Effect of a Primary Care–Based Psychological Intervention on Symptoms of Common Mental Disorders in Zimbabwe (original) (raw)
Related papers
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, 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...
BMC Public Health, 2018
Background: Suicidal ideation may lead to deliberate self-harm which increases the risk of death by suicide. Globally, the main cause of deliberate self-harm is depression. The aim of this study was to explore prevalence of, and risk factors for, suicidal ideation among men and women with common mental disorder (CMD) symptoms attending public clinics in Zimbabwe, and to determine whether problem solving therapy delivered by lay health workers can reduce common mental disorder symptoms among people with suicidal ideation, using secondary analysis of a randomised controlled trial. Methods: At trial enrolment, the Shona Symptom Questionnaire (SSQ) was used to screen for CMD symptoms. In the intervention arm, participants received six problem-solving therapy sessions conducted by trained and supervised lay health workers, while those in the control arm received enhanced usual care. We used multivariate logistic regression to identify risk factors for suicidal ideation at enrolment, and cluster-level logistic regression to compare SSQ scores at endline (6 months follow-up) between trial arms, stratified by suicidal ideation at enrolment. Results: There were 573 participants who screened positive for CMD symptoms and 75 (13.1%) reported suicidal ideation at baseline. At baseline, after adjusting for confounders, suicidal ideation was independently associated with being aged over 24, lack of household income (household income yes/no; adjusted odds ratio 0.52 (95% CI 0.29, 0.95); p = 0.03) and with having recently skipped a meal due to lack of food (adjusted odds ratio 3.06 (95% CI 1.81, 5.18); p < 0.001). Participants who reported suicidal ideation at enrolment experienced similar benefit to CMD symptoms from the Friendship Bench intervention (adjusted mean difference − 5.38, 95% CI −7.85, − 2.90; p < 0.001) compared to those who had common mental disorder symptoms but no suicidal ideation (adjusted mean difference − 4.86, 95% CI −5.68, − 4.04; p < 0.001). Conclusions: Problem-solving therapy delivered by trained and supervised lay health workers reduced common mental disorder symptoms among participants with suicidal thoughts who attended primary care facilities in Zimbabwe.
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.
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.
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...