Effect of a Primary Care–Based Psychological Intervention on Symptoms of Common Mental Disorders in Zimbabwe A Randomized Clinical Trial (original) (raw)
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JAMA, 2016
Does a lay health worker-delivered psychological intervention improve symptoms of depression and anxiety in Zimbabwe? Findings: In a cluster-randomized clinical trial of 573 randomized patients with common mental disorders and symptoms of depression, the group who received the intervention had significantly lower symptom scores after 6 months compared to a control group who had enhanced usual care. Meaning: The use of lay health workers in resource-poor countries like Zimbabwe may be effective primary-care-based management of common mental disorders.
International Journal of Mental Health Systems, 2022
Background Lay Health Workers (LHW) are important providers of community mental health services and help mitigate access and treatment gaps in Africa. However, there is a paucity of knowledge about the role and performance of these workers, as well as about the extent to which the interventions delivered are culturally adapted to the African context. Aims This scoping review aimed to explore the content and aspects concerning the cultural adaptation and sustainability of psychological interventions delivered by LHW to people with mental disorders in Africa. Methods We conducted a scoping review of the peer-reviewed literature published from January 2000 to December 2018 to identify psychological interventions delivered by LHW for people with mental disorders in Africa. We systematically searched PubMed, Google scholar and Hinari to select relevant publications. The articles were evaluated for risk of bias according to study design with the National Heart, Lung, and Blood Institute’s...
2014
Background-Mental health problems are common in primary care with prevalence rates of up to 40% reported in developing countries. The detection of psychiatric morbidity by primary care practitioners varies with most studies reporting over 50% of patients with psychiatric morbidity being missed or misdiagnosed. The aim of this study was to evaluate, using a cluster-randomised controlled trial design, the impact of a specially designed toolkit, used to train primary care practitioners in mental health, on the rates of diagnosed cases of common mental disorders, malaria and non-specific musculoskeletal pains in one of the 28 districts of Malawi. Method-All 18 health clinics with outpatient services in the designated district were randomly divided into control and intervention arms. Using a two phase sampling process, baseline data on scores on the Self Reporting Questionnaire (SRQ), diagnoses made by primary care practitioners and results of the Semi structured Clinical Interview based on DSM IV (SCID) for depression, was collected on 837 adult consecutively attending patients in the pre-intervention study. The primary care practitioners in the intervention arm received training delivered through a specially designed toolkit whereas those in the control arm received routine training before collecting data on 2600 patients in the post intervention study. Results-The point prevalence rates for probable common mental disorder and depression were found to be 28•8% and 19% respectively. The rates of diagnosis of both anxiety and depression by primary care practitioners at baseline were 0% in both arms. A large proportion of patients who met the research criteria of depression at baseline were diagnosed with malaria (31•2%) and non-specific musculoskeletal pains (14•3%). Following training, there were significant differences between the two arms in the rates of diagnosed cases of depression (9•2% vs 0•5%; OR 32•1 (95% CI, 7•4, 144•3), p = < 0•001), anxiety (1•2% vs 0%; p = <0•001) and malaria (31% vs 40%; OR 0•62 (95% CI, 0•43, 0•89), p = 0•01) with the intervention arm having more cases diagnosed with depression and anxiety while the control arm had more cases diagnosed with malaria. The diagnostic sensitivity and specificity for depression were 60•24% and 82•02% respectively in the intervention arm and 3•19% and 66•67% in the control arm. Conclusion-Training of PHC workers in mental health with an appropriate toolkit will contribute significantly to the quality of detection and management of patients seen in primary care in developing countries and reduce wastage of resources which results from misdiagnosis.
Scaling up interventions for depression in sub-Saharan Africa: lessons from Zimbabwe
Global mental health, 2016
Background. There is a dearth of information on how to scale-up evidence-based psychological interventions, particularly within the context of existing HIV programs. This paper describes a strategy for the scale-up of an intervention delivered by lay health workers (LHWs) to 60 primary health care facilities in Zimbabwe. Methods. A mixed methods approach was utilized as follows: (1) needs assessment using a semi-structured questionnaire to obtain information from nurses (n = 48) and focus group discussions with District Health Promoters (n = 12) to identify key priority areas; (2) skills assessment to identify core competencies and current gaps of LHWs (n = 300) employed in the 60 clinics; (3) consultation workshops (n = 2) with key stakeholders to determine referral pathways; and (4) in-depth interviews and consultations to determine funding mechanisms for the scale-up. Results. Five cross-cutting issues were identified as critical and needing to be addressed for a successful scale-up. These included: the lack of training in mental health, unavailability of psychiatric drugs, depleted clinical staff levels, unavailability of time for counseling, and poor and unreliable referral systems for people suffering with depression. Consensus was reached by stakeholders on supervision and support structure to address the cross-cutting issues described above and funding was successfully secured for the scale-up. Conclusion. Key requirements for success included early buy-in from key stakeholders, extensive consultation at each point of the scale-up journey, financial support both locally and externally, and a coherent sustainability plan endorsed by both government and private sectors.
International Journal of Mental Health Systems, 2016
Background: There are few accounts of evidence-based interventions for depression and other common mental disorders (CMDs) in primary care in low-income countries. The Friendship Bench Project is a collaborative care mental health intervention in primary care in Harare for CMDs which began as a pilot in 2006. Case presentation: We employed a mixture of quantitative and qualitative approaches to investigate the project's acceptability and implementation, 4-8 years after the initial pilot study. We carried out basic descriptive analyses of routine data on attendance collected between 2010 and 2014. We also conducted five focus group discussions (FGDs) with LHWs in 2013 and 12 in-depth interviews, six with staff and six with patients, to explore experiences of the intervention, which we analysed using grounded theory. Results show that the intervention appears highly acceptable as evidenced by a consistent number of visits between 2010 and 2014 (mean 505 per year, SD 132); by the finding that the same team of female community LHWs employed as government health promoters continue to deliver assessment and problem-solving therapy, and the perceived positive benefits expressed by those interviewed. Clients described feeling 'relieved and relaxed' after therapy, and having their 'mind opened' , and LHWs describing satisfaction from being agents of change. Characteristics of the LHWs (status in the community, maturity, trustworthiness), and of the intervention (use of locally validated symptom screen, perceived relevance of problem-solving therapy) and continuity of the LHW team appeared crucial. Challenges to implementation included the LHWs ongoing need for weekly supervision despite years of experience; the supervisors need for supervision for herself; training needs in managing suicidal and hostile clients; poor documentation; lack of follow-up of depressed clients; and poor access to antidepressants. Conclusions: This case study shows that a collaborative care intervention for CMDs is positively received by patients, rewarding for LHWs to deliver, and can be sustained over time at low cost. Next steps include evaluation of the impact of the intervention through a randomised trial, and testing of a technological platform for supporting supervision and monitoring clients' attendance.
Community Perceptions of Indigenous Healers and Mental Disorders in Zimbabwe
Open Journal of Psychiatry
The World Health Organisation has made recommendations for partnerships between indigenous healing (IH) and biomedical therapy (BT) in the delivery of health services as a way of creating cultural sensitivity in mental health care (Bank, 2001). Yet, literature on prevalence, distribution, burden, and unmet needs for treatment of the mental disorders often exclude the role played by indigenous healing practitioners (IHPs). This study aimed to analyze mental health care from the perspective of communities on mental health care by IHPs to reveal their possible role in the surveillance studies of mental disorders in a settlement northeast of Harare in Zimbabwe through an exploratory qualitative methodology. Thirty in-depth interviews and three focus group discussions with key-informants were conducted to gather community perceptions of the nature of mental disorders treated by IHPs in Zimbabwe. Gathered data were coded using Constant Comparison Method with multiple members of the research team, enhancing validity and reliability. The results of the study reveal that while some patients presented with some mental disorders that were consistent with the BT diagnoses such as schizophrenia (Chirwere chepfungwa), depression (Kufungisisa), anxiety (Buka), post-traumatic stress disorder (Kurotomoka) somatisation (shungu), etc., other patients reported the disorders that were not recognised from a biomedical point of view such as the supernatural, cultural or social problems in IH. The findings were similar to the results of the first 17 world mental health surveys which show that the mental disorders are commonly occurring in all participating countries. This implied that the IHPs were treating common mental disorders reported in the low-income countries. More importantly, the IHPs treated a unique category which affected the majority of Zimbabwean patients. This study highlights the importance of the IHPs as complementary to
Outcome of common mental disorders in Harare, Zimbabwe
The British Journal of Psychiatry, 1998
Background Little is known about the outcome of common mental disorders (CMD) in primary care attenders in low income countries. Method Two 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. Results The 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. Conclusions A quarter of cases of CMD were likely t...
Mental Health Services in Zimbabwe – a case of Zimbabwe National Association of Mental Health
World Federation of Occupational Therapists Bulletin, 2014
With limited resources available for healthcare in Zimbabwe, occupational therapists and mental health personnel work to provide a much needed community oriented mental health service. Community facilities and multidisciplinary mental health teams offered by the Zimbabwe National Association of Mental Health (ZIMNAMH) attempt to address the ongoing needs of the population to deal with deinstitutionalization, congestion of the health institutions and prisons, occupational alienation and deprivation, community integration and empowerment of people with mental health problems. This case study presents a story of a client who successful reintegrated through a community-based halfway house into the rural community in which the ZIMNAMH model takes advantage of the rich family support systems in the rural community. The role of the occupational therapists is elaborated.