Melanie A Abas | King's College London (original) (raw)

Papers by Melanie A Abas

IMPORTANCE Depression and anxiety are common mental disorders globally but are rarely recognized ... more IMPORTANCE Depression and anxiety are common mental disorders globally but are rarely recognized or treated in low-income settings. Task-shifting of mental health care to lay health workers (LHWs) might decrease the treatment gap. OBJECTIVE To evaluate the effectiveness of a culturally adapted psychological intervention for common mental disorders delivered by LHWs in primary care.

objective To document the lived experiences of people with both poor mental health and suboptimal... more objective To document the lived experiences of people with both poor mental health and suboptimal adherence to antiretroviral therapy in high HIV prevalence settings. methods In-depth qualitative interviews were conducted with 47 (female = 31) HIV-positive adults who scored above the cut-point on a locally validated scale for common mental disorders (CMDs). Purposive sampling was used to recruit participants with evidence of poor adherence. Six additional key informant interviews (female = 6) were conducted with healthcare workers. Data were collected and analysed inductively by an interdisciplinary coding team. results The major challenges faced by participants were stressors (poverty, stigma, marital problems) and symptoms of CMDs ('thinking too much', changes to appetite and sleep, 'burdened heart' and low energy levels). Thinking too much, which appears closely related to rumination, was the symptom with the greatest negative impact on adherence to antiretroviral therapy among HIV-positive adults with CMDs. In turn, thinking too much was commonly triggered by the stressors faced by people living with HIV/AIDS, especially poverty. Finally, participants desired private counselling, access to income-generating activities and family engagement in mental health care. conclusions Better understanding of the local expression of mental disorders and of underlying stressors can inform the development of culturally sensitive interventions to reduce CMDs and poor adherence to antiretroviral therapy.

Using a pilot trial design in an HIV care clinic in Zimbabwe, we randomised 32 adults with poor a... more Using a pilot trial design in an HIV care clinic in Zimbabwe, we randomised 32 adults with poor adherence to antiretroviral therapy (ART) and at least mild depression to either six sessions of Problem-Solving Therapy for adherence and depression (PST-AD) delivered by an adherence counsellor, or to Enhanced Usual Care (Control). Acceptability of PST-AD was high, as indicated by frequency of session attendance and through qualitative analyses of exit interviews. Fidelity was >80% for the first two sessions of PST-AD but fidelity to the adherence component of PST-AD dropped by session 4. Contamination occurred, in that seven patients in the control arm received one or two PST-AD sessions before follow-up assessment. Routine health records proved unreliable for measuring HIV viral load at follow-up. Barriers to measuring adherence electronically included device failure and participant perception of being helped by the research device. The study was not powered to detect clinical differences, however, promising change at 6-months follow-up was seen in electronic adherence, viral load suppression (PST-AD arm 9/12 suppressed; control arm 4/8 suppressed) and depression (Patient Health Questionnaire - 4.7 points in PST-AD arm versus control, adjusted p value = 0.01). Results inform and justify a future randomised controlled trial of task-shifted PST-AD.

IMPORTANCE Depression and anxiety are common mental disorders globally but are rarely recognized ... more IMPORTANCE Depression and anxiety are common mental disorders globally but are rarely recognized or treated in low-income settings. Task-shifting of mental health care to lay health workers (LHWs) might decrease the treatment gap. OBJECTIVE To evaluate the effectiveness of a culturally adapted psychological intervention for common mental disorders delivered by LHWs in primary care.

Using a pilot trial design in an HIV care clinic in Zimbabwe, we randomised 32 adults with poor a... more Using a pilot trial design in an HIV care clinic in Zimbabwe, we randomised 32 adults with poor adherence to antiretroviral therapy (ART) and at least mild depression to either six sessions of Problem-Solving Therapy for adherence and depression (PST-AD) delivered by an adherence counsellor, or to Enhanced Usual Care (Control). Acceptability of PST-AD was high, as indicated by frequency of session attendance and through qualitative analyses of exit interviews. Fidelity was >80% for the first two sessions of PST-AD but fidelity to the adherence component of PST-AD dropped by session 4. Contamination occurred, in that seven patients in the control arm received one or two PST-AD sessions before follow-up assessment. Routine health records proved unreliable for measuring HIV viral load at follow-up. Barriers to measuring adherence electronically included device failure and participant perception of being helped by the research device. The study was not powered to detect clinical differences, however, promising change at 6-months follow-up was seen in electronic adherence, viral load suppression (PST-AD arm 9/12 suppressed; control arm 4/8 suppressed) and depression (Patient Health Questionnaire - 4.7 points in PST-AD arm versus control, adjusted p value = 0.01). Results inform and justify a future randomised controlled trial of task-shifted PST-AD.

Few evidence-based interventions to improve adherence to antiretroviral therapy have been adapted... more Few evidence-based interventions to improve adherence to antiretroviral therapy have been adapted for use in Africa. We selected, culturally adapted and tested the feasibility of a cognitive-behavioural intervention for adherence and for delivery in a clinic setting in Harare, Zimbabwe. The intervention consisted of a single, 50-minute problem-solving cognitive-behavioural intervention session with four skill-based booster sessions, delivered by four lay adherence counsellors in the context of HIV care. Adaptation followed a theoretically driven approach to intervention adaptation, Assessment-Decision-Administration-Production-Topical Experts-Integration-Training-Testing (ADAPT-ITT), and included modifications to language, session length, tailoring content for delivery by lay counsellors and inclusion of culturally competent probes. The feasibility of the intervention was evaluated using a mixed-methods assessment, including ratings of provider fidelity of intervention delivery, and qualitative assessments of feasibility using individual semi-structured interviews with counsellors (n = 4) and patients (n = 15). The intervention was feasible and acceptable when administered to 42 patients and resulted in improved self-reported adherence in a subset of 15 patients who were followed up after 6 months. Next steps from this study include conducting a randomised control trial to evaluate the adapted intervention compared to standard of care in a larger sample over a long-term follow-up.

Depression, alcohol use disorders (AUD), and neuro-

Objectives: To assess the concurrent and the construct validity of the Euro-D in older Thai persons.

British Journal of Psychiatry, 2009

Context: Migration is feared to be associated with abandonment and depression in older parents "l... more Context: Migration is feared to be associated with abandonment and depression in older parents "left behind" in rural areas of low-and middle-income countries.

Health and Quality of Life Outcomes, 2009

Background There has been very little research on wellbeing, physical impairments and disability ... more Background There has been very little research on wellbeing, physical impairments and disability in older people in developing countries. Methods A community survey of 1147 older parents, one per household, aged sixty and over in rural Thailand. We used the Burvill scale of physical impairment, the Thai Psychological Wellbeing Scale and the brief WHO Disability Assessment Schedule. We rated received and perceived social support separately from children and from others and rated support to children. We used weighted analyses to take account of the sampling design. Results Impairments due to arthritis, pain, paralysis, vision, stomach problems or breathing were all associated with lower wellbeing. After adjusting for disability, only impairment due to paralysis was independently associated with lowered wellbeing. The effect of having two or more impairments compared to none was associated with lowered wellbeing after adjusting for demographic factors and social support (adjusted difference -2.37 on the well-being scale with SD = 7.9, p < 0.001) but after adjusting for disability the coefficient fell and was non-significant. The parsimonious model for wellbeing included age, wealth, social support, disability and impairment due to paralysis (the effect of paralysis was -2.97, p = 0.001). In this Thai setting, received support from children and from others and perceived good support from and to children were all independently associated with greater wellbeing whereas actual support to children was associated with lower wellbeing. Low received support from children interacted with paralysis in being especially associated with low wellbeing. Conclusion In this Thai setting, as found in western settings, most of the association between physical impairments and lower wellbeing is explained by disability. Disability is potentially mediating the association between impairment and low wellbeing. Received support may buffer the impact of some impairments on wellbeing in this setting. Giving actual support to children is associated with less wellbeing unless the support being given to children is perceived as good, perhaps reflecting parental obligation to support adult children in need. Improving community disability services for older people and optimizing received social support will be vital in rural areas in developing countries.

Aging & Mental Health, 2009

Objectives: To assess the concurrent and the construct validity of the Euro-D in older Thai perso... more Objectives: To assess the concurrent and the construct validity of the Euro-D in older Thai persons. Method: Eight local psychiatrists used the major depressive episode section of the Mini International Neuropsychiatric Interview to interview 150 consecutive psychiatric clinic attendees. A trained interviewer administered the Euro-D. We used receiver operating characteristic (ROC) analysis to assess the overall discriminability of the Euro-D scale and principal components factor analysis to assess its construct validity. Results: The area under the ROC curve for the Euro-D with respect to major depressive episode was 0.78 [95% confidence interval (CI) 0.70–0.90] indicating moderately good discriminability. At a cut-point of 5/6 the sensitivity for major depressive episodes is 84.3%, specificity 58.6%, and kappa 0.37 (95% CI 0.22–0.52) indicating fair concordance. However, at the 3/4 cut-point recommended from European studies there is high sensitivity (94%) but poor specificity (34%). The principal components analysis suggested four factors. The first two factors conformed to affective suffering (depression, suicidality and tearfulness) and motivation (interest, concentration and enjoyment). Sleep and appetite constituted a separate factor, whereas pessimism loaded on its own factor. Conclusion: Among Thai psychiatric clinic attendees Euro-D is moderately valid for major depression. A much higher cut-point may be required than that which is usually advocated. The Thai version also shares two common factors as reported from most of previous studies.

Harvard Review of Psychiatry, 2003

... From the Sections of Old Age (Dr. Abas) and Community Psychia-try (Dr. Broadhead), Institute ... more ... From the Sections of Old Age (Dr. Abas) and Community Psychia-try (Dr. Broadhead), Institute of Psychiatry, London; City of Harare Health Department (Dr. Mbengeranwa); and Departments of Ob-stetrics and Gynaecology (Dr. Mbengeranwa) and Psychiatry (Dr. Chagwedera ...

Psychiatric Services, 2008

Objective: This study examined the association between socioeconomic deprivation and extended hos... more Objective: This study examined the association between socioeconomic deprivation and extended hospitalization in severe mental disorder, after taking account of confounding variables. Methods: A representative sample of 660 inpatients from South Auckland, New Zealand, was followed for two years from their index admission. Additional data were collected during the index admission for a subsample of 291 patients. Results: Greater levels of socioeconomic deprivation in the inpatient's neighborhood of residence was associated with extended hospitalization after adjustment for demographic factors and primary diagnosis but not after adjustment for comorbid diagnosis, chronicity, function, and severity. Most extended hospitalizations were related to poor illness recovery. Conclusions: People from more deprived areas are likely to need longer psychiatric admissions, mostly because of the asso-M Me el la an ni ie e A Am mn na a A Ab ba as s, , M M. .D D. . J Ja an ne e V Va an nd de er rp py yl l, , P Ph h.

Australian and New Zealand Journal of Psychiatry, 2003

Objective: This study set out to investigate the relationship in New Zealand between the newly de... more Objective: This study set out to investigate the relationship in New Zealand between the newly developed small area index of socio-economic deprivation, NZDep96, and measures of psychiatric bed utilisation. It aims to contribute to the debate on resource allocation and to estimate the distribution of beds required in relation to levels of deprivation. Method: A cohort study of 872 persons admitted to the psychiatric in-patient unit within Counties Manukau, involving 1299 episodes of in-patient care between 1998 and 2000. The annual period prevalence of admission and the rate of total occupied bed days were calculated for the different deciles of deprivation, standardized for age and gender. Results: There was a three-fold gradient in admission prevalence and in total occupied bed days between persons living in the most and least deprived areas. Conclusions: Mental health services need to be organized and funded in ways that take account of the high use of in-patient care among those living in deprived areas. Further research is required to explore the relationship between socio-economic deprivation and use of community mental health services.

Social Psychiatry and Psychiatric Epidemiology, 2001

Background: This paper explores the applicability of a psychosocial model of depression in an A... more Background: This paper explores the applicability of a psychosocial model of depression in an African setting. Method: Of a random sample of women (n=172) from a Zimbabwean township, 79 had a severe life event in the year before interview. Twenty-nine who had an onset of depression were compared with 50 who did not. Results: Having crisis support following a severe life event reduced the risk of onset of depression. The effect of crisis support was confounded by the number of severe events in the study year, but just persisted following adjustment for number of severe events and for socio-demographic factors. Women received crisis support more often from relatives than from partners or friends. The following variables were independently associated with onset of depression following a severe life event: number of life events in the previous 6 months, age, being in formal employment, having crisis support and separation from mother in childhood. Conclusion: This study supports the ubiquity of the social support construct. For Zimbabwe, the data suggest that crisis support from family members may be of particular importance in protecting against onset of depression.

Psychological Medicine, 1997

 One hundred and seventy-two women randomly selected from a Zimbabwean township were inte... more  One hundred and seventy-two women randomly selected from a Zimbabwean township were interviewed with a Shona screen for mental disorders and a semi-structured interview to assess symptoms suggestive of emotional distress, followed by the Present State Examination. Using criteria slightly stricter than threshold level 5 of the PSE-CATEGO-ID system, 30n8% of women had a depressive or anxiety disorder during the previous year. Nearly all disorders met Bedford College criteria for depression ; 65 % of these also had anxiety features. Only 0n6% of women had a ' pure ' anxiety disorder not preceded by or associated with depression in the study year. Compared with London, the higher annual prevalence of disorders in Harare could mostly be accounted for by an excess of onset cases in the study year, 70 % of which made a full or partial recovery within 12 months. The women's own words for these episodes included ' thinking too much ', ' deep sadness ' and a variety of terms describing heart discomfort, interpretation showing many of the latter to be expressions for grief, fear, or the possession of an insoluble problem, and 73 % explained their symptoms as caused by a specific social stressor.

Australian and New Zealand Journal of Psychiatry, 2003

Objective: To describe reasons for admission and alternatives to admission in a government funded... more Objective: To describe reasons for admission and alternatives to admission in a government funded acute inpatient unit. Method: Reasons for admission and alternatives to admission were rated for a consecutive sample of 255 admissions to an acute psychiatric unit in Auckland, using interviews with staff and case note review. Result: Most patients had a functional psychosis and were admitted involuntarily. Forty percent came from areas of marked social deprivation. The major reasons for admission were for reinstatement of medication (mainly linked to non-concordance with prescribed medication), intensive observation, risk to self and risk to others. Only 12% of admissions could have been diverted, of whom most would have required daily home treatment. For those still admitted at 5 weeks, 26% could have been discharged, mainly to 24 h nurse-staffed accommodation. If the alternatives had all been available, simulated bed-day savings were 11 bed years per year. Simulated bed day savings were greater through implementing early discharge than by diverting new admissions. Conclusion: Greater availability of assertive community treatment and of interventions to improve medication concordance may have prevented a small number of admissions. For patients admitted longer than 5 weeks, it appeared that greater availability of 24 h nursestaffed accommodation would have allowed considerable bed-day savings.

British Journal of Psychiatry, 1994

Psychological Medicine, 1998

A previous paper reported that among 172 women randomly selected from a Zimbabwean township 30n8 ... more A previous paper reported that among 172 women randomly selected from a Zimbabwean township 30n8 % had a depressive or anxiety disorder during the previous year. Compared with London, the higher annual prevalence of disorders in Harare could mostly be accounted for by an excess of onset cases in the study year (annual incidence of depression 18 %). This paper reports on the role of life events and difficulties in the aetiology of depression among these women. Method. Randomly selected women (N l 172) from a township in Harare were interviewed with a Zimbabwean modification of the Bedford College Life Events and Difficulties Schedule (LEDS). Results. Events and difficulties proved critical in provoking the onset of depression in Harare. Far more events occurring in Harare were severe or disruptive. Furthermore, a proportion of the Harare severe events were more threatening than have been described in London. As in London, certain types of severe event were particularly depressogenic, i.e. those involving the woman's humiliation, her entrapment in an ongoing difficult situation, or bereavement. However, more severe events in Harare involved these specific dimensions. Conclusions. Results indicate a common mechanism for the development of depression, as defined by international criteria, between Zimbabwe and London. The high frequency of severe events, and their especially adverse qualities, offer an explanation for the high incidence of depression in Harare.

IMPORTANCE Depression and anxiety are common mental disorders globally but are rarely recognized ... more IMPORTANCE Depression and anxiety are common mental disorders globally but are rarely recognized or treated in low-income settings. Task-shifting of mental health care to lay health workers (LHWs) might decrease the treatment gap. OBJECTIVE To evaluate the effectiveness of a culturally adapted psychological intervention for common mental disorders delivered by LHWs in primary care.

objective To document the lived experiences of people with both poor mental health and suboptimal... more objective To document the lived experiences of people with both poor mental health and suboptimal adherence to antiretroviral therapy in high HIV prevalence settings. methods In-depth qualitative interviews were conducted with 47 (female = 31) HIV-positive adults who scored above the cut-point on a locally validated scale for common mental disorders (CMDs). Purposive sampling was used to recruit participants with evidence of poor adherence. Six additional key informant interviews (female = 6) were conducted with healthcare workers. Data were collected and analysed inductively by an interdisciplinary coding team. results The major challenges faced by participants were stressors (poverty, stigma, marital problems) and symptoms of CMDs ('thinking too much', changes to appetite and sleep, 'burdened heart' and low energy levels). Thinking too much, which appears closely related to rumination, was the symptom with the greatest negative impact on adherence to antiretroviral therapy among HIV-positive adults with CMDs. In turn, thinking too much was commonly triggered by the stressors faced by people living with HIV/AIDS, especially poverty. Finally, participants desired private counselling, access to income-generating activities and family engagement in mental health care. conclusions Better understanding of the local expression of mental disorders and of underlying stressors can inform the development of culturally sensitive interventions to reduce CMDs and poor adherence to antiretroviral therapy.

Using a pilot trial design in an HIV care clinic in Zimbabwe, we randomised 32 adults with poor a... more Using a pilot trial design in an HIV care clinic in Zimbabwe, we randomised 32 adults with poor adherence to antiretroviral therapy (ART) and at least mild depression to either six sessions of Problem-Solving Therapy for adherence and depression (PST-AD) delivered by an adherence counsellor, or to Enhanced Usual Care (Control). Acceptability of PST-AD was high, as indicated by frequency of session attendance and through qualitative analyses of exit interviews. Fidelity was >80% for the first two sessions of PST-AD but fidelity to the adherence component of PST-AD dropped by session 4. Contamination occurred, in that seven patients in the control arm received one or two PST-AD sessions before follow-up assessment. Routine health records proved unreliable for measuring HIV viral load at follow-up. Barriers to measuring adherence electronically included device failure and participant perception of being helped by the research device. The study was not powered to detect clinical differences, however, promising change at 6-months follow-up was seen in electronic adherence, viral load suppression (PST-AD arm 9/12 suppressed; control arm 4/8 suppressed) and depression (Patient Health Questionnaire - 4.7 points in PST-AD arm versus control, adjusted p value = 0.01). Results inform and justify a future randomised controlled trial of task-shifted PST-AD.

IMPORTANCE Depression and anxiety are common mental disorders globally but are rarely recognized ... more IMPORTANCE Depression and anxiety are common mental disorders globally but are rarely recognized or treated in low-income settings. Task-shifting of mental health care to lay health workers (LHWs) might decrease the treatment gap. OBJECTIVE To evaluate the effectiveness of a culturally adapted psychological intervention for common mental disorders delivered by LHWs in primary care.

Using a pilot trial design in an HIV care clinic in Zimbabwe, we randomised 32 adults with poor a... more Using a pilot trial design in an HIV care clinic in Zimbabwe, we randomised 32 adults with poor adherence to antiretroviral therapy (ART) and at least mild depression to either six sessions of Problem-Solving Therapy for adherence and depression (PST-AD) delivered by an adherence counsellor, or to Enhanced Usual Care (Control). Acceptability of PST-AD was high, as indicated by frequency of session attendance and through qualitative analyses of exit interviews. Fidelity was >80% for the first two sessions of PST-AD but fidelity to the adherence component of PST-AD dropped by session 4. Contamination occurred, in that seven patients in the control arm received one or two PST-AD sessions before follow-up assessment. Routine health records proved unreliable for measuring HIV viral load at follow-up. Barriers to measuring adherence electronically included device failure and participant perception of being helped by the research device. The study was not powered to detect clinical differences, however, promising change at 6-months follow-up was seen in electronic adherence, viral load suppression (PST-AD arm 9/12 suppressed; control arm 4/8 suppressed) and depression (Patient Health Questionnaire - 4.7 points in PST-AD arm versus control, adjusted p value = 0.01). Results inform and justify a future randomised controlled trial of task-shifted PST-AD.

Few evidence-based interventions to improve adherence to antiretroviral therapy have been adapted... more Few evidence-based interventions to improve adherence to antiretroviral therapy have been adapted for use in Africa. We selected, culturally adapted and tested the feasibility of a cognitive-behavioural intervention for adherence and for delivery in a clinic setting in Harare, Zimbabwe. The intervention consisted of a single, 50-minute problem-solving cognitive-behavioural intervention session with four skill-based booster sessions, delivered by four lay adherence counsellors in the context of HIV care. Adaptation followed a theoretically driven approach to intervention adaptation, Assessment-Decision-Administration-Production-Topical Experts-Integration-Training-Testing (ADAPT-ITT), and included modifications to language, session length, tailoring content for delivery by lay counsellors and inclusion of culturally competent probes. The feasibility of the intervention was evaluated using a mixed-methods assessment, including ratings of provider fidelity of intervention delivery, and qualitative assessments of feasibility using individual semi-structured interviews with counsellors (n = 4) and patients (n = 15). The intervention was feasible and acceptable when administered to 42 patients and resulted in improved self-reported adherence in a subset of 15 patients who were followed up after 6 months. Next steps from this study include conducting a randomised control trial to evaluate the adapted intervention compared to standard of care in a larger sample over a long-term follow-up.

Depression, alcohol use disorders (AUD), and neuro-

Objectives: To assess the concurrent and the construct validity of the Euro-D in older Thai persons.

British Journal of Psychiatry, 2009

Context: Migration is feared to be associated with abandonment and depression in older parents "l... more Context: Migration is feared to be associated with abandonment and depression in older parents "left behind" in rural areas of low-and middle-income countries.

Health and Quality of Life Outcomes, 2009

Background There has been very little research on wellbeing, physical impairments and disability ... more Background There has been very little research on wellbeing, physical impairments and disability in older people in developing countries. Methods A community survey of 1147 older parents, one per household, aged sixty and over in rural Thailand. We used the Burvill scale of physical impairment, the Thai Psychological Wellbeing Scale and the brief WHO Disability Assessment Schedule. We rated received and perceived social support separately from children and from others and rated support to children. We used weighted analyses to take account of the sampling design. Results Impairments due to arthritis, pain, paralysis, vision, stomach problems or breathing were all associated with lower wellbeing. After adjusting for disability, only impairment due to paralysis was independently associated with lowered wellbeing. The effect of having two or more impairments compared to none was associated with lowered wellbeing after adjusting for demographic factors and social support (adjusted difference -2.37 on the well-being scale with SD = 7.9, p < 0.001) but after adjusting for disability the coefficient fell and was non-significant. The parsimonious model for wellbeing included age, wealth, social support, disability and impairment due to paralysis (the effect of paralysis was -2.97, p = 0.001). In this Thai setting, received support from children and from others and perceived good support from and to children were all independently associated with greater wellbeing whereas actual support to children was associated with lower wellbeing. Low received support from children interacted with paralysis in being especially associated with low wellbeing. Conclusion In this Thai setting, as found in western settings, most of the association between physical impairments and lower wellbeing is explained by disability. Disability is potentially mediating the association between impairment and low wellbeing. Received support may buffer the impact of some impairments on wellbeing in this setting. Giving actual support to children is associated with less wellbeing unless the support being given to children is perceived as good, perhaps reflecting parental obligation to support adult children in need. Improving community disability services for older people and optimizing received social support will be vital in rural areas in developing countries.

Aging & Mental Health, 2009

Objectives: To assess the concurrent and the construct validity of the Euro-D in older Thai perso... more Objectives: To assess the concurrent and the construct validity of the Euro-D in older Thai persons. Method: Eight local psychiatrists used the major depressive episode section of the Mini International Neuropsychiatric Interview to interview 150 consecutive psychiatric clinic attendees. A trained interviewer administered the Euro-D. We used receiver operating characteristic (ROC) analysis to assess the overall discriminability of the Euro-D scale and principal components factor analysis to assess its construct validity. Results: The area under the ROC curve for the Euro-D with respect to major depressive episode was 0.78 [95% confidence interval (CI) 0.70–0.90] indicating moderately good discriminability. At a cut-point of 5/6 the sensitivity for major depressive episodes is 84.3%, specificity 58.6%, and kappa 0.37 (95% CI 0.22–0.52) indicating fair concordance. However, at the 3/4 cut-point recommended from European studies there is high sensitivity (94%) but poor specificity (34%). The principal components analysis suggested four factors. The first two factors conformed to affective suffering (depression, suicidality and tearfulness) and motivation (interest, concentration and enjoyment). Sleep and appetite constituted a separate factor, whereas pessimism loaded on its own factor. Conclusion: Among Thai psychiatric clinic attendees Euro-D is moderately valid for major depression. A much higher cut-point may be required than that which is usually advocated. The Thai version also shares two common factors as reported from most of previous studies.

Harvard Review of Psychiatry, 2003

... From the Sections of Old Age (Dr. Abas) and Community Psychia-try (Dr. Broadhead), Institute ... more ... From the Sections of Old Age (Dr. Abas) and Community Psychia-try (Dr. Broadhead), Institute of Psychiatry, London; City of Harare Health Department (Dr. Mbengeranwa); and Departments of Ob-stetrics and Gynaecology (Dr. Mbengeranwa) and Psychiatry (Dr. Chagwedera ...

Psychiatric Services, 2008

Objective: This study examined the association between socioeconomic deprivation and extended hos... more Objective: This study examined the association between socioeconomic deprivation and extended hospitalization in severe mental disorder, after taking account of confounding variables. Methods: A representative sample of 660 inpatients from South Auckland, New Zealand, was followed for two years from their index admission. Additional data were collected during the index admission for a subsample of 291 patients. Results: Greater levels of socioeconomic deprivation in the inpatient's neighborhood of residence was associated with extended hospitalization after adjustment for demographic factors and primary diagnosis but not after adjustment for comorbid diagnosis, chronicity, function, and severity. Most extended hospitalizations were related to poor illness recovery. Conclusions: People from more deprived areas are likely to need longer psychiatric admissions, mostly because of the asso-M Me el la an ni ie e A Am mn na a A Ab ba as s, , M M. .D D. . J Ja an ne e V Va an nd de er rp py yl l, , P Ph h.

Australian and New Zealand Journal of Psychiatry, 2003

Objective: This study set out to investigate the relationship in New Zealand between the newly de... more Objective: This study set out to investigate the relationship in New Zealand between the newly developed small area index of socio-economic deprivation, NZDep96, and measures of psychiatric bed utilisation. It aims to contribute to the debate on resource allocation and to estimate the distribution of beds required in relation to levels of deprivation. Method: A cohort study of 872 persons admitted to the psychiatric in-patient unit within Counties Manukau, involving 1299 episodes of in-patient care between 1998 and 2000. The annual period prevalence of admission and the rate of total occupied bed days were calculated for the different deciles of deprivation, standardized for age and gender. Results: There was a three-fold gradient in admission prevalence and in total occupied bed days between persons living in the most and least deprived areas. Conclusions: Mental health services need to be organized and funded in ways that take account of the high use of in-patient care among those living in deprived areas. Further research is required to explore the relationship between socio-economic deprivation and use of community mental health services.

Social Psychiatry and Psychiatric Epidemiology, 2001

Background: This paper explores the applicability of a psychosocial model of depression in an A... more Background: This paper explores the applicability of a psychosocial model of depression in an African setting. Method: Of a random sample of women (n=172) from a Zimbabwean township, 79 had a severe life event in the year before interview. Twenty-nine who had an onset of depression were compared with 50 who did not. Results: Having crisis support following a severe life event reduced the risk of onset of depression. The effect of crisis support was confounded by the number of severe events in the study year, but just persisted following adjustment for number of severe events and for socio-demographic factors. Women received crisis support more often from relatives than from partners or friends. The following variables were independently associated with onset of depression following a severe life event: number of life events in the previous 6 months, age, being in formal employment, having crisis support and separation from mother in childhood. Conclusion: This study supports the ubiquity of the social support construct. For Zimbabwe, the data suggest that crisis support from family members may be of particular importance in protecting against onset of depression.

Psychological Medicine, 1997

 One hundred and seventy-two women randomly selected from a Zimbabwean township were inte... more  One hundred and seventy-two women randomly selected from a Zimbabwean township were interviewed with a Shona screen for mental disorders and a semi-structured interview to assess symptoms suggestive of emotional distress, followed by the Present State Examination. Using criteria slightly stricter than threshold level 5 of the PSE-CATEGO-ID system, 30n8% of women had a depressive or anxiety disorder during the previous year. Nearly all disorders met Bedford College criteria for depression ; 65 % of these also had anxiety features. Only 0n6% of women had a ' pure ' anxiety disorder not preceded by or associated with depression in the study year. Compared with London, the higher annual prevalence of disorders in Harare could mostly be accounted for by an excess of onset cases in the study year, 70 % of which made a full or partial recovery within 12 months. The women's own words for these episodes included ' thinking too much ', ' deep sadness ' and a variety of terms describing heart discomfort, interpretation showing many of the latter to be expressions for grief, fear, or the possession of an insoluble problem, and 73 % explained their symptoms as caused by a specific social stressor.

Australian and New Zealand Journal of Psychiatry, 2003

Objective: To describe reasons for admission and alternatives to admission in a government funded... more Objective: To describe reasons for admission and alternatives to admission in a government funded acute inpatient unit. Method: Reasons for admission and alternatives to admission were rated for a consecutive sample of 255 admissions to an acute psychiatric unit in Auckland, using interviews with staff and case note review. Result: Most patients had a functional psychosis and were admitted involuntarily. Forty percent came from areas of marked social deprivation. The major reasons for admission were for reinstatement of medication (mainly linked to non-concordance with prescribed medication), intensive observation, risk to self and risk to others. Only 12% of admissions could have been diverted, of whom most would have required daily home treatment. For those still admitted at 5 weeks, 26% could have been discharged, mainly to 24 h nurse-staffed accommodation. If the alternatives had all been available, simulated bed-day savings were 11 bed years per year. Simulated bed day savings were greater through implementing early discharge than by diverting new admissions. Conclusion: Greater availability of assertive community treatment and of interventions to improve medication concordance may have prevented a small number of admissions. For patients admitted longer than 5 weeks, it appeared that greater availability of 24 h nursestaffed accommodation would have allowed considerable bed-day savings.

British Journal of Psychiatry, 1994

Psychological Medicine, 1998

A previous paper reported that among 172 women randomly selected from a Zimbabwean township 30n8 ... more A previous paper reported that among 172 women randomly selected from a Zimbabwean township 30n8 % had a depressive or anxiety disorder during the previous year. Compared with London, the higher annual prevalence of disorders in Harare could mostly be accounted for by an excess of onset cases in the study year (annual incidence of depression 18 %). This paper reports on the role of life events and difficulties in the aetiology of depression among these women. Method. Randomly selected women (N l 172) from a township in Harare were interviewed with a Zimbabwean modification of the Bedford College Life Events and Difficulties Schedule (LEDS). Results. Events and difficulties proved critical in provoking the onset of depression in Harare. Far more events occurring in Harare were severe or disruptive. Furthermore, a proportion of the Harare severe events were more threatening than have been described in London. As in London, certain types of severe event were particularly depressogenic, i.e. those involving the woman's humiliation, her entrapment in an ongoing difficult situation, or bereavement. However, more severe events in Harare involved these specific dimensions. Conclusions. Results indicate a common mechanism for the development of depression, as defined by international criteria, between Zimbabwe and London. The high frequency of severe events, and their especially adverse qualities, offer an explanation for the high incidence of depression in Harare.