scholarly journals Lay health worker led intervention for depressive and anxiety disorders in India: impact on clinical and disability outcomes over 12 months

2011 ◽  
Vol 199 (6) ◽  
pp. 459-466 ◽  
Author(s):  
Vikram Patel ◽  
Helen A. Weiss ◽  
Neerja Chowdhary ◽  
Smita Naik ◽  
Sulochana Pednekar ◽  
...  
Keyword(s):  
Primary Care ◽  
Mental Disorders ◽  
Anxiety Disorders ◽  
Suicidal Behaviour ◽  
Common Mental Disorders ◽  
Stepped Care ◽  
Psychological Morbidity ◽  
Public Facilities ◽  
Care Facilities ◽  
Icd 10

BackgroundDepressive and anxiety disorders (common mental disorders) are the most common psychiatric condition encountered in primary healthcare.AimsTo test the effectiveness of an intervention led by lay health counsellors in primary care settings (the MANAS intervention) to improve the outcomes of people with common mental disorders.MethodTwenty-four primary care facilities (12 public, 12 private) in Goa (India) were randomised to provide either collaborative stepped care or enhanced usual care to adults who screened positive for common mental disorders. Participants were assessed at 2, 6 and 12 months for presence of ICD-10 common mental disorders, the severity of symptoms of depression and anxiety, suicidal behaviour and disability levels. All analyses were intention to treat and carried out separately for private and public facilities and adjusted for the design. The trial has been registered with clinicaltrials.gov (NCT00446407).ResultsA total of 2796 participants were recruited. In public facilities, the intervention was consistently associated with strong beneficial effects over the 12 months on all outcomes. There was a 30% decrease in the prevalence of common mental disorders among those with baseline ICD-10 diagnoses (risk ratio (RR) = 0.70, 95% CI 0.53–0.92); and a similar effect among the subgroup of participants with depression (RR = 0.76, 95% CI 0.59–0.98). Suicide attempts/plans showed a 36% reduction over 12 months (RR = 0.64, 95% CI 0.42–0.98) among baseline ICD-10 cases. Strong effects were observed on days out of work and psychological morbidity, and modest effects on overall disability. In contrast, there was little evidence of impact of the intervention on any outcome among participants attending private facilities.ConclusionsTrained lay counsellors working within a collaborative-care model can reduce prevalence of common mental disorders, suicidal behaviour, psychological morbidity and disability days among those attending public primary care facilities.

scholarly journals Accuracy of general practitioner's prognosis of the 1-year course of depression and generalised anxiety

2001 ◽  
Vol 178 (1) ◽  
pp. 18-22 ◽  
Author(s):  
Rob H. S. Van Den Brink ◽  
Johan Ormel ◽  
Klaas Van Der Meer ◽  
Bea G. Tiemens ◽  
Titus W. D. P. Van Os ◽  
...  
Keyword(s):  
Primary Care ◽  
Anxiety Disorder ◽  
Mental Disorders ◽  
Statistical Model ◽  
General Practitioners ◽  
Common Mental Disorders ◽  
Generalised Anxiety Disorder ◽  
Model Based ◽  
Icd 10 ◽  
Course Of Depression

BackgroundA prognosis serves important functions for the management of common mental disorders in primary care.AimsTo establish the accuracy of the general practitioner's (GP) prognosis.MethodThe agreement between GP prognosis and observed course was determined for 138 cases of ICD–10 depression and 65 of generalised anxiety disorder, identified among consecutive attenders of 18 GPs.ResultsModest agreement between GP prognosis and course was found, both for depression (κ=0.21) and generalised anxiety (κ=0.111). Better agreement (κ=0.45 for depression, and κ=0.33 for generalised anxiety) was observed between the course and predictions from a statistical model based on information potentially available to the GP at the time the prognosis was made. This model assesses attainable performance for GPs.ConclusionsGeneral practitioners do a fair job in predicting the 1-year course of depression and generalised anxiety. Even so, their performance falls significantly short of attainable performance.

Mental disorders in primary care: prevalence and co-morbidity among disorders. Results from the Functional Illness in Primary care (FIP) study

2005 ◽  
Vol 35 (8) ◽  
pp. 1175-1184 ◽  
Author(s):  
TOMAS TOFT ◽  
PER FINK ◽  
EVA OERNBOEL ◽  
KAJ CHRISTENSEN ◽  
LISBETH FROSTHOLM ◽  
...  
Keyword(s):  
Primary Care ◽  
Mental Disorders ◽  
Alcohol Abuse ◽  
Anxiety Disorders ◽  
Somatoform Disorders ◽  
Psychiatric Morbidity ◽  
Somatization Disorder ◽  
Waiting Room ◽  
Co Morbidity ◽  
Icd 10

Background. Prevalence and co-occurrence of mental disorders is high among patients consulting their family general practitioner (GP) for a new health problem, but data on diagnostics and sociodemographics are sketchy.Method. A cross-sectional two-phase epidemiological study. A total of 1785 consecutive patients with new complaints, aged 18–65 years, consulting 28 family practices during March–April 2000 in Aarhus County, Denmark were screened, in the waiting room, for mental and somatic symptoms with SCL-8 and SCL-Somatization questionnaires, for illness worry with Whitely-7 and for alcohol dependency with CAGE. In a stratified random sample of 701 patients, physician interviewers established ICD-10 diagnoses using the SCAN interview. Prevalence was calculated using weighted logistic regression, thus correcting for sample skewness.Results. Half of the patients fulfilled criteria for an ICD-10 mental disorders and a third of these for more than one group of disorders. Women had higher prevalence of somatization disorder and overall mental disorders than men. Men had higher prevalence of alcohol abuse and hypochondriasis than women. Psychiatric morbidity tended to increase with age. Prevalence of somatoform disorders was 35·9% (95% CI 30·4–41·9), anxiety disorders 16·4% (95% CI 12·7–20·9), mood disorders 13·5% (95% CI 11·1–16·3), organic mental disorders 3·1% (95% CI 1·6–5·7) and alcohol abuse 2·2% (95% CI 1·5–3·1). Co-morbidities between these groups were highest for anxiety disorders, where 89% also had another mental diagnosis, and lowest for somatoform disorders with 39%.Conclusions. ICD-10 mental disorders are very prevalent in primary care and there is a high co-occurrence between most disorders. Somatoform disorders, however, more often than not exist without other mental disorders.

The Classification of Mental Disorders in Primary Care: A Guide through a Difficult Terrain

1998 ◽  
Vol 28 (2) ◽  
pp. 159-176 ◽  
Author(s):  
Henk Lamberts ◽  
Kathryn Magruder ◽  
Roger G. Kathol ◽  
Harold A. Pincus ◽  
Inge Okkes
Keyword(s):  
Primary Care ◽  
Mental Disorders ◽  
Primary Care Physicians ◽  
Common Mental Disorders ◽  
Classification Systems ◽  
Somatization Disorder ◽  
Icd 10 ◽  
Dsm Iv ◽  
Difficult Terrain ◽  
Clinical Comparability

Background: Primary care physicians traditionally have a strong interest in the mental health of their patients. Three classification systems are available for them to diagnose, label, and classify mental disorders: 1) The ICD-10 approach with three options, 2) The DSM-IV approach with two options, and 3) the ICPC approach with two options. This article lists important similarities and differences between the systems to help potential users choose the option that best meets their needs. Methods: Definitions for depressive disorder, anxiety disorder, and somatization disorder are compared on five characteristics of classification: 1. the domain, 2. the scope, 3. the nature of the definitions, 4. focus on episodes of care, and 5. clinical guidelines. Results: Primary care physicians and psychiatrists have different perspectives, reflected in different classifications. Each system has specific possibilities and limitations with regard to the diagnosis of mental disorders. For common mental disorders it is possible, however, to choose codes from one system while maintaining compatibility with the other two. Comparability as to the diagnostic content of the different classes, however, is more difficult to establish. The available classification systems give both primary care physicians and psychiatrists options to diagnose, label, and to classify mental disorders from their own perspective, but once a system has been chosen the clinical comparability of a patient with the same diagnosis in other systems is limited. Conclusion: Compatibility among systems can be optimized by strictly following a number of rules. The conversion between ICPC and ICD-10 (and consequently DSM-IV) allows simultaneous use of ICPC and ICD-10 as a classification and DSM-IV as the standard nomenclature. This is of particular interest for computer based patient records in primary care. The clinical comparability of the same diagnosis in different systems however is limited by the characteristics of the different system.

Depressive Disorders in Portugal: EAAD and the Depanx Project Regional Baseline Data and the WMH Survey National Data

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
R. Gusmão ◽  
J.M. Caldas de Almeida
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Disorders ◽  
Depressive Disorders ◽  
Common Mental Disorders ◽  
National Level ◽  
Outcome Data ◽  
Stepped Care ◽  
Therapeutic Interventions ◽  
Clinical Criteria

Firstly, recent data on depressive disorders and suicidality burden in Portugal is presented and treatment gap is stressed as well as the insufficient information until recent years (1).At the national level, the first epidemiological study on psychiatric disorders embedded within the World Mental Initiative Survey is ongoing and prevalence and needs for care data will be presented.Implementation process of the EAAD 4-level intervention in Portugal is ongoing along with restructuring of both liaison and specialized mental health care on a regional sector of 350.000 inhabitants with a mental health specialised care department and four large primary care health centres, where liaison between 4 mental health teams and 200 GP was taking place accordingly with varying models (substitute care in most) and different clinical criteria for admission and follow-up.The restructuring of mental health teams and their missions implied that while a set of sub-teams stood responsible for severe mental disorders, another subgroup was deemed to comply exclusively with common mental disorders and primary care liaison aided by standardisation of clinical criteria for referrals evaluation and reply, specialised therapeutic interventions, as well as collaborative stepped care.Baseline and some outcome data on suicide and depression will be presented such as rates, psychopharmacological prescriptions, general population knowledge and beliefs, media reporting, and pre and post training evaluation of primary care professionals.

Stepped care in primary care – guided self-help and face-to-face cognitive behavioural therapy for common mental disorders: a randomized controlled trial

2017 ◽  
Vol 48 (10) ◽  
pp. 1644-1654 ◽  
Author(s):  
Sigrid Salomonsson ◽  
Fredrik Santoft ◽  
Elin Lindsäter ◽  
Kersti Ejeby ◽  
Brjánn Ljótsson ◽  
...  
Keyword(s):  
Primary Care ◽  
Mental Disorders ◽  
Common Mental Disorders ◽  
Behavioural Therapy ◽  
Stepped Care ◽  
Care Model ◽  
Face To Face ◽  
Self Help ◽  
Cognitive Behavioural ◽  
Remission Rates

AbstractBackgroundCommon mental disorders (CMD) cause large suffering and high societal costs. Cognitive behavioural therapy (CBT) can effectively treat CMD, but access to treatment is insufficient. Guided self-help (GSH) CBT, has shown effects comparable with face-to-face CBT. However, not all patients respond to GSH, and stepping up non-responders to face-to-face CBT, could yield larger response rates. The aim was to test a stepped care model for CMD in primary care by first evaluating the effects of GSH-CBT and secondly, for non-responders, evaluating the additional effect of face-to-face CBT.MethodsConsecutive patients (N = 396) with a principal disorder of depression, anxiety, insomnia, adjustment or exhaustion disorder were included. In Step I, all patients received GSH-CBT. In Step II, non-responders were randomized to face-to-face CBT or continued GSH. The primary outcome was remission status, defined as a score below a pre-established cutoff on a validated disorder-specific scale.ResultsAfter GSH-CBT in Step I, 40% of patients were in remission. After Step II, 39% of patients following face-to-face CBT were in remission compared with 19% of patients after continued GSH (p = 0.004). Using this stepped care model required less than six therapy sessions per patient and led to an overall remission rate of 63%.ConclusionsStepped care can be effective and resource-efficient to treat CMD in primary care, leading to high remission rates with limited therapist resources. Face-to-face CBT speeded up recovery compared with continued GSH. At follow-ups after 6 and 12 months, remission rates were similar in the two groups.

Psychiatry in primary care

2012 ◽  
pp. 1480-1490
Author(s):  
David Goldberg ◽  
André Tylee ◽  
Paul Walters
Keyword(s):  
Primary Care ◽  
Mental Disorders ◽  
Common Mental Disorders ◽  
Public Health Problem ◽  
Great Majority ◽  
Mental Illnesses ◽  
Stepped Care ◽  
Specialist Care ◽  
Important Public Health Problem ◽  
Clinical Problems

At one time, it was asserted that the ‘worried well’ were treated in primary care, while true mental illnesses were seen by the mental illness services. This was not true when it was asserted, and is even less true now. The great majority of patients with common mental disorders are cared for within primary care, and many of those with severe mental illnesses are only seen in primary care. ‘Stepped care’ is a model for distributing clinical problems between the services, and ‘shared care’ refers to the care of patients seen by both primary care and specialist mental health services. Many other workers in primary care now assist GPs with the treatment of mental disorders, and special administrative arrangements within primary care are necessary to ensure that clinical services are available to those with special needs. In summary, mental disorders in primary care: ♦ Are an important public health problem ♦ Frequently present with somatic symptoms ♦ Are more likely to be detected if the doctor has better communication skills ♦ Those with disabling physical illnesses are also at greater risk ♦ Are on average less severe than those seen in specialist care

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.

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