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Koly KN, Saba J, Rao M, Rasheed S, Reidpath DD, Armstrong S, Gnani S. Stakeholder perspectives of mental healthcare services in Bangladesh, its challenges and opportunities: a qualitative study. Glob Ment Health (Camb) 2024; 11:e37. [PMID: 38572252 PMCID: PMC10988148 DOI: 10.1017/gmh.2024.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 01/20/2024] [Accepted: 03/03/2024] [Indexed: 04/05/2024] Open
Abstract
This study explores Bangladesh's mental health services from an individual- and system-level perspective and provides insights and recommendations for strengthening it's mental health system. We conducted 13 in-depth interviews and 2 focus group discussions. Thirty-one participants were recruited using a combination of purposive and snowball sampling methods. All interviews and group discussions were audio-recorded and transcribed, and key findings were translated from Bengali to English. Data were coded manually and analysed using a thematic and narrative analysis approach. Stakeholders perceived scarcity of service availability at the peripheral level, shortage of professionals, weak referral systems, lack of policy implementation and regulatory mechanisms were significant challenges to the mental health system in Bangladesh. At the population level, low levels of mental health literacy, high societal stigma, and treatment costs were barriers to accessing mental healthcare. Key recommendations included increasing the number of mental health workers and capacity building, strengthening regulatory mechanisms to enhance the quality of care within the health systems, and raising awareness about mental health. Introducing measures that relate to tackling stigma, mental health literacy as well as building the capacity of the health workforce and governance systems will help ensure universal mental health coverage.
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Affiliation(s)
- Kamrun Nahar Koly
- Health System & Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jobaida Saba
- Health System & Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mala Rao
- Department of Primary Care and Public Health, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Sabrina Rasheed
- Health System & Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Daniel D. Reidpath
- Health System & Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Stephanie Armstrong
- School of Health and Social Care, College of Health and Science, University of Lincoln, Lincoln, UK
| | - Shamini Gnani
- Department of Primary Care and Public Health, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
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Nuri NN, Sarker M, Ahmed HU, Hossain MD, Dureab F, Agbozo F, Jahn A. Overall Care-Seeking Pattern and Gender Disparity at a Specialized Mental Hospital in Bangladesh. Mater Sociomed 2019; 31:35-39. [PMID: 31213953 PMCID: PMC6511372 DOI: 10.5455/msm.2019.31.35-39] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction: The National Institute of Mental Health (NIMH) is the only national level mental health institution in Bangladesh, with both academic and clinical functions, thus playing a crucial role in delivering specialized mental health care for the entire population. Aim: This study examined the overall pattern of mental health care seeking, age and sex distribution of patients and mental health problems diagnosed in the facility. Methods: Using a facility-based cross-sectional study design, secondary data was collected from various hospital records and reports from April 2001 to June 2016, and quantitatively analyzed. Results: There has been a steady increase in the number of patients at NIMH over the years. Typically, female patients were about half in number compared to male patients and fewer in each age group and all disease categories except inpatients with neurotic, stress-related and somatoform disorders. The highest number of inpatients and outpatients were 15-30 years old and those with schizophrenia, schizotypal and delusional disorders. Conclusion: Minors and females seeking care at NIMH were underrepresented, thus highlighting the need for interventions to improve access for these patients.
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Affiliation(s)
- Nazmun Nahar Nuri
- Institute of Public Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - Malabika Sarker
- Institute of Public Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany.,James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | | | | | - Fekri Dureab
- Institute of Public Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - Faith Agbozo
- Institute of Public Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany.,University of Health and Allied Sciences, Department of Family and Community Health, Volta Region, Ghana
| | - Albrecht Jahn
- National Institute of Mental Health, Dhaka, Bangladesh
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Nuri NN, Sarker M, Ahmed HU, Hossain MD, Beiersmann C, Jahn A. Pathways to care of patients with mental health problems in Bangladesh. Int J Ment Health Syst 2018; 12:39. [PMID: 30034515 PMCID: PMC6052552 DOI: 10.1186/s13033-018-0218-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 07/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health systems in Bangladesh are not fully organized to provide optimal care services to patients with mental health problems. There is both a lack of resources and a disproportional distribution of the available resources. To design an equitable health system and plan interventions to improve access to care, a better understanding of mental health care-seeking behavior and care pathways are crucial. METHODS A facility-based cross-sectional study was conducted using a mixed-method design at the National Institute of Mental Health (NIMH), in Bangladesh. A total of 40 patients (or their attendants) visiting the outpatient department of NIMH were selected by purposive sampling. RESULTS As their first contact point for care services, 27.5% of the patients consulted a psychiatric care provider, 30% went to non-medical provider, and the majority, 42.5%, went to non-psychiatric medical care providers. Only 32.5% of the patients had been advised to go to NIMH by a private physician, hospital personnel or psychiatrist. Among all individual categories of providers, private psychiatrists were the most frequent caregivers (n = 12), followed by traditional healers (n = 9). A total of 70% of the patients had chosen a provider within 20 km. In three out of four of the cases, the family had decided on the first provider. From the start of the symptoms the median delay in the first contact with any provider was 6 months, and in reaching any psychiatric care provider was 1 year. The most common reasons for a delay in seeking care were a lack of knowledge about mental health problems, a lack of information about the place for appropriate care, and not considering the problem as serious enough to seek care. Each of those reasons were mentioned by one in every four respondents. CONCLUSIONS The majority of the patients with mental health problems in Bangladesh access various categories of providers before reaching a psychiatric care provider, and use a diverse range of pathways and loops, which results in a delay or missing appropriate care. We hope that our findings are useful for planning interventions to improve access to mental health care in general, in Bangladesh, and improving referral policies and structures in particular.
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Affiliation(s)
- Nazmun Nahar Nuri
- Institute of Public Health, Ruprecht-Karls-Universität Heidelberg, INF 130/3, 69120 Heidelberg, Germany
| | - Malabika Sarker
- James P. Grant School of Public Health, BRAC University, 66 Mohakhali, Dhaka, 1212 Bangladesh
| | - Helal Uddin Ahmed
- National Institute of Mental Health, Sher-e-Bangla Nagar, Dhaka, 1200 Bangladesh
| | - Mohammad Didar Hossain
- Foundation for Advancement of Innovations in Technology and Health, 1/15A Iqbal Road, Dhaka, 1207 Bangladesh
| | - Claudia Beiersmann
- Institute of Public Health, Ruprecht-Karls-Universität Heidelberg, INF 130/3, 69120 Heidelberg, Germany
| | - Albrecht Jahn
- Institute of Public Health, Ruprecht-Karls-Universität Heidelberg, INF 130/3, 69120 Heidelberg, Germany
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Fiskin A, Miglani M, Buzza C. Implications of Global Mental Health for Addressing Health Disparities in High-Income Countries. Psychiatr Ann 2018. [DOI: 10.3928/00485713-20180212-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Jesulola E, Micalos P, Baguley IJ. Understanding the pathophysiology of depression: From monoamines to the neurogenesis hypothesis model - are we there yet? Behav Brain Res 2017; 341:79-90. [PMID: 29284108 DOI: 10.1016/j.bbr.2017.12.025] [Citation(s) in RCA: 184] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 12/19/2017] [Accepted: 12/22/2017] [Indexed: 02/07/2023]
Abstract
A number of factors (biogenic amine deficiency, genetic, environmental, immunologic, endocrine factors and neurogenesis) have been identified as mechanisms which provide unitary explanations for the pathophysiology of depression. Rather than a unitary construct, the combination and linkage of these factors have been implicated in the pathogenesis of depression. That is, environmental stressors and heritable genetic factors acting through immunologic and endocrine responses initiate structural and functional changes in many brain regions, resulting in dysfunctional neurogenesis and neurotransmission which then manifest as a constellation of symptoms which present as depression.
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Affiliation(s)
- Emmanuel Jesulola
- Paramedicine Discipline, Charles Sturt University, Bathurst Campus, NSW Australia.
| | - Peter Micalos
- Paramedicine Discipline, Charles Sturt University, Bathurst Campus, NSW Australia
| | - Ian J Baguley
- Brain Injury Rehabilitation Service, Westmead Hospital, Hawkesbury Rd, Wentworthville, NSW Australia
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Janevic MR, Aruquipa Yujra AC, Marinec N, Aguilar J, Aikens JE, Tarrazona R, Piette JD. Feasibility of an interactive voice response system for monitoring depressive symptoms in a lower-middle income Latin American country. Int J Ment Health Syst 2016; 10:59. [PMID: 27688798 PMCID: PMC5034527 DOI: 10.1186/s13033-016-0093-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 09/17/2016] [Indexed: 11/10/2022] Open
Abstract
Background Innovative, scalable solutions are needed to address the vast unmet need for mental health care in low- and middle-income countries (LMICs). Methods We conducted a feasibility study of a 14-week automated telephonic interactive voice response (IVR) depression self-care service among Bolivian primary care patients with at least moderately severe depressive symptoms. We analyzed IVR call completion rates, the reliability and validity of IVR-collected data, and participant satisfaction. Results Of the 32 participants, the majority were women (78 % or 25/32) and non-indigenous (75 % or 24/32). Participants had moderate depressive symptoms at baseline (PHQ-8 score mean 13.3, SD = 3.5) and reported good or fair general health status (88 % or 28/32). Fifty-four percent of weekly IVR calls (approximately 7 out of 13 active call-weeks) were completed. Neither PHQ-8 scores nor IVR call completion differed significantly by ethnicity, education, self-reported depression diagnosis, self-reported overall health, number of chronic conditions, or health literacy. The reliability for IVR-collected PHQ-8 scores was good (Cronbach’s alpha = 0.83). Virtually every participant (97 %) was “mostly” or “very” satisfied with the program. Many described the program as beneficial for their mood and self-care, albeit limited by some technological difficulties and the lack of human interaction. Conclusion Findings suggest that IVR could feasibly be used to provide monitoring and self-care education to depressed patients in Bolivia. An expanded stepped-care service offering contact with lay health workers for more depressed individuals and expanded mHealth content may foster greater patient engagement and enhance its therapeutic value while remaining cost-effective. Trial registration ISRCTN ISRCTN 18403214. Registered 14 September 2016. Retrospectively registered
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Affiliation(s)
- Mary R Janevic
- Center for Managing Chronic Disease, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109 USA
| | | | - Nicolle Marinec
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI 48105 USA
| | - Juvenal Aguilar
- Estado Plurinacional de Bolivia Ministerio de Salud, La Paz, Bolivia
| | - James E Aikens
- School of Medicine, University of Michigan, 1018 Fuller St., Ann Arbor, MI 48104 USA
| | - Rosa Tarrazona
- QUANTICA Organización Profesional para el Avance de la Salud Mental, La Paz, Bolivia
| | - John D Piette
- Center for Managing Chronic Disease, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109 USA
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Ferrari AJ, Stockings E, Khoo JP, Erskine HE, Degenhardt L, Vos T, Whiteford HA. The prevalence and burden of bipolar disorder: findings from the Global Burden of Disease Study 2013. Bipolar Disord 2016; 18:440-50. [PMID: 27566286 DOI: 10.1111/bdi.12423] [Citation(s) in RCA: 336] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 07/06/2016] [Accepted: 07/18/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We present the global burden of bipolar disorder based on findings from the Global Burden of Disease Study 2013 (GBD 2013). METHODS Data on the epidemiology of bipolar disorder were obtained from a systematic literature review and assembled using Bayesian meta-regression modelling to produce prevalence by country, age, sex and year. Years lived with disability (YLDs) were estimated by multiplying prevalence by disability weights quantifying the severity of the health loss associated with bipolar disorder. As there were no years of life lost (YLLs) attributed to bipolar disorder, YLDs equated to disability-adjusted life years (DALYs) as a measure of total burden. RESULTS There were 32.7 million cases of bipolar disorder globally in 1990 and 48.8 million in 2013; equivalent to a 49.1% increase in prevalent cases, all accounted for by population increase and ageing. Bipolar disorder accounted for 9.9 million DALYs in 2013, explaining 0.4% of total DALYs and 1.3% of total YLDs. There were 5.5 million DALYs recorded for female individuals and 4.4 million for male individuals. DALYs were evident from age 10 years, peaked in the 20s, and decreased thereafter. DALYs were relatively constant geographically. CONCLUSIONS Despite being relatively rare, bipolar disorder is a disabling illness due to its early onset, severity and chronicity. Population growth and aging are leading to an increase in the burden of bipolar disorder over time. It is important that resources be directed towards improving the coverage of evidence-based intervention strategies for bipolar disorder and establishing strategies to prevent new cases of the disorder.
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Affiliation(s)
- Alize J Ferrari
- The University of Queensland, School of Public Health, Herston, QLD, Australia.,Queensland Centre for Mental Health Research, Wacol, QLD, Australia.,University of Washington, Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Emily Stockings
- University of New South Wales, National Drug and Alcohol Research Centre, Sydney, NSW, Australia
| | - Jon-Paul Khoo
- Queensland Centre for Mental Health Research, Wacol, QLD, Australia
| | - Holly E Erskine
- The University of Queensland, School of Public Health, Herston, QLD, Australia.,Queensland Centre for Mental Health Research, Wacol, QLD, Australia.,University of Washington, Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Louisa Degenhardt
- University of Washington, Institute for Health Metrics and Evaluation, Seattle, WA, USA.,University of New South Wales, National Drug and Alcohol Research Centre, Sydney, NSW, Australia.,University of Melbourne, Melbourne School of Population and Global Health, Melbourne, VIC, Australia
| | - Theo Vos
- University of Washington, Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Harvey A Whiteford
- The University of Queensland, School of Public Health, Herston, QLD, Australia.,Queensland Centre for Mental Health Research, Wacol, QLD, Australia.,University of Washington, Institute for Health Metrics and Evaluation, Seattle, WA, USA
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van Rensburg AJ, Fourie P. Health policy and integrated mental health care in the SADC region: strategic clarification using the Rainbow Model. Int J Ment Health Syst 2016; 10:49. [PMID: 27453722 PMCID: PMC4957874 DOI: 10.1186/s13033-016-0081-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 07/14/2016] [Indexed: 11/17/2022] Open
Abstract
Background Mental illness is a well-known challenge to global development, particularly in low-to-middle income countries. A key health systems response to mental illness is different models of integrated health care, especially popular in the South African Development Community (SADC) region. This complex construct is often not well-defined in health policy, hampering implementation efforts. A key development in this vein has been the Rainbow Model of integrated care, a comprehensive framework and taxonomy of integrated care based on the integrative functions of primary care. The purpose of this study was to explore the nature and strategic forms of integrated mental health care in selected SADC countries, specifically how integrated care is outlined in state-driven policies. Methods Health policies from five SADC countries were analysed using the Rainbow Model as framework. Electronic copies of policy documents were transferred into NVivo 10, which aided in the framework analysis on the different types of integrated mental health care promoted in the countries assessed. Results Several Rainbow Model components were emphasised. Clinical integration strategies (coordination of person-focused care) such as centrality of client needs, case management and continuity were central considerations, while others such as patient education and client satisfaction were largely lacking. Professional integration (inter-professional partnerships) was mentioned in terms of agreements on interdisciplinary collaboration and performance management, while organisational integration (inter-organisational relationships) emerged under the guise of inter-organisational governance, population needs and interest management. Among others, available resources, population management and stakeholder management fed into system integration strategies (horizontally and vertically integrated systems), while functional integration strategies (financial, management and information system functions) included human resource, information and resource management. Normative integration (a common frame of reference) included collective attitude, sense of urgency, and linking cultures, though aspects such as conflict management, quality features of the informal collaboration, and trust were largely lacking. Conclusions Most countries stressed the importance of integrating mental health on primary healthcare level, though an absence of supporting strategies could prove to bar implementation. Inter-service collaboration emerged as a significant goal, though a lack of (especially) normative integration dimensions could prove to be a key omission. Despite the usefulness of the Rainbow Model, it failed to adequately frame regional governance aspects of integration, as the SADC Secretariat could play an important role in coordinating and supporting the development and strengthening of better mental health systems. Electronic supplementary material The online version of this article (doi:10.1186/s13033-016-0081-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- André Janse van Rensburg
- Health and Demographic Research Unit, Department of Sociology, Ghent University, Korte Meer 5, 9000 Ghent, Belgium ; Department of Political Science, Stellenbosch University, Corner Merriman and Ryneveld Street, Stellenbosch, 7602 South Africa ; Centre for Health Systems Research & Development, University of the Free State, Nelson Mandela Road, Bloemfontein, 9300 South Africa
| | - Pieter Fourie
- Department of Political Science, Stellenbosch University, Corner Merriman and Ryneveld Street, Stellenbosch, 7602 South Africa
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Clark J. Medicalization of global health 2: The medicalization of global mental health. Glob Health Action 2014; 7:24000. [PMID: 24848660 PMCID: PMC4028926 DOI: 10.3402/gha.v7.24000] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/17/2014] [Accepted: 04/21/2014] [Indexed: 11/14/2022] Open
Abstract
Once an orphan field, 'global mental health' now has wide acknowledgement and prominence on the global health agenda. Increased recognition draws needed attention to individual suffering and the population impacts, but medicalizing global mental health produces a narrow view of the problems and solutions. Early framing by advocates of the global mental health problem emphasised biological disease, linked psychiatry with neurology, and reinforced categories of mental health disorders. Universality of biomedical concepts across culture is assumed in the globalisation of mental health but is strongly disputed by transcultural psychiatrists and anthropologists. Global mental health movement priorities take an individualised view, emphasising treatment and scale-up and neglecting social and structural determinants of health. To meet international targets and address the problem's broad social and cultural dimensions, the global mental health movement and advocates must develop more comprehensive strategies and include more diverse perspectives.
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Affiliation(s)
- Jocalyn Clark
- icddr,b, Dhaka, Bangladesh; Department of Medicine, University of Toronto, Toronto, Canada; ;
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