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Mootz JJ, de Vos L, Stockton M, Sweetland AC, Kann B, Seijo C, Bezuidenhout C, Suleman A, Feliciano P, Dos Santos PF, Shelton R, Palinkas LA, Wainberg ML. Providers' perspectives of barriers and facilitators to scale-up of mental health care in the public health delivery system of Mozambique: a qualitative inquiry. BMC Health Serv Res 2024; 24:1138. [PMID: 39334160 DOI: 10.1186/s12913-024-11594-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 09/17/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND A central challenge to closing the mental health treatment gap in low- and middle-income countries (LMICs) is determining the most effective pathway for delivering evidence-based mental health services. We are conducting a cluster-randomized, Type 2 hybrid implementation-effectiveness trial across 20 districts of Mozambique called the Partnerships in Research to Implement and Disseminate Sustainable and Scalable EBPs (PRIDE) program. Following training of nonspecialized providers in facilitation of evidence-based treatments for mental health and informed by the Consolidated Framework for Implementation Research (CFIR), we identified how PRIDE compares to care as usual and the perceived barriers and facilitators of implementation and modifications needed for widescale service delivery and scale-up. METHODS We conducted rapid ethnographic assessment using freelisting among 34 providers, followed by four focus group discussions (n = 29 participants) with a subsample of psychiatric technicians and primary care providers from 14 districts in Nampula Province. We used Thematic Analysis to inductively apply open codes to transcripts and then deductively applied the CFIR domains and constructs to organize open codes. RESULTS The main Outer Setting constructs relevant to implementation were recognition that patient mental health needs were significant. Additionally, numerous community-level characteristics were identified as barriers, including distance between clinics; shortage of providers; and low awareness of mental health problems, stigma, and discrimination among community members towards those with mental health struggles. The PRIDE program was perceived to offer a relative advantage over usual care because of its use of task-sharing and treating mental illness in the community. PRIDE addressed Inner Setting barriers of having available resources and training and provider low self-efficacy and limited knowledge of mental illness. Providers recommended leadership engagement to give support for supervision of other task-shared professionals delivering mental healthcare. CONCLUSIONS Primary care providers and psychiatric technicians in Mozambique perceived the relative advantage of the PRIDE program to address mental health treatment access barriers and offered recommendations for successful sustainment and scale up of integrated mental health care.
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Affiliation(s)
- Jennifer J Mootz
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA.
- New York State Psychiatric Institute, 1051 Riverside Drive, Kolb 117, New York, NY, 10032, USA.
| | - Lindsey de Vos
- Research Unit, Foundation for Professional Development, East London, South Africa
| | - Melissa Stockton
- Gillings School of Global Public Health, Epidemiology Department, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
| | - Annika C Sweetland
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, Kolb 117, New York, NY, 10032, USA
| | - Bianca Kann
- London School of Hygiene and tropical Medicine, Global Mental Health Department, London, UK
| | - Chariz Seijo
- College of Humanities and Sciences, Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Antonio Suleman
- Mental Health Department, Mozambique Ministry of Health, Maputo, Mozambique
| | - Paulino Feliciano
- Mental Health Department, Mozambique Ministry of Health, Maputo, Mozambique
| | | | - Rachel Shelton
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Lawrence A Palinkas
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, USA
| | - Milton L Wainberg
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, Kolb 117, New York, NY, 10032, USA
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Mukala Mayoyo E, Criel B, Sow A, Coppieters Y, Chenge F. Understanding the mix of services for mental health care in urban DR Congo: a qualitative descriptive study. BMC Health Serv Res 2023; 23:1206. [PMID: 37925407 PMCID: PMC10625694 DOI: 10.1186/s12913-023-10219-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/26/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Mental health workers (MHWs) are exposed to conflicts of competence daily when performing tasks related to the provision of mental health services. This may be linked to a lack of understanding of their tasks as caregivers and providers. Furthermore, in most low-income settings, it is unclear how the available services are organized and coordinated to provide mental health care. To understand the above, this study aimed to identify the current mix of services for mental health care in the urban Democratic Republic of the Congo (DRC). METHODS A qualitative descriptive study was carried out in Lubumbashi from February to April 2021. We conducted 7 focus group discussions (FGDs) with 74 key informants (family members, primary care physicians, etc.) and 13 in-depth interviews (IDIs) with key informants (traditional healers, psychiatrists, etc.). We performed a qualitative content analysis, guided by an analytical framework, that led to the development of a comprehensive inventory of MHWs from the household level to specialized facilities, exploring their tasks in care delivery, identifying existing services, and defining their current organization. RESULTS Analysis of transcripts from the FGDs and IDIs showed that traditional healers and family caregivers are the leading providers in Lubumbashi. The exploration of the tasks performed by MHWs revealed that lifestyle, traditional therapies, psychotherapy, and medication are the main types of care offered/advised to patients. Active informal caregivers do not currently provide care corresponding to their competencies. The rare mental health specialists available do not presently recognize the tasks of primary care providers and informal caregivers in care delivery, and their contribution is considered marginal. We identified five types of services: informal services, traditional therapy services, social services, primary care services, and psychiatric services. Analyses pointed out an inversion of the ideal mix of these services. CONCLUSIONS Our findings show a suboptimal mix of services for mental health and point to a clear lack of collaboration between MHWs. There is an urgent need to clearly define the tasks of MHWs, build the capacity of nonspecialists, shift mental health-related tasks to them, and raise awareness about collaborative care approaches.
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Affiliation(s)
- Erick Mukala Mayoyo
- School of Public Health, University of Lubumbashi, Lubumbashi, DR, Congo.
- School of Public Health, Université Libre de Bruxelles, Brussels, Belgium.
- Department of Community Health, Institut Supérieur des Techniques Médicales de Kananga, Kananga, DR, Congo.
- National Mental Health Program, Ministry of Public Health, Hygiene and Prevention, Kinshasa, DR, Congo.
- Centre de Connaissances en Santé en RD Congo, Kinshasa, DR, Congo.
| | - Bart Criel
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Abdoulaye Sow
- Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Yves Coppieters
- School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Faustin Chenge
- School of Public Health, University of Lubumbashi, Lubumbashi, DR, Congo
- Centre de Connaissances en Santé en RD Congo, Kinshasa, DR, Congo
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Sack DE, Matino A, Graves E, Emilio A, Shepherd BE, De Schacht C, Audet CM. Correlated depressive symptoms within seroconcordant, expectant partners living with HIV in Zambézia Province, Mozambique: a cross-sectional study. AIDS Care 2023; 35:1732-1740. [PMID: 36473205 PMCID: PMC10241982 DOI: 10.1080/09540121.2022.2151558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
Approximately 15% of people with HIV in sub-Saharan Africa have comorbid depression, which impacts treatment outcomes. We describe predictors of baseline depressive symptoms in 1079 female and 1079 male participants in a cluster-randomized trial in Zambézia Province, Mozambique from November 2017 to December 2020. We modeled each partners' depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]) using proportional odds models adjusted for enrollment date, age, body mass index [BMI], partner's PHQ-9 score, district, relationship status, education, occupation, WHO HIV clinical stage, and antiretroviral therapy use history. A post hoc analysis assessed covariate-adjusted rank correlation between partner depressive symptoms. Females were younger than males (median 23 vs. 28 years) and more likely to report no education (20.7% vs. 7.9%). Approximately 10% screened positive for depression (PHQ-9 score ≥ 10). Partner depressive symptoms were predictive of higher participant PHQ-9 scores. A male partner PHQ-9 score of 10 (versus 5) increased the odds that the female partner would have a higher PHQ-9 score (adjusted odds ratio: 7.25, 95% Confidence Interval [CI]: 5.43-9.67). Partner PHQ-9 scores were highly correlated after covariate adjustment (Spearman's rho 0.65, 95% CI 0.57-0.72). Interventions aimed to reduce depressive symptoms and improve HIV-related outcomes during pregnancy should address both partners' depressive symptoms.
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Affiliation(s)
- Daniel E Sack
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Erin Graves
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Bryan E Shepherd
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Carolyn M Audet
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
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Stockton MA, Mazinyo EW, Mlanjeni L, Nogemane K, Ngcelwane N, Sweetland AC, Basaraba C, Bezuidenhout C, Sansbury G, Lovero KL, Gouveia ML, dos Santos PF, Feliciano P, Fumo W, Suleman A, Oquendo MA, Grobler C, Wall MM, Nobatyi P, Medina-Marino A, Wainberg ML. An Ultra-Brief Proxy Measure for Early Mental and Substance Use Disorders and Suicide Risk Case Detection at the Community and Household Level: An Efficient and Feasible Clinical and Population-level Service Needs Screening Tool. MEDICAL RESEARCH ARCHIVES 2023; 11:10.18103/mra.v11i10.4381. [PMID: 39119120 PMCID: PMC11309766 DOI: 10.18103/mra.v11i10.4381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
Valid mental and substance use disorders and suicide risk screening tools are needed for community case finding of individuals who may not otherwise seek care. We evaluated the Proxy Mental Wellness Tool-3 (mwTool-3-proxy) a three-item screener that asks about the mental health of another adult, against a diagnostic gold standard in Mozambique and South Africa. The mwTool-3-proxy adapts the three items of the Mental Wellness Tool-3, developed in Mozambique using Mini International Neuropsychiatric Interview diagnoses as the criterion standard, regression modeling and expert consultation to determine the best three items for identifying any mental disorder. The Mental Wellness Tool-3 has been validated in South Africa, Spain and the United States, and is being validated in three countries in the Asia-Pacific and Israel. Pairs of adults in South Africa and Mozambique at primary and tertiary healthcare facilities were separately screened with the mwTool-3-proxy and diagnosed using the Mini International Neuropsychiatric Interview. We calculated the sensitivities and specificities for predicting any mental and/or substance use disorder and suicide risk among the proxy individual. We performed additional analyses restricted to respondents who were relatives of one another and who lived in the same household. The prevalence of any Mini International Neuropsychiatric Interview-diagnosed disorder among the 229 pairs in both countries was 35.6% (38.5% in Mozambique; 32.9% in South Africa). The pooled sensitivity of the mwTool-3-proxy for identifying any disorder among the proxy individual was 73.01 (95%CI: 65.5-79.65) - 70.24 (95%CI: 59.27-79.73) in Mozambique and 80.00 (95%CI 69.17-88.35) in South Africa. The mwTool-3-proxy is a culturally-relevant, ultra-brief valid measure that can improve mental and substance use disorders and suicide risk case detection with strong sensitivity at the community and household level and offer a means to efficiently and feasibly collect clinical and population-level service needs data.
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Affiliation(s)
- Melissa A Stockton
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Ernesha Webb Mazinyo
- University of California Global Health Institute, University of California, San Francisco, USA
- Research Unit, Foundation for Professional Development, Buffalo City Metro, Eastern Cape Province, South Africa
| | - Lungelwa Mlanjeni
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Kwanda Nogemane
- Eastern Cape Provincial Department of Health, Buffalo City Metro Health District, South Africa
| | - Nondumiso Ngcelwane
- Eastern Cape Provincial Department of Health, Buffalo City Metro Health District, South Africa
| | - Annika C. Sweetland
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, USA
- New York State Psychiatric Institute, New York, USA
| | - Cale Basaraba
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Charl Bezuidenhout
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | | | - Kathryn L. Lovero
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, USA
| | - Maria Lídia Gouveia
- Ministry of Health of Mozambique, Mental Health Department, Maputo, Mozambique
| | | | - Paulino Feliciano
- Ministry of Health of Mozambique, Mental Health Department, Maputo, Mozambique
| | - Wilza Fumo
- Ministry of Health of Mozambique, Mental Health Department, Maputo, Mozambique
| | - Antonio Suleman
- Ministry of Health of Mozambique, Mental Health Department, Maputo, Mozambique
| | - Maria A. Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Christoffel Grobler
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Melanie M Wall
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, USA
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Phumza Nobatyi
- Eastern Cape Provincial Department of Health, Buffalo City Metro Health District, South Africa
| | - Andrew Medina-Marino
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Milton L. Wainberg
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, USA
- New York State Psychiatric Institute, New York, USA
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Abstract
PURPOSE OF REVIEW We review recent research on the epidemiology and etiology of suicide in the global context. We focus on data from low- and middle-income countries (LMIC), with the goal of highlighting findings from these under-researched, over-burdened settings. RECENT FINDINGS Prevalence of suicide in LMIC adults varies across region and country income-level, but is, on average, lower than in high-income countries. Recent gains in suicide reduction, however, have been smaller in LMIC compared to global rates. LMIC youth have much higher rates of suicide attempts than youth from high-income countries. Females as well as people with psychiatric disorders, those living with HIV, those who are LGBTQ + , and those with poor socioeconomic status are highly vulnerable populations in LMIC. Limited and low-quality data from LMIC hinder clear interpretation and comparison of results. A greater body of more rigorous research is needed to understand and prevent suicide in these settings.
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Affiliation(s)
- Kathryn L Lovero
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | | | - Amalio X Come
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Milton L Wainberg
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Maria A Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 200, Philadelphia, PA, 19104, USA.
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Giusto A, Romer A, Lovero K, dos Santos PF, Greene C, Gouveia L, Suleman A, Feliciano P, Oquendo MA, Mootz J, Wainberg ML. Examination of the Factor Structure of Psychopathology in a Mozambican Sample. Clin Psychol Sci 2023; 11:409-424. [PMID: 37181407 PMCID: PMC10181828 DOI: 10.1177/21677026221122773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Factor-analytic studies are needed in global samples to advance understanding of psychopathology. We aimed to examine the structure of psychopathology and a general psychopathology ('p') factor using data from a cross-sectional study of 971 adults (63% women) from Maputo City, Mozambique. We used confirmatory factor analyses of symptoms from 15 psychiatric disorders to test common models of the structure of psychopathology. Models including internalizing, substance use, and thought disorder factors as well as a general p-factor fit the data well. Measurement invariance testing revealed that factor loadings on p differed by gender. Higher levels of p, internalizing, and thought disorder factors were associated with greater suicide risk, psychiatric comorbidity, chronic medical illnesses, and poorer functioning. A general psychopathology ('p') factor and internalizing, substance use, and thought disorder factors are identifiable in this Mozambican sample. Understanding psychopathology dimensions is a step toward building more scalable mental health service approaches globally.
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Affiliation(s)
- Ali Giusto
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Dr. Unit #24, New York, New York, USA
| | - Adrienne Romer
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
- Harvard Medical School, Belmont, MA, USA
| | - Kathryn Lovero
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Palmira Fortunado dos Santos
- Department of Mental Health, Ministry of Health, Av. Eduardo Mondlane/Av. Salvador Allende P.O. Box 1613, Maputo, Mozambique
| | - Claire Greene
- Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Lidia Gouveia
- Department of Mental Health, Ministry of Health, Av. Eduardo Mondlane/Av. Salvador Allende P.O. Box 1613, Maputo, Mozambique
| | - Antonio Suleman
- Department of Mental Health, Ministry of Health, Av. Eduardo Mondlane/Av. Salvador Allende P.O. Box 1613, Maputo, Mozambique
| | - Paulino Feliciano
- Department of Mental Health, Ministry of Health, Av. Eduardo Mondlane/Av. Salvador Allende P.O. Box 1613, Maputo, Mozambique
| | - Maria A. Oquendo
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street Suite 200, Philadelphia, Pennsylvania, USA
| | - Jennifer Mootz
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Dr. Unit #24, New York, New York, USA
| | - Milton L. Wainberg
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Dr. Unit #24, New York, New York, USA
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Wang L, Yi Z. Marital status and all-cause mortality rate in older adults: a population-based prospective cohort study. BMC Geriatr 2023; 23:214. [PMID: 37016371 PMCID: PMC10074686 DOI: 10.1186/s12877-023-03880-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 03/09/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Living with a partner and separation is becoming more common among older people. Mortality disparities associated with marital status are significant in increasingly diverse aging populations. The link between marital status and all-cause mortality risk in older adults remains uncertain. METHODS This prospective cohort study included data from the US National Health and Nutrition Examination Survey (NHANES). We included NHANES participants ≥ 60 years of age (data from 1999 to 2014). Data for mortality follow-up beginning from the commencement date of survey participation to the last day of December 2015. Univariate- and multivariate-adjusted Cox proportional hazard models for marital status were estimated, and the findings were presented as regression coefficients and 95% confidence intervals (CI). Kaplan-Meier curves were reported. RESULTS Compared to never married individuals, the risk of all-cause mortality was 0.77 (0.50-1.18), 0.72 (0.56-0.93), 0.56 (0.36-0.88), and 0.84 (0.67-1.07) in those people living with a partner, married, separated, and divorced, respectively, after adjusting for demographics, socioeconomics, behavior, anthropometric variables, and medical history. The risk of all-cause mortality was 1.24 (0.97-1.59) in widowed participants. CONCLUSION This population-based cohort study included a large sample size followed by long-term follow-up. The association between marriage, health, and reduced mortality in older individuals has been illustrated in this study. Being married or separated was associated with a lower risk of mortality.
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Affiliation(s)
- Lei Wang
- Department of Cardiology, Aerospace Center Hospital, 15 Yuquan Road, Haidian District, 100049, Beijing, PR China
| | - Zhong Yi
- Department of Geriatric Medicine, Aerospace Center Hospital, 15 Yuquan Road, Haidian District, 100049, Beijing, PR China.
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Muanido A, Cumbe V, Manaca N, Hicks L, Fabian KE, Wagenaar BH. Prevalence and associated factors of common mental disorders in primary care settings in Sofala Province, Mozambique. BJPsych Open 2023; 9:e12. [PMID: 36632814 PMCID: PMC9885355 DOI: 10.1192/bjo.2022.613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/21/2022] [Accepted: 11/05/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND In Mozambique, the prevalence of common mental illness in primary care is not well established. AIMS This study aimed to assess the prevalence of, and associated factors for, common mental illness in patients accessing primary care services in three Ministry of Health clinics in Mozambique. METHOD Adult patients were recruited from the waiting rooms of prenatal, postpartum and general out-patient consultations. A mental health professional administered a diagnostic interview to examine prevalence of major depressive disorder (MDD), generalised anxiety disorder (GAD), post-traumatic stress disorder (PTSD) and any substance misuse or dependence. Generalised linear mixed models were used to examine the odds of each disorder and sociodemographic associations. RESULTS Of 502 patients interviewed, 74.1% were female (n = 372) and the average age was 27.8 years (s.d. = 7.4). Of all participants, 23.9% (n = 120) met diagnostic criteria for at least one common mental disorder; 8.6% were positive for MDD (n = 43), 13.3% were positive for GAD (n = 67), 4.8% were positive for PTSD (n = 24) and 4.0% were positive for any substance misuse or dependence (n = 20). Patients attending prenatal or postpartum consultations had significantly lower odds of any common mental disorder than patients attending out-patient primary care. Age was negatively associated with MDD, but positively associated with substance misuse or dependence. CONCLUSIONS Over 20% of patients attending primary care in Mozambique may have common mental disorders. A specific focus on patients attending general out-patient visits, young people for depression, and older people and men for substance misuse/dependence would provide a targeted response to high-risk demographics.
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Affiliation(s)
| | - Vasco Cumbe
- Sofala Provincial Health Directorate, Department of Mental Health, Ministry of Health, Mozambique
| | | | - Lee Hicks
- Health Alliance International, Washington, USA
| | - Katrin E. Fabian
- Department of Global Health, University of Washington, Washington, USA
| | - Bradley H. Wagenaar
- Health Alliance International, Washington, USA; Department of Global Health, University of Washington, Washington, USA; and Department of Epidemiology, University of Washington, Washington, USA
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Padrós-Blázquez F, Pintor Sánchez BE, Valdés García KP. Análisis psicométrico de la escala de ideación suicida de Roberts en universitarios mexicanos. PSICUMEX 2022. [DOI: 10.36793/psicumex.v13i1.513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
El incremento observado en las tasas de suicidio en jóvenes hace necesario contar con escalas de cribaje para la identificación de personas en riesgo. La escala de ideación suicida de Roberts (EIS) es un instrumento breve que ha mostrado propiedades psicométricas adecuadas en adolescentes mexicanos. El objetivo del presente estudio fue corroborar la estructura de dicho instrumento mediante un análisis factorial confirmatorio (AFC) y analizar sus propiedades psicométricas en estudiantes universitarios. Aplicando un método cuantitativo instrumental, se administró la EIS a 1190 universitarios. Los resultados del AFC corroboran la estructura unifactorial de la EIS; asimismo, la consistencia interna, reportada con el alfa de Cronbach ordinal (αO = 0.813), resultó adecuada. Se concluye que el instrumento muestra una estructura unifactorial y que las características psicométricas de los reactivos fueron adecuadas, resalta que 2.9 % de la muestra obtuvo una puntuación que indica alto riesgo suicida.
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Cumbe VFJ, Manaca MN, Atkins DL, Muanido A, Hicks L, Oquendo MA, de Jesus Mari J, Wagenaar BH. Prevalence and correlates of suicidal behavior in primary care settings in Mozambique. BMC Psychiatry 2022; 22:423. [PMID: 35739519 PMCID: PMC9218046 DOI: 10.1186/s12888-022-04059-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 06/13/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND This study assessed the prevalence of suicidal behavior and associated risk factors in public primary health care in Mozambique. METHODS The Mini International Neuropsychiatric Interview was used to evaluate suicidal behavior among 502 adults attending three Primary Health Care (PHC) settings. RESULTS In the past month, 13% (n = 63) of PHC attendees expressed suicidal ideation, 8% (n = 40) had made a suicide plan, 4% (n = 20) had made a suicide attempt, and 5% (n = 25) reported a lifetime suicide attempt. Females had 2.8-fold increased odds of suicide plan (95% CI: 1.5, 5.5) and 3.3-fold increased odds of suicide attempt in the past month (95% CI: 1.2, 9.1). Each 10-year increase in age was associated with 0.61-fold the odds of suicide plan (95% CI: 0.38, 0.98) and 0.09-fold the odds of suicide attempt (95% CI: 0.01, 0.69) in the past month. People living with HIV (PLWHA) had 2.2-fold increased adjusted odds of past month suicide attempt (CI: 1.1, 4.1). CONCLUSION Suicidal behaviors are common among adults attending PHC clinics in Mozambique. Screening and linkage to effective preventive interventions are urgently needed in PHC settings. Females, younger individuals, and PLWHA are at elevated risk for suicidal behavior in PHC.
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Affiliation(s)
- Vasco F. J. Cumbe
- grid.415752.00000 0004 0457 1249Mental Health Department, Ministry of Health, Provincial Health Directorate of Sofala, Beira, Mozambique ,grid.8295.60000 0001 0943 5818Mental Health and Psychiatry Department, Faculty of Medicine, Eduardo Mondlane University (UEM), Maputo, Mozambique ,Medicine Department, Psychiatry and Mental Health Service, Beira Central Hospital, Sofala, Beira, Mozambique ,grid.411249.b0000 0001 0514 7202Departamento de Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil
| | | | - Dana L. Atkins
- grid.34477.330000000122986657Department of Global Health, University of Washington, Seattle, WA USA
| | | | | | - Maria A. Oquendo
- grid.25879.310000 0004 1936 8972Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Jair de Jesus Mari
- grid.411249.b0000 0001 0514 7202Departamento de Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil
| | - Bradley H. Wagenaar
- grid.34477.330000000122986657Department of Global Health, University of Washington, Seattle, WA USA ,grid.429096.0Health Alliance International, Seattle, WA USA ,grid.34477.330000000122986657Department of Epidemiology, University of Washington, Seattle, WA USA
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11
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Gbadamosi IT, Henneh IT, Aluko OM, Yawson EO, Fokoua AR, Koomson A, Torbi J, Olorunnado SE, Lewu FS, Yusha'u Y, Keji-Taofik ST, Biney RP, Tagoe TA. Depression in Sub-Saharan Africa. IBRO Neurosci Rep 2022; 12:309-322. [PMID: 35746974 PMCID: PMC9210463 DOI: 10.1016/j.ibneur.2022.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 03/14/2022] [Indexed: 12/23/2022] Open
Abstract
Mood disorders can be considered among the most common and debilitating mental disorders. Major depression, as an example of mood disorders, is known to severely reduce the quality of life as well as psychosocial functioning of those affected. Its impact on the burden of disease worldwide has been enormous, with the World Health Organisation projecting depression to be the leading cause of mental illness by 2030. Despite several studies on the subject, little has been done to contextualise the condition in Africa, coupled with the fact that there is still much to be understood on the subject. This review attempts to shed more light on the prevalence of depression in Sub-Saharan Africa (SSA), its pathophysiology, risk factors, diagnosis and the experimental models available to study depression within the sub-region. It also evaluates the contribution of the sub-region to the global research output of depression as well as bottlenecks associated with full exploitation of the sub region's resources to manage the disorder.
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Affiliation(s)
- Ismail Temitayo Gbadamosi
- Department of Anatomy, University of Ilorin, Nigeria
- Laboratory for Translational Research in Neuropsychiatric Disorders, BRAINCITY Nencki-EMBL Center of Excellence for Neural Plasticty and Brain Disorders, Warsaw, Poland
| | - Isaac Tabiri Henneh
- Department of Pharmacotherapeutics and Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University of Cape Coast, Ghana
| | - Oritoke Modupe Aluko
- Department of Physiology, School of Basic Medical Sciences, Federal University of Technology, Akure, Nigeria
| | | | | | - Awo Koomson
- Department of Pharmacology and Toxicology University of Ghana, Ghana
| | - Joseph Torbi
- Department of Pharmacology and Toxicology University of Ghana, Ghana
| | | | | | - Yusuf Yusha'u
- Department of Human Physiology Ahmadu Bello University, Zaria, Nigeria
| | | | - Robert Peter Biney
- Department of Pharmacotherapeutics and Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University of Cape Coast, Ghana
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12
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O’Grady MA, Mootz J, Suleman A, Sweetland A, Teodoro E, Anube A, Feliciano P, Bezuidenhout C, Dos Santos PF, Fumo W, Gouveia L, Pinsky I, Mello M, Kann B, Wainberg ML. Mobile technology and task shifting to improve access to alcohol treatment services in Mozambique. J Subst Abuse Treat 2022; 134:108549. [PMID: 34210568 PMCID: PMC8702577 DOI: 10.1016/j.jsat.2021.108549] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/09/2021] [Accepted: 06/15/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Unhealthy alcohol use (UAU) is a major public health challenge, particularly in low- and middle-income countries. Mozambique is the fourth poorest country in the world where half of the population lives below the poverty line. UAU is frequent among drinkers in Mozambique; however, resources and infrastructure to treat UAU are very limited. This paper examines how task-shifting and a provider-facing mobile health application are being used to improve access to care. In this paper, the feasibility, acceptability and appropriateness of a provider-facing mobile health application being used under a task-shifting model to identify UAU and provide a four-session brief motivational interviewing intervention are described. METHOD The study used a sequential exploratory mixed-methods design with a QUAL → quan structure. First, 15 psychiatric technicians and primary care providers in Mozambique's Nampula Province participated in semi-structured interviews. These interviews were recorded and transcribed. Then, 45 providers completed a 12-item quantitative survey on tablets. Quantitative analysis used descriptive statistic calculation and qualitative analysis used thematic analysis. RESULTS Nonspecialized providers found the mobile health app to be acceptable, appropriate, and feasible when delivering a 4-session brief motivational intervention under a task-shifting model. Central benefits of the technology were enhanced standardization and efficiency of sessions as well as feelings of legitimacy when interacting with patients. Main concerns were feasibility of implementing the intervention due to time constraints of workload and internet connectivity issues. CONCLUSIONS Provider-facing technology shows promise in supporting task-shifting models that can expand alcohol intervention services and increase access to care in low- and middle-income countries. Providers without specialized training in behavioral health interventions can provide critical services to patients with UAU and provider-facing mobile health applications may help bring such models to scale.
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Affiliation(s)
- Megan A. O’Grady
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, Corresponding Author: Megan A. O’Grady, Assistant Professor, Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Ave., Farmington, CT, 06030-6325; ; 860-679-5483
| | - Jennifer Mootz
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY
| | - Antonio Suleman
- Department of Psychiatry and Mental Health, Psychiatric Hospital of Nampula, Mozambique
| | - Annika Sweetland
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY
| | - Eugénia Teodoro
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Anibal Anube
- Department of Psychiatry and Mental Health, Psychiatric Hospital of Nampula, Mozambique
| | - Paulino Feliciano
- Department of Psychiatry and Mental Health, Psychiatric Hospital of Nampula, Mozambique
| | - Charl Bezuidenhout
- Research Unit, Foundation for Professional Development, Pretoria, South Africa
| | | | - Wilza Fumo
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Lidia Gouveia
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Ilana Pinsky
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY
| | - Milena Mello
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY
| | - Bianca Kann
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY
| | - Milton L. Wainberg
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY
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13
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Jurinsky J, Perkins JM, Kakuhikire B, Nyakato VN, Baguma C, Rasmussen JD, Satinsky EN, Ahereza P, Kananura J, Audet CM, Bangsberg DR, Tsai AC. Ease of marital communication and depressive symptom severity among men and women in rural Uganda: cross-sectional, whole-population study. Soc Psychiatry Psychiatr Epidemiol 2022; 57:343-352. [PMID: 34355265 PMCID: PMC8792190 DOI: 10.1007/s00127-021-02135-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/22/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE Depression is a major contributor to the global burden of disease. The extent to which marital communication may influence depression in contexts with little mental health support is unknown. METHODS We conducted a whole-population study of married adult residents of eight villages in a rural region of southwestern Uganda. Depression symptom severity was measured using a modified version of the Hopkins Symptom Checklist for Depression, with > 1.75 classified as a positive screen for probable depression. Respondents were asked to report about ease of marital communication ('never easy', 'easy once in a while', 'easy most of the time' or 'always easy'). Sex-stratified, multivariable Poisson regression models were fit to estimate the association between depression symptom severity and marital communication. RESULTS Among 492 female and 447 male participants (response rate = 96%), 23 women and 5 men reported communication as 'never easy' and 154 women and 72 men reported it as 'easy once in a while'. Reporting communication as 'never easy' was associated with an increased risk of probable depression among women (adjusted relative risk [ARR], 2.06; 95% confidence interval [CI], 1.08-3.93, p = 0.028) and among men (ARR, 7.10; 95% CI 1.70-29.56, p = 0.007). CONCLUSION In this whole-population study of married adults in rural Uganda, difficulty of marital communication was associated with depression symptom severity. Additional research is needed to assess whether communication training facilitated by local leaders or incorporated into couples-based services might be a novel pathway to address mental health burden.
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Affiliation(s)
| | - Jessica M. Perkins
- Peabody College, Vanderbilt University, Nashville, TN, USA,Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA,Corresponding author: Dr. Jessica M. Perkins, , Phone: (615) 875-3289, Fax: 615-343-2661
| | | | | | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Emily N. Satinsky
- Center for Global Health, Massachusetts General Hospital, Boston MA USA
| | - Phionah Ahereza
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Justus Kananura
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Carolyn M. Audet
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA,University of Witwatersrand, Johannesburg, South Africa
| | - David R. Bangsberg
- Mbarara University of Science and Technology, Mbarara, Uganda,Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
| | - Alexander C. Tsai
- Mbarara University of Science and Technology, Mbarara, Uganda,Center for Global Health, Massachusetts General Hospital, Boston MA USA,Harvard Medical School, Boston, MA, USA,Mongan Institute, Massachusetts General Hospital, Boston MA USA
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14
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Cumbe VFJ, Muanido A, Manaca MN, Fumo H, Chiruca P, Hicks L, de Jesus Mari J, Wagenaar BH. Validity and item response theory properties of the Patient Health Questionnaire-9 for primary care depression screening in Mozambique (PHQ-9-MZ). BMC Psychiatry 2020; 20:382. [PMID: 32698788 PMCID: PMC7374823 DOI: 10.1186/s12888-020-02772-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 06/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression is one of the leading causes of disability in Mozambique; however, few patients with depression are identified in primary care. To our knowledge, there are no validated tools for depression screening in Mozambique. The aim of this study was to validate the Patient Health Questionnaire-9 (PHQ-9) for use in primary care settings in Mozambique. METHODS The PHQ-9 was adapted using a structured multi-phase process led by a team of bilingual experts followed by a review by lay individuals and pilot-testing including cognitive interviews. The final Mozambican PHQ-9 (PHQ-9-MZ) was applied among 502 individuals randomly selected from antenatal, postpartum, and general outpatient consultations in three Ministry of Health primary healthcare clinics in Sofala Province, Mozambique. The PHQ-9-MZ was evaluated against the MINI 5.0-MZ as a gold standard diagnostic tool. RESULTS The majority of participants were female (74%), with a mean age of 28. Using the MINI 5.0-MZ, 43 (9%) of the sample tested positive for major depressive disorder. Items of the PHQ-9-MZ showed good discrimination and factor loadings. One latent factor of depression explained 54% of the variance in scores. Questions 3 (sleep) and 5 (appetite) had the lowest item discrimination and factor loadings. The PHQ-9-MZ showed good internal consistency, with a Cronbach's alpha of 0.84, and an area under the receiver operating characteristic curve (AUROC) of 0.81 (95% CI: 0.73, 0.89). The PHQ-2-MZ had an AUROC of 0.78 (95% CI: 0.70, 0.85). Using a cut-point of ≥9, the PHQ-9-MZ had a sensitivity of 46.5% and a specificity of 93.5%. Using a cut-point of ≥2, the PHQ-2-MZ had a sensitivity of 74.4% and a specificity of 71.7%. Increasing the cut-point to ≥3, the PHQ-2-MZ has a sensitivity of 32.6% and a specificity of 94.6%. CONCLUSIONS The PHQ-9-MZ and PHQ-2-MZ emerge as two valid alternatives for screening for depression in primary health care settings in Mozambique. Depending on program needs and weighing the value of minimizing false positives and false negatives, the PHQ-9-MZ can be employed with cut-points ranging from ≥8 to ≥11, and the PHQ-2-MZ with cut-points ranging from ≥2 to ≥3.
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Affiliation(s)
- Vasco F J Cumbe
- Department of Mental Health, Sofala Provincial Health Directorate, Ministry of Health, Rua Poder Popular n.° 11 - 50. Caixa Postal 583. 4° Andar, Beira, Sofala, Moçambique.
- Departamento de Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Moçambique.
| | | | | | - Hélder Fumo
- Department of Mental Health, Sofala Provincial Health Directorate, Ministry of Health, Rua Poder Popular n.° 11 - 50. Caixa Postal 583. 4° Andar, Beira, Sofala, Moçambique
| | - Pedro Chiruca
- Department of Mental Health, Sofala Provincial Health Directorate, Ministry of Health, Rua Poder Popular n.° 11 - 50. Caixa Postal 583. 4° Andar, Beira, Sofala, Moçambique
| | | | - Jair de Jesus Mari
- Departamento de Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Bradley H Wagenaar
- Health Alliance International, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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