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Mkubwa B, Angwenyi V, Nzioka B, Newton CR, Sijbrandij M, Abubakar A. Knowledge, attitudes, and practices on child and adolescent mental health among healthcare workers in sub-Saharan Africa: a scoping review. Int J Ment Health Syst 2024; 18:27. [PMID: 39014469 PMCID: PMC11253363 DOI: 10.1186/s13033-024-00644-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 07/09/2024] [Indexed: 07/18/2024] Open
Abstract
INTRODUCTION Child and adolescent mental health is a global priority. In sub-Saharan Africa, despite the high burden, there is a gap in health services for children and adolescents with mental health disorders. To bridge this gap, healthcare workers require a good understanding of child and adolescent mental health, the right attitude, and practices geared to improving child and adolescent mental health. This scoping review examined the knowledge, attitudes, and practices related to child and adolescent mental health among sub-Saharan African healthcare workers. METHODS The search was restricted between January 2010, the year when the Mental Health Gap Action Programme guidelines were launched, and April 2024. The review followed the methodological framework proposed by Arksey and O'Malley for conducting scoping reviews. The databases searched included CINHAL, PubMed, Web of Science, PsycINFO, and grey literature databases. Additional articles were identified through cited references of the studies included. A data extraction template was used to retrieve relevant text. A narrative synthesis approach was adopted to explore the relationships within and between the included studies. RESULTS The literature search yielded 4658 studies. Among these, 817 were identified as duplicates, and 3740 were excluded after screening. Only twenty-one articles met the criteria for inclusion in the review. The findings showed that healthcare workers have insufficient knowledge of child and adolescent mental health, hold negative attitudes toward children and adolescents with mental health problems, and exhibit poor practices related to child and adolescent mental health. CONCLUSION It is crucial to build capacity and improve healthcare workers' practices, knowledge, and attitudes toward child and adolescent mental health in sub-Saharan Africa. This could lead to better access to mental health services for children and adolescents in the region.
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Affiliation(s)
- Beatrice Mkubwa
- Institute for Human Development, Aga Khan University, Nairobi, Kenya.
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Vibian Angwenyi
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Brenda Nzioka
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Charles R Newton
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
- Neuroscience Unit, KEMRI-Wellcome Trust, Center for Geographic Medicine Research Coast, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Amina Abubakar
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
- Neuroscience Unit, KEMRI-Wellcome Trust, Center for Geographic Medicine Research Coast, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
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Mutiso VN, Musyimi CW, Gitonga I, Tele A, Ndetei DM. Depression and Intimate Partner Violence (IPV) in mothers 6 weeks to 12 months post-delivery in a rural setting in Kenya. Transcult Psychiatry 2024:13634615231187259. [PMID: 38500372 DOI: 10.1177/13634615231187259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Using a cohort of 544 postpartum mothers, 6 weeks to 12 months post-delivery in the largely rural Makueni County in Kenya, we aimed to determine: (1) the prevalence of postpartum depression (PPD) and the prevalence of each of the four domains of intimate partner violence (IPV), that is physical violence, sexual violence, emotional violence, and controlling behavior; (2) the co-occurrence of PPD and IPV; (3) risk factors and associations between sociodemographic variables and IPV, PPD and IPV and PPD co-occurring. We concurrently administered a researcher-designed sociodemographic ad hoc questionnaire, the WHO Intimate Partner Violence questionnaire and the Mini-International Neuropsychiatric Interview for adults (MINI Plus) for DSM-IV/ICD10 depression. The prevalence of PPD was 14.5%; Emotional violence 80.3%; Controlling behavior 74.4% (a form of emotional violence); Physical violence 40.3%; Sexual violence 28.9%. We found the following overlaps: 39% of participants reported both physical and emotional violence; 39% had both sexual and emotional violence; 15% experienced physical and sexual violence; and 15% of participants reported physical, sexual, and emotional violence. Postpartum depression was associated with physical violence during pregnancy, self-employed status, history of mood disorders and medical problems in the child. Further, we report associations between various types of IPV and history of depression, physical violence during pregnancy, low education level, marital status, and current depression diagnosis. IPV and PPD were highly prevalent in our population of postpartum mothers. Various types of IPV were significantly associated with various sociodemographic indicators while only sexual violence was significantly associated with PPD. Based on our results, we provide suggestions for potential interventions in the Kenyan setting.
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Affiliation(s)
- Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Christine W Musyimi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Isaiah Gitonga
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Albert Tele
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
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Klingberg S, Adhikari B, Draper CE, Bosire E, Nyirenda D, Tiigah P, Mukumbang FC. Enhanced or hindered research benefits? A realist review of community engagement and participatory research practices for non-communicable disease prevention in low- and middle-income countries. BMJ Glob Health 2024; 9:e013712. [PMID: 38341191 PMCID: PMC10862340 DOI: 10.1136/bmjgh-2023-013712] [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: 08/15/2023] [Accepted: 12/20/2023] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION Community engagement and participatory research are widely used and considered important for ethical health research and interventions. Based on calls to unpack their complexity and observed biases in their favour, we conducted a realist review with a focus on non-communicable disease prevention. The aim was to generate an understanding of how and why engagement or participatory practices enhance or hinder the benefits of non-communicable disease research and interventions in low- and middle-income countries. METHODS We retroductively formulated theories based on existing literature and realist interviews. After initial searches, preliminary theories and a search strategy were developed. We searched three databases and screened records with a focus on theoretical and empirical relevance. Insights about contexts, strategies, mechanisms and outcomes were extracted and synthesised into six theories. Five realist interviews were conducted to complement literature-based theorising. The final synthesis included 17 quality-appraised articles describing 15 studies. RESULTS We developed six theories explaining how community engagement or participatory research practices either enhance or hinder the benefits of non-communicable disease research or interventions. Benefit-enhancing mechanisms include community members' agency being realised, a shared understanding of the benefits of health promotion, communities feeling empowered, and community members feeling solidarity and unity. Benefit-hindering mechanisms include community members' agency remaining unrealised and participation being driven by financial motives or reputational expectations. CONCLUSION Our review challenges assumptions about community engagement and participatory research being solely beneficial in the context of non-communicable disease prevention in low- and middle-income countries. We present both helpful and harmful pathways through which health and research outcomes are affected. Our practical recommendations relate to maximising benefits and minimising harm by addressing institutional inflexibility and researcher capabilities, managing expectations on research, promoting solidarity in solving public health challenges and sharing decision-making power.
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Affiliation(s)
- Sonja Klingberg
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Catherine E Draper
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Edna Bosire
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Johannesburg, Gauteng, South Africa
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Deborah Nyirenda
- Community Engagement & Bioethics, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
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Ndetei DM, Mutiso V, Osborn T. Moving away from the scarcity fallacy: three strategies to reduce the mental health treatment gap in LMICs. World Psychiatry 2023; 22:163-164. [PMID: 36640407 PMCID: PMC9840495 DOI: 10.1002/wps.21054] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 01/15/2023] Open
Affiliation(s)
- David M. Ndetei
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya,Africa Mental Health Research and Training Foundation, Nairobi, Kenya,WPA Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Victoria Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya,WPA Collaborating Centre for Research and Training, Nairobi, Kenya
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Winter S, Musyimi C, Mutiso V, Ndetei D. Depressive symptoms and associated social and environmental factors among women living in informal settlements in Nairobi, Kenya. Glob Public Health 2023; 18:2200499. [PMID: 37054444 DOI: 10.1080/17441692.2023.2200499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
Approximately 280 million people around the world suffer from depression, and the rates are higher among women than men. For women living in informal settlements in lower - and middle-income countries (LMICs) the prevalence and associated burden of depressive symptoms may be particularly high. The purpose of this paper was to explore factors associated with possible major depressive disorder (MDD) in a probability sample of women living in Mathare informal settlement in Nairobi, Kenya and to identify potential points for intervention and/or support. Quantitative surveys were conducted with 552 women aged 18-75. Possible MDD was measured using the Patient Health Questionnaire and regressed on individual, household/familial-, and community/interpersonal-level factors. Findings highlight the potential importance of factors such as physical health, economic stress, access to water and sanitation, household and family dynamics, and neighbourhood/village differences in possible MDD among women living in informal settlements. We identify potential points for research, intervention and policy including: providing appropriate tangible assistance or interventions to reduce economic stress/strain; expanding access to water and sanitation and, in doing so, reducing potential burdens to physical health; providing and expanding healthcare to include mental healthcare; and investigating family dynamics and bolstering support for families, particularly for those experiencing conflict.
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Affiliation(s)
- Samantha Winter
- School of Social Work, Columbia University, New York, NY, USA
| | - Christine Musyimi
- African Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Victoria Mutiso
- African Mental Health Research and Training Foundation, Nairobi, Kenya
| | - David Ndetei
- African Mental Health Research and Training Foundation, Nairobi, Kenya
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Siddaiah A, Srinivasan K, Satyanarayana V, Ekstrand ML. Feasibility and preliminary efficacy of training health workers in detecting Priority Mental Health Conditions among adolescents in rural South India. Pilot Feasibility Stud 2022; 8:267. [PMID: 36587228 PMCID: PMC9805108 DOI: 10.1186/s40814-022-01215-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/29/2022] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Half of all mental disorders start during adolescence, before 14 years. In India, the current prevalence of mental disorders in 13-17 years age group was 7.3%. Many gaps persist in the mental healthcare delivery through the national mental health program, the low psychiatrist population ratio being one of them. Community health workers can play an essential role in providing mental healthcare in such resource-constrained settings. The World Health Organization mental health gap action program (WHO mhGAP) is a widely studied mental health tool that health workers can use to identify mental disorders. The study's aim was to test the preliminary efficacy of training healthcare workers (HCWs) in identifying mental health conditions among adolescents using modified WHO mhGAP modules. METHODS The feasibility study was carried out in two Primary Health Centers (PHCs) in rural Bengaluru. Study had two components: (1) training of HCWs on adolescent mental health and (2) detection of selected priority mental health conditions among adolescents by trained HCWs. HCWs were trained in five adolescent mental health conditions using a training manual and modified WHO mhGAP modules that excluded emergency presentations and management sections. Pre- and post-training assessments were carried out. A sample of 272 adolescents attending PHCs were assessed for any mental health condition by HCWs using mhGAP modules. A sub-sample of adolescents and all adolescents identified by HCWs with a mental health condition was interviewed by the investigator to validate the diagnosis. Qualitative interviews were carried out with participating HCWs to understand the acceptability of the intervention, acceptability, and barriers to training in identifying mental health conditions among adolescents RESULTS: A total of 23 HCWs underwent training. There was a significant increase in the mental health knowledge scores of HCWs post-training compared to baseline (p value <0.001). Out of 272 adolescents, 18 (6.8%) were detected to have any mental health condition by HCWs as per the modified WHO mhGAP modules. A sample of 72 adolescents consisting of all adolescents identified with a mental health condition by HCWs and a random sample of adolescents without any diagnosis were validated by the research investigator (AS). There was a good agreement between diagnosis by health workers and the research investigator with a Cohen's Kappa of 0.88. Four themes emerged from the qualitative analysis. CONCLUSIONS Training was effective in improving the knowledge of HCWs. There was a good agreement between trained HCWs and the investigator in detecting adolescent mental health conditions using modified mhGAP modules. The modified WHO mhGAP can thus be used by trained non-specialist HCWs to screen for adolescent mental health conditions in primary health centers.
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Affiliation(s)
- Archana Siddaiah
- grid.416432.60000 0004 1770 8558Community Health Department, St John’s Medical College Hospital, Sarjapur road, John Nagar, Kormangala, Bengaluru, 560034 India
| | - Krishnamachari Srinivasan
- grid.416432.60000 0004 1770 8558Department of Psychiatry, St John’s Medical College, Head, Division of Mental Health and Neurosciences, St John’s Research Institute, Bengaluru, 560034 India
| | - Veena Satyanarayana
- grid.416861.c0000 0001 1516 2246Department of Clinical Psychology, National Institute of Mental Health and Neuro Science, Bengaluru, 560034 India
| | - Maria L. Ekstrand
- grid.266102.10000 0001 2297 6811Department of Medicine, Division of Prevention Science, University of California, San Francisco, USA
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Singh SP, Jilka S, Abdulmalik J, Bouliotis G, Chadda R, Egbokhare O, Huque R, Hundt GL, Iyer S, Jegede O, Khera N, Lilford R, Madan J, Omigbodun A, Omigbodun O, Raja T, Read UM, Siddiqi BA, Sood M, Soron TR, Ahmed HU. Transforming access to care for serious mental disorders in slums (the TRANSFORM Project): rationale, design and protocol. BJPsych Open 2022; 8:e185. [PMID: 36226591 PMCID: PMC9634584 DOI: 10.1192/bjo.2022.584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This paper introduces the TRANSFORM project, which aims to improve access to mental health services for people with serious and enduring mental disorders (SMDs - psychotic disorders and severe mood disorders, often with co-occurring substance misuse) living in urban slums in Dhaka (Bangladesh) and Ibadan (Nigeria). People living in slum communities have high rates of SMDs, limited access to mental health services and conditions of chronic hardship. Help is commonly sought from faith-based and traditional healers, but people with SMDs require medical treatment, support and follow-up. This multicentre, international mental health mixed-methods research project will (a) conduct community-based ethnographic assessment using participatory methods to explore community understandings of SMDs and help-seeking; (b) explore the role of traditional and faith-based healing for SMDs, from the perspectives of people with SMDs, caregivers, community members, healers, community health workers (CHWs) and health professionals; (c) co-design, with CHWs and healers, training packages for screening, early detection and referral to mental health services; and (d) implement and evaluate the training packages for clinical and cost-effectiveness in improving access to treatment for those with SMDs. TRANSFORM will develop and test a sustainable intervention that can be integrated into existing clinical care and inform priorities for healthcare providers and policy makers.
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Affiliation(s)
- Swaran P Singh
- Warwick Medical School, University of Warwick, Coventry, UK; and Coventry and Warwickshire NHS Partnership Trust, Coventry, UK
| | - Sagar Jilka
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jibril Abdulmalik
- Centre for Child & Adolescent Mental Health & Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Rakesh Chadda
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Olayinka Egbokhare
- Department of Communication and Language Arts, University of Ibadan, Ibadan, Nigeria
| | - Rumana Huque
- Department of Economics, University of Dhaka, Dhaka, Bangladesh
| | | | - Srividya Iyer
- Douglas Mental Health University Institute, Verdun, Quebec, Canada
| | - Obafemi Jegede
- Institute of African Studies, University of Ibadan, Ibadan, Nigeria
| | | | - Richard Lilford
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jason Madan
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Akinyinka Omigbodun
- Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Olayinka Omigbodun
- Centre for Child & Adolescent Mental Health & Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Tasneem Raja
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Ursula M Read
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Bulbul Ashraf Siddiqi
- Department of Political Science and Sociology, North South University, Dhaka, Bangladesh
| | - Mamta Sood
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | | | - Helal Uddin Ahmed
- Adolescent and family Psychiatry Department National Institute of Mental Health, Dhaka, Bangladesh; on behalf of the TRANSFORM consortium
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Affiliation(s)
| | | | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
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Lloyd CE, Musyimi C, Mutiso V, Ndetei D. Individual and community experiences and the use of language in understanding diabetes and depression in rural Kenya. Glob Public Health 2022; 18:2049841. [PMID: 35298349 DOI: 10.1080/17441692.2022.2049841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
As the prevalence of long-term conditions continues to rise it becomes increasingly important to identify ways to mitigate their effects, including the psychological impact. In rural Kenya identifying people with diabetes or mental health problems is challenging due to the stigma and negative experiences within community settings.Four broad themes were identified; (1) misconceptions and stigma: the use of language, (2) treatment and medications, (3) community beliefs and alternative treatment pathways, (4) the role of informal and formal care.Our study demonstrated the detrimental effect of the use of stigmatising language and misconceptions surrounding diabetes and depression at both the individual and community levels. Inequalities in health care access were observed and a lack of resources in rural communities was evident. Improvements in support for health care workers at the community level as well as acknowledging the importance of informal care could help improve the psychological and emotional impact of diabetes and depression.
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Affiliation(s)
- Cathy E Lloyd
- School of Health, Wellbeing & Social Care, Faculty of Wellbeing, Education & Language Studies, The Open University, Milton Keynes, UK
| | - Christine Musyimi
- Africa Mental Health Research and Training Foundation (AMHRTF), The University of Nairobi, Nairobi, Kenya
| | - Victoria Mutiso
- Africa Mental Health Research and Training Foundation (AMHRTF), The University of Nairobi, Nairobi, Kenya
| | - David Ndetei
- Africa Mental Health Research and Training Foundation (AMHRTF), The University of Nairobi, Nairobi, Kenya
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Searle K, Blashki G, Kakuma R, Yang H, Lu S, Li B, Xiao Y, Minas H. Adapting the depression component of WHO Mental Health Gap Intervention Guide (mhGAP-IG.v2) for primary care in Shenzhen, China: a DELPHI study. Int J Ment Health Syst 2022; 16:13. [PMID: 35168656 PMCID: PMC8845283 DOI: 10.1186/s13033-022-00523-0] [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: 06/27/2021] [Accepted: 01/13/2022] [Indexed: 12/02/2022] Open
Abstract
Background Primary care doctors in Shenzhen, China are increasingly expected to identify and prevent depressive disorder; however, they have received limited mental health training and community healthcare centres (CHC) do not provide standardised protocols for the diagnosis and care of depressive disorder. The World Health Organization’s mental health gap intervention guide, version 2 (mhGAP-IG.v2) is a decision support tool for non-specialists for the assessment, management and follow-up of mental, neurological and substance use disorders (including depressive disorder). Given that mhGAP-IG.v2 is a generic tool, it requires adaptation to take account of cultural differences in depression presentation and unique characteristics of China’s emergent mental health system. Methods A two-round, web-based, Delphi survey was conducted. A panel of primary care doctors from Shenzhen, were invited to score their level of agreement with 199 statements (arranged across 10 domains) proposing changes to the content and structure of mhGAP-IG.v2 for use in Shenzhen. Consensus was predefined as 80% panelists providing a rating of either “somewhat agree/definitely agree”, or “definitely disagree/somewhat disagree” on a five-point scale for agreement. Results 79% of statements received consensus with a mean score of 4.26 (i.e. “somewhat agree”). Agreed adaptations for mhGAP-IG.v2 included:- an assessment approach which considers a broader spectrum of depression symptoms and reflects the life course of disease; incorporating guidance for screening tool usage; clarifying physicians’ roles and including referral pathways for intersectorial care with strong family involvement; aligning drug treatment with national formularies; stronger emphasis of suicide prevention throughout all sections of the guide; contextualizing health education; reflecting a person-centred approach to care. Panelists chose to maintain diagnostic and treatment advice for bipolar patients experiencing a depressive episode as in the current guide. Conclusions An adapted mhGAP-IG.v2 for depression recognises China’s cultural and contextual needs for assessment guidance; unique primary healthcare system organization, priorities and treatment availability; and diverse psychosocial educational needs. An adapted mhGAP-IG.v2 could both inform the future training programs for primary care in Shenzhen and also offer an additional mental health resource for non-specialists in other countries. Supplementary Information The online version contains supplementary material available at 10.1186/s13033-022-00523-0.
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Affiliation(s)
- Kendall Searle
- Global and Cultural Mental Health Unit, Centre for Mental Health, School of Population and Global Health, University of Melbourne, Parkville, VIC, 3010, Australia.
| | - Grant Blashki
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Ritsuko Kakuma
- London School of Hygiene and Tropical Medicine, London, WC1E 7HTE, England, UK
| | - Hui Yang
- Monash Institute for Health and Clinical Education, School of Primary Health Care, Monash University, Notting Hill, VIC, 3168, Australia
| | - Shurong Lu
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Baoqi Li
- Shenzhen Guangming Hospital of the University of Chinese Academy of Sciences, Bao'an District, Shenzhen, 518107, China
| | - Yingying Xiao
- Shenzhen Guangming Hospital of the University of Chinese Academy of Sciences, Bao'an District, Shenzhen, 518107, China
| | - Harry Minas
- Global and Cultural Mental Health Unit, Centre for Mental Health, School of Population and Global Health, University of Melbourne, Parkville, VIC, 3010, Australia
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Mutiso VN, Musyimi CW, Gitonga I, Rebello TJ, Tele A, Pike KM, Ndetei DM. Toward Community Coverage on Self-Screening, Diagnosis, and Help-Seeking Behavior for Both Gender Victims of Intimate Partner Violence (IPV) in a Kenyan Setting: The Development of IPV-Brief Self-Screener (IPV-BSS) Version of the WHO-IPV Instrument. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP9344-NP9363. [PMID: 31208269 DOI: 10.1177/0886260519855666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Intimate partner violence (IPV) is a major public health concern. The prevalence of IPV in women in Kenya is in the range of 41% to 45% but has also been reported in 20% of men. The most widely used instrument for the screening and diagnosis of IPV is the World Health Organization-Intimate Partner Violence (WHO-IPV). However, it is lengthy for routine large-scale screening and is administered by a trained person, thus limiting the number it can reach for screening. There is therefore a need for a shorter screening version that can be self-administered to reach critical masses. Those who screen positive can then be subjected to the longer version. In addition, the short version should be culturally sensitive, can be used by either gender, can be used in busy clinical settings as the patients wait to be attended to, and can be used for large-scale community populations to raise awareness and promote help-seeking behavior. It should be applicable in similar cultural settings and is aligned to the longer version of the WHO-IPV instrument. This study aimed to develop such a tool. We administered the WHO-IPV to two groups: firstly, postnatal mothers attending postnatal clinics and secondly, men and women attending general clinics to which they had been referred. These referrals were by traditional healers (TH), faith healers (FH), and community health workers (CHW) who had been trained to screen for mental disorders using the Mental Health Gap Action Programme-Intervention Guide (mhGAP-IG) master checklist. Using factor analysis of the scores, we came up with questions that had the highest predictive value for different types of IPV diagnosis and which could therefore be used for self-screening purposes. We call the tool the Intimate Partner Violence-Brief Self-Screener (IPV-BSS; Adapted by the Africa Mental Health Research and Training Foundation from the WHO-IPV).
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Affiliation(s)
- Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | | | - Isaiah Gitonga
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | | | - Albert Tele
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Kathleen M Pike
- Columbia University, Global Mental Health Program, New York, USA
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
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Leis M, McDermott M, Koziarz A, Szadkowski L, Kariri A, Beattie TS, Kaul R, Kimani J. Intimate partner and client-perpetrated violence are associated with reduced HIV pre-exposure prophylaxis (PrEP) uptake, depression and generalized anxiety in a cross-sectional study of female sex workers from Nairobi, Kenya. J Int AIDS Soc 2021; 24 Suppl 2:e25711. [PMID: 34164924 PMCID: PMC8222843 DOI: 10.1002/jia2.25711] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/19/2021] [Accepted: 03/23/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION UNAIDS has identified female sex workers (FSW) as a key HIV at-risk population. FSW disproportionately experience gender-based violence, which compounds their risk of HIV acquisition and may contribute to adverse mental health outcomes. Pre-exposure prophylaxis (PrEP) is a powerful but underused HIV prevention tool for these women. This study explored the associations between intimate partner violence (IPV) and client-perpetrated violence against FSW, mental health outcomes and PrEP use. METHODS An anonymous questionnaire was administered to a convenience sample of 220 Nairobi FSW attending dedicated clinics from June to July 2019, where PrEP was available free of charge. A modified version of the WHO Violence Against Women Instrument assessed IPV and client-perpetrated violence, and the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) assessed depressive and anxiety symptoms respectively. Multivariable logistic regressions evaluated predictors of depression, generalized anxiety and PrEP use. RESULTS Of the total 220 women (median [IQR] age 32 [27-39]), 56.8% (125/220) reported depression (PHQ-9 ≥ 10) and 39.1% (86/220) reported anxiety (GAD-7 ≥ 10). Only 41.4% (91/220) reported optimal use of PrEP (taken correctly six to seven days/week) despite the cohort pursuing sex work for a median of 7 (4 to 12) years. Most women reported experiencing any violence in the past 12 months (90%, 198/220). Any recent IPV was frequent (78.7%, 129/164), particularly emotional IPV (66.5%, 109/164), as was any client-perpetrated violence in the past 12 months (80.9%, 178/220). Regression analyses found that violence was independently associated with depression (adjusted OR [aOR] 9.39, 95% CI 2.90 to 30.42, p = 0.0002) and generalized anxiety (aOR 3.47, 95% CI 1.10 to 10.88, p = 0.03), with the strongest associations between emotional IPV and both depression and anxiety. Recent client-perpetrated emotional violence (aOR 0.23, 95% CI 0.07 to 0.71, p = 0.01) was associated with decreased PrEP use, whereas client-perpetrated physical violence was associated with increased PrEP use (aOR 3.01, 95% CI 1.16 to 7.81, p = 0.02). CONCLUSIONS There was a high prevalence of recent violence by different perpetrators as well as depression and anxiety among FSW from Nairobi. PrEP use was relatively infrequent, and recent client-perpetrated emotional violence was associated with PrEP non-use. Interventions to reduce gender-based violence may independently enhance HIV prevention and reduce the mental health burden in this community.
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Affiliation(s)
- Maria Leis
- Department of MedicineUniversity of TorontoTorontoCanada
| | | | - Alex Koziarz
- Department of MedicineUniversity of TorontoTorontoCanada
| | - Leah Szadkowski
- Biostatistics Research UnitUniversity Health NetworkTorontoCanada
| | - Antony Kariri
- Department of Medical MicrobiologyUniversity of NairobiNairobiKenya
| | - Tara S Beattie
- Department of Global Health and DevelopmentLondon School of Hygiene and Tropical MedicineLondonEngland
| | - Rupert Kaul
- Department of MedicineUniversity of TorontoTorontoCanada
| | - Joshua Kimani
- Department of Medical MicrobiologyUniversity of NairobiNairobiKenya
- Department of Medical MicrobiologyUniversity of ManitobaManitobaCanada
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13
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Lee Y, Brietzke E, Cao B, Chen Y, Linnaranta O, Mansur RB, Cortes P, Kösters M, Majeed A, Tamura JK, Lui LMW, Vinberg M, Keinänen J, Kisely S, Naveed S, Barbui C, Parker G, Owolabi M, Nishi D, Lee J, Srisurapanont M, Gill H, Guo L, Balanzá-Martínez V, Partonen T, Nolen WA, Lee JH, Kim JH, Chavannes NH, Ewais T, Atienza-Carbonell B, Silven AV, Yasuma N, Gil A, Novikov A, Lacey C, Versluis A, von Malortie S, Chan LF, Waqas A, Purgato M, Aardoom JJ, Ly-Uson JT, Sim K, Tuineag M, van der Kleij RMJJ, van Luenen S, Suttajit S, Hajek T, Lee YW, Porter RJ, Alsuwaidan M, Rosenblat JD, Ravindran AV, Lam RW, McIntyre RS. Development and implementation of guidelines for the management of depression: a systematic review. Bull World Health Organ 2020; 98:683-697H. [PMID: 33177758 PMCID: PMC7652558 DOI: 10.2471/blt.20.251405] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 12/12/2022] Open
Abstract
Objective To evaluate the development and implementation of clinical practice guidelines for the management of depression globally. Methods We conducted a systematic review of existing guidelines for the management of depression in adults with major depressive or bipolar disorder. For each identified guideline, we assessed compliance with measures of guideline development quality (such as transparency in guideline development processes and funding, multidisciplinary author group composition, systematic review of comparative efficacy research) and implementation (such as quality indicators). We compared guidelines from low- and middle-income countries with those from high-income countries. Findings We identified 82 national and 13 international clinical practice guidelines from 83 countries in 27 languages. Guideline development processes and funding sources were explicitly specified in a smaller proportion of guidelines from low- and middle-income countries (8/29; 28%) relative to high-income countries (35/58; 60%). Fewer guidelines (2/29; 7%) from low- and middle-income countries, relative to high-income countries (22/58; 38%), were authored by a multidisciplinary development group. A systematic review of comparative effectiveness was conducted in 31% (9/29) of low- and middle-income country guidelines versus 71% (41/58) of high-income country guidelines. Only 10% (3/29) of low- and middle-income country and 19% (11/58) of high-income country guidelines described plans to assess quality indicators or recommendation adherence. Conclusion Globally, guideline implementation is inadequately planned, reported and measured. Narrowing disparities in the development and implementation of guidelines in low- and middle-income countries is a priority. Future guidelines should present strategies to implement recommendations and measure feasibility, cost–effectiveness and impact on health outcomes.
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Affiliation(s)
- Yena Lee
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada
| | - Elisa Brietzke
- Department of Psychiatry, Queen's University School of Medicine, Kingston, Canada
| | - Bing Cao
- School of Psychology and Key Laboratory of Cognition and Personality, Southwest University, Chongqing, China
| | - Yan Chen
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Outi Linnaranta
- Bipolar Disorders Clinic, Douglas Mental Health University Institute, Montréal, Canada
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada
| | - Paulina Cortes
- Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile
| | - Markus Kösters
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Amna Majeed
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada
| | - Jocelyn K Tamura
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada
| | - Leanna M W Lui
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada
| | - Maj Vinberg
- Psychiatric Research Unit, Psychiatric Centre North Zealand, Hilleroed, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Jaakko Keinänen
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Steve Kisely
- School of Clinical Medicine, The University of Queensland, Brisbane, Australia
| | - Sadiq Naveed
- Department of Psychiatry and Behavioral Sciences, University of Kansas Medical Center, Kansas, USA
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Biomedicine and Movement Sciences, Verona, Italy
| | - Gary Parker
- Global Alliance for Chronic Diseases, Wellcome Trust, London, England
| | - Mayowa Owolabi
- Center for Genomics and Precision Medicine, University of Ibadan, Ibadan, Nigeria
| | - Daisuke Nishi
- Department of Mental Health, The University of Tokyo, Tokyo, Japan
| | - JungGoo Lee
- Paik Institute for Clinical Research, Inje University, Busan, Republic of Korea
| | | | - Hartej Gill
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada
| | - Lan Guo
- School of Public Health, Sun Yat-sen University, Guangdong, China
| | - Vicent Balanzá-Martínez
- Teaching Unit of Psychiatry and Psychological Medicine, University of Valencia, Valencia, CIBERSAM, Spain
| | - Timo Partonen
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Willem A Nolen
- Department of Psychiatry, University of Groningen, Groningen, Netherlands
| | - Jae-Hon Lee
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Ji Hwan Kim
- Paik Institute for Clinical Research, Inje University, Busan, Republic of Korea
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Tatjana Ewais
- School of Clinical Medicine, The University of Queensland, Brisbane, Australia
| | | | - Anna V Silven
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Naonori Yasuma
- Department of Mental Health, The University of Tokyo, Tokyo, Japan
| | - Artyom Gil
- WHO European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programme, Moscow, Russian Federation
| | - Andrey Novikov
- Psychiatric and Neurological Hospital, Surgut, Russian Federation
| | - Cameron Lacey
- Maori Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Anke Versluis
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | | | - Lai Fong Chan
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada.,Department of Psychiatry, Queen's University School of Medicine, Kingston, Canada
| | - Ahmed Waqas
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada.,School of Psychology and Key Laboratory of Cognition and Personality, Southwest University, Chongqing, China
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Biomedicine and Movement Sciences, Verona, Italy
| | - Jiska Joëlle Aardoom
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Josefina T Ly-Uson
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Kang Sim
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada.,Bipolar Disorders Clinic, Douglas Mental Health University Institute, Montréal, Canada
| | - Maria Tuineag
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada.,Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile
| | | | - Sanne van Luenen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Sirijit Suttajit
- Department of Psychiatry, Chiang Mai University, Chiang Mai, Thailand
| | - Tomas Hajek
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada.,Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Yu Wei Lee
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada.,Bipolar Disorders Clinic, Douglas Mental Health University Institute, Montréal, Canada
| | - Richard J Porter
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada.,Psychiatric Research Unit, Psychiatric Centre North Zealand, Hilleroed, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Mohammad Alsuwaidan
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada.,Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada.,School of Clinical Medicine, The University of Queensland, Brisbane, Australia
| | - Arun V Ravindran
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada.,School of Clinical Medicine, The University of Queensland, Brisbane, Australia
| | - Raymond W Lam
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada.,Department of Psychiatry and Behavioral Sciences, University of Kansas Medical Center, Kansas, USA
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada
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Winter SC, Obara LM, McMahon S. Intimate partner violence: A key correlate of women's physical and mental health in informal settlements in Nairobi, Kenya. PLoS One 2020; 15:e0230894. [PMID: 32240207 PMCID: PMC7117691 DOI: 10.1371/journal.pone.0230894] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 02/08/2020] [Indexed: 01/09/2023] Open
Abstract
Globally, one billion people live in informal settlements, and that number is expected to triple by 2050. Studies suggests that health in informal settlements is a serious and growing concern, yet there is a paucity of research focused on health outcomes and the correlates of health in these settlements. Studies cite individual, environmental and social correlates to health in informal settlements, but they often lack empirical evidence. In particular, research suggests that high rates of violence against women (VAW) in informal settlements may be associated with detrimental effects on women's health, but few studies have investigated this link. The purpose of this study was to fill this gap by empirically exploring associations between women's experiences of intimate partner violence (IPV) and their physical and mental health. Data for this study were collected in August 2018 in Mathare Valley Informal Settlement in Nairobi, Kenya. A total of 550 randomly-selected women participated in surveys; however, analyses for this study were run on a subpopulation of the women (n = 361). Multivariate logistic regressions were used to investigate the link between psychological, sexual, and emotional IPV and women's mental and physical health. Results suggest that while some socioeconomic, demographic, and environmental variables were significantly associated with women's mental and physical health outcomes, all types of IPV emerged key correlates in this context. In particular, women's experiences of IPV were associated with lower odds of normal-high physical health component scores (based on SF-36); higher odds of gynecological and reproductive health issues, psychological distress (based on K-10), depression, suicidality, and substance use. Findings from this study suggest that policies and interventions focused on prevention and response to VAW in informal settlements may make critical contributions to improving health for women in these rapidly growing settlements.
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Affiliation(s)
- Samantha C. Winter
- Columbia School of Social Work, Columbia University, New York, New York, United States of America
- * E-mail:
| | - Lena Moraa Obara
- Department of Sociology and Social Work, University of Nairobi, Nairobi, Kenya
| | - Sarah McMahon
- Center on Violence Against Women and Children, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, United States of America
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15
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Buddhiraja R, Sharma S, Sharma S, Bansal RK, Setia RK, Bansal N, Chowdhury A, Goraya JS, Kaur S, Kaur M, Kalra S, Sander JW, Singh G. Epilepsy knowledge, attitudes, and practices among primary healthcare providers in an Indian district. Epilepsy Behav 2020; 104:106899. [PMID: 32058300 DOI: 10.1016/j.yebeh.2019.106899] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 12/28/2019] [Accepted: 12/29/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Scaling up the involvement of primary care providers in epilepsy management in low- and middle-income countries (LMICs) requires an understanding of their epilepsy knowledge, attitudes, and practices (KAP). AIM The aim of the study was to document levels of knowledge about, attitudes towards, and practices regarding epilepsy among different ranks of primary healthcare providers in a North-Western Indian district. METHODS The survey included government medical officers (MOs), auxiliary nurse midwives (ANMs), and accredited social health activists (ASHAs). They were administered a specially designed KAP questionnaire. Responses were analyzed according to rank. RESULTS The survey showed that nearly 10% of ANMs and almost a fifth of ASHAs had never heard about epilepsy. A quarter of MOs and over two-thirds of ANMs and ASHAs had never provided care to someone with epilepsy. There were significant differences in the levels of knowledge between the three groups of workers. CONCLUSIONS Closing the huge gaps in KAP by educating primary care and community health workers about epilepsy should be a priority before engaging them in the epilepsy care delivery.
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Affiliation(s)
- Richa Buddhiraja
- Research & Development Unit, Dayanand Medical College, Ludhiana, India
| | - Sarit Sharma
- Department of Social & Preventive Medicine, Dayanand Medical College, Ludhiana, India
| | - Suman Sharma
- Research & Development Unit, Dayanand Medical College, Ludhiana, India
| | - Rajnder K Bansal
- Department of Neurology, Dayanand Medical College, Ludhiana, India
| | - Raj K Setia
- Punjab Remote Sensing Centre, Ludhiana, India
| | - Namita Bansal
- Research & Development Unit, Dayanand Medical College, Ludhiana, India
| | - Anuraag Chowdhury
- Department of Social & Preventive Medicine, Dayanand Medical College, Ludhiana, India
| | - Jatinder S Goraya
- Department of Paediatrics, Dayanand Medical College, Ludhiana, India
| | - Sukhpreet Kaur
- Research & Development Unit, Dayanand Medical College, Ludhiana, India
| | - Manpreet Kaur
- Research & Development Unit, Dayanand Medical College, Ludhiana, India
| | - Shivani Kalra
- College of Nursing, Dayanand Medical College, Ludhiana, India
| | - Josemir W Sander
- NIHR University College London Hospitals, UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom; Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom; Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede 2103 SW, Netherlands
| | - Gagandeep Singh
- Research & Development Unit, Dayanand Medical College, Ludhiana, India; Department of Social & Preventive Medicine, Dayanand Medical College, Ludhiana, India; Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom.
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16
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Doherty S, Dass G, Edward A, Manolova G, Solomon M. Challenges and lessons learned in re-filming the WHO mhGAP training videos for Sri Lankan context - a qualitative study. Confl Health 2020; 14:7. [PMID: 32082416 PMCID: PMC7017543 DOI: 10.1186/s13031-020-00259-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/07/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Understanding and addressing the unmet mental health needs burden in the Northern Province of Sri Lanka is the subject of the COMGAP-S two-phase study. Phase Two involves the implementation of the World Health Organization's mental health Gap Action Programme (mhGAP) in primary healthcare settings. As part of the contextual adaptation of mhGAP, eleven of the videos provided in the mhGAP training package have been re-filmed by a local team. We investigated the challenges, barriers and good practices of this adaptation effort from the point of view of team participants. METHODS Twelve persons from the adaptation team, including students of medicine and drama, doctors, drama lecturers and professionals, consented to in-depth individual interviews following an open-ended topic guide with a member of the COMGAP-S study team. Interviews were recorded, transcribed, translated as necessary, and subjected to thematic analysis. RESULTS The majority of participants perceived the process positively and had pride in their involvement. Expectations, opportunities, and exposure were discussed as stemming from the video production. The main challenges derived from the analysis were lack of discussion around budgeting, logistical difficulties, struggles with team cooperation, and creative differences. Issues around exact translation into the local Tamil dialect and modelling around mental health were emphasised by the majority of participants. Potential uses for the videos were identified beyond the current study and recommendations included setting out clear guidance around available funding and role allocation, and increasing the flexibility in adapting the material. CONCLUSIONS This study illustrated details of the adaptation of existing video materials to facilitate locally-based training for non-specialists on mhGAP curricula. With this, we have added to the knowledge base on conducting cultural and language adaptations and our findings indicate participants felt adapting the mhGAP films to local context was vital to ensuring training materials were culturally appropriate and valid. TRIAL REGISTRATION This project was nested within the larger COMGAP-S clinical trial. Ethics approval was granted from the Ethics Review Committee, Faculty of Medicine, University of Jaffna (J/ERC/17/81/NDR/0170) and the Faculty Research Ethics Panel, Faculty of Medical Science, Anglia Ruskin University (SC/jc/FMSFREP/16/17076). The project is registered with the Sri Lankan Clinical Trial Registry (SLCTR/2018/008) and listed on the ISRCTN registry (trial ID ISRCTN62598070).
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Affiliation(s)
- Shannon Doherty
- Faculty of Health, Education, Medicine, and Social Care, Anglia Ruskin University, Bishop Hall Lane, Chelmsford, CM1 1SQ UK
| | - Giselle Dass
- Faculty of Health, Education, Medicine, and Social Care, Anglia Ruskin University, Bishop Hall Lane, Chelmsford, CM1 1SQ UK
- THEME Institute, Colombo, Sri Lanka
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Gergana Manolova
- Globally Minded Foundation, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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17
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Mutiso VN, Musyimi CW, Gitonga I, Tele A, Pervez R, Rebello TJ, Pike KM, Ndetei DM. Using the WHO-AIMS to inform development of mental health systems: the case study of Makueni County, Kenya. BMC Health Serv Res 2020; 20:51. [PMID: 31959175 PMCID: PMC6971996 DOI: 10.1186/s12913-020-4906-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 01/14/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In order to develop a context appropriate in mental health system, there is a need to document relevant existing resources and practices with a view of identifying existing gaps, challenges and opportunities at baseline for purposes of future monitoring and evaluation of emerging systems. The World Health Organization Assessments Instrument for Mental Health Systems (WHO-AIMS) was developed as a suitable tool for this purpose. Our overall objective of this study, around which research questions and specific aims were formulated, was to establish a baseline on mental health system as at the time of the study, at Makueni County in Kenya, using the WHO-AIMS. METHODS To achieve our overall objective, answer our research questions and achieve specific aims, we conducted a mixed methods approach in which we did an audit of DHIS records and county official records, and conducted qualitative interviews with the various officers to establish the fidelity of the data according to their views. The records data was processed via the prescribed WHO-Aims 2.2 excel spreadsheet while the qualitative data was analyzed thematically. This was guided by the six domains stipulated in the WHO AIMS. RESULTS We found that at the time point of the study, there were no operational governance, policy or administrative structures specific to mental health, despite recognition by the County Government of the importance of mental health. The identified interviewees and policy makers were cooperative and participatory in identifying the gaps, barriers and potential solutions to those barriers. The main barriers and gaps were human and financial resources and low prioritization of mental health in comparison to physical conditions. The solutions lay in bridging of the gaps and addressing the barriers. CONCLUSION There is a need to address the identified gaps and barriers and follow up on solutions suggested at the time of the study, if a functional mental health system is to be achieved at Makueni County.
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Affiliation(s)
- Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Mawensi Road, Off Elgon Road, Mawensi Gardens, P.O.BOX 48423-00100, Nairobi, Kenya
| | - Christine W Musyimi
- Africa Mental Health Research and Training Foundation, Mawensi Road, Off Elgon Road, Mawensi Gardens, P.O.BOX 48423-00100, Nairobi, Kenya
| | - Isaiah Gitonga
- Africa Mental Health Research and Training Foundation, Mawensi Road, Off Elgon Road, Mawensi Gardens, P.O.BOX 48423-00100, Nairobi, Kenya
| | - Albert Tele
- Africa Mental Health Research and Training Foundation, Mawensi Road, Off Elgon Road, Mawensi Gardens, P.O.BOX 48423-00100, Nairobi, Kenya
| | - Romaisa Pervez
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, Ontario, N6A 5C1, Canada
| | - Tahilia J Rebello
- Columbia University Global Mental Health Program, 1051 Riverside Drive, New York, NY, 1003, USA
| | - Kathleen M Pike
- Columbia University Global Mental Health Program, 1051 Riverside Drive, New York, NY, 1003, USA
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Mawensi Road, Off Elgon Road, Mawensi Gardens, P.O.BOX 48423-00100, Nairobi, Kenya. .,Department of Psychiatry, University of Nairobi, P. O. Box 30197 - 00100, Nairobi, Kenya.
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18
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Contextualizing and pilot testing the Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) to primary healthcare workers in Kilifi, Kenya. Glob Ment Health (Camb) 2020; 7:e11. [PMID: 32742669 PMCID: PMC7379318 DOI: 10.1017/gmh.2020.6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 03/01/2020] [Accepted: 03/29/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Little data exists about the methodology of contextualizing version two of the Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) in resource-poor settings. This paper describes the contextualisation and pilot testing of the guide in Kilifi, Kenya. METHODS Contextualisation was conducted as a collaboration between the KEMRI-Wellcome Trust Research Programme (KWTRP) and Kilifi County Government's Department of Health (KCGH) between 2016 and 2018. It adapted a mixed-method design and involved a situational analysis, stakeholder engagement, local adaptation and pilot testing of the adapted guide. Qualitative data were analysed using content analysis to identify key facilitators and barriers to the implementation process. Pre- and post-training scores of the adapted guide were compared using the Wilcoxon signed-rank test. RESULTS Human resource for mental health in Kilifi is strained with limited infrastructure and outdated legislation. Barriers to implementation included few specialists for referral, unreliable drug supply, difficulty in translating the guide to Kiswahili language, lack of clarity of the roles of KWTRP and KCGH in the implementation process and the unwillingness of the biomedical practitioners to collaborate with traditional health practitioners to enhance referrals to hospital. In the adaptation process, stakeholders recommended the exclusion of child and adolescent mental and behavioural problems, as well as dementia modules from the final version of the guide. Pilot testing of the adapted guide showed a significant improvement in the post-training scores: 66.3% (95% CI 62.4-70.8) v. 76.6% (95% CI 71.6-79.2) (p < 0.001). CONCLUSION The adapted mhGAP-IG version two can be used across coastal Kenya to train primary healthcare providers. However, successful implementation in Kilifi will require a review of new evidence on the burden of disease, improvements in the mental health system and sustained dialogue among stakeholders.
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Ndetei D, Pike K, Mutiso V, Tele A, Gitonga I, Rebello T, Musyimi C, Mamah D. The psychometric properties of the Washington Early Recognition Center Affectivity and Psychosis (WERCAP) screen in adults in the Kenyan context: Towards combined large scale community screening for affectivity and psychosis. Psychiatry Res 2019; 282:112569. [PMID: 31727439 DOI: 10.1016/j.psychres.2019.112569] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 09/16/2019] [Accepted: 09/16/2019] [Indexed: 10/26/2022]
Abstract
There is a need for screening for early symptoms of psychosis and affectivity at community level to promote early diagnosis and management. Any screening instrument should have good psychometric properties. One such instrument is the Washington Early Recognition Center Affectivity and Psychosis (WERCAP) Screen that has been used in the USA, Kenya and Rwanda. However, its properties have not been studied outside the USA, and not in adults. The study aims to document the psychometric properties of the WERCAP Screen in Kenyan adults with positive screens on the WHO mental health treatment GAP- Intervention Guidelines (mhGAP-IG). We administered the WERCAP Screen and a gold standard - the Mini-International Neuropsychiatric Interview (MINI-Plus) section on psychosis to 674 Kenyan adults who had screened positive on the WHO mhGAP-IG. Out of these, 464 (68.84%) scored positive for both affectivity and psychosis sections on the MINI-Plus. The WERCAP affectivity and psychosis scales had good psychometric properties as screening measures, with a cut-off point of 22 for affectivity and 20 for psychosis. The WERCAP Screen has the potential for combined scale up screening for affectivity and psychosis in Kenyan population.
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Affiliation(s)
- David Ndetei
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya; Africa Mental Health Research and Training Foundation, Nairobi, Kenya.
| | - Kathleen Pike
- Global Mental Health Program, Columbia University, New York, USA
| | - Victoria Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Albert Tele
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Isaiah Gitonga
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Tahilia Rebello
- Global Mental Health Program, Columbia University, New York, USA
| | - Christine Musyimi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
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Mutiso VN, Musyimi CW, Rebello TJ, Ogutu MO, Ruhara R, Nyamai D, Pike KM, Ndetei DM. Perceived impacts as narrated by service users and providers on practice, policy and mental health system following the implementation of the mhGAP-IG using the TEAM model in a rural setting in Makueni County, Kenya: a qualitative approach. Int J Ment Health Syst 2019; 13:56. [PMID: 31423149 PMCID: PMC6693225 DOI: 10.1186/s13033-019-0309-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 08/05/2019] [Indexed: 11/13/2022] Open
Abstract
Background A team approach is key to reduction of the mental health treatment gap. It requires collaborative effort of all formal and informal community based service providers and the consumers of the services. Qualitative evaluations of such an approach add value to the quantitative evaluations. Methods A qualitative study was conducted among 205 participants. These were grouped into a total of 19 focus group discussions for community health workers (CHW), traditional healers (TH), faith healers (FH) and patients. For nurses and clinical officers we held 10 key informant interviews and three key informant discussions. We aimed to document personal perceptions as expressed in narratives on mental health following a community based application of the WHO mental health treatment Gap-intervention guideline (mhGAP-IG) using the TEAM model. We also aimed to document how the narratives corroborated key findings on the quantitative wing of the TEAM model. Results There were three categories of perceptions: (i) patient-related, (ii) health provider-related and, (iii) health system related. The patient related narratives were linked to improvement in their mental and physical health, increased mental health awareness, change in lifestyle and behavior, enhanced social functioning and an increase in family productivity. Health provider perceptions were related to job satisfaction, capacity building and increased interest in mental health training. Mental health system related narratives included effectiveness and efficiency in service delivery and increase in number of referrals at the primary health care facilities. Conclusion The TEAM is a feasible model for the implementation of the mhGAP-IG. It led to positive perceptions and narratives by service provides and service consumers. The qualitative findings corroborated the quantitative findings of TEAM.
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Affiliation(s)
- Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Matumbato Road, Mawensi Gardens, Upper Hill, Nairobi, Kenya
| | - Christine W Musyimi
- Africa Mental Health Research and Training Foundation, Matumbato Road, Mawensi Gardens, Upper Hill, Nairobi, Kenya
| | | | - Michael O Ogutu
- Africa Mental Health Research and Training Foundation, Matumbato Road, Mawensi Gardens, Upper Hill, Nairobi, Kenya
| | - Ruth Ruhara
- Africa Mental Health Research and Training Foundation, Matumbato Road, Mawensi Gardens, Upper Hill, Nairobi, Kenya
| | - Darius Nyamai
- Africa Mental Health Research and Training Foundation, Matumbato Road, Mawensi Gardens, Upper Hill, Nairobi, Kenya
| | - Kathleen M Pike
- 2Global Mental Health Program, Columbia University, New York, USA
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Matumbato Road, Mawensi Gardens, Upper Hill, Nairobi, Kenya.,3Department of Psychiatry, University of Nairobi, Nairobi, Kenya
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Mutiso VN, Pike KM, Musyimi CW, Gitonga I, Tele A, Rebello TJ, Thornicroft G, Ndetei DM. Feasibility and effectiveness of nurses and clinical officers in implementing the WHO mhGAP intervention guide: Pilot study in Makueni County, Kenya. Gen Hosp Psychiatry 2019; 59:20-29. [PMID: 31096165 DOI: 10.1016/j.genhosppsych.2019.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 01/12/2023]
Abstract
OBJECTIVES (1) To determine the feasibility and effectiveness of nurses and clinical officers in using the mental health Global Action Programme Intervention Guide (mhGAP-IG) as an intervention tool in reducing disability, improving quality of life in the clinical outcomes in patients with the mhGAP-IG priority mental disorders in a Kenyan rural setting. (2) To identify any gaps that can be contributed towards future research. METHODS This study was conducted in 20 healthcare facilities across Makueni County in the South East of Kenya. This county had a population of approximately one million people, with no psychiatrist or clinical psychologist. We recruited 2306 participants from the healthcare facilities in the catchment areas that had previously been exposed to the community mental health awareness campaigns, while being subjected to screening for the mhGAP-IG disorders. We used the Mini-International Neuropsychiatric Interview for adults (MINI-Plus) for DSM-IV confirmatory diagnosis on those who screened positive on the mhGAP-IG. We measured disability using WHO-Disability Assessment Schedule II (DAS II), Quality of Life (QoL) using the WHO QoL-BREF, depression using Patient Health Questionnaire (PHQ-9), suicidality using The Beck Suicide Scale (BSS), psychosis using the Washington Early Recognition Center Affectivity and Psychosis (WERCAP), epilepsy using a seizure questionnaire and alcohol and substance abuse using The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). These measurements were at the baseline, followed by the training for the health professionals on using the WHO mhGAP-IG as an interventional tool. The measurements were repeated at 3 and 6 months post-intervention. RESULTS Of the 2306 participants enrolled in the study, we followed 1718 at 3 months and 1371 at 6 months a follow-up rate of 74.5% and 59.4% respectively. All participants received psycho-education and most depending on condition also received medication. Overall, there was significant decline in disabilities, improvement in seizure control and improvement in clinical outcomes on the identified mental disorders. CONCLUSIONS Trained, supervised and supported nurses and clinical officers can produce good outcomes using the mhGAP-IG for mental health.
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Affiliation(s)
- V N Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.
| | - K M Pike
- Columbia University, Global Mental Health Program, New York, USA.
| | - C W Musyimi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.
| | - I Gitonga
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.
| | - A Tele
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.
| | - T J Rebello
- Columbia University, Global Mental Health Program, New York, USA.
| | | | - D M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya; Department of Psychiatry, University of Nairobi, Nairobi, Kenya.
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