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.

Poverty, psychological disorder and disability in primary care attenders in Goa, India

1998 ◽  
Vol 172 (6) ◽  
pp. 533-536 ◽  
Author(s):  
Vikram Patel ◽  
Jerson Pereira ◽  
Livia Countinho ◽  
Romaldina Fernandes ◽  
John Fernandes ◽  
...  
Keyword(s):  
Mental Disorders ◽  
Mental Disorder ◽  
Low Income ◽  
Common Mental Disorders ◽  
Common Mental Disorder ◽  
Female Gender ◽  
Psychological Disorder ◽  
Low Income Countries ◽  
Health Clinic ◽  
Primary Health

BackgroundThis study examined the association of common mental disorders in primary health clinic attenders with indicators of poverty and disability in Goa, India.MethodAdult attenders (n=303) in two primary health clinics were recruited.ResultsThere were 141 (46.5%) cases of common mental disorder. The following were associated with common mental disorder: female gender; inability to buy food due to lack of money; and being in debt. Cases scored significantly higher on all measures of disability. Primary health clinic staff recognised a third of the morbidity but used multiple oral drugs, injectable vitamins and benzodiazepines to treat common mental disorders.ConclusionsPoverty is closely associated with common mental disorder which in turn is associated with deprivation and despair. Primary mental health care priorities in low-income countries need to shift from psychotic disorders which often need specialist care to common mental disorders. Health policy and development agencies need to acknowledge the intimate association of female gender and poverty with these disorders.

Common Mental Disorders and Primary Health Care: Current Practice in Low-Income Countries

2003 ◽  
Vol 11 (3) ◽  
pp. 166-173 ◽  
Author(s):  
Melanie Abas ◽  
Florence Baingana ◽  
Jeremy Broadhead ◽  
Eduardo Iacoponi ◽  
Jane Vanderpyl
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Mental Disorders ◽  
Low Income ◽  
Current Practice ◽  
Common Mental Disorders ◽  
Low Income Countries ◽  
Primary Health

The onset of common mental disorders in primary care attenders in Harare, Zimbabwe

1999 ◽  
Vol 29 (1) ◽  
pp. 97-104 ◽  
Author(s):  
C. TODD ◽  
V. PATEL ◽  
E. SIMUNYU ◽  
F. GWANZURA ◽  
W. ACUDA ◽  
...  
Keyword(s):  
Primary Care ◽  
Mental Disorders ◽  
Common Mental Disorders ◽  
Common Mental Disorder ◽  
Medical Practitioner ◽  
Female Gender ◽  
Degree Relative ◽  
Medical Practitioners ◽  
Health Care Clinics

Background. This study aimed to investigate the onset and predictors of common mental disorders (CMD) in primary-care attenders in Harare, Zimbabwe.Method. Two (T1) and 12-month (T2) follow-up of a cohort of primary-care attenders without a common mental disorder (N=197) as defined by the Shona Symposium Questionnaire (SSQ), recruited from primary health care clinics, traditional medical practitioner clinics and general practitioner surgeries. Outcome measure was caseness as determined by scores on the SSQ at follow-up.Results. Follow-up rate was 86% at 2 months and 75% at 12 months. Onset of CMD was recorded in 16% at T1 and T2. Higher psychological morbidity scores at recruitment, death of a first-degree relative and disability predicted the presence of a CMD at both follow-up points. While female gender and economic difficulties predicted onset only in the short-term, belief in supernatural causation was strongly predictive of CMD at T2. Caseness at both follow-up points was associated with economic problems and disability at those follow-up points.Conclusions. Policy initiatives to reduce economic deprivation and targeting interventions to primary-care attenders who are subclinical cases and those who have been bereaved or who are disabled may reduce the onset of new cases of CMD. Closer collaboration between biomedical and traditional medical practitioners may provide avenues for developing methods of intervention for persons with supernatural illness models.

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 Duration of untreated symptoms in common mental disorders: association with outcomes

2006 ◽  
Vol 189 (1) ◽  
pp. 79-80 ◽  
Author(s):  
Stephen Kisely ◽  
Anita Scott ◽  
Jennifer Denney ◽  
Gregory Simon
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Mental Disorders ◽  
Psychiatric Disorders ◽  
Prospective Cohort ◽  
Common Mental Disorders ◽  
Specialist Care ◽  
Psychosocial Status ◽  
Psychiatric Outcome

SummaryStudies have assessed the association between a longer duration of untreated symptoms and outcome for psychoses in specialist care. We investigated the effect of longer duration on the outcome of common psychiatric disorders in primary care, where most patients are treated. Patients presenting to primary care for new episodes in 10 countries were recruited into a prospective cohort study. Information on duration of untreated symptoms and psychosocial status was collected for 351 individuals using standardised instruments and this was repeated 1 year later. At 1-year follow-up, longer duration was associated with worse psychiatric outcome even after controlling for potential confounders.

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 Detecting common mental disorders in primary care in India: a comparison of five screening questionnaires

2007 ◽  
Vol 38 (2) ◽  
pp. 221-228 ◽  
Author(s):  
V. Patel ◽  
R. Araya ◽  
N. Chowdhary ◽  
M. King ◽  
B. Kirkwood ◽  
...  
Keyword(s):  
Primary Care ◽  
Mental Disorders ◽  
Common Mental Disorders ◽  
General Health Questionnaire ◽  
Diagnostic Interview ◽  
Systematic Sampling ◽  
Health Questionnaire ◽  
Primary Care Settings ◽  
Self Reporting Questionnaire ◽  
Distress Scale

BackgroundScreening of patients for common mental disorders (CMDs) is needed in primary-care management programmes. This study aimed to compare the screening properties of five widely used questionnaires.MethodAdult attenders in five primary-care settings in India were recruited through systematic sampling. Four questionnaires were administered, in pairs, in random order to participants: the General Health Questionnaire (GHQ, 12 items); the Primary Health Questionnaire (PHQ, nine items); the Kessler Psychological Distress Scale (K10, 10 items), and from which we could extract the score of the shorter 6-item K6; and the Self-Reporting Questionnaire (SRQ, 20 items). All participants were interviewed with a structured lay diagnostic interview, the Revised Clinical Interview Schedule (CIS-R).ResultsComplete data were available for 598 participants (participation rate 99.3%). All five questionnaires showed moderate to high discriminating ability; the GHQ and SRQ showed the best results. All five showed moderate to high degrees of correlation with one another, the poorest being between the two shortest questionnaires, K6 and PHQ. All five had relatively good internal consistency. However, the positive predictive value (PPV) of the questionnaires compared with the diagnostic interview ranged from 51% to 77% at the optimal cut-off scores.ConclusionsThere is little difference in the ability of these questionnaires to identify cases accurately, but none showed high PPVs without a considerable compromise on sensitivity. Hence, the choice of an optimum cut-off score that yields the best balance between sensitivity and PPV may need to be tailored to individual settings, with a higher cut-off being recommended in resource-limited primary-care settings.

scholarly journals Assessing and predicting adolescent and early adulthood common mental disorders using electronic primary care data: analysis of a prospective cohort study (ALSPAC) in Southwest England

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e053624
Author(s):  
Daniel Smith ◽  
Kathryn Willan ◽  
Stephanie L Prady ◽  
Josie Dickerson ◽  
Gillian Santorelli ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Mental Disorders ◽  
Outcome Measures ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Common Mental Disorders ◽  
Free Text ◽  
Primary Care Data ◽  
Time Point

ObjectivesWe aimed to examine agreement between common mental disorders (CMDs) from primary care records and repeated CMD questionnaire data from ALSPAC (the Avon Longitudinal Study of Parents and Children) over adolescence and young adulthood, explore factors affecting CMD identification in primary care records, and construct models predicting ALSPAC-derived CMDs using only primary care data.Design and settingProspective cohort study (ALSPAC) in Southwest England with linkage to electronic primary care records.ParticipantsPrimary care records were extracted for 11 807 participants (80% of 14 731 eligible). Between 31% (3633; age 15/16) and 11% (1298; age 21/22) of participants had both primary care and ALSPAC CMD data.Outcome measuresALSPAC outcome measures were diagnoses of suspected depression and/or CMDs. Primary care outcome measure were Read codes for diagnosis, symptoms and treatment of depression/CMDs. For each time point, sensitivities and specificities for primary care CMD diagnoses were calculated for predicting ALSPAC-derived measures of CMDs, and the factors associated with identification of primary care-based CMDs in those with suspected ALSPAC-derived CMDs explored. Lasso (least absolute selection and shrinkage operator) models were used at each time point to predict ALSPAC-derived CMDs using only primary care data, with internal validation by randomly splitting data into 60% training and 40% validation samples.ResultsSensitivities for primary care diagnoses were low for CMDs (range: 3.5%–19.1%) and depression (range: 1.6%–34.0%), while specificities were high (nearly all >95%). The strongest predictors of identification in the primary care data for those with ALSPAC-derived CMDs were symptom severity indices. The lasso models had relatively low prediction rates, especially in the validation sample (deviance ratio range: −1.3 to 12.6%), but improved with age.ConclusionsPrimary care data underestimate CMDs compared to population-based studies. Improving general practitioner identification, and using free-text or secondary care data, is needed to improve the accuracy of models using clinical data.

scholarly journals Food insecurity and common mental disorders in perinatal women living in low socio-economic settings in Cape Town, South Africa during the COVID-19 pandemic: a cohort study

2021 ◽  
Author(s):  
Zulfa Abrahams ◽  
Crick Lund
Keyword(s):  
Mental Health ◽  
South Africa ◽  
Mental Disorders ◽  
Food Insecurity ◽  
Common Mental Disorders ◽  
Cape Town ◽  
Baseline Risk ◽  
Multivariable Logistic Regression Analysis ◽  
Perinatal Women

Abstract Background Common mental disorders (CMDs) such as depression and anxiety are highly prevalent during the perinatal period, and are associated with poverty, food insecurity and domestic violence. We used data collected from perinatal women at two time-points during the COVID-19 pandemic to test the hypotheses that (1) socio-economic adversities at baseline would be associated with higher CMD prevalence at follow-up and (2) worse mental health at baseline would be associated with higher food insecurity prevalence at follow-up. Methods Telephonic interviews were conducted with perinatal women attending healthcare facilities in Cape Town, South Africa. Multivariable logistic regression analysis was used to model the associations of baseline risk factors with the prevalence of household food insecurity and CMD at 3 months follow-up. Results At baseline 859 women were recruited, of whom 217 (25%) were pregnant, 106 (12%) had probable CMD, and 375 (44%) were severely food insecure. At follow-up (n=634), 22 (4%) were still pregnant, 44 (7%) had probable CMD, and 207 (33%) were severely food insecure. In the multivariable regression model, after controlling for confounders, the odds of being food insecure at follow-up were greater in women who were unemployed [OR=2.05 (1.46-2.87); p<0.001] or had probable CMD [OR=2.37 (1.35-4.18); p=0.003] at baseline; and the odds of probable CMD at follow-up were greater in women with psychological distress [OR=2.81 (1.47-5.39); p=0.002] and abuse [OR=2.47 (1.47-4.39); p=0.007] at baseline. Conclusions This study highlights the complex bidirectional relationship between mental health and socioeconomic adversity among perinatal women during the COVID-19 pandemic.

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