratory ◽

Faecal Immunochemical Test ◽

Primary Health ◽

Immunochemical Test

Background Optimizing colonoscopy resources is challenging, and information regarding performing diagnostic quantitative faecal immunochemical test (FIT) in daily clinical practice in primary health care is still limited. This study aimed to assess the sensitivity, specificity, positive predictive value and negative predictive value of varying FIT positivity thresholds on colorectal cancer (CRC) detection in primary health care. Methods A retrospective cohort study of 38,675 asymptomatic and symptomatic patients with a FIT (OC-Sensor™) performed between 2012 and 2016 in a primary health-care setting, using a clinical laboratory database of two Spanish areas linked with the National Health System’s Hospital Discharge Records Database. The primary outcome was 2-year CRC incidence. Results The mean age of the participants was 63.2 years; 17,792 (46.0%) were male. CRC prevalence was 1.7% (650/38,675). The percentage of patients with a FIT result above the threshold was 20.7% and 14.6% for 10 µg Hb/g faeces and 20 µg Hb/g faeces thresholds, respectively. Sensitivity was 90.5% (95% confidence interval 88.0–92.5%) at a 10 µg Hb/g faeces threshold, and this decreased by 3.1% when a 20 µg Hb/g faeces threshold was used. The negative predictive value for CRC was at least 99.2% in any subgroup analysed. At a 20 µg Hb/g faeces threshold, less than one additional CRC would be missed per 1000 patients investigated, while approximately 1.3 times more colonoscopy examinations were needed to identify an incidence of CRC using the lowest threshold for any situation analysed. Conclusions In primary health care, a quantitative FIT threshold should be tailored to colonoscopy capacity and CRC prevalence in specific populations.

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Detection of mental disorders with the Patient Health Questionnaire in primary care settings in Nigeria

Mental Illness ◽

10.4081/mi.2010.e10 ◽

2010 ◽

Vol 2 (1) ◽

pp. 46-50 ◽

Cited By ~ 9

Author(s):

Olawale O. Ogunsemi ◽

Francis A. Oluwole ◽

Festus Abasiubong ◽

Adebayo R. Erinfolami ◽

Olufemi E. Amoran ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

Primary Health Care ◽

Mental Disorders ◽

Patient Health Questionnaire ◽

Health Questionnaire ◽

Primary Care Settings ◽

Primary Health ◽

Patient Health ◽

The Impact

Mental disorders lead to difficulties in social, occupational and marital relations. Failure to detect mental disorder denies patients potentially effective treatment. This study aimed to assess the prevalence and nature of mental disorders at the primary care settings and the recognition of these disorders by the attending physicians. Over a period of eight weeks, consecutive and consenting patients who attended three randomly selected primary health care facilities in Sagamu Local Government Area of Ogun state were recruited and administered a questionnaire that included a socio-demographic section and Patient Health Questionnaire (PHQ). A total of 412 subjects took part in the study. Subject age ranged from 18-90 years with a mean age of 52.50±21.08 years. One hundred and seventy-six (42.7%) of the subjects were males. A total of 120 (29.1%) of the subjects had depressive disorder, 100 (24.3%) had anxiety disorder, 196 (47.6%) somatoform disorder and 104 (25.2%) met the criteria for an alcohol related problem. The PHC physicians were only able to diagnose disorders relating to mental health in 52 (12.6%) of the subjects. Health and work situations accounted for more than three-quarters of the causes of stress experienced by the subjects. We conclude that there is a high prevalence of mental disorders among patients seen in primary care settings and that a significant proportion of them are not recognized by the primary care physicians. Stress relating to health, work and financial problems is common among primary health care attendees. Physicians in primary health care should be alert to the possibility and the impact of undetected psychiatric morbidity.

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