2019
|
Lund, Crick; Schneider, Marguerite; Garman, Emily C; Davies, Thandi; Munodawafa, Memory; Honikman, Simone; Bhana, Arvin; Bass, Judith; Bolton, Paul; Dewey, Michael; Joska, John; Kagee, Ashraf; Myer, Landon; Petersen, Inge; Prince, Martin; Stein, Dan J; Tabana, Hanani; Thornicroft, Graham; Tomlinson, Mark; Hanlon, Charlotte; Alem, Atalay; Susser, Ezra Task-sharing of psychological treatment for antenatal depression in Khayelitsha, South Africa: Effects on antenatal and postnatal outcomes in an individual randomised controlled trial Journal Article Behaviour Research and Therapy, (September), 2019, ISSN: 1873622X. Abstract | Links | BibTeX @article{Lund2019,
title = {Task-sharing of psychological treatment for antenatal depression in Khayelitsha, South Africa: Effects on antenatal and postnatal outcomes in an individual randomised controlled trial},
author = {Crick Lund and Marguerite Schneider and Emily C Garman and Thandi Davies and Memory Munodawafa and Simone Honikman and Arvin Bhana and Judith Bass and Paul Bolton and Michael Dewey and John Joska and Ashraf Kagee and Landon Myer and Inge Petersen and Martin Prince and Dan J Stein and Hanani Tabana and Graham Thornicroft and Mark Tomlinson and Charlotte Hanlon and Atalay Alem and Ezra Susser},
doi = {10.1016/j.brat.2019.103466},
issn = {1873622X},
year = {2019},
date = {2019-01-01},
journal = {Behaviour Research and Therapy},
number = {September},
publisher = {Elsevier},
abstract = {The study's objective was to determine the effectiveness of a task-sharing psychological treatment for perinatal depression using non-specialist community health workers. A double-blind individual randomised controlled trial was conducted in two antenatal clinics in the peri-urban settlement of Khayelitsha, Cape Town. Adult pregnant women who scored 13 or above on the Edinburgh Postnatal Depression rating Scale (EPDS) were randomised into the intervention arm (structured six-session psychological treatment) or the control arm (routine antenatal health care and three monthly phone calls). The primary outcome was response on the Hamilton Depression Rating Scale (HDRS) at three months postpartum (minimum 40% score reduction from baseline) among participants who did not experience pregnancy or infant loss (modified intention-to-treat population) (registered on Clinical Trials: NCT01977326). Of 2187 eligible women approached, 425 (19.4%) screened positive on the EPDS and were randomised; 384 were included in the modified intention-to-treat analysis (control: n = 200; intervention: n = 184). There were no significant differences in response on the HDRS at three months postpartum between the intervention and control arm. A task-sharing psychological treatment was not effective in treating depression among women living in Khayelitsha, South Africa. The findings give cause for reflection on the strategy of task-sharing in low-resource settings.},
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The study's objective was to determine the effectiveness of a task-sharing psychological treatment for perinatal depression using non-specialist community health workers. A double-blind individual randomised controlled trial was conducted in two antenatal clinics in the peri-urban settlement of Khayelitsha, Cape Town. Adult pregnant women who scored 13 or above on the Edinburgh Postnatal Depression rating Scale (EPDS) were randomised into the intervention arm (structured six-session psychological treatment) or the control arm (routine antenatal health care and three monthly phone calls). The primary outcome was response on the Hamilton Depression Rating Scale (HDRS) at three months postpartum (minimum 40% score reduction from baseline) among participants who did not experience pregnancy or infant loss (modified intention-to-treat population) (registered on Clinical Trials: NCT01977326). Of 2187 eligible women approached, 425 (19.4%) screened positive on the EPDS and were randomised; 384 were included in the modified intention-to-treat analysis (control: n = 200; intervention: n = 184). There were no significant differences in response on the HDRS at three months postpartum between the intervention and control arm. A task-sharing psychological treatment was not effective in treating depression among women living in Khayelitsha, South Africa. The findings give cause for reflection on the strategy of task-sharing in low-resource settings. |
Davies, Thandi; Garman, Emily C; Lund, Crick; Schneider, Marguerite Adaptation and validation of a structured version of the Hamilton Depression Rating Scale for use by non-clinicians in South Africa (AFFIRM-HDRS) Journal Article Journal of Evaluation in Clinical Practice, (November), pp. 1–11, 2019, ISSN: 13652753. Abstract | Links | BibTeX @article{Davies2019,
title = {Adaptation and validation of a structured version of the Hamilton Depression Rating Scale for use by non-clinicians in South Africa (AFFIRM-HDRS)},
author = {Thandi Davies and Emily C Garman and Crick Lund and Marguerite Schneider},
doi = {10.1111/jep.13327},
issn = {13652753},
year = {2019},
date = {2019-01-01},
journal = {Journal of Evaluation in Clinical Practice},
number = {November},
pages = {1--11},
abstract = {Rationale, aims and objectives: The Hamilton depression rating scale (HDRS) is seen as an international gold standard for the measurement of depression. High rates of untreated depression, including perinatal depression, support the rationale to adapt and validate a structured version of the HDRS to be used by non-clinicians in low-income settings. Methods: Using previous structured versions of the HDRS as a foundation, the tool was adapted, translated, and then validated with an isiXhosa speaking perinatal population in South Africa (n = 187), using cognitive testing, test-retest reliability, and inter-rater assessments. The AFFIRM-HDRS was compared with the Edinburgh postnatal depression scale (EPDS) using the non-parametric Spearman Rho test to assess concurrent validity. Internal consistency was examined using Cronbach's Alpha, and inter-rater and test-retest reliability were assessed with the intra-class coefficient (ICC). Cohen's Kappa was used to assess the overall percentage agreement for each individual item of the AFFIRM-HDRS. Results: The AFFIRM-HDRS showed good construct and content validity had significant associations with the EPDS (Rho = 0.60 and 0.43, P textless.001), and acceptable internal consistency (Cronbach's alpha = 0.74.). Inter-rater reliability and test-retest scores were excellent, with intraclass correlations ranging from 0.97 (0.94-0.99) to 0.98 (0.97-0.99) between raters, and test-retest reliability being 0.90 (95% CI: 0.86-0.93). The tool performed similarly to previous structured versions. Individual item-rest correlations suggest that the items “Weight loss or gain,” “Insight,” and “Libido” did not fit well with the overall instrument, but that the rest of the items performed well. Conclusion: The AFFIRM-HDRS is adequately structured to be used by non-clinicians in an isiXhosa speaking perinatal population. It is hoped that this structured tool can be used to assist with identification and referral of these at-risk populations by non-clinicians in resource-constrained environments, thereby playing a role in addressing the treatment gap for perinatal depression in LMICs.},
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pubstate = {published},
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Rationale, aims and objectives: The Hamilton depression rating scale (HDRS) is seen as an international gold standard for the measurement of depression. High rates of untreated depression, including perinatal depression, support the rationale to adapt and validate a structured version of the HDRS to be used by non-clinicians in low-income settings. Methods: Using previous structured versions of the HDRS as a foundation, the tool was adapted, translated, and then validated with an isiXhosa speaking perinatal population in South Africa (n = 187), using cognitive testing, test-retest reliability, and inter-rater assessments. The AFFIRM-HDRS was compared with the Edinburgh postnatal depression scale (EPDS) using the non-parametric Spearman Rho test to assess concurrent validity. Internal consistency was examined using Cronbach's Alpha, and inter-rater and test-retest reliability were assessed with the intra-class coefficient (ICC). Cohen's Kappa was used to assess the overall percentage agreement for each individual item of the AFFIRM-HDRS. Results: The AFFIRM-HDRS showed good construct and content validity had significant associations with the EPDS (Rho = 0.60 and 0.43, P textless.001), and acceptable internal consistency (Cronbach's alpha = 0.74.). Inter-rater reliability and test-retest scores were excellent, with intraclass correlations ranging from 0.97 (0.94-0.99) to 0.98 (0.97-0.99) between raters, and test-retest reliability being 0.90 (95% CI: 0.86-0.93). The tool performed similarly to previous structured versions. Individual item-rest correlations suggest that the items “Weight loss or gain,” “Insight,” and “Libido” did not fit well with the overall instrument, but that the rest of the items performed well. Conclusion: The AFFIRM-HDRS is adequately structured to be used by non-clinicians in an isiXhosa speaking perinatal population. It is hoped that this structured tool can be used to assist with identification and referral of these at-risk populations by non-clinicians in resource-constrained environments, thereby playing a role in addressing the treatment gap for perinatal depression in LMICs. |
Garman, Emily C; Schneider, Marguerite; Lund, Crick Perinatal depressive symptoms among low-income South African women at risk of depression: Trajectories and predictors Journal Article BMC Pregnancy and Childbirth, 19 (1), pp. 1–11, 2019, ISSN: 14712393. Abstract | Links | BibTeX @article{Garman2019,
title = {Perinatal depressive symptoms among low-income South African women at risk of depression: Trajectories and predictors},
author = {Emily C Garman and Marguerite Schneider and Crick Lund},
doi = {10.1186/s12884-019-2355-y},
issn = {14712393},
year = {2019},
date = {2019-01-01},
journal = {BMC Pregnancy and Childbirth},
volume = {19},
number = {1},
pages = {1--11},
publisher = {BMC Pregnancy and Childbirth},
abstract = {Background: The aim of the study was to identify trajectories of perinatal depressive symptoms and their predictors among women living in a low-resource setting in South Africa, and who present with a risk of depression during pregnancy. Methods: This is a secondary analysis of a randomised controlled trial among 384 women living in Khayelitsha, a low income setting in South Africa, recruited at their first antenatal visit if they scored 13 or above on the Edinburgh Postnatal Depression Scale, were at least 18 years of age, less than 29 weeks pregnant and spoke isiXhosa. Participants were followed up at 8 months gestation, 3 and 12 months postpartum. Latent trajectories of depressive symptoms were identified using growth mixture modelling, based on the Hamilton Depression Rating Scale (HDRS). There were no differences in HDRS scores between the control and intervention arms, so all participants were assessed together. Health, social and economic predictors of trajectories were investigated to identify high-risk groups with greater or more chronic depressive symptoms, using univariate logistic regression. Results: Two trajectories were identified: antenatal only (91.4%), with moderate to severe symptoms at baseline which later subside; and antenatal and postnatal (8.6%), with severe depressive symptoms during pregnancy and later in the postpartum period, which subside temporarily to moderate levels at 3 months postpartum. Predictors for the antenatal and postnatal trajectory include severe food insecurity, intimate partner violence, lower social support, greater functional impairment, problematic drinking and suicide risk. Conclusions: A small proportion of women who are at risk for depression antenatally remain at risk throughout the perinatal period, and can be differentiated from those who show a natural remission. Identification and referral strategies should be developed with these findings in mind, especially given the limited mental health resources in low-income settings.},
keywords = {},
pubstate = {published},
tppubtype = {article}
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Background: The aim of the study was to identify trajectories of perinatal depressive symptoms and their predictors among women living in a low-resource setting in South Africa, and who present with a risk of depression during pregnancy. Methods: This is a secondary analysis of a randomised controlled trial among 384 women living in Khayelitsha, a low income setting in South Africa, recruited at their first antenatal visit if they scored 13 or above on the Edinburgh Postnatal Depression Scale, were at least 18 years of age, less than 29 weeks pregnant and spoke isiXhosa. Participants were followed up at 8 months gestation, 3 and 12 months postpartum. Latent trajectories of depressive symptoms were identified using growth mixture modelling, based on the Hamilton Depression Rating Scale (HDRS). There were no differences in HDRS scores between the control and intervention arms, so all participants were assessed together. Health, social and economic predictors of trajectories were investigated to identify high-risk groups with greater or more chronic depressive symptoms, using univariate logistic regression. Results: Two trajectories were identified: antenatal only (91.4%), with moderate to severe symptoms at baseline which later subside; and antenatal and postnatal (8.6%), with severe depressive symptoms during pregnancy and later in the postpartum period, which subside temporarily to moderate levels at 3 months postpartum. Predictors for the antenatal and postnatal trajectory include severe food insecurity, intimate partner violence, lower social support, greater functional impairment, problematic drinking and suicide risk. Conclusions: A small proportion of women who are at risk for depression antenatally remain at risk throughout the perinatal period, and can be differentiated from those who show a natural remission. Identification and referral strategies should be developed with these findings in mind, especially given the limited mental health resources in low-income settings. |
Garman, Emily C; Cois, Annibale; Schneider, Marguerite; Lund, Crick Association between perinatal depressive symptoms and suicidal risk among low-income South African women: a longitudinal study Journal Article Social Psychiatry and Psychiatric Epidemiology, 54 (10), pp. 1219–1230, 2019, ISSN: 14339285. Abstract | Links | BibTeX @article{Garman2019a,
title = {Association between perinatal depressive symptoms and suicidal risk among low-income South African women: a longitudinal study},
author = {Emily C Garman and Annibale Cois and Marguerite Schneider and Crick Lund},
url = {https://doi.org/10.1007/s00127-019-01730-w},
doi = {10.1007/s00127-019-01730-w},
issn = {14339285},
year = {2019},
date = {2019-01-01},
journal = {Social Psychiatry and Psychiatric Epidemiology},
volume = {54},
number = {10},
pages = {1219--1230},
publisher = {Springer Berlin Heidelberg},
abstract = {Purpose: The aim of this study was to assess the association between depressive symptoms and suicidal risk over time among perinatal women at risk for depression antenatally, and assess modifying effects of age, perinatal stage and depressive symptom trajectory. Methods: A total of 384 adult pregnant women were recruited from two antenatal clinics in an informal settlement near Cape Town, South Africa, and followed up at eight months gestation, and at 3- and 12-month postpartum. The MINI 6.0 Suicidality module and the Hamilton Depression Rating Scale (HDRS) were used to measure suicidal risk and depression, respectively. Generalised Estimating Equations were used to assess the association between change in depressive symptoms from one assessment to the next (predictor) and change in suicide score or change in suicidal risk (score ≥ 9) (outcomes). Results: HDRS scores were positively correlated with suicide score (95% CI 0.35, 0.78; p textless 0.001), and with odds of being at moderate risk for suicide, after controlling for risk of suicide at the previous assessment (adjusted odds ratio = 1.15; 95% CI 1.09, 1.22; p textless 0.001). Age was a significant effect modifier: change in HDRS scores was not associated with change in suicide scores among participants aged 35–45 years. Secondary analyses indicated that a decrease in HDRS score was associated with a decrease in suicide scores, but an increase in HDRS score was not associated with change in suicide score. Conclusions: Depression and suicide are overlapping but relatively independent phenomena, especially among older or more chronically depressed perinatal women.},
keywords = {},
pubstate = {published},
tppubtype = {article}
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Purpose: The aim of this study was to assess the association between depressive symptoms and suicidal risk over time among perinatal women at risk for depression antenatally, and assess modifying effects of age, perinatal stage and depressive symptom trajectory. Methods: A total of 384 adult pregnant women were recruited from two antenatal clinics in an informal settlement near Cape Town, South Africa, and followed up at eight months gestation, and at 3- and 12-month postpartum. The MINI 6.0 Suicidality module and the Hamilton Depression Rating Scale (HDRS) were used to measure suicidal risk and depression, respectively. Generalised Estimating Equations were used to assess the association between change in depressive symptoms from one assessment to the next (predictor) and change in suicide score or change in suicidal risk (score ≥ 9) (outcomes). Results: HDRS scores were positively correlated with suicide score (95% CI 0.35, 0.78; p textless 0.001), and with odds of being at moderate risk for suicide, after controlling for risk of suicide at the previous assessment (adjusted odds ratio = 1.15; 95% CI 1.09, 1.22; p textless 0.001). Age was a significant effect modifier: change in HDRS scores was not associated with change in suicide scores among participants aged 35–45 years. Secondary analyses indicated that a decrease in HDRS score was associated with a decrease in suicide scores, but an increase in HDRS score was not associated with change in suicide score. Conclusions: Depression and suicide are overlapping but relatively independent phenomena, especially among older or more chronically depressed perinatal women. |
Da Silva, Andrea Tenório Correia ; Hanlon, Charlotte; Susser, Ezra; Rojas, Graciela; Claro, Heloísa Garcia; Quayle, Julieta; Habtamu, Kassahun; Burrone, María Soledad; Cavalcanti, Maria Tavares; Sharma, Mona; Schneider, Marguerite; Adhikari, Ramesh Prasad; Van De Water, Tanya ; Mohammed, Yasmin; ñ, Anna Ordó E; Seedat, Soraya Enhancing mental health research capacity: Emerging voices from the National Institute of Mental Health (NIMH) global hubs Journal Article International Journal of Mental Health Systems, 13 (1), pp. 1–9, 2019, ISSN: 17524458. Abstract | Links | BibTeX @article{DaSilva2019,
title = {Enhancing mental health research capacity: Emerging voices from the National Institute of Mental Health (NIMH) global hubs},
author = {Andrea Tenório Correia {Da Silva} and Charlotte Hanlon and Ezra Susser and Graciela Rojas and Heloísa Garcia Claro and Julieta Quayle and Kassahun Habtamu and María Soledad Burrone and Maria Tavares Cavalcanti and Mona Sharma and Marguerite Schneider and Ramesh Prasad Adhikari and Tanya {Van De Water} and Yasmin Mohammed and Anna E Ordó{ñ}ez and Soraya Seedat},
url = {https://doi.org/10.1186/s13033-019-0276-9},
doi = {10.1186/s13033-019-0276-9},
issn = {17524458},
year = {2019},
date = {2019-01-01},
journal = {International Journal of Mental Health Systems},
volume = {13},
number = {1},
pages = {1--9},
publisher = {BioMed Central},
abstract = {Background: Emerging researchers in low- and middle-income countries (LMIC) face many barriers, including inadequacies in funding, international exposure and mentorship. In 2012, the National Institute of Mental Health (NIMH) funded five research hubs aimed at improving the research core for evidence-based mental health interventions, enhancing research skills in global mental health, and providing capacity building (CB) opportunities for early career investigators in LMIC. In this paper emerging researchers contextualize their experiences. Case presentation: Each of the five hubs purposively selected an emerging researcher who had experienced more than one hub-related CB opportunity and actively participated in hub-related clinical trial activities. The five 'voices' were invited to contribute narratives on their professional backgrounds, CB experience, challenges and successes as an emerging mental health researcher, and suggestions for future CB activities. These narratives are presented as case studies. CB activities provided broader learning opportunities for emerging researchers. Benefits included the receipt of research funding, hands-on training and mentorship, as well as exposure to networks and collaborative opportunities on a global scale. To overcome ongoing challenges of access to funding, mentoring, networking and global exposure, the emerging voices recommend making mentorship and training opportunities available to a wider range of emerging mental health researchers. Conclusions: Investing in CB is not enough to ensure sustainability and leave a legacy unless it is accompanied by ongoing mentorship and international exposure. Financial investment in building research capacity, promotion of mentorship and supervision, and international networking are essential to yield well-prepared young investigators in LMIC as experienced by these rising stars. Governments and policymakers should prioritize educational policies to support the continuous development and international engagement of emerging researchers. This can advance strategies to deal with one of most important and costly problems faced by healthcare systems in LMIC: the mental health treatment gap.},
keywords = {},
pubstate = {published},
tppubtype = {article}
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Background: Emerging researchers in low- and middle-income countries (LMIC) face many barriers, including inadequacies in funding, international exposure and mentorship. In 2012, the National Institute of Mental Health (NIMH) funded five research hubs aimed at improving the research core for evidence-based mental health interventions, enhancing research skills in global mental health, and providing capacity building (CB) opportunities for early career investigators in LMIC. In this paper emerging researchers contextualize their experiences. Case presentation: Each of the five hubs purposively selected an emerging researcher who had experienced more than one hub-related CB opportunity and actively participated in hub-related clinical trial activities. The five 'voices' were invited to contribute narratives on their professional backgrounds, CB experience, challenges and successes as an emerging mental health researcher, and suggestions for future CB activities. These narratives are presented as case studies. CB activities provided broader learning opportunities for emerging researchers. Benefits included the receipt of research funding, hands-on training and mentorship, as well as exposure to networks and collaborative opportunities on a global scale. To overcome ongoing challenges of access to funding, mentoring, networking and global exposure, the emerging voices recommend making mentorship and training opportunities available to a wider range of emerging mental health researchers. Conclusions: Investing in CB is not enough to ensure sustainability and leave a legacy unless it is accompanied by ongoing mentorship and international exposure. Financial investment in building research capacity, promotion of mentorship and supervision, and international networking are essential to yield well-prepared young investigators in LMIC as experienced by these rising stars. Governments and policymakers should prioritize educational policies to support the continuous development and international engagement of emerging researchers. This can advance strategies to deal with one of most important and costly problems faced by healthcare systems in LMIC: the mental health treatment gap. |
2018
|
Schneider, M; Baron, E; Davies, T; Munodawafa, M; Lund, C Patterns of intimate partner violence among perinatal women with depression symptoms in Khayelitsha, South Africa: a longitudinal analysis Journal Article Global Mental Health, 5 , 2018, ISSN: 2054-4251. Abstract | Links | BibTeX @article{Schneider2018,
title = {Patterns of intimate partner violence among perinatal women with depression symptoms in Khayelitsha, South Africa: a longitudinal analysis},
author = {M Schneider and E Baron and T Davies and M Munodawafa and C Lund},
doi = {10.1017/gmh.2018.1},
issn = {2054-4251},
year = {2018},
date = {2018-01-01},
journal = {Global Mental Health},
volume = {5},
abstract = {textlessdiv class="abstract" data-abstract-type="normal"textgreatertextlessdiv class='sec'textgreatertextlessspan class="bold"textgreaterBackground.textless/spantextgreatertextlessptextgreaterA combination of intimate partner violence (IPV) and depression is a common feature of the perinatal period globally. Understanding this association can provide indications of how IPV can be addressed or prevented during pregnancy. This paper aims to determine the prevalence and correlates of IPV among pregnant low-income women with depressive symptoms in Khayelitsha, South Africa, and changes in IPV reports during the course of the perinatal period.textless/ptextgreatertextless/divtextgreatertextlessdiv class='sec'textgreatertextlessspan class="bold"textgreaterMethods.textless/spantextgreatertextlessptextgreaterThis study is a secondary analysis of data collected as part of a randomised controlled trial testing a psychosocial intervention for antenatal depression. IPV, socio-demographic measures, depression and other mental health measures were collected at recruitment (first antenatal visit), 8 months gestation, and 3 and 12 months postpartum. IPV was defined as a sexual or physical violence perpetrated by the participant's partner in the past 3 months. Descriptive statistics are reported.textless/ptextgreatertextless/divtextgreatertextlessdiv class='sec'textgreatertextlessspan class="bold"textgreaterResults.textless/spantextgreatertextlessptextgreaterOf 425 recruited depressed participants, 59 (13.9%) reported IPV at baseline, with physical IPV being the most frequently reported (69.5%). Reported IPV was associated with greater emotional distress, potentially higher food insecurity and higher rates of alcohol abuse. There were clear longitudinal trends in reported IPV with the majority of women no longer reporting IPV postpartum. However, some women reported IPV at later assessment points after not reporting IPV at baseline.textless/ptextgreatertextless/divtextgreatertextlessdiv class='sec'textgreatertextlessspan class="bold"textgreaterConclusions.textless/spantextgreatertextlessptextgreaterThere is a strong association between IPV and depression in pregnancy. IPV reports remit over time for the women in this study, although the reason for this reduction is not clear and requires further investigation.textless/ptextgreatertextless/divtextgreatertextless/divtextgreater},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
textlessdiv class="abstract" data-abstract-type="normal"textgreatertextlessdiv class='sec'textgreatertextlessspan class="bold"textgreaterBackground.textless/spantextgreatertextlessptextgreaterA combination of intimate partner violence (IPV) and depression is a common feature of the perinatal period globally. Understanding this association can provide indications of how IPV can be addressed or prevented during pregnancy. This paper aims to determine the prevalence and correlates of IPV among pregnant low-income women with depressive symptoms in Khayelitsha, South Africa, and changes in IPV reports during the course of the perinatal period.textless/ptextgreatertextless/divtextgreatertextlessdiv class='sec'textgreatertextlessspan class="bold"textgreaterMethods.textless/spantextgreatertextlessptextgreaterThis study is a secondary analysis of data collected as part of a randomised controlled trial testing a psychosocial intervention for antenatal depression. IPV, socio-demographic measures, depression and other mental health measures were collected at recruitment (first antenatal visit), 8 months gestation, and 3 and 12 months postpartum. IPV was defined as a sexual or physical violence perpetrated by the participant's partner in the past 3 months. Descriptive statistics are reported.textless/ptextgreatertextless/divtextgreatertextlessdiv class='sec'textgreatertextlessspan class="bold"textgreaterResults.textless/spantextgreatertextlessptextgreaterOf 425 recruited depressed participants, 59 (13.9%) reported IPV at baseline, with physical IPV being the most frequently reported (69.5%). Reported IPV was associated with greater emotional distress, potentially higher food insecurity and higher rates of alcohol abuse. There were clear longitudinal trends in reported IPV with the majority of women no longer reporting IPV postpartum. However, some women reported IPV at later assessment points after not reporting IPV at baseline.textless/ptextgreatertextless/divtextgreatertextlessdiv class='sec'textgreatertextlessspan class="bold"textgreaterConclusions.textless/spantextgreatertextlessptextgreaterThere is a strong association between IPV and depression in pregnancy. IPV reports remit over time for the women in this study, although the reason for this reduction is not clear and requires further investigation.textless/ptextgreatertextless/divtextgreatertextless/divtextgreater |
Kpobi, Lily; Swartz, Leslie; Ofori-Atta, Angela L Challenges in the use of the mental health information system in a resource-limited setting: Lessons from Ghana Journal Article BMC Health Services Research, 18 (1), pp. 1–8, 2018, ISSN: 14726963. Abstract | Links | BibTeX @article{Kpobi2018,
title = {Challenges in the use of the mental health information system in a resource-limited setting: Lessons from Ghana},
author = {Lily Kpobi and Leslie Swartz and Angela L Ofori-Atta},
doi = {10.1186/s12913-018-2887-2},
issn = {14726963},
year = {2018},
date = {2018-01-01},
journal = {BMC Health Services Research},
volume = {18},
number = {1},
pages = {1--8},
publisher = {BMC Health Services Research},
abstract = {Background: One of the most successful modes of record-keeping and data collection is the use of health management information systems, where patient information and management plans are uniformly entered into a database to streamline the information and for ease of further patient management. For mental healthcare, a Mental Health Information System (MHIS) has been found most successful since a properly established and operational MHIS is helpful for developing equitable and appropriate mental health care systems. Until 2010, the system of keeping patient records and information in the Accra Psychiatric Hospital of Ghana was old and outdated. In light of this and other factors, a complete reforming of the mental health information systems in three psychiatric hospitals in Ghana was undertaken in 2010. Four years after its implementation, we explored user experiences with the new system, and report here the challenges that were identified with use of the new MHIS. Methods: Individual semi-structured interviews were conducted with nine clinical and administrative staff of the Accra Psychiatric Hospital to examine their experiences with the new MHIS. Participants in the study were in three categories: clinical staff, administrator, and records clerk. Participants' knowledge of the system and its use, as well as the challenges they had experienced in its use were explored using an interpretative phenomenological approach. Results: The data suggest that optimal use of the current MHIS had faced significant implementation challenges in a number of areas. Central challenges reported by users included increased workload, poor staff involvement and training, and absence of logistic support to keep the system running. Conclusions: Setting up a new system does not guarantee its success. As important as it is to have a mental health information system, its usefulness is largely dependent on proper implementation and maintenance. Further, the system can facilitate policy transformation only when the place of mental health in district, regional and national health discourse improves.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: One of the most successful modes of record-keeping and data collection is the use of health management information systems, where patient information and management plans are uniformly entered into a database to streamline the information and for ease of further patient management. For mental healthcare, a Mental Health Information System (MHIS) has been found most successful since a properly established and operational MHIS is helpful for developing equitable and appropriate mental health care systems. Until 2010, the system of keeping patient records and information in the Accra Psychiatric Hospital of Ghana was old and outdated. In light of this and other factors, a complete reforming of the mental health information systems in three psychiatric hospitals in Ghana was undertaken in 2010. Four years after its implementation, we explored user experiences with the new system, and report here the challenges that were identified with use of the new MHIS. Methods: Individual semi-structured interviews were conducted with nine clinical and administrative staff of the Accra Psychiatric Hospital to examine their experiences with the new MHIS. Participants in the study were in three categories: clinical staff, administrator, and records clerk. Participants' knowledge of the system and its use, as well as the challenges they had experienced in its use were explored using an interpretative phenomenological approach. Results: The data suggest that optimal use of the current MHIS had faced significant implementation challenges in a number of areas. Central challenges reported by users included increased workload, poor staff involvement and training, and absence of logistic support to keep the system running. Conclusions: Setting up a new system does not guarantee its success. As important as it is to have a mental health information system, its usefulness is largely dependent on proper implementation and maintenance. Further, the system can facilitate policy transformation only when the place of mental health in district, regional and national health discourse improves. |
Habtamu, Kassahun; Alem, Atalay; Medhin, Girmay; Fekadu, Abebaw; Hanlon, Charlotte Functional impairment among people with severe and enduring mental disorder in rural Ethiopia: a cross-sectional study Journal Article Social Psychiatry and Psychiatric Epidemiology, 53 (8), pp. 803–814, 2018, ISSN: 09337954. Abstract | Links | BibTeX @article{Habtamu2018,
title = {Functional impairment among people with severe and enduring mental disorder in rural Ethiopia: a cross-sectional study},
author = {Kassahun Habtamu and Atalay Alem and Girmay Medhin and Abebaw Fekadu and Charlotte Hanlon},
url = {http://dx.doi.org/10.1007/s00127-018-1546-6},
doi = {10.1007/s00127-018-1546-6},
issn = {09337954},
year = {2018},
date = {2018-01-01},
journal = {Social Psychiatry and Psychiatric Epidemiology},
volume = {53},
number = {8},
pages = {803--814},
publisher = {Springer Berlin Heidelberg},
abstract = {Purpose: Evidence regarding functional impairment in people with severe mental disorders (SMD) is sparse in low- and middle-income countries. The aim of this study was to identify factors associated with functional impairment in people with enduring SMD in a rural African setting. Methods: A cross-sectional study was conducted at the baseline of a health service intervention trial. A total of 324 participants were recruited from an existing community-ascertained cohort of people with SMD (n = 218), and attendees at the Butajira General Hospital psychiatric clinic (n = 106). Inclusion criteria defined people with SMD who had ongoing need for care: those who were on psychotropic medication, currently symptomatic or had a relapse in the preceding 2 years. The World Health Organization Disability Assessment schedule (WHODAS-2.0) and the Butajira Functioning Scale (BFS) were used to assess functional impairment. Multivariable negative binomial regression models were fitted to investigate the association between demographic, socio-economic and clinical characteristics, and functional impairment. Results: Increasing age, being unmarried, rural residence, poorer socio-economic status, symptom severity, continuous course of illness, medication side effects, and internalized stigma were associated with functional impairment across self-reported and caregiver responses for both the WHODAS and the BFS. Diagnosis per se was not associated consistently with functional impairment. Conclusion: To optimize functioning in people with chronic SMD in this setting, services need to target residual symptoms, poverty, medication side effects, and internalized stigma. Testing the impact of community interventions to promote recovery will be useful. Advocacy for more tolerable treatment options is warranted.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Purpose: Evidence regarding functional impairment in people with severe mental disorders (SMD) is sparse in low- and middle-income countries. The aim of this study was to identify factors associated with functional impairment in people with enduring SMD in a rural African setting. Methods: A cross-sectional study was conducted at the baseline of a health service intervention trial. A total of 324 participants were recruited from an existing community-ascertained cohort of people with SMD (n = 218), and attendees at the Butajira General Hospital psychiatric clinic (n = 106). Inclusion criteria defined people with SMD who had ongoing need for care: those who were on psychotropic medication, currently symptomatic or had a relapse in the preceding 2 years. The World Health Organization Disability Assessment schedule (WHODAS-2.0) and the Butajira Functioning Scale (BFS) were used to assess functional impairment. Multivariable negative binomial regression models were fitted to investigate the association between demographic, socio-economic and clinical characteristics, and functional impairment. Results: Increasing age, being unmarried, rural residence, poorer socio-economic status, symptom severity, continuous course of illness, medication side effects, and internalized stigma were associated with functional impairment across self-reported and caregiver responses for both the WHODAS and the BFS. Diagnosis per se was not associated consistently with functional impairment. Conclusion: To optimize functioning in people with chronic SMD in this setting, services need to target residual symptoms, poverty, medication side effects, and internalized stigma. Testing the impact of community interventions to promote recovery will be useful. Advocacy for more tolerable treatment options is warranted. |
2017
|
Davies, T; Lund, C Integrating mental health care into primary care systems in low- and middle-income countries: lessons from PRIME and AFFIRM Journal Article Global Mental Health, 4 , 2017, ISSN: 2054-4251. Abstract | Links | BibTeX @article{Davies2017,
title = {Integrating mental health care into primary care systems in low- and middle-income countries: lessons from PRIME and AFFIRM},
author = {T Davies and C Lund},
doi = {10.1017/gmh.2017.3},
issn = {2054-4251},
year = {2017},
date = {2017-01-01},
journal = {Global Mental Health},
volume = {4},
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Mayston, Rosie; Habtamu, Kassahun; Medhin, Girmay; Alem, Atalay; Fekadu, Abebaw; Habtamu, Alehegn; Prince, Martin; Hanlon, Charlotte Developing a measure of mental health service satisfaction for use in low income countries: a mixed methods study Journal Article BMC Health Services Research, 17 (1), pp. 1–13, 2017, ISSN: 14726963. Abstract | Links | BibTeX @article{Mayston2017,
title = {Developing a measure of mental health service satisfaction for use in low income countries: a mixed methods study},
author = {Rosie Mayston and Kassahun Habtamu and Girmay Medhin and Atalay Alem and Abebaw Fekadu and Alehegn Habtamu and Martin Prince and Charlotte Hanlon},
doi = {10.1186/s12913-017-2126-2},
issn = {14726963},
year = {2017},
date = {2017-01-01},
journal = {BMC Health Services Research},
volume = {17},
number = {1},
pages = {1--13},
publisher = {BMC Health Services Research},
abstract = {Background: Service satisfaction is integral to quality of care and measures are therefore considered important indicators of quality. Patient's responses to their experiences of using services are under-researched in the context of mental healthcare in low income countries. Our aim was to use mixed methods to develop a new measure of satisfaction for use among consumers of the new models of mental healthcare which are currently being scaled-up. Methods: We used qualitative methods to explore the concept of service satisfaction. On the basis of these findings, we developed a new ‘Mental health service satisfaction scale' (MHSSS v0.0) by adapting existing measures of service satisfaction. We evaluated psychometric properties of the new measure, among a sample of service users with severe mental disorder (SMD) (n = 200) and caregivers (n = 200). Following expert review, a modified version of the measure was developed (MHSSS v1.0) and psychometric properties were examined with data from a second independent sample (n = 150 service users with SMD and n = 150 caregivers). Results: Factors identified in analysis of the first quantitative sample coincide with core concepts of service satisfaction as reported in the literature and were reflected in the key themes which emerged from our qualitative study: interpersonal factors, efficacy, communication, technical competency and adequacy of facilities. There was generally consensus among caregivers and service users regarding dimensions of satisfaction. However there was evidence of some differences in prioritization. Revisions made to version 0.0 of the Mental Health Service Satisfaction Scale (MHSSS) led to an improved instrument, with excellent internal consistency, convergent validity and factor loadings indicative of a uni-dimensional construct. Conclusions: Our findings suggest that conceptions of service satisfaction among people accessing a service for SMD are broadly similar with those established in the literature. Our findings indicate that the MHSSS might be a useful candidate for inclusion in the new toolkit of measures needed to facilitate monitoring of service satisfaction which will be crucial to quality improvement.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: Service satisfaction is integral to quality of care and measures are therefore considered important indicators of quality. Patient's responses to their experiences of using services are under-researched in the context of mental healthcare in low income countries. Our aim was to use mixed methods to develop a new measure of satisfaction for use among consumers of the new models of mental healthcare which are currently being scaled-up. Methods: We used qualitative methods to explore the concept of service satisfaction. On the basis of these findings, we developed a new ‘Mental health service satisfaction scale' (MHSSS v0.0) by adapting existing measures of service satisfaction. We evaluated psychometric properties of the new measure, among a sample of service users with severe mental disorder (SMD) (n = 200) and caregivers (n = 200). Following expert review, a modified version of the measure was developed (MHSSS v1.0) and psychometric properties were examined with data from a second independent sample (n = 150 service users with SMD and n = 150 caregivers). Results: Factors identified in analysis of the first quantitative sample coincide with core concepts of service satisfaction as reported in the literature and were reflected in the key themes which emerged from our qualitative study: interpersonal factors, efficacy, communication, technical competency and adequacy of facilities. There was generally consensus among caregivers and service users regarding dimensions of satisfaction. However there was evidence of some differences in prioritization. Revisions made to version 0.0 of the Mental Health Service Satisfaction Scale (MHSSS) led to an improved instrument, with excellent internal consistency, convergent validity and factor loadings indicative of a uni-dimensional construct. Conclusions: Our findings suggest that conceptions of service satisfaction among people accessing a service for SMD are broadly similar with those established in the literature. Our findings indicate that the MHSSS might be a useful candidate for inclusion in the new toolkit of measures needed to facilitate monitoring of service satisfaction which will be crucial to quality improvement. |
Munodawafa, Memory; Lund, Crick; Schneider, Marguerite A process evaluation exploring the lay counsellor experience of delivering a task shared psycho-social intervention for perinatal depression in Khayelitsha, South Africa Journal Article BMC Psychiatry, 17 (1), pp. 1–12, 2017, ISSN: 1471244X. Abstract | Links | BibTeX @article{Munodawafa2017,
title = {A process evaluation exploring the lay counsellor experience of delivering a task shared psycho-social intervention for perinatal depression in Khayelitsha, South Africa},
author = {Memory Munodawafa and Crick Lund and Marguerite Schneider},
doi = {10.1186/s12888-017-1397-9},
issn = {1471244X},
year = {2017},
date = {2017-01-01},
journal = {BMC Psychiatry},
volume = {17},
number = {1},
pages = {1--12},
publisher = {BMC Psychiatry},
abstract = {Background: Task sharing of psycho-social interventions for perinatal depression has been shown to be feasible, acceptable and effective in low and middle-income countries. This study conducted a process evaluation exploring the perceptions of counsellors who delivered a task shared psycho-social counselling intervention for perinatal depression in Khayelitsha, Cape Town together with independent fidelity ratings. Methods: Post intervention qualitative semi-structured interviews were conducted with six counsellors from the AFrica Focus on Intervention Research for Mental health (AFFIRM-SA) randomised controlled trial on their perceptions of delivering a task shared psycho-social intervention for perinatal depression. Themes were identified using the framework approach and were coded and analysed using Nvivo v11. These interviews were supplemented with fidelity ratings for each counsellor and supervision notes. Results: Facilitating factors in the delivery of the intervention included intervention related factors such as: the content of the intervention, ongoing training and supervision, using a counselling manual, conducting counselling sessions in the local language (isiXhosa) and fidelity to the manual; counsellor factors included counsellors' confidence and motivation to conduct the sessions; participant factors included older age, commitment and a desire to be helped. Barriers included contextual factors such as poverty, crime and lack of space to conduct counselling sessions and participant factors such as the nature of the participant's problem, young age, and avoidance of contact with counsellors. Fidelity ratings and dropout rates varied substantially between counsellors. Conclusion: These findings show that a variety of intervention, counsellor, participant and contextual factors need to be considered in the delivery of task sharing counselling interventions. Careful attention needs to be paid to ongoing supervision and quality of care if lay counsellors are to deliver good quality task shared counselling interventions in under-resourced communities. Trial registration: Clinical Trials: NCT01977326 , registered on 24/10/2013; Pan African Clinical Trials Registry: PACTR201403000676264, registered on 11/10/2013.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: Task sharing of psycho-social interventions for perinatal depression has been shown to be feasible, acceptable and effective in low and middle-income countries. This study conducted a process evaluation exploring the perceptions of counsellors who delivered a task shared psycho-social counselling intervention for perinatal depression in Khayelitsha, Cape Town together with independent fidelity ratings. Methods: Post intervention qualitative semi-structured interviews were conducted with six counsellors from the AFrica Focus on Intervention Research for Mental health (AFFIRM-SA) randomised controlled trial on their perceptions of delivering a task shared psycho-social intervention for perinatal depression. Themes were identified using the framework approach and were coded and analysed using Nvivo v11. These interviews were supplemented with fidelity ratings for each counsellor and supervision notes. Results: Facilitating factors in the delivery of the intervention included intervention related factors such as: the content of the intervention, ongoing training and supervision, using a counselling manual, conducting counselling sessions in the local language (isiXhosa) and fidelity to the manual; counsellor factors included counsellors' confidence and motivation to conduct the sessions; participant factors included older age, commitment and a desire to be helped. Barriers included contextual factors such as poverty, crime and lack of space to conduct counselling sessions and participant factors such as the nature of the participant's problem, young age, and avoidance of contact with counsellors. Fidelity ratings and dropout rates varied substantially between counsellors. Conclusion: These findings show that a variety of intervention, counsellor, participant and contextual factors need to be considered in the delivery of task sharing counselling interventions. Careful attention needs to be paid to ongoing supervision and quality of care if lay counsellors are to deliver good quality task shared counselling interventions in under-resourced communities. Trial registration: Clinical Trials: NCT01977326 , registered on 24/10/2013; Pan African Clinical Trials Registry: PACTR201403000676264, registered on 11/10/2013. |
Baron, Emily; Bass, Judith; Murray, Sarah M; Schneider, Marguerite; Lund, Crick A systematic review of growth curve mixture modelling literature investigating trajectories of perinatal depressive symptoms and associated risk factors Journal Article Journal of Affective Disorders, 223 (February), pp. 194–208, 2017, ISSN: 15732517. Abstract | Links | BibTeX @article{Baron2017,
title = {A systematic review of growth curve mixture modelling literature investigating trajectories of perinatal depressive symptoms and associated risk factors},
author = {Emily Baron and Judith Bass and Sarah M Murray and Marguerite Schneider and Crick Lund},
url = {http://dx.doi.org/10.1016/j.jad.2017.07.046},
doi = {10.1016/j.jad.2017.07.046},
issn = {15732517},
year = {2017},
date = {2017-01-01},
journal = {Journal of Affective Disorders},
volume = {223},
number = {February},
pages = {194--208},
publisher = {Elsevier B.V.},
abstract = {Background The aim of this study was to review the growth curve mixture modelling (GCMM) literature investigating trajectories of perinatal maternal depressive symptoms and associated risk factors. Methods A systematic search of peer-reviewed articles published until November 2015 was conducted in seven databases. Articles using GCMM to identify trajectories of perinatal depressive symptoms were considered. Symptoms had to be assessed at least three times, anytime from pregnancy to two years postpartum (PROSPERO; 2016:CRD42016032600). Results Eleven studies met inclusion criteria. All reported a low risk trajectory, characterised by stable low depressive symptoms throughout the perinatal period. A stable moderate-high or high symptom trajectory was reported in eight of 11 studies, suggesting a high-risk group with persistent depressive symptoms. Six studies also reported transient trajectories, with either increasing, decreasing or episodic depressive symptoms. None of the demographic, personality or clinical characteristics investigated systematically differentiated groups of women with different symptom trajectories, within or across studies. Thus, it is difficult to differentiate women at high or low risk of specific perinatal depression trajectories. Limitations A meta-analysis was not possible. The studies' settings and inclusion criteria limit the generalisability of the findings to low-risk, middle- to high-income women. Conclusions Relatively similar trajectories of perinatal depressive symptoms were identified across studies. Evidence on factors differentiating women assigned to different trajectories was inconsistent. Research with larger samples and in more diverse settings is needed to inform services and policies on how and when to effectively identify subgroups of women at high risk of perinatal depression.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background The aim of this study was to review the growth curve mixture modelling (GCMM) literature investigating trajectories of perinatal maternal depressive symptoms and associated risk factors. Methods A systematic search of peer-reviewed articles published until November 2015 was conducted in seven databases. Articles using GCMM to identify trajectories of perinatal depressive symptoms were considered. Symptoms had to be assessed at least three times, anytime from pregnancy to two years postpartum (PROSPERO; 2016:CRD42016032600). Results Eleven studies met inclusion criteria. All reported a low risk trajectory, characterised by stable low depressive symptoms throughout the perinatal period. A stable moderate-high or high symptom trajectory was reported in eight of 11 studies, suggesting a high-risk group with persistent depressive symptoms. Six studies also reported transient trajectories, with either increasing, decreasing or episodic depressive symptoms. None of the demographic, personality or clinical characteristics investigated systematically differentiated groups of women with different symptom trajectories, within or across studies. Thus, it is difficult to differentiate women at high or low risk of specific perinatal depression trajectories. Limitations A meta-analysis was not possible. The studies' settings and inclusion criteria limit the generalisability of the findings to low-risk, middle- to high-income women. Conclusions Relatively similar trajectories of perinatal depressive symptoms were identified across studies. Evidence on factors differentiating women assigned to different trajectories was inconsistent. Research with larger samples and in more diverse settings is needed to inform services and policies on how and when to effectively identify subgroups of women at high risk of perinatal depression. |
Habtamu, Kassahun; Alem, Atalay; Medhin, Girmay; Fekadu, Abebaw; Dewey, Michael; Prince, Martin; Hanlon, Charlotte Validation of the World Health Organization Disability Assessment Schedule in people with severe mental disorders in rural Ethiopia Journal Article Health and Quality of Life Outcomes, 15 (1), pp. 1–11, 2017, ISSN: 14777525. Abstract | Links | BibTeX @article{Habtamu2017,
title = {Validation of the World Health Organization Disability Assessment Schedule in people with severe mental disorders in rural Ethiopia},
author = {Kassahun Habtamu and Atalay Alem and Girmay Medhin and Abebaw Fekadu and Michael Dewey and Martin Prince and Charlotte Hanlon},
doi = {10.1186/s12955-017-0647-3},
issn = {14777525},
year = {2017},
date = {2017-01-01},
journal = {Health and Quality of Life Outcomes},
volume = {15},
number = {1},
pages = {1--11},
publisher = {Health and Quality of Life Outcomes},
abstract = {Background: The World Health Organization Disability Assessment Schedule (WHODAS-2.0) has been adapted and validated in several cultures, but data on performance in the African context are lacking. The aim of the study was to evaluate the validity and psychometric properties of the WHODAS-2.0 among people with severe mental disorders (SMD) and their caregivers in a rural African setting. Methods: The content validity of the 36 item WHODAS was assessed using free listing and pile sorting in 36 community members. Cognitive interviewing was conducted with 20 people with SMD and 20 caregivers to assess comprehensibility. Convergent validity and sensitivity to change were evaluated in a facility-based cohort study of new or acutely relapsed cases of people with SMD (n = 150) and their caregivers (n = 150) consecutively recruited from a psychiatric clinic. A repeat assessment was conducted in a sub-sample (n = 84) after 6 weeks. Confirmatory factor analysis was used to evaluate construct validity in people with SMD (n = 250) and their caregivers (n = 250). Results: Internal consistency of the items of the overall scale and each domain ranged from very good (alpha = 0.82) to excellent (alpha = 0.98). Scores on the WHODAS-2.0 correlated highly with a locally developed measure of functioning (r = 0.88) and moderately with clinical symptom severity (r = 0.52). The WHODAS- 2.0 was sensitive to treatment changes (effect size = 0.50). As hypothesized, the six sub-scales loaded highly onto the general disability factor and each item loaded significantly onto their respective domains. The factor loadings of each item in the one factor model of the brief version of WHODAS (12 item) were also high. For both 12- and 36-item scales the goodness of fit indices, were close to, but outside of, recommended ranges. The caregiver data of both the 36 and 12 item versions had similar psychometric properties, but higher mean values and better responsiveness to change. Conclusions: Our study showed that both the 12 and 36 item versions of the WHODAS 2.0 have acceptable validity and psychometric properties and can be used as a cross-cultural measure; however, careful and rigorous adaptation is required for rural African settings.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: The World Health Organization Disability Assessment Schedule (WHODAS-2.0) has been adapted and validated in several cultures, but data on performance in the African context are lacking. The aim of the study was to evaluate the validity and psychometric properties of the WHODAS-2.0 among people with severe mental disorders (SMD) and their caregivers in a rural African setting. Methods: The content validity of the 36 item WHODAS was assessed using free listing and pile sorting in 36 community members. Cognitive interviewing was conducted with 20 people with SMD and 20 caregivers to assess comprehensibility. Convergent validity and sensitivity to change were evaluated in a facility-based cohort study of new or acutely relapsed cases of people with SMD (n = 150) and their caregivers (n = 150) consecutively recruited from a psychiatric clinic. A repeat assessment was conducted in a sub-sample (n = 84) after 6 weeks. Confirmatory factor analysis was used to evaluate construct validity in people with SMD (n = 250) and their caregivers (n = 250). Results: Internal consistency of the items of the overall scale and each domain ranged from very good (alpha = 0.82) to excellent (alpha = 0.98). Scores on the WHODAS-2.0 correlated highly with a locally developed measure of functioning (r = 0.88) and moderately with clinical symptom severity (r = 0.52). The WHODAS- 2.0 was sensitive to treatment changes (effect size = 0.50). As hypothesized, the six sub-scales loaded highly onto the general disability factor and each item loaded significantly onto their respective domains. The factor loadings of each item in the one factor model of the brief version of WHODAS (12 item) were also high. For both 12- and 36-item scales the goodness of fit indices, were close to, but outside of, recommended ranges. The caregiver data of both the 36 and 12 item versions had similar psychometric properties, but higher mean values and better responsiveness to change. Conclusions: Our study showed that both the 12 and 36 item versions of the WHODAS 2.0 have acceptable validity and psychometric properties and can be used as a cross-cultural measure; however, careful and rigorous adaptation is required for rural African settings. |
2016
|
Davies, Thandi; Schneider, Marguerite; Nyatsanza, Memory; Lund, Crick "the sun has set even though it is morning": Experiences and explanations of perinatal depression in an urban township, Cape Town Journal Article Transcultural Psychiatry, 53 (3), pp. 286–312, 2016, ISSN: 14617471. Abstract | Links | BibTeX @article{Davies2016,
title = {"the sun has set even though it is morning": Experiences and explanations of perinatal depression in an urban township, Cape Town},
author = {Thandi Davies and Marguerite Schneider and Memory Nyatsanza and Crick Lund},
doi = {10.1177/1363461516632389},
issn = {14617471},
year = {2016},
date = {2016-01-01},
journal = {Transcultural Psychiatry},
volume = {53},
number = {3},
pages = {286--312},
abstract = {This study examined experiences and explanations of depression amongst Xhosa-speaking pregnant women, mothers, and health workers in an urban township in Cape Town, South Africa. The study was conducted as part of formative research for a randomised controlled trial to develop and evaluate a task-sharing counselling intervention for maternal depression in this setting. We conducted qualitative semi-structured interviews with 12 depressed and 9 nondepressed pregnant women and mothers of young babies, and 13 health care providers. We employed an in-depth framework analysis approach to explore the idioms, descriptions, and perceived causes of depression particular to these women, and compared these with the ICD-10 and DSM-5 criteria for major depression. We found that symptoms of major depression are similar in this township to those described in international criteria (withdrawal, sadness, and poor concentration), but that local descriptions of these symptoms vary. In addition, all the symptoms described by participants were directly related to stressors occurring in the women's lives. These stressors included poverty, unemployment, lack of support from partners, abuse, and death of loved ones, and were exacerbated by unwanted or unplanned pregnancies and the discovery of HIV positive status at antenatal appointments. The study calls attention to the need for specifically designed counselling interventions for perinatal depression that are responsive to the lived experiences of these women and grounded in the broader context of poor socioeconomic conditions and living environments in South Africa, all of which have a direct impact on mental health.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
This study examined experiences and explanations of depression amongst Xhosa-speaking pregnant women, mothers, and health workers in an urban township in Cape Town, South Africa. The study was conducted as part of formative research for a randomised controlled trial to develop and evaluate a task-sharing counselling intervention for maternal depression in this setting. We conducted qualitative semi-structured interviews with 12 depressed and 9 nondepressed pregnant women and mothers of young babies, and 13 health care providers. We employed an in-depth framework analysis approach to explore the idioms, descriptions, and perceived causes of depression particular to these women, and compared these with the ICD-10 and DSM-5 criteria for major depression. We found that symptoms of major depression are similar in this township to those described in international criteria (withdrawal, sadness, and poor concentration), but that local descriptions of these symptoms vary. In addition, all the symptoms described by participants were directly related to stressors occurring in the women's lives. These stressors included poverty, unemployment, lack of support from partners, abuse, and death of loved ones, and were exacerbated by unwanted or unplanned pregnancies and the discovery of HIV positive status at antenatal appointments. The study calls attention to the need for specifically designed counselling interventions for perinatal depression that are responsive to the lived experiences of these women and grounded in the broader context of poor socioeconomic conditions and living environments in South Africa, all of which have a direct impact on mental health. |
Hanlon, Charlotte; Alem, Atalay; Medhin, Girmay; Shibre, Teshome; Ejigu, Dawit A; Negussie, Hanna; Dewey, Michael; Wissow, Lawrence; Prince, Martin; Susser, Ezra; Lund, Crick; Fekadu, Abebaw Task sharing for the care of severe mental disorders in a low-income country (TaSCS): Study protocol for a randomised, controlled, non-inferiority trial Journal Article Trials, 17 (1), pp. 1–14, 2016, ISSN: 17456215. Abstract | Links | BibTeX @article{Hanlon2016,
title = {Task sharing for the care of severe mental disorders in a low-income country (TaSCS): Study protocol for a randomised, controlled, non-inferiority trial},
author = {Charlotte Hanlon and Atalay Alem and Girmay Medhin and Teshome Shibre and Dawit A Ejigu and Hanna Negussie and Michael Dewey and Lawrence Wissow and Martin Prince and Ezra Susser and Crick Lund and Abebaw Fekadu},
url = {http://dx.doi.org/10.1186/s13063-016-1191-x},
doi = {10.1186/s13063-016-1191-x},
issn = {17456215},
year = {2016},
date = {2016-01-01},
journal = {Trials},
volume = {17},
number = {1},
pages = {1--14},
publisher = {Trials},
abstract = {Background: Task sharing mental health care through integration into primary health care (PHC) is advocated as a means of narrowing the treatment gap for mental disorders in low-income countries. However, the effectiveness, acceptability, feasibility and sustainability of this service model for people with a severe mental disorder (SMD) have not been evaluated in a low-income country. Methods/Design: A randomised, controlled, non-inferiority trial will be carried out in a predominantly rural area of Ethiopia. A sample of 324 people with SMD (diagnoses of schizophrenia, schizoaffective disorder, bipolar disorder or major depressive disorder) with an ongoing need for mental health care will be recruited from 1) participants in a population-based cohort study and 2) people attending a psychiatric nurse-led out-patient clinic. The intervention is a task-sharing model of locally delivered mental health care for people with SMD integrated into PHC delivered over 18months. Participants in the active control arm will receive the established and effective model of specialist mental health care delivered by psychiatric nurses at an out-patient clinic within a centrally located general hospital. The hypothesis is that people with SMD who receive mental health care integrated into PHC will have a non-inferior clinical outcome, defined as a mean symptom score on the Brief Psychiatric Rating Scale, expanded version, of no more than six points higher, compared to participants who receive the psychiatric nurse-led service, after 12months. The primary outcome is change in symptom severity. Secondary outcomes are functional status, relapse, service use costs, service satisfaction, drop-out and medication adherence, nutritional status, physical health care, quality of care, medication side effects, stigma, adverse events and cost-effectiveness. Sustainability and cost-effectiveness will be further evaluated at 18months. Randomisation will be stratified by health centre catchment area using random permuted blocks. The outcome assessors and investigators will be masked to allocation status. Discussion: Evidence about the effectiveness of task sharing mental health care for people with SMD in a rural, low-income African country will inform the World Health Organisation's mental health Gap Action Programme to scale-up mental health care globally. Trial registration:NCT02308956(ClinicalTrials.gov). Date of registration: 3 December 2014.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: Task sharing mental health care through integration into primary health care (PHC) is advocated as a means of narrowing the treatment gap for mental disorders in low-income countries. However, the effectiveness, acceptability, feasibility and sustainability of this service model for people with a severe mental disorder (SMD) have not been evaluated in a low-income country. Methods/Design: A randomised, controlled, non-inferiority trial will be carried out in a predominantly rural area of Ethiopia. A sample of 324 people with SMD (diagnoses of schizophrenia, schizoaffective disorder, bipolar disorder or major depressive disorder) with an ongoing need for mental health care will be recruited from 1) participants in a population-based cohort study and 2) people attending a psychiatric nurse-led out-patient clinic. The intervention is a task-sharing model of locally delivered mental health care for people with SMD integrated into PHC delivered over 18months. Participants in the active control arm will receive the established and effective model of specialist mental health care delivered by psychiatric nurses at an out-patient clinic within a centrally located general hospital. The hypothesis is that people with SMD who receive mental health care integrated into PHC will have a non-inferior clinical outcome, defined as a mean symptom score on the Brief Psychiatric Rating Scale, expanded version, of no more than six points higher, compared to participants who receive the psychiatric nurse-led service, after 12months. The primary outcome is change in symptom severity. Secondary outcomes are functional status, relapse, service use costs, service satisfaction, drop-out and medication adherence, nutritional status, physical health care, quality of care, medication side effects, stigma, adverse events and cost-effectiveness. Sustainability and cost-effectiveness will be further evaluated at 18months. Randomisation will be stratified by health centre catchment area using random permuted blocks. The outcome assessors and investigators will be masked to allocation status. Discussion: Evidence about the effectiveness of task sharing mental health care for people with SMD in a rural, low-income African country will inform the World Health Organisation's mental health Gap Action Programme to scale-up mental health care globally. Trial registration:NCT02308956(ClinicalTrials.gov). Date of registration: 3 December 2014. |
Nyatsanza, Memory; Schneider, Marguerite; Davies, Thandi; Lund, Crick Filling the treatment gap: Developing a task sharing counselling intervention for perinatal depression in Khayelitsha, South Africa Journal Article BMC Psychiatry, 16 (1), pp. 1–12, 2016, ISSN: 1471244X. Abstract | Links | BibTeX @article{Nyatsanza2016,
title = {Filling the treatment gap: Developing a task sharing counselling intervention for perinatal depression in Khayelitsha, South Africa},
author = {Memory Nyatsanza and Marguerite Schneider and Thandi Davies and Crick Lund},
url = {http://dx.doi.org/10.1186/s12888-016-0873-y},
doi = {10.1186/s12888-016-0873-y},
issn = {1471244X},
year = {2016},
date = {2016-01-01},
journal = {BMC Psychiatry},
volume = {16},
number = {1},
pages = {1--12},
publisher = {BMC Psychiatry},
abstract = {Background: Perinatal depression is a major public health issue especially in low income settings in South Africa, where there is a shortage of mental health professionals. New psychological interventions delivered by non-specialists are needed to fill the treatment gap. This paper describes the process of developing a manual based task sharing counselling intervention for perinatal depression in Khayelitsha, Cape Town. Methods: Qualitative semi-structured interviews were conducted with 26 participants, including service providers and service users at a clinic in Khayelitsha in order to explore the feasibility, acceptability and content of a task sharing counselling intervention. The interviews were recorded, translated and transcribed. Themes were identified using the framework analysis approach and were coded and analysed using NVivo v10. After the semi-structured interviews, a workshop was conducted with mental health experts on evidence-based psychological interventions for depression, together with a document review of counselling manuals for community health workers in South Africa. Results: The findings indicate that a task sharing counselling intervention was acceptable and feasible for depressed women in Khayelitsha, under the following conditions: (1) respondents preferred a female counsellor and felt that clinic based individual sessions should be provided at least once a month by an experienced Xhosa speaking counsellor from the community; and (2) the content of a counselling intervention should include psycho-education on cognitive and behavioural effects of depression, how to cope with interpersonal problems, and financial stressors. Based on these conditions, the review of manuals and expert consultation, key components of the counselling intervention were identified as: psycho-education, problem solving, healthy thinking and behaviour activation. These were included in the final counselling manual. Conclusion: The development of task sharing counselling interventions for perinatal depression should be informed by the views and needs of local service users and service providers. The study illustrates the manner in which these views can be incorporated for the development of evidence-based psychological interventions, within a task sharing framework in low and middle-income countries.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: Perinatal depression is a major public health issue especially in low income settings in South Africa, where there is a shortage of mental health professionals. New psychological interventions delivered by non-specialists are needed to fill the treatment gap. This paper describes the process of developing a manual based task sharing counselling intervention for perinatal depression in Khayelitsha, Cape Town. Methods: Qualitative semi-structured interviews were conducted with 26 participants, including service providers and service users at a clinic in Khayelitsha in order to explore the feasibility, acceptability and content of a task sharing counselling intervention. The interviews were recorded, translated and transcribed. Themes were identified using the framework analysis approach and were coded and analysed using NVivo v10. After the semi-structured interviews, a workshop was conducted with mental health experts on evidence-based psychological interventions for depression, together with a document review of counselling manuals for community health workers in South Africa. Results: The findings indicate that a task sharing counselling intervention was acceptable and feasible for depressed women in Khayelitsha, under the following conditions: (1) respondents preferred a female counsellor and felt that clinic based individual sessions should be provided at least once a month by an experienced Xhosa speaking counsellor from the community; and (2) the content of a counselling intervention should include psycho-education on cognitive and behavioural effects of depression, how to cope with interpersonal problems, and financial stressors. Based on these conditions, the review of manuals and expert consultation, key components of the counselling intervention were identified as: psycho-education, problem solving, healthy thinking and behaviour activation. These were included in the final counselling manual. Conclusion: The development of task sharing counselling interventions for perinatal depression should be informed by the views and needs of local service users and service providers. The study illustrates the manner in which these views can be incorporated for the development of evidence-based psychological interventions, within a task sharing framework in low and middle-income countries. |
Marimbe, Bazondlile D; Cowan, Frances; Kajawu, Lazarus; Muchirahondo, Florence; Lund, Crick Perceived burden of care and reported coping strategies and needs for family caregivers of people with mental disorders in Zimbabwe Journal Article African Journal of Disability, 5 (1), pp. 1–9, 2016, ISSN: 2223-9170. Abstract | Links | BibTeX @article{Marimbe2016,
title = {Perceived burden of care and reported coping strategies and needs for family caregivers of people with mental disorders in Zimbabwe},
author = {Bazondlile D Marimbe and Frances Cowan and Lazarus Kajawu and Florence Muchirahondo and Crick Lund},
doi = {10.4102/ajod.v5i1.209},
issn = {2223-9170},
year = {2016},
date = {2016-01-01},
journal = {African Journal of Disability},
volume = {5},
number = {1},
pages = {1--9},
abstract = {Background: Mental health service resources are inadequate in low-income countries, and families are frequently expected to provide care for their relative with a mental disorder. However, research on the consequences of care giving has been limited in low-income countries, including Zimbabwe.Objective: The study explored the perceived impact of mental illness, reported coping strategies and reported needs of family members of persons diagnosed with bipolar affective disorder or schizophrenia attending a psychiatric hospital in Harare, Zimbabwe.Methods: A purposive sample of 31 family members participated in in-depth interviews and focus group discussions using standardized study guides. Participants were also screened for Common Mental Disorders (CMD) using the 14-item Shona Symptom questionnaire (SSQ). Qualitative data were analyzed thematically. Statistical Package for Social Sciences (SPSS version 16) was used for quantitative data analysis.Results: Caregivers experienced physical, psychological, emotional, social and financial burden associated with care giving. They used both emotion-focused and problem-focused coping strategies depending on the ill family members' behaviours. Seeking spiritual assistance emerged as their most common way of coping. Twenty one (68%) of the caregivers were at risk of CMD and were referred to a psychiatrist for further management. Caregivers required support from health care professionals to help them cope better.Conclusion: Caregivers carry a substantial and frequently unrecognized burden of caring for a family member with mental disorder. Better support is needed from health professionals and social services to help them cope better. Further research is required to quantitatively measure caregiver burden and evaluate potential interventions in Zimbabwe.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: Mental health service resources are inadequate in low-income countries, and families are frequently expected to provide care for their relative with a mental disorder. However, research on the consequences of care giving has been limited in low-income countries, including Zimbabwe.Objective: The study explored the perceived impact of mental illness, reported coping strategies and reported needs of family members of persons diagnosed with bipolar affective disorder or schizophrenia attending a psychiatric hospital in Harare, Zimbabwe.Methods: A purposive sample of 31 family members participated in in-depth interviews and focus group discussions using standardized study guides. Participants were also screened for Common Mental Disorders (CMD) using the 14-item Shona Symptom questionnaire (SSQ). Qualitative data were analyzed thematically. Statistical Package for Social Sciences (SPSS version 16) was used for quantitative data analysis.Results: Caregivers experienced physical, psychological, emotional, social and financial burden associated with care giving. They used both emotion-focused and problem-focused coping strategies depending on the ill family members' behaviours. Seeking spiritual assistance emerged as their most common way of coping. Twenty one (68%) of the caregivers were at risk of CMD and were referred to a psychiatrist for further management. Caregivers required support from health care professionals to help them cope better.Conclusion: Caregivers carry a substantial and frequently unrecognized burden of caring for a family member with mental disorder. Better support is needed from health professionals and social services to help them cope better. Further research is required to quantitatively measure caregiver burden and evaluate potential interventions in Zimbabwe. |
Schneider, M; van de Water, T; Araya, R; Bonini, B B; Pilowsky, D J; Pratt, C; Price, L; Rojas, G; Seedat, S; Sharma, M; Susser, E Monitoring and evaluating capacity building activities in low and middle income countries: challenges and opportunities Journal Article Global Mental Health, 3 , 2016, ISSN: 2054-4251. Abstract | Links | BibTeX @article{Schneider2016,
title = {Monitoring and evaluating capacity building activities in low and middle income countries: challenges and opportunities},
author = {M Schneider and T van de Water and R Araya and B B Bonini and D J Pilowsky and C Pratt and L Price and G Rojas and S Seedat and M Sharma and E Susser},
doi = {10.1017/gmh.2016.24},
issn = {2054-4251},
year = {2016},
date = {2016-01-01},
journal = {Global Mental Health},
volume = {3},
abstract = {Background Lower and middle income countries (LMICs) are home to textgreater 80% of the global population, but mental health researchers and LMIC investigator led publications are concentrated in 10% of LMICs. Increasing research and research outputs, such as in the form of peer reviewed publications, require increased capacity building (CB) opportunities in LMICs. The National Institute of Mental Health (NIMH) initiative, Collaborative Hubs for International Research on Mental Health reaches across five regional 'hubs' established in LMICs, to provide training and support for emerging researchers through hub-specific CB activities. This paper describes the range of CB activities, the process of monitoring, and the early outcomes of CB activities conducted by the five research hubs. Methods The indicators used to describe the nature, the monitoring, and the early outcomes of CB activities were developed collectively by the members of an inter-hub CB workgroup representing all five hubs. These indicators included but were not limited to courses, publications, and grants. Results Results for all indicators demonstrate a wide range of feasible CB activities. The five hubs were successful in providing at least one and the majority several courses; 13 CB recipient-led articles were accepted for publication; and nine grant applications were successful. Conclusions The hubs were successful in providing CB recipients with a wide range of CB activities. The challenge remains to ensure ongoing CB of mental health researchers in LMICs, and in particular, to sustain the CB efforts of the five hubs after the termination of NIMH funding.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background Lower and middle income countries (LMICs) are home to textgreater 80% of the global population, but mental health researchers and LMIC investigator led publications are concentrated in 10% of LMICs. Increasing research and research outputs, such as in the form of peer reviewed publications, require increased capacity building (CB) opportunities in LMICs. The National Institute of Mental Health (NIMH) initiative, Collaborative Hubs for International Research on Mental Health reaches across five regional 'hubs' established in LMICs, to provide training and support for emerging researchers through hub-specific CB activities. This paper describes the range of CB activities, the process of monitoring, and the early outcomes of CB activities conducted by the five research hubs. Methods The indicators used to describe the nature, the monitoring, and the early outcomes of CB activities were developed collectively by the members of an inter-hub CB workgroup representing all five hubs. These indicators included but were not limited to courses, publications, and grants. Results Results for all indicators demonstrate a wide range of feasible CB activities. The five hubs were successful in providing at least one and the majority several courses; 13 CB recipient-led articles were accepted for publication; and nine grant applications were successful. Conclusions The hubs were successful in providing CB recipients with a wide range of CB activities. The challenge remains to ensure ongoing CB of mental health researchers in LMICs, and in particular, to sustain the CB efforts of the five hubs after the termination of NIMH funding. |
Schneider, M; Sorsdahl, K; Mayston, R; Ahrens, J; Chibanda, D; Fekadu, A; Hanlon, C; Holzer, S; Musisi, S; Ofori-Atta, A; Thornicroft, G; Prince, M; Alem, A; Susser, E; Lund, C Developing mental health research in sub-Saharan Africa: capacity building in the AFFIRM project Journal Article Global Mental Health, 3 , 2016, ISSN: 2054-4251. Abstract | Links | BibTeX @article{Schneider2016a,
title = {Developing mental health research in sub-Saharan Africa: capacity building in the AFFIRM project},
author = {M Schneider and K Sorsdahl and R Mayston and J Ahrens and D Chibanda and A Fekadu and C Hanlon and S Holzer and S Musisi and A Ofori-Atta and G Thornicroft and M Prince and A Alem and E Susser and C Lund},
doi = {10.1017/gmh.2016.28},
issn = {2054-4251},
year = {2016},
date = {2016-01-01},
journal = {Global Mental Health},
volume = {3},
abstract = {Background There remains a large disparity in the quantity, quality and impact of mental health research carried out in sub-Saharan Africa, relative to both the burden and the amount of research carried out in other regions. We lack evidence on the capacity-building activities that are effective in achieving desired aims and appropriate methodologies for evaluating success. Methods AFFIRM was an NIMH-funded hub project including a capacity-building program with three components open to participants across six countries: (a) fellowships for an M.Phil. program; (b) funding for Ph.D. students conducting research nested within AFFIRM trials; (c) short courses in specialist research skills. We present findings on progression and outputs from the M.Phil. and Ph.D. programs, self-perceived impact of short courses, qualitative data on student experience, and reflec-tions on experiences and lessons learnt from AFFIRM consortium members. Results AFFIRM delivered funded research training opportunities to 25 mental health professionals, 90 researchers and five Ph.D. students across 6 countries over a period of 5 years. A number of challenges were identified and suggestions for improv-ing the capacity-building activities explored. Conclusions Having protected time for research is a barrier to carrying out research activities for busy clinicians. Funders could support sustainability of capacity-building initiatives through funds for travel and study leave. Adoption of a train-the-trainers model for specialist skillstraining and strategies for improving the rigor of evaluation of capacity-building activities should be considered.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background There remains a large disparity in the quantity, quality and impact of mental health research carried out in sub-Saharan Africa, relative to both the burden and the amount of research carried out in other regions. We lack evidence on the capacity-building activities that are effective in achieving desired aims and appropriate methodologies for evaluating success. Methods AFFIRM was an NIMH-funded hub project including a capacity-building program with three components open to participants across six countries: (a) fellowships for an M.Phil. program; (b) funding for Ph.D. students conducting research nested within AFFIRM trials; (c) short courses in specialist research skills. We present findings on progression and outputs from the M.Phil. and Ph.D. programs, self-perceived impact of short courses, qualitative data on student experience, and reflec-tions on experiences and lessons learnt from AFFIRM consortium members. Results AFFIRM delivered funded research training opportunities to 25 mental health professionals, 90 researchers and five Ph.D. students across 6 countries over a period of 5 years. A number of challenges were identified and suggestions for improv-ing the capacity-building activities explored. Conclusions Having protected time for research is a barrier to carrying out research activities for busy clinicians. Funders could support sustainability of capacity-building initiatives through funds for travel and study leave. Adoption of a train-the-trainers model for specialist skillstraining and strategies for improving the rigor of evaluation of capacity-building activities should be considered. |
Pilowsky, Daniel J; Rojas, Graciela; Price, Leshawndra N; Appiah-Poku, John; Razzaque, Bushra; Sharma, Mona; Schneider, Marguerite; Seedat, Soraya; Bonini, Bárbara B; Gureje, Oye; Kola, Lola; Lund, Crick; Sorsdahl, Katherine; Araya, Ricardo; Menezes, Paulo R Building research capacity across and within low- and middle-income countries: The collaborative hubs for international research on mental health Journal Article Academic Psychiatry, 40 (4), pp. 686–691, 2016, ISSN: 15457230. Links | BibTeX @article{Pilowsky2016,
title = {Building research capacity across and within low- and middle-income countries: The collaborative hubs for international research on mental health},
author = {Daniel J Pilowsky and Graciela Rojas and Leshawndra N Price and John Appiah-Poku and Bushra Razzaque and Mona Sharma and Marguerite Schneider and Soraya Seedat and Bárbara B Bonini and Oye Gureje and Lola Kola and Crick Lund and Katherine Sorsdahl and Ricardo Araya and Paulo R Menezes},
doi = {10.1007/s40596-016-0493-3},
issn = {15457230},
year = {2016},
date = {2016-01-01},
journal = {Academic Psychiatry},
volume = {40},
number = {4},
pages = {686--691},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
|
Habtamu, Kassahun; Alem, Atalay; Medhin, Girmay; Fekadu, Abebaw; Prince, Martin; Hanlon, Charlotte Development and validation of a contextual measure of functioning for people living with severe mental disorders in rural Africa Journal Article BMC Psychiatry, 16 (1), pp. 1–13, 2016, ISSN: 1471244X. Abstract | Links | BibTeX @article{Habtamu2016,
title = {Development and validation of a contextual measure of functioning for people living with severe mental disorders in rural Africa},
author = {Kassahun Habtamu and Atalay Alem and Girmay Medhin and Abebaw Fekadu and Martin Prince and Charlotte Hanlon},
url = {http://dx.doi.org/10.1186/s12888-016-1022-3},
doi = {10.1186/s12888-016-1022-3},
issn = {1471244X},
year = {2016},
date = {2016-01-01},
journal = {BMC Psychiatry},
volume = {16},
number = {1},
pages = {1--13},
publisher = {BMC Psychiatry},
abstract = {Background: Most measures of functioning in people with severe mental disorders (SMD) have been developed in Western societies. Many of the questions in these scales are culture-bound, fail to capture differentiation of tasks by gender and are difficult to adapt to other contexts. The aim of this study was to develop a measure of functioning for people with SMD which is contextually appropriate for a rural African setting. Methods: A review of existing scales, a qualitative study, free listing and pile sorting exercises, and expert consensus were used to establish a pool of items. Cognitive interviewing guided initial item reduction and refinement. The resulting scale was pilot-tested in people with SMD (n=200) and their caregivers (n=200) to inform further item reduction based on psychometric properties. The final Butajira Functioning Scale (BFS) comprised 33 items that were common to both men and women, and an additional eight items for women only, covering the following domains: self-care, work, and family and community participation. Psychometric properties of the finalized BFS were examined in a facility-based sample of 150 people with SMD and their caregivers (n=150), with longitudinal follow-up of n=84. Results: The BFS in people with SMD had excellent internal consistency (Cronbach's $alpha$=0.99), acceptable convergent validity (r=0.88 with the World Health Organization Disability Assessment Schedule [WHODAS-2.0] and r=0.32 with the Brief Psychiatric Rating Scale [BPRS-E]) and was sensitive to change following treatment (effect size =0.50). Addition of the items specific to women did not improve the psychometric properties. The caregiver version had similar psychometric properties but higher mean values for each item and better responsiveness to change. Exploratory factor analysis of the BFS provided evidence of construct validity, with four underlying dimensions. Conclusions: We have developed a measure of functioning for people with SMD in a rural, low income country setting with acceptable psychometric properties. The BFS is easy to administer, sensitive to changes following treatment and has content, construct and convergent validity. The BFS includes domains from existing measures, but has more emphasis on social and occupational domains, which reflects priorities in the setting.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: Most measures of functioning in people with severe mental disorders (SMD) have been developed in Western societies. Many of the questions in these scales are culture-bound, fail to capture differentiation of tasks by gender and are difficult to adapt to other contexts. The aim of this study was to develop a measure of functioning for people with SMD which is contextually appropriate for a rural African setting. Methods: A review of existing scales, a qualitative study, free listing and pile sorting exercises, and expert consensus were used to establish a pool of items. Cognitive interviewing guided initial item reduction and refinement. The resulting scale was pilot-tested in people with SMD (n=200) and their caregivers (n=200) to inform further item reduction based on psychometric properties. The final Butajira Functioning Scale (BFS) comprised 33 items that were common to both men and women, and an additional eight items for women only, covering the following domains: self-care, work, and family and community participation. Psychometric properties of the finalized BFS were examined in a facility-based sample of 150 people with SMD and their caregivers (n=150), with longitudinal follow-up of n=84. Results: The BFS in people with SMD had excellent internal consistency (Cronbach's $alpha$=0.99), acceptable convergent validity (r=0.88 with the World Health Organization Disability Assessment Schedule [WHODAS-2.0] and r=0.32 with the Brief Psychiatric Rating Scale [BPRS-E]) and was sensitive to change following treatment (effect size =0.50). Addition of the items specific to women did not improve the psychometric properties. The caregiver version had similar psychometric properties but higher mean values for each item and better responsiveness to change. Exploratory factor analysis of the BFS provided evidence of construct validity, with four underlying dimensions. Conclusions: We have developed a measure of functioning for people with SMD in a rural, low income country setting with acceptable psychometric properties. The BFS is easy to administer, sensitive to changes following treatment and has content, construct and convergent validity. The BFS includes domains from existing measures, but has more emphasis on social and occupational domains, which reflects priorities in the setting. |
2015
|
Schneider, Marguerite; Baron, Emily; Davies, Thandi; Bass, Judith; Lund, Crick Making assessment locally relevant: measuring functioning for maternal depression in Khayelitsha, Cape Town Journal Article Social Psychiatry and Psychiatric Epidemiology, 50 (5), pp. 797–806, 2015, ISSN: 09337954. Abstract | Links | BibTeX @article{Schneider2015,
title = {Making assessment locally relevant: measuring functioning for maternal depression in Khayelitsha, Cape Town},
author = {Marguerite Schneider and Emily Baron and Thandi Davies and Judith Bass and Crick Lund},
doi = {10.1007/s00127-014-1003-0},
issn = {09337954},
year = {2015},
date = {2015-01-01},
journal = {Social Psychiatry and Psychiatric Epidemiology},
volume = {50},
number = {5},
pages = {797--806},
abstract = {Purpose: We developed a locally relevant functioning assessment instrument (FAI) for pregnant women and mothers of young babies to complement a widely validated instrument—the World Health Organization's Disability Assessment Schedule (WHODAS) 12-item version. The FAI is an outcome measure in a randomised controlled trial on the effectiveness of a lay counsellor administered intervention for distressed pregnant women in Khayelitsha, Cape Town. Methods: Nine items most commonly reported by 40 pregnant women or mothers with young babies in qualitative interviews were selected for the instrument, with a 10th item ‘Other'. The FAI was validated with 142 pregnant women and mothers in Khayelitsha. Analysis was conducted to assess internal reliability, exploratory factor analysis and convergent validity. Results: The FAI had good internal reliability (Cronbach's alpha = 0.77) and the explanatory factor analysis showed a clear 3-factor solution, relating to domestic, childcare and social activities. The FAI scores showed floor effects, but were positively correlated with the two measures of functioning (WHODAS 2.0 and Washington Group Short Set). The FAI scores also correlated with the measure of depression (Edinburgh Postnatal Depression Scale—EPDS), reflecting increased functional limitations associated with increased depressive symptoms. Conclusion: The results show that the FAI has good internal reliability, and good convergent and construct validity as a measure of functioning for this context. This paper reports on the process of developing an instrument and highlights the importance of using instruments that are locally relevant to ensure accurate measurement of functional status.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Purpose: We developed a locally relevant functioning assessment instrument (FAI) for pregnant women and mothers of young babies to complement a widely validated instrument—the World Health Organization's Disability Assessment Schedule (WHODAS) 12-item version. The FAI is an outcome measure in a randomised controlled trial on the effectiveness of a lay counsellor administered intervention for distressed pregnant women in Khayelitsha, Cape Town. Methods: Nine items most commonly reported by 40 pregnant women or mothers with young babies in qualitative interviews were selected for the instrument, with a 10th item ‘Other'. The FAI was validated with 142 pregnant women and mothers in Khayelitsha. Analysis was conducted to assess internal reliability, exploratory factor analysis and convergent validity. Results: The FAI had good internal reliability (Cronbach's alpha = 0.77) and the explanatory factor analysis showed a clear 3-factor solution, relating to domestic, childcare and social activities. The FAI scores showed floor effects, but were positively correlated with the two measures of functioning (WHODAS 2.0 and Washington Group Short Set). The FAI scores also correlated with the measure of depression (Edinburgh Postnatal Depression Scale—EPDS), reflecting increased functional limitations associated with increased depressive symptoms. Conclusion: The results show that the FAI has good internal reliability, and good convergent and construct validity as a measure of functioning for this context. This paper reports on the process of developing an instrument and highlights the importance of using instruments that are locally relevant to ensure accurate measurement of functional status. |
Lund, C; Alem, A; Schneider, M; Hanlon, C; Ahrens, J; Bandawe, C; Bass, J; Bhana, A; Burns, J; Chibanda, D; Cowan, F; Davies, T; Dewey, M; Fekadu, A; Freeman, M; Honikman, S; Joska, J; Kagee, A; Mayston, R; Medhin, G; Musisi, S; Myer, L; Ntulo, T; Nyatsanza, M; Ofori-Atta, A; Petersen, I; Phakathi, S; Prince, M; Shibre, T; Stein, D J; Swartz, L; Thornicroft, G; Tomlinson, M; Wissow, L; Susser, E Generating evidence to narrow the treatment gap for mental disorders in sub-Saharan Africa: Rationale, overview and methods of AFFIRM Journal Article Epidemiology and Psychiatric Sciences, 24 (3), pp. 233–240, 2015, ISSN: 20457979. Abstract | Links | BibTeX @article{Lund2015,
title = {Generating evidence to narrow the treatment gap for mental disorders in sub-Saharan Africa: Rationale, overview and methods of AFFIRM},
author = {C Lund and A Alem and M Schneider and C Hanlon and J Ahrens and C Bandawe and J Bass and A Bhana and J Burns and D Chibanda and F Cowan and T Davies and M Dewey and A Fekadu and M Freeman and S Honikman and J Joska and A Kagee and R Mayston and G Medhin and S Musisi and L Myer and T Ntulo and M Nyatsanza and A Ofori-Atta and I Petersen and S Phakathi and M Prince and T Shibre and D J Stein and L Swartz and G Thornicroft and M Tomlinson and L Wissow and E Susser},
doi = {10.1017/S2045796015000281},
issn = {20457979},
year = {2015},
date = {2015-01-01},
journal = {Epidemiology and Psychiatric Sciences},
volume = {24},
number = {3},
pages = {233--240},
abstract = {There is limited evidence on the acceptability, feasibility and cost-effectiveness of task-sharing interventions to narrow the treatment gap for mental disorders in sub-Saharan Africa. The purpose of this article is to describe the rationale, aims and methods of the Africa Focus on Intervention Research for Mental health (AFFIRM) collaborative research hub. AFFIRM is investigating strategies for narrowing the treatment gap for mental disorders in sub-Saharan Africa in four areas. First, it is assessing the feasibility, acceptability and cost-effectiveness of task-sharing interventions by conducting randomised controlled trials in Ethiopia and South Africa. The AFFIRM Task-sharing for the Care of Severe mental disorders (TaSCS) trial in Ethiopia aims to determine the acceptability, affordability, effectiveness and sustainability of mental health care for people with severe mental disorder delivered by trained and supervised non-specialist, primary health care workers compared with an existing psychiatric nurse-led service. The AFFIRM trial in South Africa aims to determine the cost-effectiveness of a task-sharing counselling intervention for maternal depression, delivered by non-specialist community health workers, and to examine factors influencing the implementation of the intervention and future scale up. Second, AFFIRM is building individual and institutional capacity for intervention research in sub-Saharan Africa by providing fellowship and mentorship programmes for candidates in Ethiopia, Ghana, Malawi, Uganda and Zimbabwe. Each year five Fellowships are awarded (one to each country) to attend the MPhil in Public Mental Health, a joint postgraduate programme at the University of Cape Town and Stellenbosch University. AFFIRM also offers short courses in intervention research, and supports PhD students attached to the trials in Ethiopia and South Africa. Third, AFFIRM is collaborating with other regional National Institute of Mental Health funded hubs in Latin America, sub-Saharan Africa and south Asia, by designing and executing shared research projects related to task-sharing and narrowing the treatment gap. Finally, it is establishing a network of collaboration between researchers, non-governmental organisations and government agencies that facilitates the translation of research knowledge into policy and practice. This article describes the developmental process of this multi-site approach, and provides a narrative of challenges and opportunities that have arisen during the early phases. Crucial to the long-term sustainability of this work is the nurturing and sustaining of partnerships between African mental health researchers, policy makers, practitioners and international collaborators.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
There is limited evidence on the acceptability, feasibility and cost-effectiveness of task-sharing interventions to narrow the treatment gap for mental disorders in sub-Saharan Africa. The purpose of this article is to describe the rationale, aims and methods of the Africa Focus on Intervention Research for Mental health (AFFIRM) collaborative research hub. AFFIRM is investigating strategies for narrowing the treatment gap for mental disorders in sub-Saharan Africa in four areas. First, it is assessing the feasibility, acceptability and cost-effectiveness of task-sharing interventions by conducting randomised controlled trials in Ethiopia and South Africa. The AFFIRM Task-sharing for the Care of Severe mental disorders (TaSCS) trial in Ethiopia aims to determine the acceptability, affordability, effectiveness and sustainability of mental health care for people with severe mental disorder delivered by trained and supervised non-specialist, primary health care workers compared with an existing psychiatric nurse-led service. The AFFIRM trial in South Africa aims to determine the cost-effectiveness of a task-sharing counselling intervention for maternal depression, delivered by non-specialist community health workers, and to examine factors influencing the implementation of the intervention and future scale up. Second, AFFIRM is building individual and institutional capacity for intervention research in sub-Saharan Africa by providing fellowship and mentorship programmes for candidates in Ethiopia, Ghana, Malawi, Uganda and Zimbabwe. Each year five Fellowships are awarded (one to each country) to attend the MPhil in Public Mental Health, a joint postgraduate programme at the University of Cape Town and Stellenbosch University. AFFIRM also offers short courses in intervention research, and supports PhD students attached to the trials in Ethiopia and South Africa. Third, AFFIRM is collaborating with other regional National Institute of Mental Health funded hubs in Latin America, sub-Saharan Africa and south Asia, by designing and executing shared research projects related to task-sharing and narrowing the treatment gap. Finally, it is establishing a network of collaboration between researchers, non-governmental organisations and government agencies that facilitates the translation of research knowledge into policy and practice. This article describes the developmental process of this multi-site approach, and provides a narrative of challenges and opportunities that have arisen during the early phases. Crucial to the long-term sustainability of this work is the nurturing and sustaining of partnerships between African mental health researchers, policy makers, practitioners and international collaborators. |
Habtamu, Kassahun; Alem, Atalay; Hanlon, Charlotte Conceptualizing and contextualizing functioning in people with severe mental disorders in rural Ethiopia: A qualitative study Journal Article BMC Psychiatry, 15 (1), pp. 1–13, 2015, ISSN: 1471244X. Abstract | Links | BibTeX @article{Habtamu2015,
title = {Conceptualizing and contextualizing functioning in people with severe mental disorders in rural Ethiopia: A qualitative study},
author = {Kassahun Habtamu and Atalay Alem and Charlotte Hanlon},
doi = {10.1186/s12888-015-0418-9},
issn = {1471244X},
year = {2015},
date = {2015-01-01},
journal = {BMC Psychiatry},
volume = {15},
number = {1},
pages = {1--13},
abstract = {Background: The functional outcome of people with severe mental disorders (SMD) is purported to be better in low- and middle-income countries compared to high-income countries; however, cross-cultural measures of functioning may not capture adequately the relevant functional activities in rural, non-Western settings. This study aimed to gain in-depth understanding of day-to-day functioning in a rural Ethiopian setting and the functional impairments associated with SMD. Method: A qualitative study was carried out in the Butajira area, south Ethiopia. In-depth interviews were conducted with people with SMD (n=6), religious healers (n=2) and psychiatric nurses (n=2). Four focus group discussions were carried out with caregivers of people with SMD (n=37) and one with project outreach workers (n=5). A thematic analysis approach was used. Results: Participants emphasized that functional impairment in people with SMD arose not only because of the symptoms associated with the illness, but also due to poverty, social exclusion and lack of social support. Within this rural community, the ability to work productively, engage in family life, maintain self-care and fulfill social obligations were the most highly valued domains of functioning. A wide range of farming tasks were elaborated in detail and noted to be of varying levels of difficulty. Although many people with symptomatic SMD were reported to be able to carry out simple farming tasks, this was distinguished from effective farming. Gender differences were most apparent in the domains of work and family life. Impaired functioning was reported to have a critical immediate impact on survival and longer-term impacts on the lifetime opportunities of people with SMD, their caregivers and the younger generation within the family. Conclusions: The study indicates that tackling social exclusion and poverty is needed alongside medical treatment through contextual community based rehabilitation programs. The gendering of functional roles and the complexity of work activities in this subsistence farming community lend support to arguments for locally contextualized measures of functioning in people with SMD.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: The functional outcome of people with severe mental disorders (SMD) is purported to be better in low- and middle-income countries compared to high-income countries; however, cross-cultural measures of functioning may not capture adequately the relevant functional activities in rural, non-Western settings. This study aimed to gain in-depth understanding of day-to-day functioning in a rural Ethiopian setting and the functional impairments associated with SMD. Method: A qualitative study was carried out in the Butajira area, south Ethiopia. In-depth interviews were conducted with people with SMD (n=6), religious healers (n=2) and psychiatric nurses (n=2). Four focus group discussions were carried out with caregivers of people with SMD (n=37) and one with project outreach workers (n=5). A thematic analysis approach was used. Results: Participants emphasized that functional impairment in people with SMD arose not only because of the symptoms associated with the illness, but also due to poverty, social exclusion and lack of social support. Within this rural community, the ability to work productively, engage in family life, maintain self-care and fulfill social obligations were the most highly valued domains of functioning. A wide range of farming tasks were elaborated in detail and noted to be of varying levels of difficulty. Although many people with symptomatic SMD were reported to be able to carry out simple farming tasks, this was distinguished from effective farming. Gender differences were most apparent in the domains of work and family life. Impaired functioning was reported to have a critical immediate impact on survival and longer-term impacts on the lifetime opportunities of people with SMD, their caregivers and the younger generation within the family. Conclusions: The study indicates that tackling social exclusion and poverty is needed alongside medical treatment through contextual community based rehabilitation programs. The gendering of functional roles and the complexity of work activities in this subsistence farming community lend support to arguments for locally contextualized measures of functioning in people with SMD. |
2014
|
Lund, Crick; Schneider, Marguerite; Davies, Thandi; Nyatsanza, Memory; Honikman, Simone; Bhana, Arvin; Bass, Judith; Bolton, Paul; Dewey, Michael; Joska, John; Kagee, Ashraf; Myer, Landon; Petersen, Inge; Prince, Martin; Stein, Dan J; Thornicroft, Graham; Tomlinson, Mark; Alem, Atalay; Susser, Ezra Task sharing of a psychological intervention for maternal depression in Khayelitsha, South Africa: Study protocol for a randomized controlled trial Journal Article Trials, 15 (1), pp. 1–11, 2014, ISSN: 17456215. Abstract | Links | BibTeX @article{Lund2014,
title = {Task sharing of a psychological intervention for maternal depression in Khayelitsha, South Africa: Study protocol for a randomized controlled trial},
author = {Crick Lund and Marguerite Schneider and Thandi Davies and Memory Nyatsanza and Simone Honikman and Arvin Bhana and Judith Bass and Paul Bolton and Michael Dewey and John Joska and Ashraf Kagee and Landon Myer and Inge Petersen and Martin Prince and Dan J Stein and Graham Thornicroft and Mark Tomlinson and Atalay Alem and Ezra Susser},
doi = {10.1186/1745-6215-15-457},
issn = {17456215},
year = {2014},
date = {2014-01-01},
journal = {Trials},
volume = {15},
number = {1},
pages = {1--11},
abstract = {Background: Maternal depression carries a major public health burden for mothers and their infants, yet there is a substantial treatment gap for this condition in low-resourced regions such as sub-Saharan Africa. To address this treatment gap, the strategy of "task sharing" has been proposed, involving the delivery of interventions by non-specialist health workers trained and supervised by specialists in routine healthcare delivery systems. Several psychological interventions have shown benefit in treating maternal depression, but few have been rigorously evaluated using a task sharing approach. The proposed trial will be the first randomised controlled trial (RCT) evaluating a task sharing model of delivering care for women with maternal depression in sub-Saharan Africa. The objective of this RCT is to determine the effectiveness and cost-effectiveness of a task sharing counseling intervention for maternal depression in South Africa. Methods/Design: The study is an individual-level two-arm RCT. A total of 420 depressed pregnant women will be recruited from two ante-natal clinics in a low-income township area of Cape Town, using the Edinburgh Postnatal Depression Scale to screen for depression; 210 women will be randomly allocated to each of the intervention and control arms. The intervention group will be given six sessions of basic counseling over a period of 3 to 4 months, provided by trained community health workers (CHW)s. The control group will receive three monthly phone calls from a CHW trained to conduct phone calls but not basic counseling. The primary outcome measure is the 17-Item Hamilton Depression Rating Scale (HDRS-17). The outcome measures will be applied at the baseline assessment, and at three follow-up points: 1 month before delivery, and 3 and 12 months after delivery. The primary analysis will be by intention-to-treat and secondary analyses will be on a per protocol population. The primary outcome measure will be analyzed using linear regression adjusting for baseline symptom severity measured using the HDRS-17. Discussion: The findings of this trial can provide policy makers with evidence regarding the effectiveness and cost-effectiveness of structured psychological interventions for maternal depression delivered by appropriately trained and supervised non-specialist CHWs in sub-Saharan Africa. Trial registration: Clinical Trials (ClinicalTrials.gov): NCT01977326, registered on 24/10/2013; Pan African Clinical Trials Registry (www.pactr.org): PACTR201403000676264, registered on 11/10/2013.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: Maternal depression carries a major public health burden for mothers and their infants, yet there is a substantial treatment gap for this condition in low-resourced regions such as sub-Saharan Africa. To address this treatment gap, the strategy of "task sharing" has been proposed, involving the delivery of interventions by non-specialist health workers trained and supervised by specialists in routine healthcare delivery systems. Several psychological interventions have shown benefit in treating maternal depression, but few have been rigorously evaluated using a task sharing approach. The proposed trial will be the first randomised controlled trial (RCT) evaluating a task sharing model of delivering care for women with maternal depression in sub-Saharan Africa. The objective of this RCT is to determine the effectiveness and cost-effectiveness of a task sharing counseling intervention for maternal depression in South Africa. Methods/Design: The study is an individual-level two-arm RCT. A total of 420 depressed pregnant women will be recruited from two ante-natal clinics in a low-income township area of Cape Town, using the Edinburgh Postnatal Depression Scale to screen for depression; 210 women will be randomly allocated to each of the intervention and control arms. The intervention group will be given six sessions of basic counseling over a period of 3 to 4 months, provided by trained community health workers (CHW)s. The control group will receive three monthly phone calls from a CHW trained to conduct phone calls but not basic counseling. The primary outcome measure is the 17-Item Hamilton Depression Rating Scale (HDRS-17). The outcome measures will be applied at the baseline assessment, and at three follow-up points: 1 month before delivery, and 3 and 12 months after delivery. The primary analysis will be by intention-to-treat and secondary analyses will be on a per protocol population. The primary outcome measure will be analyzed using linear regression adjusting for baseline symptom severity measured using the HDRS-17. Discussion: The findings of this trial can provide policy makers with evidence regarding the effectiveness and cost-effectiveness of structured psychological interventions for maternal depression delivered by appropriately trained and supervised non-specialist CHWs in sub-Saharan Africa. Trial registration: Clinical Trials (ClinicalTrials.gov): NCT01977326, registered on 24/10/2013; Pan African Clinical Trials Registry (www.pactr.org): PACTR201403000676264, registered on 11/10/2013. |
Udedi, Michael; Swartz, Leslie; Stewart, Robert C; Kauye, Felix Health service utilization by patients with common mental disorder identified by the Self-Reporting Questionnaire in a primary care setting in Zomba, Malawi: A descriptive study Journal Article International Journal of Social Psychiatry, 60 (5), pp. 454–461, 2014, ISSN: 17412854. Abstract | Links | BibTeX @article{Udedi2014,
title = {Health service utilization by patients with common mental disorder identified by the Self-Reporting Questionnaire in a primary care setting in Zomba, Malawi: A descriptive study},
author = {Michael Udedi and Leslie Swartz and Robert C Stewart and Felix Kauye},
doi = {10.1177/0020764013495527},
issn = {17412854},
year = {2014},
date = {2014-01-01},
journal = {International Journal of Social Psychiatry},
volume = {60},
number = {5},
pages = {454--461},
abstract = {Background: There has been no study carried out to assess health service utilization by people with common mental disorder (CMD) in Malawi. Aim: The aim of the study was to evaluate health service utilization patterns of patients with CMD in primary health care (PHC) clinics. Methods: The study was conducted in two PHC clinics in one of the 28 districts in Malawi. Face-to-face interviews with the Self-Reporting Questionnaire (SRQ-20) were conducted in a sample of 323 PHC attendees aged 18 years and older who attended the PHC clinics for any reason. Results: The prevalence of probable CMD in the sample was 20.1%. People with probable CMD had a higher mean number of health facility visits in the previous three months compared to those without probable CMD (1.6 vs 1.19},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: There has been no study carried out to assess health service utilization by people with common mental disorder (CMD) in Malawi. Aim: The aim of the study was to evaluate health service utilization patterns of patients with CMD in primary health care (PHC) clinics. Methods: The study was conducted in two PHC clinics in one of the 28 districts in Malawi. Face-to-face interviews with the Self-Reporting Questionnaire (SRQ-20) were conducted in a sample of 323 PHC attendees aged 18 years and older who attended the PHC clinics for any reason. Results: The prevalence of probable CMD in the sample was 20.1%. People with probable CMD had a higher mean number of health facility visits in the previous three months compared to those without probable CMD (1.6 vs 1.19 |
There is growing international consensus that a task sharing approach is required to narrow the treatment gap for mental disorders in low and middle-income countries (LMIC). This means essentially that general health workers need to deliver mental health interventions through routine health care delivery systems, supervised by mental health specialists.
The project’s specific aims included:
THE SOUTH AFRICAN TRIAL IN KHAYELITSHA, CAPE TOWN – URBAN AREA
PHASE 2
THE ETHIOPIAN TRIAL IN BUTAJIRA, GURAGE ZONE – RURAL AREA
is being adapted for the Ethiopian context. These culturally appropriate measures will be used primarily as secondary outcome measures, but will also provide important insights into the functional status or people with mental disorders. They will be an important contribution from the AFFIRM project, with potential application in both clinical and research settings.
