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Ionescu A, Mannell J, Vaughan M, Burgess R. Misunderstood and underappreciated: a critical review of mental health advocacy and activism in low- and middle-income countries. Health Policy Plan 2024; 39:528-539. [PMID: 38441280 PMCID: PMC11095268 DOI: 10.1093/heapol/czae016] [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: 03/06/2023] [Revised: 02/12/2024] [Accepted: 02/22/2024] [Indexed: 05/16/2024] Open
Abstract
Mental health advocacy and activism have been highlighted as important in the effort towards creating environments for better mental health. However, relevant research in low- and middle-income country settings remains limited and lacks critical exploration. We seek to contribute to filling this gap by exploring driving factors behind mental health advocacy and activism efforts in low- and middle-income country settings. This review uses a critically informed thematic analysis employing conceptual frameworks of productive power to analyse peer-reviewed articles on mental health advocacy or activism over the last 20 years. We suggest that the current body of research is marred by superficial explorations of activism and advocacy, partly due to a lack of cohesion around definitions. Based on our findings, we suggest a conceptual framework to guide deeper explorations of mental health advocacy and activism. This framework identifies 'legitimacy', 'context' and 'timing' as the main dimensions to consider in understanding activism and advocacy efforts. The fact that they remain misunderstood and underappreciated creates missed opportunities for meaningful inclusion of lived experience in policy decisions and limits our understanding of how communities envision and enact change.
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Affiliation(s)
- Alma Ionescu
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, United Kingdom
| | - Jenevieve Mannell
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, United Kingdom
| | - Megan Vaughan
- Institute for Advanced Studies, University College London, South Wing, Wilkins Building, Gower Street, London WC1E 6BT, United Kingdom
| | - Rochelle Burgess
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, United Kingdom
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Kumar A, Bartoli B, Lichand G, Wolf S. Sociodemographic predictors of depression and anxiety symptomatology among parents in rural Côte d'Ivoire. J Affect Disord 2023; 338:1-9. [PMID: 37245553 DOI: 10.1016/j.jad.2023.05.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/12/2023] [Accepted: 05/18/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND In Côte d'Ivoire, cocoa farming is a widespread practice in rural households, an occupation with increased risks of depression and anxiety exacerbated by economic instability. We used the Goldberg-18 Depression and Anxiety diagnostic tool to identify predictors of depressive and anxiety symptomatology among a sample of parents in rural cocoa farming communities. METHODS In a cross-sectional survey, the Goldberg-18 was administered to Ivorian parents (N = 2471). Confirmatory factor analysis (CFA) was conducted to confirm the factor structure of the assessment tool, and Ordinary Least Squares (OLS) regression with clustered standard errors was used to identify sociodemographic predictors of symptomatology. RESULTS CFA showed adequate fit statistics for a two-factor model measuring depressive and anxiety symptoms. Among respondents, 87 % screened positive for requiring further referral for clinical diagnosis. Sociodemographic predictors of depressive and anxiety symptoms were similar for males and females. For the total sample, higher monthly income, more years of education, and belonging to the Mandinka ethnic group predicted fewer depressive and anxiety symptoms. In contrast, higher depressive and anxiety symptomatology were associated with age. Single marital status predicted increased anxiety but not depressive symptoms for the full sample model and the female only sample, but not the male sample. LIMITATIONS This is a cross-sectional study. CONCLUSIONS The Goldberg-18 measures distinct domains of depressive and anxiety symptoms in a rural Ivorian sample. Age and single marital status are predictors of increased symptoms. Higher monthly income, higher education, and certain ethnic affiliations are protective factors.
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Affiliation(s)
- Anahita Kumar
- University of Pennsylvania, Graduate School of Education, United States of America.
| | | | | | - Sharon Wolf
- University of Pennsylvania, Graduate School of Education, United States of America
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Irusen H, Fernandez P, Van der Merwe A, Suliman S, Esterhuizen T, Lazarus J, Parkes J, Seedat S. Depression, Anxiety, and Their Association to Health-Related Quality of Life in Men Commencing Prostate Cancer Treatment at Tertiary Hospitals in Cape Town, South Africa. Cancer Control 2022; 29:10732748221125561. [PMID: 36112984 PMCID: PMC9478688 DOI: 10.1177/10732748221125561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Comorbid depression and anxiety in men with localised prostate cancer (CaP)
largely go undiagnosed and untreated and their effects on health-related
quality of life (HRQOL) in men with CaP should not be underestimated. We
examined the prevalence of depression and anxiety and its association with
HRQOL in men about to commence treatment for CaP and the differences between
treatment groups, radical prostatectomy (RP) and radiation therapy (RT). Method One hundred and seven participants from a longitudinal prospective
observational study assessing depression, anxiety and HRQOL in men with
localised CaP (DAHCaP), were used in this cross-sectional analysis. Data
were collected shortly before participants were scheduled to receive their
treatment. The Centre for Epidemiologic Studies Depression Scale (CES-D),
the State Trait Anxiety Inventory (STAI), the Memorial Anxiety Scale for
Prostate Cancer (MAX-PC), the European Organisation for Research and
Treatment in Cancer Quality of Life questionnaire (EORTC QLQ-C30) and (EORTC
QLQ-PR25) were used in this analysis. Results Symptoms of depression pre-treatment were noted in 39.3%, state anxiety 28%,
trait anxiety 31.4% and prostate cancer anxiety in 12.1% of participants.
Statistically significant correlations (P ≤ .05) with the
CES-D and a cluster of symptoms on the EORTC QLQ-C30 domains for Global
Health (rs = −.35), fatigue (rs = .38), pain
(rs = .32), dyspnoea (rs = .28), insomnia
(rs = .30) and finance (rs = .26) and EORTC
QLQ-PR25 domains for urinary symptoms (rs = .43), bowel
(rs = .43) and hormone replacement therapy (HRT)
(rs = .41) were observed. Statistically significant correlations were also noted between the STAI-S and
EORTC QLQ-C30 and EORTC QLQ-PR25. No statistically significant difference
was noted between treatments. Conclusion More men were depressed than anxious with significant associations with HRQOL
prior to commencement of treatment. CaP treatments should focus not only on
the prevailing indisposition but include a psychooncological and HRQOL
assessment at pre-treatment in high-risk individuals.
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Affiliation(s)
- Hayley Irusen
- Department of Urology, Faculty of Medicine and Health Sciences, 26697Stellenbosch University, Cape Town, South Africa
| | - Pedro Fernandez
- Department of Urology, Faculty of Medicine and Health Sciences, 26697Stellenbosch University, Cape Town, South Africa
| | - Andre Van der Merwe
- Department of Urology, Faculty of Medicine and Health Sciences, 26697Stellenbosch University, Cape Town, South Africa
| | - Sharain Suliman
- Department of Psychiatry, Stellenbosch University and SA MRC Genomics of Brain Disorders Unit, Cape Town, South Africa
| | - Tonya Esterhuizen
- Biostatistics Unit, Faculty of Medicine and Health Sciences, 26697Stellenbosch University, Cape Town, South Africa
| | - John Lazarus
- Department of Urology, Groote Schuur Hospital, 63726University of Cape Town, South Africa
| | - Jeannette Parkes
- Department of Radiation Oncology, Groote Schuur Hospital, 63726University of Cape Town, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, 26697Stellenbosch University, Cape Town, South Africa
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Boothby N, Veatch M, Pentes M. Evaluating treatment of Axis I mental health disorders in Aceh, Indonesia. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/pb.bp.110.030205] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and methodTo share evaluation findings of a new decentralised mental healthcare system addressing Axis I disorders, developed in four subdistricts of Aceh Besar in Indonesia following the 2004 Asian tsunami. Two complementary methodologies were employed: an adequacy survey that assessed whether agreed programme implementation tasks were completed, and an outcome study that utilised patient, caregiver and staff assessment of the programme to determine what changes, if any, resulted from participation in the programme.ResultsThe system is functional in 3 of 4 subdistricts, and 47 of 53 subdistrict clinics (puskesmas) have trained mental healthcare nurses. Both patients and caregivers reported statistically significant differences when ranking patient wellbeing and were able to qualitatively describe specific changes in patient symptomatology and social functioning.Clinical implicationsResults indicate that (a) the creation of a decentralised system with outreach at multiple levels, (b) emphasis on staff capacity building within a wider household-to-hospital continuum of care, and (c) incorporation of community volunteers working with trained medical personnel led to effective treatment options for people with Axis I disorders in a resource-poor setting.
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Yi S, Tuot S, Chhoun P, Pal K, Choub SC, Mburu G. Prevalence and correlates of psychological distress among drug users in Phnom Penh, Cambodia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 36:25-32. [PMID: 27450717 DOI: 10.1016/j.drugpo.2016.06.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/12/2016] [Accepted: 06/01/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Compared to the general population, drug users are at increased risk of both poor mental health and HIV infection. The aim of this study was to determine the prevalence and correlates of high psychological distress among drug users in Cambodia. METHODS In April 2014, a two-stage cluster sampling method was used to randomly select 169 drug users from hotspots in Phnom Penh. Psychological distress was measured using General Health Questionnaire (GHQ-12). Bivariate and multivariable analyses were conducted to identify factors associated with levels of psychological distress among this population. RESULTS Our study found high prevalence of attempted suicide (15.3%), drug related arrests (46.2%), and incarceration (31.4%). Of the 169 participants, 42.0% were found to have high levels of psychological distress, indicating poor mental health. After adjustment, high levels of psychological distress were independently associated with suicidal ideation (p<0.001), higher frequency of drug use (p=0.02), sharing of needles or syringes (p=0.005), and having been sent to a rehabilitation centre (p=0.02). In addition, participants who perceived their overall health as being poor or very poor were more likely to have high levels of psychological distress (p=0.002). CONCLUSION Integration of mental health within HIV and needle and syringe exchange programmes is required to address psychological distress among drug users in Cambodia. Health system interventions, such as screening, referral, and training of health providers, need to be strengthened. In addition, interventions addressing social determinants of mental health and mitigation of frequent arrests and improving conditions in rehabilitation centres are required.
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Affiliation(s)
- Siyan Yi
- KHANA Center for Population Health Research, Phnom Penh, Cambodia; Center for Global Health Research, Touro University California, USA.
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Pheak Chhoun
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Khuondyla Pal
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | | | - Gitau Mburu
- International HIV/AIDS Alliance, Brighton, UK; Division of Health Research, Lancaster University, Lancaster, UK
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Assad T, Okasha T, Ramy H, Goueli T, El-Shinnawy H, Nasr M, Fathy H, Enaba D, Ibrahim D, Elhabiby M, Mohsen N, Khalil S, Fekry M, Zaki N, Hamed H, Azzam H, Meguid MA, AbdelMaksoud Rabie M, Sultan M, Elghoneimy S, Refaat O, Nader D, Elserafi D, Elmissiry M, Shorab I. Role of traditional healers in the pathway to care of patients with bipolar disorder in Egypt. Int J Soc Psychiatry 2015; 61:583-90. [PMID: 25575578 DOI: 10.1177/0020764014565799] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A large number of mentally ill patients prefer to visit non-medical practitioners such as traditional healers because of the confidence in the system, affordability and accessibility of the service. This may lead to delay in seeking psychiatric services and has prognostic impact. AIM To assess the rate of bipolar affective disorder (BAD) patients seeking traditional healers, the sociodemographic and clinical correlates of those patients. METHODS We assessed 350 patients with BAD after confirmation of diagnosis with Structured Clinical Interview for DSM-IV Axis I Disorder (SCID-I) research version and assessment of functioning with Global Assessment of Functioning scale. They were assessed for percent, rate and timing of seeking traditional healers. RESULTS In all, 40.8% sought traditional healers, with 34.9% more than four times. Of those, 62.2% were before seeking psychiatric services and 37.8% after. Lower educational level, less impairment of functioning and presence of hallucinations were significant correlates. CONCLUSION This study shows that most of the patients suffering from mental illness prefer to approach faith healers first, which may delay entry to psychiatric care and thereby negatively impact the prognosis of BAD. This highlights the importance of mental health education and developing a positive collaborative relationship with traditional healers.
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Petersen I, Fairall L, Egbe CO, Bhana A. Optimizing lay counsellor services for chronic care in South Africa: a qualitative systematic review. PATIENT EDUCATION AND COUNSELING 2014; 95:201-210. [PMID: 24629835 DOI: 10.1016/j.pec.2014.02.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 01/06/2014] [Accepted: 02/01/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To conduct a qualitative systematic review on the use of lay counsellors in South Africa to provide lessons on optimizing their use for psychological and behavioural change counselling for chronic long-term care in scare-resource contexts. METHOD A qualitative systematic review of the literature on lay counsellor services in South Africa. RESULTS Twenty-nine studies met the inclusion criteria. Five randomized control trials and two cohort studies reported that lay counsellors can provide behaviour change counselling with good outcomes. One multi-centre cohort study provided promising evidence of improved anti-retroviral treatment adherence and one non-randomized controlled study provided promising results for counselling for depression. Six studies found low fidelity of lay counsellor-delivered interventions in routine care. Reasons for low fidelity include poor role definition, inconsistent remuneration, lack of standardized training, and poor supervision and logistical support. CONCLUSION Within resource-constrained settings, adjunct behaviour change and psychological services provided by lay counsellors can be harnessed to promote chronic care at primary health care level. PRACTICE IMPLICATIONS Optimizing lay counsellor services requires interventions at an organizational level that provide a clear role definition and scope of practice; in-service training and formal supervision; and sensitization of health managers to the importance and logistical requirements of counselling.
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Affiliation(s)
- Inge Petersen
- Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, South Africa.
| | - Lara Fairall
- Knowledge Translation Unit, University of Cape Town Lung Institute, South Africa
| | - Catherine O Egbe
- Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, South Africa
| | - Arvin Bhana
- Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, South Africa; Human and Social Development, Human Sciences Research Council, South Africa
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Haney E, Singh K, Nyamukapa C, Gregson S, Robertson L, Sherr L, Halpern C. One size does not fit all: psychometric properties of the Shona Symptom Questionnaire (SSQ) among adolescents and young adults in Zimbabwe. J Affect Disord 2014; 167:358-67. [PMID: 25020271 PMCID: PMC4894474 DOI: 10.1016/j.jad.2014.05.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 05/23/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Depression is a major contributor to the global burden of disease. Onset commonly occurs during the adolescent period. Understanding how depression tools are functioning among adolescents has been relatively overlooked. METHODS Using cross-sectional survey data among a sample of 2768 adolescents (aged 15-19) and 2027 young adults (aged 20-24) living in Zimbabwe this paper calibrated the Shona Symptom Questionnaire (SSQ) against the Self Report Questionnaire (SRQ-20) and examined the performance indices of the SSQ based on various cut points for classification. Using a multivariate logistic regression model we isolated particular characteristics to test their association with the odds of being misclassified as non-depressed by the SSQ. RESULTS A modified cut point of five or more substantially increases the depression estimates for both age groups. The prevalence of depression increased from 3.5% to 13.2% among adolescents and from 5.1% to 16.2% among young adults based on these revisions. Adolescents who were orphaned or ever had sex had significantly a greater odd of being misclassified. When retested using the modified cut point of five or greater, associations with misclassification disappeared. LIMITATIONS Scales were not administered separately or in their entirety but rather overlapping items were only asked once, utilizing exclusively SRQ-20 phrasing rather than the culturally-emic language in the SSQ. CONCLUSIONS Not all depression scales are appropriate for use among adolescents given their unique developmental stage. An alternative cut point for depression classification could improve detection of depression among Zimbabwean adolescents.
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Affiliation(s)
- Erica Haney
- Department of Maternal and Child Health, University of North
Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kavita Singh
- Department of Maternal and Child Health, University of North
Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Constance Nyamukapa
- Department of Infectious Disease Epidemiology, Imperial College
London, London, UK
| | - Simon Gregson
- Department of Infectious Disease Epidemiology, Imperial College
London, London, UK
| | - Laura Robertson
- Department of Infectious Disease Epidemiology, Imperial College
London, London, UK
| | - Lorraine Sherr
- Department of Infectious Disease Epidemiology, Imperial College
London, London, UK
| | - Carolyn Halpern
- Department of Maternal and Child Health, University of North
Carolina at Chapel Hill, Chapel Hill, NC, USA
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Baldwin DS, Stein DJ. A joint European and South African research network in anxiety disorders. Hum Psychopharmacol 2012; 27:4-5. [PMID: 22278972 DOI: 10.1002/hup.1267] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
| | - Dan J. Stein
- Department of Psychiatry and Mental Health; University of Cape Town; Cape Town South Africa
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Abbo C. Profiles and outcome of traditional healing practices for severe mental illnesses in two districts of Eastern Uganda. Glob Health Action 2011; 4:GHA-4-7117. [PMID: 21845144 PMCID: PMC3150106 DOI: 10.3402/gha.v4i0.7117] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 06/23/2011] [Accepted: 06/23/2011] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The WHO estimates that more than 80% of African populations attend traditional healers for health reasons and that 40%-60% of these have some kind of mental illness. However, little is known about the profiles and outcome of this traditional approach to treatment. OBJECTIVE The purpose of this study was to describe the profiles and outcome of traditional healing practices for severe mental illnesses in Jinja and Iganga districts in the Busoga region of Eastern Uganda. METHODS Four studies were conducted. Study I used focus group discussions (FGDs) with case vignettes with local community members and traditional healers to explore the lay concepts of psychosis. Studies II and III concerned a cross-sectional survey of patients above 18 years at the traditional healer's shrines and study IV was made on a prospective cohort of patients diagnosed with psychosis in study III. Manual content analysis was used in study I; quantitative data in studies II, III, and IV were analyzed at univariate, bivariate, and multivariate levels to determine the association between psychological distress and socio-demographic factors; for study IV, factors associated with outcome were analyzed. One-way ANOVA for independent samples was the analysis used in Study IV. RESULTS The community gave indigenous names to psychoses (mania, schizophrenia, and psychotic depression) and had multiple explanatory models for them. Thus multiple solutions for these problems were sought. Of the 387 respondents, the prevalence of psychological distress was 65.1%, where 60.2% had diagnosable current mental illness, and 16.3% had had one disorder in their lifetime. Over 80% of patients with psychosis used both biomedical and traditional healing systems. Those who combined these two systems seemed to have a better outcome. All the symptom scales showed a percentage reduction of more than 20% at the 3- and 6-month follow-ups. CONCLUSION Traditional healers shoulder a large burden of care of patients with mental health problems. This calls for all those who share the goal of improving the mental health of individuals to engage with traditional healers.
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Affiliation(s)
- Catherine Abbo
- Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
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Affiliation(s)
- Dan J Stein
- University of Cape Town Department of Psychiatry, Groote Schuur Hospital J-2, Anzio Road, Observatory 7925, Cape Town, South Africa.
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Tomlinson M, Rudan I, Saxena S, Swartz L, Tsai AC, Patel V. Setting priorities for global mental health research. Bull World Health Organ 2009; 87:438-46. [PMID: 19565122 PMCID: PMC2686213 DOI: 10.2471/blt.08.054353] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2008] [Revised: 09/03/2008] [Accepted: 09/09/2008] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To set investment priorities in global mental health research and to propose a more rational use of funds in this under-resourced and under-investigated area. METHODS Members of the Lancet Mental Health Group systematically listed and scored research investment options on four broad classes of disorders: schizophrenia and other major psychotic disorders, major depressive disorder and other common mental disorders, alcohol abuse and other substance abuse disorders, and the broad class of child and adolescent mental disorders. Using the priority-setting approach of the Child Health and Nutrition Research Initiative, the group listed various research questions and evaluated them using the criteria of answerability, effectiveness, deliverability, equity and potential impact on persisting burden of mental health disorders. Scores were then weighted according to the system of values expressed by a larger group of stakeholders. FINDINGS The research questions that scored highest were related to health policy and systems research, where and how to deliver existing cost-effective interventions in a low-resource context, and epidemiological research on the broad categories of child and adolescent mental disorders or those pertaining to alcohol and drug abuse questions. The questions that scored lowest related to the development of new interventions and new drugs or pharmacological agents, vaccines or other technologies. CONCLUSION In the context of global mental health and with a time frame of the next 10 years, it would be best to fill critical knowledge gaps by investing in research into health policy and systems, epidemiology and improved delivery of cost-effective interventions.
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Affiliation(s)
- Mark Tomlinson
- Department of Psychology, Stellenbosch University, Matieland, South Africa.
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