1
|
Pati S, van den Akker M, Schellevis FFG, Sahoo KC, Burgers JS. Management of diabetes patients with comorbidity in primary care: a mixed-method study in Odisha, India. Fam Pract 2023; 40:714-721. [PMID: 36610706 DOI: 10.1093/fampra/cmac144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Diabetes patients with comorbidities need regular and comprehensive care for their disease management. Hence, it is essential to assess the primary care preparedness for managing diabetes patients and the perspectives of the diabetes patients on the care received at the primary care facilities. METHODS All 21 Urban Primary Health Centres (UPHCs) in Bhubaneswar city of Odisha, India, were assessed using the modified Primary Care Evaluation Tool and WHO Package of Essential Non-communicable disease interventions questionnaire. Additionally, 21 diabetes patients with comorbidities were interviewed in-depth to explore their perception of the care received at the primary care facilities. RESULTS All the UPHCs had provisions to meet the basic requirements for the management of diabetes and common comorbidities like hypertension. There were few provisions for chronic kidney illness, cardiovascular disease, mental health, and cancer. Diabetes patients felt that frequent change in primary care physicians at the primary care facilities affected their continuity of care. Easy accessibility, availability of free medicines, and provisions of basic laboratory tests at the facilities were felt to be necessary by the diabetes patients. CONCLUSION Our study highlights the existing gaps in India's healthcare system preparedness and the needs of diabetes patients with comorbidity. The government of India's Health and Wellness (HWC) scheme aims to deliver comprehensive healthcare to the population and provide holistic care at the primary care level for NCD patients. It is imperative that there is an early implementation of the various components of the HWC scheme to provide optimal care to diabetes patients.
Collapse
Affiliation(s)
- Sandipana Pati
- Department of Health and Family Welfare, Government of Odisha, Orissa State Institute of Health and Family Welfare, Bhubaneswar, India
| | - Marjan van den Akker
- Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Family Medicine, Goethe-Universität Frankfurt am Main Institut für Allgemeinmedizin, Frankfurt, Germany
- Katholieke Universiteit Leuven Academisch Centrum voor Huisartsgeneeskunde, Leuven, Belgium
- Department of General Practice & Elderly Care Medicine, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
- Department of General Practice & Elderly Care Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - F François G Schellevis
- Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Family Medicine, Goethe-Universität Frankfurt am Main Institut für Allgemeinmedizin, Frankfurt, Germany
- Katholieke Universiteit Leuven Academisch Centrum voor Huisartsgeneeskunde, Leuven, Belgium
- Department of General Practice & Elderly Care Medicine, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
- Department of General Practice & Elderly Care Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Krushna Chandra Sahoo
- Health Technology Assessment in India (HTAIn), ICMR-Regional Medical Research Centre, Bhubaneswar, India
| | - Jako S Burgers
- Department of Family Medicine, School CAPRI, Maastricht University, Maastricht, The Netherlands
- Dutch College of General Practitioners, Utrecht, The Netherlands
| |
Collapse
|
2
|
Zheng S, Edney SM, Goh CH, Tai BC, Mair JL, Castro O, Salamanca-Sanabria A, Kowatsch T, van Dam RM, Müller-Riemenschneider F. Effectiveness of holistic mobile health interventions on diet, and physical, and mental health outcomes: a systematic review and meta-analysis. EClinicalMedicine 2023; 66:102309. [PMID: 38053536 PMCID: PMC10694579 DOI: 10.1016/j.eclinm.2023.102309] [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: 07/04/2023] [Revised: 10/16/2023] [Accepted: 10/26/2023] [Indexed: 12/07/2023] Open
Abstract
Background Good physical and mental health are essential for healthy ageing. Holistic mobile health (mHealth) interventions-including at least three components: physical activity, diet, and mental health-could support both physical and mental health and be scaled to the population level. This review aims to describe the characteristics of holistic mHealth interventions and their effects on related behavioural and health outcomes among adults from the general population. Methods In this systematic review and meta-analysis, we searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, Scopus, China National Knowledge Infrastructure, and Google Scholar (first 200 records). The initial search covered January 1, 2011, to April 13, 2022, and an updated search extended from April 13, 2022 to August 30, 2023. Randomised controlled trials (RCTs) and non-randomised studies of interventions (NRSIs) were included if they (i) were delivered via mHealth technologies, (ii) included content on physical activity, diet, and mental health, and (iii) targeted adults (≥18 years old) from the general population or those at risk of non-communicable diseases (NCDs) or mental disorders. Studies were excluded if they targeted pregnant women (due to distinct physiological responses), individuals with pre-existing NCDs or mental disorders (to emphasise prevention), or primarily utilised web, email, or structured phone support (to focus on mobile technologies without exclusive human support). Data (summary data from published reports) extraction and risk-of-bias assessment were completed by two reviewers using a standard template and Cochrane risk-of-bias tools, respectively. Narrative syntheses were conducted for all studies, and random-effects models were used in the meta-analyses to estimate the pooled effect of interventions for outcomes with comparable data in the RCTs. The study was registered in PROSPERO, CRD42022315166. Findings After screening 5488 identified records, 34 studies (25 RCTs and 9 pre-post NRSIs) reported in 43 articles with 5691 participants (mean age 39 years, SD 12.5) were included. Most (91.2%, n = 31/34) were conducted in high-income countries. The median intervention duration was 3 months, and only 23.5% (n = 8/34) of studies reported follow-up data. Mobile applications, short-message services, and mobile device-compatible websites were the most common mHealth delivery modes; 47.1% (n = 16/34) studies used multiple mHealth delivery modes. Of 15 studies reporting on weight change, 9 showed significant reductions (6 targeted on individuals with overweight or obesity), and in 10 studies reporting perceived stress levels, 4 found significant reductions (all targeted on general adults). In the meta-analysis, holistic mHealth interventions were associated with significant weight loss (9 RCTs; mean difference -1.70 kg, 95% CI -2.45 to -0.95; I2 = 89.00%) and a significant reduction in perceived stress levels (6 RCTs; standardised mean difference [SMD] -0.32; 95% CI -0.52 to -0.12; I2 = 14.52%). There were no significant intervention effects on self-reported moderate-to-vigorous physical activity (5 RCTs; SMD 0.21; 95%CI -0.25 to 0.67; I2 = 74.28%) or diet quality scores (5 RCTs; SMD 0.21; 95%CI -0.47 to 0.65; I2 = 62.27%). All NRSIs were labelled as having a serious risk of bias overall; 56% (n = 14/25) of RCTs were classified as having some concerns, and the others as having a high risk of bias. Interpretation Findings from identified studies suggest that holistic mHealth interventions may aid reductions in weight and in perceived stress levels, with small to medium effect sizes. The observed effects on diet quality scores and self-reported moderate-to-vigorous physical activity were less clear and require more research. High-quality RCTs with longer follow-up durations are needed to provide more robust evidence. To promote population health, future research should focus on vulnerable populations and those in middle- and low-income countries. Optimal combinations of delivery modes and components to improve efficacy and sustain long-term effects should also be explored. Funding National Research Foundation, Prime Minister's Office, Singapore, under its Campus for Research Excellence and Technological Enterprise (CREATE) Programme and Physical Activity and Nutrition Determinants in Asia (PANDA) Research Programme.
Collapse
Affiliation(s)
- Shenglin Zheng
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore
| | - Sarah Martine Edney
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Chin Hao Goh
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - Jacqueline Louise Mair
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore
| | - Oscar Castro
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore
| | - Alicia Salamanca-Sanabria
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A∗STAR), Singapore
| | - Tobias Kowatsch
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore
- Institute for Implementation Science in Health Care, University of Zürich, Zürich, Switzerland
- School of Medicine, University of St. Gallen, St. Gallen, Switzerland
- Centre for Digital Health Interventions, Department of Management, Technology and Economics ETH Zürich, Zürich, Switzerland
| | - Rob M. van Dam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Departments of Exercise and Nutrition Sciences and Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
- Digital Health Centre, Berlin Institute of Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
3
|
van Loggerenberg F, Akena D, Alinaitwe R, Birabwa-Oketcho H, Méndez CAC, Gómez-Restrepo C, Kulenović AD, Selak N, Kiseljaković M, Musisi S, Nakasujja N, Sewankambo NK, Priebe S. Feasibility and outcomes of using DIALOG+ in primary care to improve quality of life and mental distress of patients with long-term physical conditions: an exploratory non-controlled study in Bosnia and Herzegovina, Colombia and Uganda. BMC PRIMARY CARE 2023; 24:241. [PMID: 37968592 PMCID: PMC10652546 DOI: 10.1186/s12875-023-02197-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 10/30/2023] [Indexed: 11/17/2023]
Abstract
INTRODUCTION The management of long-term physical conditions is a challenge worldwide, absorbing a majority resources despite the importance of acute care. The management of these conditions is done largely in primary care and so interventions to improve primary care could have an enormous impact. However, very little data exist on how to do this. Mental distress is frequently comorbid with long term physical conditions, and can impact on health behaviour and adherence, leading to poorer outcomes. DIALOG+ is a low-cost, patient-centred and solution-focused intervention, which is used in routine patient-clinician meetings and has been shown to improve outcomes in mental health care. The question arises as to whether it could also be used in primary care to improve the quality of life and mental health of patients with long-term physical conditions. This is particularly important for low- and middle-income countries with limited health care resources. METHODS An exploratory non-controlled multi-site trial was conducted in Bosnia and Herzegovina, Colombia, and Uganda. Feasibility was determined by recruitment, retention, and session completion. Patient outcomes (quality of life, anxiety and depression symptoms, objective social situation) were assessed at baseline and after three approximately monthly DIALOG+ sessions. RESULTS A total of 117 patients were enrolled in the study, 25 in Bosnia and Herzegovina, 32 in Colombia, and 60 in Uganda. In each country, more than 75% of anticipated participants were recruited, with retention rates over 90% and completion of the intervention exceeding 92%. Patients had significantly higher quality of life and fewer anxiety and depression symptoms at post-intervention follow-up, with moderate to large effect sizes. There were no significant improvements in objective social situation. CONCLUSION The findings from this exploratory trial suggest that DIALOG+ is feasible in primary care settings for patients with long-term physical conditions and may substantially improve patient outcomes. Future research may test implementation and effectiveness of DIALOG+ in randomized controlled trials in wider primary care settings in low- and middle-income countries. TRIAL REGISTRATION All studies were registered prospectively within the ISRCTN Registry. ISRCTN17003451, 02/12/2020 (Bosnia and Herzegovina), ISRCTN14018729, 01/12/2020 (Colombia) and ISRCTN50335796, 02/12/2020 (Uganda).
Collapse
Affiliation(s)
- Francois van Loggerenberg
- Youth Resilience Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
| | - Dickens Akena
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Racheal Alinaitwe
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - Carlos Gómez-Restrepo
- Departments of Clinical Epidemiology and Biostatistics and Psychiatry and Mental Health, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Nejra Selak
- Primary Care Center Zenica, Zenica, Bosnia and Herzegovina
| | - Meliha Kiseljaković
- Emergency Medical Center of Canton Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Seggane Musisi
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Noeline Nakasujja
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Nelson K Sewankambo
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, East London NHS Foundation Trust, London, UK
| |
Collapse
|
4
|
Zainab R, Kandasamy A, Bhat NA, Dsouza CV, Jennings H, Jackson C, Mazumdar P, Hewitt CE, Ekers D, Narayanan G, Rao GN, Coales K, Muliyala KP, Chaturvedi SK, Murthy P, Siddiqi N. Behavioral Activation for Comorbid Depression in People With Noncommunicable Disease in India: Protocol for a Randomized Controlled Feasibility Trial. JMIR Res Protoc 2023; 12:e41127. [PMID: 37971791 PMCID: PMC10690525 DOI: 10.2196/41127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 03/23/2023] [Accepted: 04/18/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The increasing burden of depression and noncommunicable disease (NCD) is a global challenge, especially in low- and middle-income countries, considering the resource constraints and lack of trained human resources in these settings. Effective treatment of depression in people with NCDs has the potential to enhance both the mental and physical well-being of this population. It will also result in the effective use of the available health care resources. Brief psychological therapies, such as behavioral activation (BA), are effective for the treatment of depression. BA has not been adapted in the community health care services of India, and the feasibility of using BA as an intervention for depression in NCD and its effectiveness in these settings have not been systematically evaluated. OBJECTIVE Our objective is to adapt BA for the Indian NCD context and test the acceptability, feasibility, and implementation of the adapted BA intervention (BEACON intervention package [BIP]). Additionally, we aim to test the feasibility of a randomized controlled trial evaluation of BIP for the treatment of depression compared with enhanced usual care. METHODS Following well-established frameworks for intervention adaptation, we first adapted BA (to fit the linguistic, cultural, and resource context) for delivery in India. The intervention was also adapted for potential remote delivery by telephone. In a randomized controlled trial, we will be testing the acceptability, feasibility, and implementation of the adapted BA intervention (BIP). We shall also test if a randomized controlled feasibility trial can be delivered effectively and estimate important parameters (eg, recruitment and retention rates and completeness of follow-up) needed to design a future definitive trial. RESULTS Following the receipt of approval from all the relevant agencies, the development of the BIP was started on November 28, 2020, and completed on August 18, 2021, and the quantitative data collection was started on August 23, 2021, and completed on December 10, 2021. Process evaluation (qualitative data) collection is ongoing. Both the qualitative and quantitative data analyses are ongoing. CONCLUSIONS This study may offer insights that could help in closing the gap in the treatment of common mental illness, particularly in nations with limited resources, infrastructure, and systems such as India. To close this gap, BEACON tries to provide BA for depression in NCDs through qualified NCD (BA) counselors integrated within the state-run NCD clinics. The results of this study may aid in understanding whether BA as an intervention is acceptable for the population and how feasible it will be to deliver such interventions for depression in NCD in South Asian countries such as India. The BIP may also be used in the future by Indian community clinics as a brief intervention program. TRIAL REGISTRATION Clinical Trials Registry of India CTRI/2020/05/025048; https://tinyurl.com/mpt33jv5. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/41127.
Collapse
Affiliation(s)
- Rayeesa Zainab
- National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Arun Kandasamy
- National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Naseer Ahmad Bhat
- Jindal School of Psychology and Counselling, O P Jindal Global University, Sonipat, India
| | | | - Hannah Jennings
- Department of Health Sciences, University of York & Hull York Medical School, Heslington, United Kingdom
| | - Cath Jackson
- Valid Research LTD, West Yorkshire, United Kingdom
| | - Papiya Mazumdar
- School of Politics and International Studies, Faculty of Social Science, University of Leeds, Leeds, United Kingdom
| | | | - David Ekers
- Tees Esk and Wear Valleys NHS Foundation Trust, North Yorkshire, United Kingdom
- Department of Medicine, Pharmacy, and Health, Durham University, North Yorkshire, United Kingdom
| | | | - Girish N Rao
- National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Karen Coales
- Department of Health Sciences, University of York & Hull York Medical School, Heslington, United Kingdom
| | | | | | - Pratima Murthy
- National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Najma Siddiqi
- Department of Health Sciences, University of York & Hull York Medical School, Heslington, United Kingdom
| |
Collapse
|
5
|
Isfandari S, Roosihermiatie B, Tuminah S, Mihardja LK. The risk associated with psychiatric disturbances in patients with diabetes in Indonesia (2018): a cross-sectional observational study. Osong Public Health Res Perspect 2023; 14:368-378. [PMID: 37920894 PMCID: PMC10626316 DOI: 10.24171/j.phrp.2023.0144] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/06/2023] [Accepted: 09/10/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND The global prevalence of psychiatric disturbances is rising, detrimentally affecting the quality of care and treatment outcomes for individuals, particularly those with diabetes.This study investigated the association of risk factors for psychiatric disturbances among productive-age patients with diabetes (ages 30-59 years), considering sociodemographic characteristics and co-existing diseases. The risk factors considered included sociodemographic factors (e.g., residence, age, sex, marital status, education, and occupation) and co-existing diseases (e.g., hypertension, heart disease, stroke, renal failure, rheumatism, asthma, and cancer). METHODS This cross-sectional study utilized data from the 2018 Indonesian National Health Survey (Riskesdas). The study population comprised respondents aged between 30 and 59 years who had diabetes and had completed the 20-question self-reporting questionnaire (SRQ-20). After the exclusion of incomplete SRQ-20 data, the sample included 8,917 respondents. Data were analyzed using logistic regression. RESULTS Approximately 18.29% of individuals with diabetes displayed symptoms indicative of psychiatric disturbances. After adjusting for sociodemographic factors such as age, sex, education level, occupation, marital status, and place of residence, patients with diabetes who had co-existing conditions such as hypertension, heart diseases, rheumatic disorders, asthma, or cancer had a higher risk for developing psychiatric disturbances than those with diabetes alone (adjusted odds ratio, 6.67; 95% confidence interval, 4.481-9.928; p<0.001). CONCLUSION The elevated risk of psychiatric disturbances among patients with diabetes who had comorbidities underscores the importance of addressing mental health issues in the management of diabetes, especially in patients with concurrent disease conditions.
Collapse
Affiliation(s)
- Siti Isfandari
- Research Center for Public Health and Nutrition, Research Organization for Health, National Research and Innovation Agency, Bandung, Indonesia
| | - Betty Roosihermiatie
- Research Center for Public Health and Nutrition, Research Organization for Health, National Research and Innovation Agency, Bandung, Indonesia
| | - Sulistyowati Tuminah
- Research Center for Public Health and Nutrition, Research Organization for Health, National Research and Innovation Agency, Bandung, Indonesia
| | - Laurentia Konadi Mihardja
- Research Center for Pre-Clinical and Clinical Medicine, Research Organization for Health, National Research and Innovation Agency, Bandung, Indonesia
- Faculty of Medicine, University of Malahayati, Bandar Lampung, Indonesia
| |
Collapse
|
6
|
Al-Abri K, Armitage CJ, Edge D. Views of healthcare professionals and service users regarding anti-, peri- and post-natal depression in Oman. J Psychiatr Ment Health Nurs 2023; 30:795-812. [PMID: 36719270 DOI: 10.1111/jpm.12908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/01/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Anti-, peri- and post-natal depression negatively affect the relationship between mothers and their children. At least half of cases of anti-, peri- and post-natal depression were missed and underdiagnosed by healthcare professionals (HCPs) including doctors, nurses and midwives. Previous qualitative studies considered women's experiences relating to anti-, peri- and post-natal depression separately from studies looking at the views of HCPs. There is a lack of research in Middle Eastern countries, despite the high prevalence of anti-, peri- and post-natal depression. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: This is the first qualitative study investigating the experiences of both HCPs and service users regarding anti-, peri- and post-natal depression from the Middle East perspective, particularly in Oman. This study revealed that anti-, peri- and post-natal depression has been neglected in primary healthcare systems in Oman. The study explored many barriers and facilitators which have been identified by both HCPs and patients in identifying and managing anti-, peri- and post-natal depression in the primary healthcare system. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses, midwives and doctors should develop an empathic screening procedure that allows for the discussion of mental health concerns and help-seeking behaviours with their patients. Training nurses and midwives in motivational interviewing, routinely screening mothers with any depressive symptoms, as well as providing public education programmes to increase mental health awareness, resources and access to a variety of mental healthcare alternatives, could be successful in recognizing and managing anti-, peri- and post-natal depression. ABSTRACT INTRODUCTION: Anti-, peri- and post-natal depression is known to affect the relationship between infants and their mothers adversely. Previous studies have identified barriers and facilitators, reported by women and HCPs, related to the identification and management of anti-, peri- and post-natal depression. However, these studies considered the experiences of women separately from those of the healthcare professionals, even though their experiences of anti-, peri- and post-natal depression are interconnected. Additionally, there is a lack of research among people living in the Middle East, including Oman, which has one of the highest rates of anti-, peri- and post-natal depression globally. AIM This study aimed to explore the views and experiences of HCPs and service users relating to anti-, peri- and post-natal depression from the Middle East perspective. METHOD A qualitative descriptive study using semi-structured interviews was conducted. This study took place at the Family Medicine and Community Clinic at the University Hospital and three selected primary healthcare centres in Muscat, between May 2020 and February 2021. Purposive sampling was used: 15 HCPs with 2-20 years of clinical experience in anti-, peri- and post-natal primary care and 13 pregnant patients plus 2 post-birth patients were interviewed. Audio-recordings were transcribed verbatim, and the anonymized transcripts were then entered into the qualitative data management software, NVIVO 12. RESULTS A thematic approach was used to analyse the data. Four themes were identified in the data, namely: (1) making sense of anti-, peri- and post-natal depression; (2) how to deal with anti-, peri- and post-natal depression; (3) barriers to addressing anti-, peri- and post-natal depression in primary anti-, peri- and post-natal care settings and (4) bridging the gap: facilitators in detecting and managing anti-, peri- and post-natal depression. CONCLUSIONS Improving the identification and management of anti-, peri- and post-natal depression in primary healthcare systems will require a whole-system approach with interventions at the patient, practice and comprehensive primary care team levels. IMPLICATIONS FOR PRACTICE The findings suggest implications for improving the identification and management of anti-, peri- and post-natal depression including an increased emphasis on mental health by enhancing the routine screening of mothers during the anti-, peri- and post-natal period, clearer referral systems, improving resources, providing training with regard to mental health and improving communication skills.
Collapse
Affiliation(s)
- Khalood Al-Abri
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- Department of Community and Mental Health, College of Nursing, Sultan Qaboos University, Muscat, Oman
| | - Christopher J Armitage
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Dawn Edge
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- Equality, Diversity & Inclusion Research Unit, Greater Manchester Mental Health NHS Trust, Manchester, UK
| |
Collapse
|
7
|
Ngo VK, Vu TT, Vu QA, McBain R, Yu G, Nguyen NB, Mai Thi Nguyen H, Ho HT, Van Hoang M. Study protocol for type II hybrid implementation-effectiveness trial of strategies for depression care task-sharing in community health stations in Vietnam: DEP Project. BMC Public Health 2023; 23:1450. [PMID: 37507720 PMCID: PMC10386582 DOI: 10.1186/s12889-023-16312-4] [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: 05/06/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND It is not clear what the most effective implementation strategies are for supporting the enactment and sustainment of depression care services in primary care settings. This type-II Hybrid Implementation-Effectiveness study will compare the effectiveness of three system-level strategies for implementing depression care programs at 36 community health stations (CHSs) across 2 provinces in Vietnam. METHODS In this cluster-randomized controlled trial, CHSs will be randomly assigned to one of three implementation conditions: (1) Usual Implementation (UI), which consists of training workshops and toolkits; (2) Enhanced Supervision (ES), which includes UI combined with bi-weekly/monthly supervision; and (3) Community-Engaged Learning Collaborative (CELC), which includes all components of ES, combined with bi-monthly province-wide learning collaborative meetings, during which cross-site learning and continuous quality improvement (QI) strategies are implemented to achieve better implementation outcomes. The primary outcome will be measured based on the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation quality, and Maintenance) using indicators on implementation, provider, and client factors. The secondary outcome examines factors associated with barriers and facilitators of quality implementation, while the tertiary outcome evaluates the incremental cost-effectiveness ratio of services provided in the ES and CELC conditions, relative to UI condition for depression care. A total of 1,296 clients receiving depression care at CHSs will be surveyed at baseline and 6-month follow-up to assess mental health and psychosocial outcomes (e.g., depression and anxiety severity, health function, quality of life). Additionally, 180 CHS staff and 180 non-CHS staff will complete pre- and post-training evaluation and surveys at baseline, 6, 12, and 24 months. DISCUSSION We hypothesize that the additional implementation supports will make mental health service implementation superior in the ES and CELC arms compared to the UI arm. The findings of this project could identify effective implementation models and assess the added value of specific QI strategies for implementing depression care in primary care settings in Vietnam, with implications and recommendations for other low- and middle-income settings. More importantly, this study will provide evidence for key stakeholders and policymakers to consider policies that disseminate, scale up, and advance quality mental health care in Vietnam. TRIAL REGISTRATION NCT04491045 on Clinicaltrials.gov. Registered July 29, 2020.
Collapse
Affiliation(s)
- Victoria Khanh Ngo
- Center for Innovation in Mental Health, Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, US
- Department of Community Health & Social Sciences, Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, US
| | - Thinh Toan Vu
- Center for Innovation in Mental Health, Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, US.
- Department of Community Health & Social Sciences, Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, US.
| | - Quan Anh Vu
- Center for Innovation in Mental Health, Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, US
| | | | - Gary Yu
- Columbia University, New York, US
| | | | | | - Hien Thi Ho
- Hanoi University of Public Health, Hanoi, Vietnam
| | | |
Collapse
|
8
|
Mazumdar P, Zavala G, Aslam F, Muliyala KP, Chaturvedi SK, Kandasamy A, Nizami A, Ul Haq B, Kellar I, Jackson C, Thomson H, McDaid D, Siddiqi K, Hewitt C, Siddiqi N, Gilbody S, Murthy P, Dadirai Mdege N. IMPACT smoking cessation support for people with severe mental illness in South Asia (IMPACT 4S): A protocol for a randomised controlled feasibility trial of a combined behavioural and pharmacological support intervention. PLoS One 2023; 18:e0287185. [PMID: 37315070 DOI: 10.1371/journal.pone.0287185] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 05/30/2023] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION The prevalence of smoking is high among people living with severe mental illness (SMI). Evidence on feasibility, acceptability and effectiveness of smoking cessation interventions among smokers with SMI is lacking, particularly in low- and middle-income countries. We aim to test the feasibility and acceptability of delivering an evidence-based intervention,i.e., the IMPACT smoking cessation support for people with severe mental illness in South Asia (IMPACT 4S) intervention that is a combination of behavioural support and smoking cessation pharmacotherapies among adult smokers with SMI in India and Pakistan. We will also test the feasibility and acceptability of evaluating the intervention in a randomised controlled trial. METHODS We will conduct a parallel, open label, randomised controlled feasibility trial among 172 (86 in each country) adult smokers with SMI in India and Pakistan. Participants will be allocated 1:1 to either Brief Advice (BA) or the IMPACT 4S intervention. BA comprises a single five-minute BA session on stopping smoking. The IMPACT 4S intervention comprises behavioural support delivered in upto 15 one-to-one, face-to-face or audio/video, counselling sessions, with each session lasting between 15 and 40 minutes; nicotine gum and/or bupropion; and breath carbon monoxide monitoring and feedback. Outcomes are recruitment rates, reasons for ineligibility/non-participation/non-consent of participants, length of time required to achieve required sample size, retention in study and treatments, intervention fidelity during delivery, smoking cessation pharmacotherapy adherence and data completeness. We will also conduct a process evaluation. RESULTS Study will address- uncertainty about feasibility and acceptability of delivering smoking cessation interventions, and ability to conduct smoking cessation trials, among adult smokers with SMI in low- and middle-income countries. CONCLUSIONS This is to inform further intervention adaptation, and the design and conduct of future randomised controlled trials on this topic. Results will be disseminated through peer-review articles, presentations at national, international conferences and policy-engagement forums. TRIAL REGISTRATION ISRCTN34399445 (Updated 22/03/2021), ISRCTN Registry https://www.isrctn.com/.
Collapse
Affiliation(s)
- Papiya Mazumdar
- Department of Health Sciences, University of York, York, United Kingdom
- School of Politics and International Studies, University of Leeds, Leeds, United Kingdom
| | - Gerardo Zavala
- Department of Health Sciences, University of York, York, United Kingdom
| | - Faiza Aslam
- Institute of Psychiatry, Rawalpindi, Pakistan
| | | | | | - Arun Kandasamy
- National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Asad Nizami
- Institute of Psychiatry, Rawalpindi, Pakistan
| | - Baha Ul Haq
- Institute of Psychiatry, Rawalpindi, Pakistan
| | - Ian Kellar
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Cath Jackson
- Department of Health Sciences, University of York, York, United Kingdom
- Valid Research Ltd, Wetherby, United Kingdom
| | | | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, Heslington, United Kingdom
| | - Catherine Hewitt
- Department of Health Sciences, University of York, York, United Kingdom
| | - Najma Siddiqi
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, Heslington, United Kingdom
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, United Kingdom
- National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
- Hull York Medical School, Heslington, United Kingdom
| | - Pratima Murthy
- National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | | |
Collapse
|
9
|
Hattori R, Irie K, Mori T, Tsurumi K, Murai T, Inadomi H. Sensory processing, autonomic nervous function, and social participation in people with mental illnesses. Hong Kong J Occup Ther 2023; 36:39-47. [PMID: 37332298 PMCID: PMC10273795 DOI: 10.1177/15691861231177355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 04/07/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction This study investigated the relationship between sensory processing, respiratory sinus arrhythmia, and social participation in people with psychiatric disorders. Method This study recruited 30 participants, primarily women, from a psychiatric university hospital with a mental health diagnosis listed in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (mean age: 37.7 ± 16.0 years). Sensory processing, autonomic nervous function, and social participation were measured using the Adolescent/Adult Sensory Profile®, respiratory sinus arrhythmia, and World Health Organization Disability Assessment Schedule, respectively. Through mediation analysis, a model wherein sensory processing mediated the relationship between respiratory sinus arrhythmia and social participation was developed. Results Social participation was moderately to highly correlated with Adolescent/Adult Sensory Profile® quadrants (excluding sensory seeking) and respiratory sinus arrhythmia. Furthermore, the mediation analysis revealed that sensory avoiding mediated the relationship between respiratory sinus arrhythmia and social participation, consequently counteracting the direct relationship. Conclusion A mediation model was constructed, which indicated that individuals with psychiatric disorders and low parasympathetic nervous system activity expressed higher sensory processing quadrant of sensory avoiding. Ultimately, this was associated with reduced social participation.
Collapse
Affiliation(s)
- Ritsuko Hattori
- Department of Day Care Units, Hospital of Kyoto University, Kyoto, Japan
| | - Keisuke Irie
- Department of Advanced Occupational Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Taisuke Mori
- Department of Day Care Units, Hospital of Kyoto University, Kyoto, Japan
| | - Kosuke Tsurumi
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshiya Murai
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroyuki Inadomi
- Department of Advanced Occupational Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| |
Collapse
|
10
|
Zheng S, Edney SM, Mair JL, Kowatsch T, Castro O, Salamanca-Sanabria A, Müller-Riemenschneider F. Holistic mHealth interventions for the promotion of healthy ageing: protocol for a systematic review. BMJ Open 2023; 13:e066662. [PMID: 37130675 PMCID: PMC10163532 DOI: 10.1136/bmjopen-2022-066662] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
INTRODUCTION Maintaining physical and mental health is essential for healthy ageing. It can be supported by modifying lifestyle factors such as physical activity and diet. Poor mental health, in turn, contributes to the opposing effect. The promotion of healthy ageing may therefore benefit from holistic interventions integrating physical activity, diet and mental health. These interventions can be scaled up to the population level by using mobile technologies. However, systematic evidence regarding the characteristics and effectiveness of such holistic mHealth interventions remains limited. This paper presents a protocol for a systematic review that aims to provide an overview of the current state of the evidence for holistic mHealth interventions, including their characteristics and effects on behavioural and health outcomes in general adult populations . METHODS AND ANALYSIS We will conduct a comprehensive search for randomised controlled trials and non-randomised studies of interventions published between January 2011 and April 2022 in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, Scopus, China National Knowledge Infrastructure and Google Scholar (first 200 records). Eligible studies will be mHealth interventions targeting general adult populations with content on physical activity, diet and mental health. We will extract information on all relevant behavioural and health outcomes, as well as those related to intervention feasibility. Screening and data extraction processes will be carried out independently by two reviewers. Cochrane risk-of-bias tools will be used to assess risk of bias. We will provide a narrative overview of the findings from eligible studies. With sufficient data, a meta-analysis will be conducted. ETHICS AND DISSEMINATION Ethical approval is not required because this study is a systematic review based on published data. We intend to publish our findings in a peer-reviewed journal and present the study at international conferences. PROSPERO REGISTRATION NUMBER CRD42022315166.
Collapse
Affiliation(s)
- Shenglin Zheng
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore
| | - Sarah Martine Edney
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Jacqueline Louise Mair
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore
| | - Tobias Kowatsch
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore
- Institute for Implementation Science in Health Care, University of Zürich, Zürich, Switzerland
- School of Medicine, University of St. Gallen, St. Gallen, Switzerland
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, ETH Zürich, Zürich, Switzerland
| | - Oscar Castro
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore
| | - Alicia Salamanca-Sanabria
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Digital Health Centre, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
11
|
Tao TJ, Lim TK, Yeung ETF, Liu H, Shris PB, Ma LKY, Lee TMC, Hou WK. Internet-based and mobile-based cognitive behavioral therapy for chronic diseases: a systematic review and meta-analysis. NPJ Digit Med 2023; 6:80. [PMID: 37117458 PMCID: PMC10141870 DOI: 10.1038/s41746-023-00809-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 03/30/2023] [Indexed: 04/30/2023] Open
Abstract
Positive adjustment to chronic diseases reduces psychiatric comorbidity and enhances quality of life. Very little is known about the benefit of internet-based and mobile-based Cognitive Behavioral Therapy (IM-CBT) on physical outcomes and its reciprocal interactions with psychiatric outcomes, the active therapeutic elements, and effect moderators among people with major chronic medical conditions. In this systematic review and meta-analysis (PROSPERO: CRD42022265738), CINAHL of Systematic Reviews, MEDLINE, PsycINFO, PubMed, Web of Science are systematically searched up to 1 June 2022, for randomized controlled trials (RCTs) comparing IM-CBT against non-CBT control condition(s) among people with chronic disease(s). Primary outcomes include improvements in psychiatric symptoms (depressive, anxiety, PTSD symptoms, general psychological distress) from baseline to post-intervention and follow-ups. Secondary outcomes include improvements in physical distress (physical symptoms, functional impairment, self-rated ill health, objective physiological dysfunction). Among 44 RCTs (5077 patients with seven different chronic diseases), IM-CBT improves depressive symptoms, anxiety symptoms, and general psychological distress at post-intervention and across follow-ups, and improves physical distress and functional impairment at post-intervention. Preliminary evidence suggests that behavioral modification and problem-solving could be necessary components to reduce psychiatric symptoms in IM-CBT, whereas cognitive restructuring, psychoeducation, and mindfulness elements relate to reduced physical distress. IM-CBT shows stronger benefits in chronic pain, cancer, arthritis, and cardiovascular disease, relative to other conditions. Changes in psychiatric symptoms and physical distress prospectively predict each other over time. IM-CBT is an effective intervention for comprehensive symptom management among people with chronic diseases.
Collapse
Affiliation(s)
- Tiffany Junchen Tao
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
| | - Teck Kuan Lim
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
| | - Ernest Tsun Fung Yeung
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
| | - Huinan Liu
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
- Department of Special Education and Counselling, The Education University of Hong Kong, Hong Kong SAR, China
| | - Phoenix Bibha Shris
- Department of Psychology, The Education University of Hong Kong, Hong Kong SAR, China
| | - Lawrence Ka Yin Ma
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
- Department of Psychology, The Education University of Hong Kong, Hong Kong SAR, China
| | - Tatia Mei Chun Lee
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Neuropsychology & Human Neuroscience, The University of Hong Kong, Hong Kong SAR, China
| | - Wai Kai Hou
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China.
- Department of Psychology, The Education University of Hong Kong, Hong Kong SAR, China.
| |
Collapse
|
12
|
Mushi D, Hanlon C, Francis JM, Candida M, Demissie M, Teferra S. Adaptation of a model for integration of interventions for alcohol use disorders in primary health care in Tanzania. BMC PRIMARY CARE 2023; 24:106. [PMID: 37085751 PMCID: PMC10120272 DOI: 10.1186/s12875-023-02061-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/13/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Integrating evidence-based interventions for people with alcohol use disorder (AUD) into primary healthcare (PHC) can increase access to care and reduce morbidity, mortality, and population burden. However, for the integration to be feasible, acceptable, and sustainable, there is a need to contextualize the approach and involve stakeholders. Therefore, this study aimed to use participatory methods to adapt a model for integrating AUD interventions in Tanzania's PHC system at the community, facility, and organizational levels. METHODS A mixed-methods study was used. Participants include key mental health stakeholders, experts, and PHC providers. We conducted a situational analysis to investigate opportunities and constraints in the existing systems of care, utilizing data available from the routine collection and/or in the public domain, individual semi-structured interviews (n = 11), and focus group discussions (3 groups; total n = 26 participants) and a series of theory of change (ToC) workshops (n = 32). Data from the three methods were triangulated to develop the adapted model for integrating interventions for AUD in PHC. RESULTS A situational appraisal revealed limited community, facility, and organizational resources and infrastructures for supporting services delivery of integrated AUD interventions. Also, shortage of health workforce, inadequate health management information systems, and limited medical supply and financing. Nevertheless, the theory of change proposed integrated AUD intervention packages and strategies to facilitate integrated care for people with AUD. Additionally, the barriers and facilitators for implementing these integrated AUD interventions and how to overcome them were explored. CONCLUSIONS The adapted model for the integrated AUD intervention in Tanzanian PHC revealed limited resources and system functioning for facilitating integrated AUD services. Nevertheless, it proposes the needed integrated AUD interventions and its barriers, facilitators, and strategies for overcoming them. There is a need to pilot the adapted model to inform plans for more comprehensive implementation or scaling up.
Collapse
Affiliation(s)
- Dorothy Mushi
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Science, P.O Box 65001, United Nations Road, Dar Es Salaam, Tanzania.
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Charlotte Hanlon
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Joel M Francis
- Department of Family Medicine and Primary Care, Witwatersrand University, Faculty of Health Sciences, Johannesburg, South Africa
| | - Moshiro Candida
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Mekdes Demissie
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
- Psychiatric Nursing Department, School of Nursing and Midwifery, College of Health and medical Sciences, Haramaya University, Ethiopia, Dire Dawa , Ethiopia
| | - Solomon Teferra
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| |
Collapse
|
13
|
Habimana S, Biracyaza E, Mpunga T, Nsabimana E, Kayitesi F, Nzamwita P, Jansen S. Prevalence and associated factors of depression and anxiety among patients with cancer seeking treatment at the Butaro Cancer Center of Excellence in Rwanda. Front Public Health 2023; 11:972360. [PMID: 36875374 PMCID: PMC9978744 DOI: 10.3389/fpubh.2023.972360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 01/25/2023] [Indexed: 02/18/2023] Open
Abstract
Background Depression and anxiety are psychological and physiological disturbances persisting in cancer patients with high prevalence worldwide, particularly in low- and middle-income countries, due to complexities of determinants of health including biological, individual, socio-cultural, and treatment-related characteristics. Although depression and anxiety have an enormous impact on adherence, length of stay at the hospital, quality of life, and treatment outcomes, studies on psychiatric disorders remain limited. Thus, this study determined the prevalence and factors of depression and anxiety among patients with cancer in Rwanda. Methods A cross-sectional study was conducted among 425 patients with cancer from the Butaro Cancer Center of Excellence. We administered socio-demographic questionnaires and psychometric instruments. Bivariate logistic regressions were computed to identify significant factors to be exported into the multivariate logistic models. Then, odds ratios and their 95% confidence intervals were applied, and statistical significance at p < 0.05 were considered to confirm significant associations. Results The prevalence of depression and anxiety was 42.6 and 40.9%, respectively. Patients with cancer initiated to chemotherapy had a greater likelihood of being depressed [AOR = 2.06; 95% CI (1.11-3.79)] than those initiated to chemotherapy and counseling. Breast cancer was significantly associated with a greater risk of depression [AOR = 2.07, 95% CI (1.01-4.22)] than Hodgikins's Lymphoma cancer. Furthermore, patients with depression had greater odds of developing anxiety [AOR = 1.76, 95% CI (1.01-3.05)] than those with no depression. Those suffering from depression were almost two times more likely to experience anxiety [AOR = 1.76; 95% CI (1.01-3.05)] than their counterparts. Conclusion Our results revealed that depressive and anxious symptomatology is a health threat in clinical settings that requires enhancement of clinical monitoring and prioritization of mental health in cancer health facilities. Designing biopsychosocial interventions to address associated factors needs special attention to promote the health and wellbeing of patients with cancer.
Collapse
Affiliation(s)
- Samuel Habimana
- Department of Social work and Social Ecology, School of Behavioral Health, Loma Linda University, Loma Linda, CA, United States.,Rwanda Resilience and Grounding Organization, Kigali, Rwanda
| | - Emmanuel Biracyaza
- Rwanda Resilience and Grounding Organization, Kigali, Rwanda.,Faculty of Medicine, School of Rehabilitation, Université de Montréal, Montréal, QC, Canada
| | | | | | - Florence Kayitesi
- Acquired Immunodeficiency Syndrome Health Care Foundation, Kigali, Rwanda
| | - Pascal Nzamwita
- Acquired Immunodeficiency Syndrome Health Care Foundation, Kigali, Rwanda
| | - Stefan Jansen
- Center for Research and Innovation, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| |
Collapse
|
14
|
Landrum KR, Pence BW, Gaynes BN, Dussault JM, Hosseinipour MC, Kulisewa K, Malava JK, Masiye J, Akello H, Udedi M, Zimba CC. The cross-sectional association of stressful life events with depression severity among patients with hypertension and diabetes in Malawi. PLoS One 2022; 17:e0279619. [PMID: 36584142 PMCID: PMC9803137 DOI: 10.1371/journal.pone.0279619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 11/23/2022] [Indexed: 12/31/2022] Open
Abstract
Depressive disorders are a leading cause of global morbidity and remain disproportionately high in low- and middle-income settings. Stressful life events (SLEs) are known risk factors for depressive episodes and worsened depressive severity, yet are under-researched in comparison to other depression risk factors. As depression is often comorbid with hypertension, diabetes, and other noncommunicable diseases (NCDs), research into this relationship among patients with NCDs is particularly relevant to increasing opportunities for integrated depression and NCD care. This study aims to estimate the cross-sectional association between SLEs in the three months preceding baseline interviews and baseline depressive severity among patients with at least mild depressive symptoms who are seeking NCD care at 10 NCD clinics across Malawi. SLEs were measured by the Life Events Survey and depressive severity (mild vs. moderate to severe) was measured by the Patient Health Questionnaire-9. The study population (n = 708) was predominately currently employed, grand multiparous (5-8 children) women with a primary education level. Two thirds (63%) had mild depression while 26%, 8%, and 3% had moderate, moderately severe, and severe depression, respectively. Nearly all participants (94%) reported at least one recent SLE, with the most common reported SLEs being financial stress (48%), relationship changes (45%), death of a family member or friend (41%), or serious illness of a family member or friend (39%). Divorce/separation, estrangement from a family member, losing source of income, and major new health problems were significant predictors of greater (moderate or severe) depressive severity compared to mild severity. Having a major new health problem or experiencing divorce/separation resulted in particularly high risk of more severe depression. After adjustment, each additional SLE was associated with a 9% increased risk of moderate or worse depressive severity compared to mild depressive severity (RR: 1.09; (95% CI: 1.05, 1.13), p<0.0001). Among patients with NCDs with at least mild depressive symptoms, SLEs in the prior 3 months were associated with greater depressive severity. While many SLEs may not be preventable, this research suggests that assessment of SLEs and teaching of positive coping strategies when experiencing SLEs may play an important role in integrated NCD and depression treatment models.
Collapse
Affiliation(s)
- Kelsey R. Landrum
- University of North Carolina at Chapel Hill, Department of Epidemiology, Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - Brian W. Pence
- University of North Carolina at Chapel Hill, Department of Epidemiology, Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - Bradley N. Gaynes
- University of North Carolina at Chapel Hill, Department of Epidemiology, Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
- University of North Carolina at Chapel Hill, Department of Psychiatry, Chapel Hill, North Carolina, United States of America
| | - Josée M. Dussault
- University of North Carolina at Chapel Hill, Department of Epidemiology, Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - Mina C. Hosseinipour
- University of North Carolina at Chapel Hill, Department of Medicine, Chapel Hill, North Carolina, United States of America
- UNC Project Malawi, UNC Project, Tidziwe Centre, Lilongwe, Malawi
| | - Kazione Kulisewa
- Kamuzu University of Health, Department of Psychiatry and Mental Health, Blantyre, Malawi
| | | | - Jones Masiye
- Malawi Ministry of Health, Noncommunicable Diseases and Mental Health Unit, Lilongwe, Malawi
| | - Harriet Akello
- UNC Project Malawi, UNC Project, Tidziwe Centre, Lilongwe, Malawi
| | - Michael Udedi
- Malawi Ministry of Health, Noncommunicable Diseases and Mental Health Unit, Lilongwe, Malawi
| | | |
Collapse
|
15
|
Magnitude of depression and its associated factors among patients with diabetes mellitus at public hospitals in Southwest Ethiopia, 2021. Sci Rep 2022; 12:22134. [PMID: 36550160 PMCID: PMC9780233 DOI: 10.1038/s41598-022-26330-8] [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: 06/25/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
Depression is the third-leading cause of disability measured in terms of disability-adjusted life-years. When depression coexists with diabetes mellitus, it is associated with major health consequences and results in poor health outcomes, decreased quality of life, lost productivity and increased risk of death. The current study aimed to assess the magnitude of depression and its associated factors among adult patients with diabetes mellitus attending follow-up at the public hospitals of Buno Bedele zone, Southwest Ethiopia. A multi-centre cross-sectional study was done among people living with diabetes mellitus at an outpatient clinic of Buno Bedele zone hospitals. The study period was from April to May 2021. A systematic random sampling technique was used to select the study participants. Data were collected using a structured questionnaire. Depression was assessed by the Patient Health Questionnaire-9. Patient Health Questionnaire-9 is a validated tool to assess depression with sensitivity 86% and specificity 67%. The collected data were cleaned, edited, and entered into epi-data version 3.1, and analysed using SPSS version 24. Logistic regression analysis was employed to identify factors associated with depression occurrence. A p value of 0.05 was considered statistically significant. A total of 310 study participants were included in this study. Among study participants, 41.6% fulfilled the criteria for depression. Variables significantly associated with depression were female gender [AOR: 2.26, 95% CI (1.30, 3.95)], duration of diabetes greater than 5 years [AOR: 2.68, 95% CI (1.57, 4.56)], poor social support [AOR: 2.46, 95% CI (1.10, 5.49)], moderate social support [AOR: 2.63, 95% CI (1.34, 5.16)], current alcohol consumption [AOR: 3.55, 95% CI (1.20, 10.52)] and previous alcohol consumption [AOR = 2.81, 95% CI (1.40, 5.60)]. According to this study, depression is relatively common among diabetic individuals. Being a female, having diabetes for a long time, having poor social support, using alcohol now and in the past were factors that substantially linked to depression. Healthcare professionals should consider screening for depression using the Patient Health Questionnaire-9 or other validated tools in all diabetic patients, especially in those who are at higher risk.
Collapse
|
16
|
Mutyambizi-Mafunda V, Myers B, Sorsdahl K, Chanakira E, Lund C, Cleary S. Economic evaluation of psychological treatments for common mental disorders in low- and middle-income countries: a systematic review. Health Policy Plan 2022; 38:239-260. [PMID: 36005943 PMCID: PMC9923379 DOI: 10.1093/heapol/czac069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 07/29/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
Common mental disorders (CMDs) constitute a major public health and economic burden on low- and middle-income countries (LMICs). Systematic reviews of economic evaluations of psychological treatments for CMDs are limited. This systematic review examines methods, reports findings and appraises the quality of economic evaluations of psychological treatments for CMDs in LMICs. We searched a range of bibliographic databases (including PubMed, EconLit, APA-PsycINFO and Cochrane library) and the African Journals Online (AJoL) and Google Scholar platforms. We used a pre-populated template to extract data and the Drummond & Jefferson checklist for quality appraisal. We present results as a narrative synthesis. The review included 26 studies, mostly from Asia (12) and Africa (9). The majority were cost-effectiveness analyses (12), some were cost-utility analyses (5), with one cost-benefit analysis or combinations of economic evaluations (8). Most interventions were considered either cost-effective or potentially cost-effective (22), with 3 interventions being not cost-effective. Limitations were noted regarding appropriateness of conclusions drawn on cost-effectiveness, the use of cost-effectiveness thresholds and application of 'societal' incremental cost-effectiveness ratios to reflect value for money (VfM) of treatments. Non-specialist health workers (NSHWs) delivered most of the treatments (16) for low-cost delivery at scale, and costs should reflect the true opportunity cost of NSHWs' time to support the development of a sustainable cadre of health care providers. There is a 4-fold increase in economic evaluations of CMD psychological treatments in the last decade over the previous one. Yet, findings from this review highlight the need for better application of economic evaluation methodology to support resource allocation towards the World Health Organization recommended first-line treatments of CMDs. We suggest impact inventories to capture societal economic gains and propose a VfM assessment framework to guide researchers in evaluating cost-effectiveness.
Collapse
Affiliation(s)
- Vimbayi Mutyambizi-Mafunda
- *Corresponding author. Health Economics Unit, School of Public Health and Family Medicine, Health Sciences Faculty, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa. E-mail:
| | - Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, Perth, WA 6102, Australia,Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie van Zyl Drive, Tygerberg, Cape Town 7505, South Africa,Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, 1st Floor, Neuroscience Institute, Groote Schuur Hospital, University of Cape Town, Observatory, Cape Town 7925, South Africa
| | - Katherine Sorsdahl
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town 7700, South Africa
| | - Esther Chanakira
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Crick Lund
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town 7700, South Africa,Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s Global Health Institute, King’s College London, De Crespigny Park, London, SE5 8AF, UK
| | - Susan Cleary
- Health Economics Unit, School of Public Health and Family Medicine, Health Sciences Faculty, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa
| |
Collapse
|
17
|
Smith C, Goss HR, Issartel J, Meegan S, Belton S. LifeLab: Co-Design of an Interactive Health Literacy Intervention for Socioeconomically Disadvantaged Adolescents’. CHILDREN 2022; 9:children9081230. [PMID: 36010120 PMCID: PMC9406774 DOI: 10.3390/children9081230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/03/2022] [Accepted: 08/10/2022] [Indexed: 11/16/2022]
Abstract
Low socioeconomic populations, when compared to more affluent groups, are at greater risk of initiating risky behaviours and consequently developing health complications. Health literacy has been identified as a possible means to improve and sustain positive health behaviours, with adolescence being a time point when such behaviours can be embedded. To develop a meaningful health intervention, it has been recommended that relevant stakeholders be included in the design phase. This formative evaluation study was the second phase of co-design of an engaging health literacy intervention ‘LifeLab’ with, and for, socioeconomically disadvantaged adolescents in Ireland. In Spring 2021, a series of co-design workshops (n = 17) were facilitated with a convenience sample of adolescents from socially disadvantaged areas (n = 22) to gather their perceptions, feedback, and suggested changes on the LifeLab learning activities that had emerged from Phase 1 of the work. The data was analysed using reflexive thematic analysis, resulting in the development of three themes: (i) preferred learning engagement strategies, (ii) practical and logistical considerations and (iii) ideas for LifeLab content. The results highlight the value in adopting a participatory approach, as participants offered an array of suggestions and details to maximise the potential for LifeLab to be contextually relevant and engaging; suggestions which will directly inform the development and implementation of the intervention.
Collapse
|
18
|
Srinivasan K, Heylen E, Johnson Pradeep R, Mony PK, Ekstrand ML. Collaborative care compared to enhanced standard treatment of depression with co-morbid medical conditions among patients from rural South India: a cluster randomized controlled trial (HOPE Study). BMC Psychiatry 2022; 22:394. [PMID: 35698087 PMCID: PMC9195442 DOI: 10.1186/s12888-022-04000-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 05/11/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Depression is common among primary care patients in LMIC but treatments are largely ineffective. In this cluster-randomized controlled trial, we tested whether depression outcomes are different among recipients of a collaborative care model compared to enhanced standard treatment in patients with co-morbid chronic medical conditions. METHODS We conducted a cluster randomized controlled trial among participants 30 years or older seeking care at 49 primary health centers (PHCs) in rural Karnataka, diagnosed with major depressive disorder, dysthymia, generalized anxiety disorder, or panic disorder on the MINI-International Neuropsychiatric Interview plus either hypertension, diabetes, or ischemic heart disease. From a list of all PHCs in the district, 24 PHCs were randomized a priori to deliver collaborative care and 25 PHCs enhanced standard treatment. The collaborative care model consisted of a clinic-based and a community-based component. Study assessment staff was blinded to treatment arm allocation. The primary outcome was the individual-level PHQ-9 score over time. RESULTS Between May 2015 and Nov 2018, 2486 participants were enrolled, 1264 in the control arm, and 1222 in the intervention arm. They were assessed at baseline, 3, 6 and 12 months. The mean PHQ-9 depression score was around 8.5 at baseline. At each follow-up PHQ-9 scores were significantly lower in the intervention (5.24, 4.81 and 4.22 at respective follow-ups) than in the control group (6.69, 6.13, 5.23, respectively). A significant time-by-treatment interaction (p < 0.001) in a multi-level model over all waves, nested within individuals who were nested within PHCs, confirmed that the decrease in depression score from baseline was larger for collaborative care than enhanced standard care throughout follow-up. CONCLUSIONS The collaborative care intervention resulted in significantly lower depression scores compared to enhanced standard care among participants with co-morbid physical conditions. The findings have potential implications for integrating mental health and chronic disease treatment in resource constrained settings. TRIAL REGISTRATION ClinicalTrials.gov NCT02310932 , registered on December 8, 2014, and Clinical Trials Registry India CTRI/2018/04/013001 , registered on April 4, 2018. Retrospectively registered.
Collapse
Affiliation(s)
- Krishnamachari Srinivasan
- grid.418280.70000 0004 1794 3160Division of Mental Health & Neurosciences, St John’s Research Institute, Bangalore, India ,grid.416432.60000 0004 1770 8558Department of Psychiatry, St John’s Medical College, Bangalore, India
| | - Elsa Heylen
- grid.266102.10000 0001 2297 6811Division of Prevention Sciences, University of California, San Francisco, USA
| | - R. Johnson Pradeep
- grid.416432.60000 0004 1770 8558Department of Psychiatry, St John’s Medical College, Bangalore, India
| | - Prem K. Mony
- grid.416432.60000 0004 1770 8558Division of Epidemiology and Community Health, St John’s Medical College & Research Institute, Bangalore, India
| | - Maria L. Ekstrand
- grid.418280.70000 0004 1794 3160Division of Mental Health & Neurosciences, St John’s Research Institute, Bangalore, India ,grid.266102.10000 0001 2297 6811Division of Prevention Sciences, University of California, San Francisco, USA
| |
Collapse
|
19
|
Truter ZM. Collaborative care for mental health in South Africa: a qualitative systematic review. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2022. [DOI: 10.1177/00812463221093525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Collaborative care for mental health is a strategy that restructures the roles of health care providers, and sectors outside of health care provision, to encourage a team-based approach in dealing with mental illness. Previous research proposed a collaborative care strategy to make mental health care more accessible and culturally appropriate. This study systematically reviewed the available literature to produce a summary of collaborative care in the context of mental health care in South Africa. More specifically, the aims were to document existing efforts towards collaboration and highlight barriers and challenges associated with collaborative care in mental health care in South Africa. This review was conducted in accordance with PRISMA guidelines. South African studies published in English between 2002 and October 2021 were considered for inclusion. Twenty-five studies with heterogeneous study designs were included in this review and analysed using a thematic synthesis approach. Collaborative care models hold promise for closing the mental health treatment gap and providing culturally appropriate mental health care in South Africa. However, despite progress made, several challenges remain in the implementation of collaborative policies. Four main strategies were identified to improve the implementation of collaborative care models in South Africa. These included (1) redirecting resources and improving infrastructure, (2) formalising roles and relationships and improving leadership, (3) improving communication and supervisory structures, and (4) improving training and education. This review offers valuable recommendations for South African mental health care policy that might also be useful for other resource-constrained countries.
Collapse
|
20
|
Abdin E, Chong SA, Vaingankar JA, Shafie S, Seah D, Chan CT, Ma S, James L, Heng D, Subramaniam M. Changes in the prevalence of comorbidity of mental and physical disorders in Singapore between 2010 and 2016. Singapore Med J 2022; 63:196-202. [PMID: 32798362 PMCID: PMC9251260 DOI: 10.11622/smedj.2020124] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Few studies have examined the changes in the prevalence of comorbidity of mental and physical disorders in recent years. The present study sought to examine whether the prevalence of comorbidity of mental and physical disorders in Singapore showed any changes between 2010 and 2016. METHODS We extracted data from two repeated nationally representative cross-sectional surveys conducted among resident adults aged ≥ 18 years in Singapore. Significant changes were tested using pooled multinomial logistic regression analyses. RESULTS The prevalence of comorbid mental and physical disorders increased significantly from 5.8% in 2010 to 6.7% in 2016. Among those with physical disorders, there were significant increases over time in the prevalence of comorbid generalised anxiety disorder (GAD) (0.1% vs. 0.4%) and obsessive-compulsive disorder (OCD) (1.4% vs. 3.9%) in diabetes mellitus, and alcohol dependence in cardiovascular disorders (0.1% vs. 1.3%). Among those with mental disorders, there were significant increases over time in the prevalence of comorbid diabetes mellitus in OCD (4.1% vs. 10.9%), cancer in major depressive disorder (0.4% vs. 2.4%), and cardiovascular disorders in GAD (0.4% vs. 6.7%) and alcohol dependence (0.9% vs. 11.8%). Significant changes in the overall prevalence of comorbid mental and physical disorders were also observed across age group, education and employment status. CONCLUSION The prevalence of comorbid mental and physical disorders increased significantly over time. This finding supports the need for more appropriate clinical management with better integration between mental health and general medical care professionals across all aspects of the healthcare system to treat this comorbidity in Singapore.
Collapse
Affiliation(s)
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore
| | | | - Saleha Shafie
- Research Division, Institute of Mental Health, Singapore
| | - Darren Seah
- Family Medicine Department, National Healthcare Group Polyclinics, Singapore
| | - Chun Ting Chan
- Department of Early Psychosis Intervention, Institute of Mental Health, Singapore
| | | | | | | | | |
Collapse
|
21
|
Johnson LJ, Schopp LH, Waggie F, Frantz JM. Challenges experienced by community health workers and their motivation to attend a self-management programme. Afr J Prim Health Care Fam Med 2022; 14:e1-e9. [PMID: 35144456 PMCID: PMC8831930 DOI: 10.4102/phcfm.v14i1.2911] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 10/27/2021] [Accepted: 11/04/2021] [Indexed: 11/02/2022] Open
Abstract
Background: Community health workers (CHWs) are change agents expected to assist in decreasing the global burden of disease in the communities they serve. However, they themselves have health risk behaviours, which predispose them to non-communicable diseases and thus need to be empowered to make better health choices. There is a gap in literature detailing the challenges faced by CHWs in addressing their own health risk behaviours.Aim: This study aimed to explore the challenges experienced by CHWs in carrying out their daily duties and the motivating factors to join a self-management programme.Setting: The study was conducted in a low socio-economic urban area of the Western Cape, South Africa.Methods: This study used a qualitative exploratory design using in-depth interviews to obtain rich data about the personal and professional challenges that CHWs experience on a daily basis.Results: Five themes emerged with regard to professional challenges (social conditions, mental health of patients, work environment, patient adherence and communication). This cadre identified ineffective self-management as a personal challenge and two themes emerged as motivation for participating in a self-management programme: empowerment and widening perspective.Conclusion: The challenges raised by the CHWs have a direct impact on their role in communities. This study therefore highlights an urgent need for policymakers and leaders who plan training programmes to take intentional strategic action to address their health challenges and to consider utilising a self-management intervention model to improve their overall health status.
Collapse
Affiliation(s)
- Levona J Johnson
- Department of Physiotherapy, Faculty of Community and Health Sciences, University of the Western Cape, Bellville.
| | | | | | | |
Collapse
|
22
|
Tan ST, Low PTA, Howard N, Yi H. Social capital in the prevention and management of non-communicable diseases among migrants and refugees: a systematic review and meta-ethnography. BMJ Glob Health 2021; 6:bmjgh-2021-006828. [PMID: 34952855 PMCID: PMC8710856 DOI: 10.1136/bmjgh-2021-006828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 12/05/2021] [Indexed: 12/31/2022] Open
Abstract
Globally, the burden of non-communicable diseases (NCDs) falls disproportionately on underserved populations. Migrants and refugees are particularly vulnerable due to economic instability and systemic poverty. Despite the myriad of health risks faced by migrants and refugees, access to appropriate healthcare is hindered by structural, cultural and socioeconomic barriers. We conducted a systematic review and meta-ethnography to obtain critical insight into how the interplay of social capital and structural factors (eg, state policies and socioeconomic disadvantage) influences the prevention and treatment of NCDs in migrant and refugee populations. We included 26 studies of 14 794 identified articles, which reported qualitative findings on the structure and functions of social capital in NCD prevention and management among migrants and refugees. We synthesised findings, using the process outlined by Noblit and Hare, which indicated that migrants and refugees experienced weakened social networks in postmigration settings. They faced multiple barriers in healthcare access and difficulty navigating healthcare systems perceived as complex. Family as the core of social capital appeared of mixed value in their NCD prevention and management, interacting with cultural dissonance and economic stress. Community organisations were integral in brokering healthcare access, especially for information diffusion and logistics. Healthcare providers, especially general practitioners, were important bridges providing service-user education and ensuring a full continuum of quality care. While social capital reduced immediate barriers in healthcare access for NCD prevention and management, it was insufficient to address structural barriers. System-level interventions appear necessary to achieve equitable healthcare access in host countries. PROSPERO registration number: CCRD42020167846.
Collapse
Affiliation(s)
- Sok Teng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Pei Ting Amanda Low
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Natasha Howard
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Huso Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| |
Collapse
|
23
|
Miller AP, Espinosa da Silva C, Ziegel L, Mugamba S, Kyasanku E, Malyabe RB, Wagman JA, Mia Ekström A, Nalugoda F, Kigozi G, Nakigozi G, Kagaayi J, Watya S, Kigozi G. Construct validity and internal consistency of the Patient Health Questionnaire-9 (PHQ-9) depression screening measure translated into two Ugandan languages. PSYCHIATRY RESEARCH COMMUNICATIONS 2021; 1:100002. [PMID: 35187539 PMCID: PMC8855962 DOI: 10.1016/j.psycom.2021.100002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND In Uganda, depression is a major public health issue because of its direct disease burden and as a risk factor and co-morbidity for other pervasive health issues. Psychometric assessment of translated depression measures is critical to public health planning to ensure proper screening, surveillance, and treatment of depression and related outcomes. We examined aspects of the validity and reliability of the Patient Health Questionnaire-9 (PHQ-9) translated into Luganda and Runyoro in a large population-based cohort of Ugandan adolescents and adults. METHODS Data from the ongoing open cohort AMBSO Population Health Surveillance study were analyzed from the Wakiso and Hoima districts in Uganda. Descriptive statistics were calculated for the overall sample and stratified by translated language. Construct validity was assessed for each translated scale using confirmatory factor analysis for ordinal data. The internal consistency of each translated scale was assessed using Cronbach's alpha, McDonald's omega total and omega hierarchical. RESULTS Compared to the Runyoro-speaking subsample from Hoima (n=2297), participants in the Luganda-speaking subsample from Wakiso (n=672) were older (27 vs 21 years, p < 0.01) and a greater proportion were female (62% vs. 55%, p < 0.01). The Luganda-translated PHQ-9 had a sample mean of 3.46 (SD=3.26), supported a single-factor structure (RMSEA=0.05, CFI=0.96, TLI=0.94), and demonstrated satisfactory internal consistency (Cronbach's alpha=0.73, McDonald's omega total=0.76, McDonald's omega hierarchical=0.53). The Runyoro-translated PHQ-9 had a comparable sample mean of 3.58 (SD=3.00), also supported a one-factor structure (RMSEA=0.08, CFI=0.92, TLI=0.90), and demonstrated satisfactory internal consistency (Cronbach's alpha=0.72, McDonald's omega total=0.76, McDonald's omega hierarchical=0.57). CONCLUSIONS Our preliminary findings indicate that the Luganda and Runyoro translations of the PHQ-9 had satisfactory construct validity and internal consistency in our sample of Ugandan adolescents and adults. Future studies should expand on this promising work by assessing additional psychometric characteristics of these translated measures in other communities in Uganda.
Collapse
Affiliation(s)
- Amanda P. Miller
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
- Corresponding author: Amanda P Miler
| | - Cristina Espinosa da Silva
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
- San Diego State University, Department of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA
| | - Leo Ziegel
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Stephen Mugamba
- Africa Medical and Behavioral Sciences Organization (AMBSO), Uro Care Limited, Wakiso District, Uganda
- Makerere University Walter Reed Project (MUWRP), Kampala, Uganda
| | - Emma Kyasanku
- Africa Medical and Behavioral Sciences Organization (AMBSO), Uro Care Limited, Wakiso District, Uganda
| | - Robert B. Malyabe
- Africa Medical and Behavioral Sciences Organization (AMBSO), Uro Care Limited, Wakiso District, Uganda
| | - Jennifer A. Wagman
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Fred Nalugoda
- Africa Medical and Behavioral Sciences Organization (AMBSO), Uro Care Limited, Wakiso District, Uganda
| | - Grace Kigozi
- Africa Medical and Behavioral Sciences Organization (AMBSO), Uro Care Limited, Wakiso District, Uganda
| | - Gertrude Nakigozi
- Africa Medical and Behavioral Sciences Organization (AMBSO), Uro Care Limited, Wakiso District, Uganda
| | - Josehp Kagaayi
- Africa Medical and Behavioral Sciences Organization (AMBSO), Uro Care Limited, Wakiso District, Uganda
| | - Stephen Watya
- Africa Medical and Behavioral Sciences Organization (AMBSO), Uro Care Limited, Wakiso District, Uganda
| | - Godfrey Kigozi
- Africa Medical and Behavioral Sciences Organization (AMBSO), Uro Care Limited, Wakiso District, Uganda
| |
Collapse
|
24
|
Myers B, Browne FA, Carney T, Kline T, Bonner CP, Wechsberg WM. The Association of Recurrent and Multiple Types of Abuse with Adverse Mental Health, Substance Use, and Sexual Health Outcomes among Out-of-School Adolescent Girls and Young Women in Cape Town, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11403. [PMID: 34769920 PMCID: PMC8582840 DOI: 10.3390/ijerph182111403] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 12/03/2022]
Abstract
Although physical and sexual abuse exposure is a well-established risk for poor health, the dimensions of abuse associated with health among socially vulnerable adolescent girls and young women (AGYW) remain underexamined. This article describes associations between combinations of abuse type and timing with mental health, substance use, and sexual risk outcomes among a sample of 499 AGYW (aged 16 to 19) who had left school early and were recruited for a cluster randomized trial in Cape Town, South Africa. Approximately one-third (33.5%; 95% CI: 28.7, 38.6) of participants reported lifetime abuse. Exposure to more than one type of abuse was associated with increased risk of depression (β = 3.92; 95% CI: 2.25, 5.59) and anxiety (β = 3.70; 95% CI: 2.11, 5.28), and greater odds of polydrug use (OR = 2.10; 95% CI: 1.02, 4.34) and substance-impaired sex (OR = 2.17; 95% CI: 1.31, 3.86). Exposure to multiple types of abuse during childhood/early adolescence and again in late adolescence was associated with increased risk of depression (β = 4.65; 95% CI: 3.15, 6.14), anxiety (β = 4.35; 95% CI: 2.70, 6.02), and polydrug use (OR = 2.37; 95% CI: 1.03, 5.73). Findings underscore the need for trauma-informed interventions that reduce mental health, substance use, and sexual risks among AGYW who have experienced multiple forms of abuse and recurrent abuse.
Collapse
Affiliation(s)
- Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
- Alcohol, Tobacco and Other Drug Abuse Research Unit, South African Medical Research Council, P.O. Box 19070, Tygerberg 7505, South Africa
- Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7701, South Africa
| | - Felicia A Browne
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - Tara Carney
- Alcohol, Tobacco and Other Drug Abuse Research Unit, South African Medical Research Council, P.O. Box 19070, Tygerberg 7505, South Africa
- Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7701, South Africa
| | - Tracy Kline
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
| | | | - Wendee M Wechsberg
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
- Maternal and Child Health Department, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27514, USA
- Department of Psychology, North Carolina State University, Raleigh, NC 27529, USA
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27703, USA
| |
Collapse
|
25
|
Amu H, Osei E, Kofie P, Owusu R, Bosoka SA, Konlan KD, Kim E, Orish VN, Maalman RSE, Manu E, Parbey PA, Saah FI, Mumuni H, Appiah PK, Komesuor J, Ayanore MA, Amenuvegbe GK, Kim S, Jung H, Adjuik M, Tarkang EE, Alhassan RK, Donkor ES, Zottor FB, Kweku M, Amuna P, Kim SY, Gyapong JO. Prevalence and predictors of depression, anxiety, and stress among adults in Ghana: A community-based cross-sectional study. PLoS One 2021; 16:e0258105. [PMID: 34624044 PMCID: PMC8500438 DOI: 10.1371/journal.pone.0258105] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 09/19/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Over the past two decades, there have been several global interventions including the Sustainable Development Goals (SDGs), aimed at improving health outcomes. Despite efforts by countries to achieve the SDG targets, mental health challenges remain major public health concerns globally. We examined the prevalence and predictors of depression, anxiety, and stress as well as the comorbidities of these mental health issues among adults. Materials and methods This was a community-based cross-sectional study conducted among 2456 adults in four districts of the Volta Region of Ghana using data from the UHAS-Yonsei University Partnership Project. We analysed the data using frequency, percentage, mean, standard deviation, correlation, and binary logistic regression. Results Overall, 51.8% of the participants had at least one of the mental health issues examined. The prevalence of a mental health issue was 25.2%, 53.3%, and 9.7% for depression, anxiety, and stress respectively. Participants constituting 8.3% experienced all three mental health issues as comorbidities. Participants’ level of formal education and income significantly predicted depression, anxiety, and stress respectively at the multivariable level. Adults with a tertiary level of education were, for instance, 68% (AOR = 0.32, 95%CI = 0.15–0.66), 65% (AOR = 0.35, 95%CI = 0.17–0.73), and 50% (AOR = 0.50, 95%CI = 0.33–0.76) less likely to experience depression, anxiety, and stress, respectively compared with those who had no formal education. Conclusion The majority of our study participants either experienced depression, anxiety, or stress. There were quite high comorbidities of the mental health issues among the adult population. To accelerate progress towards the achievement of SDG 3.4 target of promoting mental health and wellbeing for all by the year 2030, there is a need for effective implementation of the country’s 2012 Mental Health Act which makes provisions for the establishment of a Mental Health Fund. This could improve the financial circumstances of indigenes as income has been realised in the present study as an important factor influencing depression, anxiety, and stress among the adult population.
Collapse
Affiliation(s)
- Hubert Amu
- School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
- * E-mail:
| | - Eric Osei
- School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
- Department of Public Health, Yonsei University Graduate School, Seoul, Republic of Korea
| | - Philip Kofie
- School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Richard Owusu
- School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Samuel Adolf Bosoka
- School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Kennedy Diema Konlan
- Department of Public Health, Yonsei University Graduate School, Seoul, Republic of Korea
- School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Eunji Kim
- Korean Foundation for International Healthcare, Seoul, Korea
| | | | | | - Emmanuel Manu
- School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Phyllis Atta Parbey
- School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | | | - Hadiru Mumuni
- School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Prince Kubi Appiah
- School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
- Asian Institute for Bioethics and Health Law, College of Medicine, Yonsei University, Seoul, Korea
| | - Joyce Komesuor
- School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | | | | | - Siwoo Kim
- Asian Institute for Bioethics and Health Law, College of Medicine, Yonsei University, Seoul, Korea
| | - Hajun Jung
- Asian Institute for Bioethics and Health Law, College of Medicine, Yonsei University, Seoul, Korea
| | - Martin Adjuik
- School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | | | - Robert Kaba Alhassan
- Directorate of International Affairs, University of Health and Allied Sciences, Ho, Ghana
| | | | | | - Margaret Kweku
- School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Paul Amuna
- School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - So Yoo Kim
- Asian Institute for Bioethics and Health Law, College of Medicine, Yonsei University, Seoul, Korea
| | - John Owusu Gyapong
- Office of the Vice-Chancellor, University of Health and Allied Sciences, Ho, Ghana
| |
Collapse
|
26
|
Mlaki DA, Asmal L, Paddick SM, Gray WK, Dotchin C, Walker R. Prevalence and associated factors of depression among older adults in rural Tanzania. Int J Geriatr Psychiatry 2021; 36:1559-1566. [PMID: 34018234 DOI: 10.1002/gps.5584] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 05/17/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Depression is the commonest mental disorder in older adults worldwide, affecting 7% of the world's older population and accounting for 5.7% of years lived with disability among adults aged over 60 years. We conducted a secondary data analysis to determine the point prevalence, associated risk factors and treatment gap for DSM-IV depression among older adults in the Hai District, rural Tanzania. METHODS The primary data source was a cross-sectional two-stage community-based dementia study where older adults aged ≥70 years (n = 296) were fully-assessed for dementia and depression in the second stage. Age-adjusted prevalence of depression was determined based on the WHO standard population using the Direct Method. Univariate and multivariate logistic regression models were performed. RESULTS Of the 296 older adults assessed for depression, 48 were diagnosed with depression based on Diagnostic and Statistical Manual of Mental Disorders-IV criteria. The median (Inter Quartile Range; QR) age was 80 (75-88) years. Age-adjusted point prevalence of depression was 21.2% (95% CI: 16.6-21.9) and the treatment gap for depression was 100%. There was reduced odds of depression in older adults who rated their physical health as good or very good (adjusted odds ratio [AOR] = 0.22; 95%CI: 0.10-0.46; p < 0.001), or moderate (AOR 0.26; 95%CI: 0.10-0.66; p = 0.005). CONCLUSIONS Depression in older adults is associated with physical health status and there is an alarmingly high treatment gap. Future research on depression in older adults should focus on effective interventions to address physical morbidity, psychosocial factors and the treatment gap.
Collapse
Affiliation(s)
- Damas Andrea Mlaki
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Directorate of Clinical Services, Mirembe Mental Health Hospital, Dodoma, Tanzania
| | - Laila Asmal
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Stella-Maria Paddick
- Translational and Clinical Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - William K Gray
- Department of Old Age Psychiatry Gateshead Health, Northumbria Healthcare NHS Foundation Trust, UK
| | - Catherine Dotchin
- Department of Old Age Psychiatry Gateshead Health, Northumbria Healthcare NHS Foundation Trust, UK
| | - Richard Walker
- Translational and Clinical Medicine, Newcastle University, Newcastle upon Tyne, UK.,Department of Old Age Psychiatry Gateshead Health, Northumbria Healthcare NHS Foundation Trust, UK
| |
Collapse
|
27
|
van Loggerenberg F, McGrath M, Akena D, Birabwa-Oketcho H, Méndez CAC, Gómez-Restrepo C, Džubur Kulenoviĉ A, Muhić M, Sewankambo NK, Sikira H, Priebe S. Feasibility, experiences and outcomes of using DIALOG+ in primary care to improve quality of life and mental distress of patients with chronic conditions: an exploratory non-controlled trial in Bosnia and Herzegovina, Colombia and Uganda. Pilot Feasibility Stud 2021; 7:180. [PMID: 34593055 PMCID: PMC8481761 DOI: 10.1186/s40814-021-00914-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 09/07/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND DIALOG+ is a resource-oriented and evidence-based intervention to improve quality of life and reduce mental distress. While it has been extensively studied in mental health care, there is little evidence for how to use it in primary care settings for patients with chronic physical conditions. Considering that DIALOG+ is used in existing routine patient-clinician meetings and is very low cost, it may have the potential to help large numbers of patients with chronic physical conditions, mental distress and poor quality of life who are treated in primary care. This is particularly relevant in low- and middle-income countries (LMICs) where resources for specialised services for such patients are scarce or non-existent. METHODS An exploratory non-controlled trial will be conducted to primarily assess the feasibility and acceptability and, secondarily, outcomes of delivering DIALOG+ to patients with chronic physical conditions and poor quality of life in primary care settings in Bosnia and Herzegovina, Colombia and Uganda. Thirty patients in each country will receive DIALOG+ up to three times in monthly meetings over a 3-month period. Feasibility will be assessed by determining the extent to which the intervention is implemented as planned. Experiences will be captured in interviews and focus groups with care providers and participants to understand acceptability. Quality of life, symptoms of anxiety and depression, objective social situation and health status will be assessed at baseline and again after the three-session intervention. DISCUSSION This study will inform our understanding of the extent to which DIALOG+ may be used in the routine care of patients with chronic physical conditions in different primary care settings. The findings of this exploratory trial can inform the design of future full randomised controlled trials of DIALOG+ in primary care settings in LMICs. TRIAL REGISTRATION All studies were registered prospectively (on 02/12/2020 for Uganda and Bosnia and Herzegovina, and 01/12/2020 for Colombia) within the ISRCTN Registry. ISRCTN17003451 (Bosnia and Herzegovina), ISRCTN14018729 (Colombia) and ISRCTN50335796 (Uganda). Protocol version and date: v2.0; 28/07/2020 (Bosnia and Herzegovina), v0.3 02/08/2020 (Colombia) and v1.0, 05/11/2020 (Uganda).
Collapse
Affiliation(s)
| | - Michael McGrath
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| | - Dickens Akena
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - Carlos Gómez-Restrepo
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia
- Department of Psychiatry and Mental Health, Pontificia Universidad Javeriana, Bogotá, Colombia
- Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | - Maja Muhić
- Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Nelson K Sewankambo
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Hana Sikira
- Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| |
Collapse
|
28
|
Zimba CC, Akiba CF, Matewere M, Thom A, Udedi M, Masiye JK, Kulisewa K, Go VFL, Hosseinipour MC, Gaynes BN, Pence BW. Facilitators, barriers and potential solutions to the integration of depression and non-communicable diseases (NCDs) care in Malawi: a qualitative study with service providers. Int J Ment Health Syst 2021; 15:59. [PMID: 34116699 PMCID: PMC8196431 DOI: 10.1186/s13033-021-00480-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 05/25/2021] [Indexed: 11/24/2022] Open
Abstract
Background Integration of depression services into infectious disease care is feasible, acceptable, and effective in sub-Saharan African settings. However, while the region shifts focus to include chronic diseases, additional information is required to integrate depression services into chronic disease settings. We assessed service providers’ views on the concept of integrating depression care into non-communicable diseases’ (NCD) clinics in Malawi. The aim of this analysis was to better understand barriers, facilitators, and solutions to integrating depression into NCD services. Methods Between June and August 2018, we conducted nineteen in-depth interviews with providers. Providers were recruited from 10 public hospitals located within the central region of Malawi (i.e., 2 per clinic, with the exception of one clinic where only one provider was interviewed because of scheduling challenges). Using a semi structured interview guide, we asked participants questions related to their understanding of depression and its management at their clinic. We used thematic analysis allowing for both inductive and deductive approach. Themes that emerged related to facilitators, barriers and suggested solutions to integrate depression assessment and care into NCD clinics. We used CFIR constructs to categorize the facilitators and barriers. Results Almost all providers knew what depression is and its associated signs and symptoms. Almost all facilities had an NCD-dedicated room and reported that integrating depression into NCD care was feasible. Facilitators of service integration included readiness to integrate services by the NCD providers, availability of antidepressants at the clinic. Barriers to service integration included limited knowledge and lack of training regarding depression care, inadequacy of both human and material resources, high workload experienced by the providers and lack of physical space for some depression services especially counseling. Suggested solutions were training of NCD staff on depression assessment and care, engaging hospital leaders to create an NCD and depression care integration policy, integrating depression information into existing documents, increasing staff, and reorganizing clinic flow. Conclusion Findings of this study suggest a need for innovative implementation science solutions such as reorganizing clinic flow to increase the quality and duration of the patient-provider interaction, as well as ongoing trainings and supervisions to increase clinical knowledge. Trial registration This study reports finding of part of the formative phase of “The Sub-Saharan Africa Regional Partnership (SHARP) for Mental Health Capacity Building—A Clinic-Randomized Trial of Strategies to Integrate Depression Care in Malawi” registered as NCT03711786
Collapse
Affiliation(s)
| | - Christopher F Akiba
- Gillings School of Global and Public Health, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | | | - Annie Thom
- Malawi Ministry of Health, Lilongwe, Malawi
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Nzamwita P, Biracyaza E. Factors Associated with Low Uptake of Voluntary Medical Male Circumcision as HIV-Prevention Strategy among Men Aged 18-49 Years from Nyanza District, Rwanda. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2021; 13:377-388. [PMID: 33833586 PMCID: PMC8021263 DOI: 10.2147/hiv.s301045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/15/2021] [Indexed: 01/22/2023]
Abstract
Background Voluntary medical male circumcision (VMMC) is an effective biomedical intervention against HIV in developed and developing countries. However, there is low uptake of VMMC due to various factors, which hinders achievement of health-policy goals to increase uptake. Numerous campaigns offering the procedure free of charge exist in developing countries, but such initiatives seem to bear little fruit in attracting men to these services. This study assessed risk factors associated with the low uptake of VMMC among men in Nyanza district, Southern Province, Rwanda. Methods A cross-sectional study was conducted among adult males in Nyanza. A total of 438 men participated in individual interviews. Bivariate and multivariate logistic regression models were used with 95% confidence intervals and p≤0.05 was taken as statistically significant. Results Our results indicated that a low update of VMMC was highly prevalent (35.8%). A majority (84.7%) of participants had heard about VMMC, its complications, advantages in preventiing penile cancer, sexually transmitted infections, and HIV, condom use after circumcision, abstinence for 6 weeks after circumcision, and improving penile hygiene. Religion and education were significant factors in low uptake. Catholics were less likely to undergo VMMC than Muslims (OR 7.19, 95% CI 1.742–29.659; p=0.01). Those of other faiths were less likely to undergo VMMC than Muslims (OR 6.035, 95% CI 1.731–21.039; p=0.005). Participants with secondary education were less likely to undergo VMMC than those with primary education only (OR 1.4, 95% CI 0.74–2.64; p=0.03). Having no formal education decreased the odds of being uncircumcised (OR 0.37, 95% CI 0.14–0.977; p=0.045) when compared to those with primary education. Conclusion Uptake of VMMC remains low in Nyanza, but most men had sufficient knowledge about it. Education, religion, and marital status were major factors in the low uptake. Programs targeting peer influences and parents need to be prioritized.
Collapse
Affiliation(s)
- Pascal Nzamwita
- Department of Community Health, School of Public Health, University of Rwanda, Kigali, Rwanda.,Department of Prevention, ADIS Healthcare Foundation (AHF) Rwanda, Kigali, Rwanda
| | - Emmanuel Biracyaza
- Department of Community Health, School of Public Health, University of Rwanda, Kigali, Rwanda.,District Manager of Sociotherapy Programme, Prison Fellowship Rwanda (PFR), Kigali, Rwanda
| |
Collapse
|
30
|
Pillai A, Keyes KM, Susser E. Antidepressant prescriptions and adherence in primary care in India: Insights from a cluster randomized control trial. PLoS One 2021; 16:e0248641. [PMID: 33739982 PMCID: PMC7978355 DOI: 10.1371/journal.pone.0248641] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 03/02/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The World Health Organization recommends that treatment of depression in low and middle-income countries with a scarcity of psychiatrists could be done in primary care and should include prescription of antidepressant medications for moderate and severe depression. Little is known, however, about the actual practices of antidepressant prescription by primary care physicians in low and middle-income countries, nor about adherence by people receiving such prescriptions. In a large study of primary care clinics in Goa, India, we examined the relationship of actual to recommended prescribing practices for depression, among all patients who screened positive for common mental disorder. We also examined other patient and clinic characteristics associated with antidepressant prescription, and self-reported adherence over a one-month period. METHODS Patients attending 24 primary care clinics were screened for common mental disorders. Those who screened positive were eligible to enroll in a trial to assess the effectiveness of a collaborative stepped care (CSC) intervention for mental disorders. Physicians in the 12 intervention and 12 control clinics (usual care) were free to prescribe antidepressants and follow-up interviews were conducted at 2, 6 and 12 months. Screening results were shared with the physician, but they were blinded to the diagnosis generated later using a standardized diagnostic interview administered by a health counsellor. We categorized these later diagnoses as "moderate/severe depression", "mild depression or non-depression diagnosis", and "no diagnosis". We used a two-level hierarchical logistic regression model to examine diagnostic and other factors associated with antidepressant prescription and one-month adherence. RESULTS Overall, about 47% of screened positive patients (n = 1320) received an antidepressant prescription: 60% of those with moderate/severe depression, 48% of those with mild depression or non-depression diagnosis, and 31% with no diagnosis. Women (OR 1.29; 95%CI 1.04-1.60) and older adults (OR 1.80; 95%CI 1.32-2.47) were more likely to receive an antidepressant prescription. While the overall rate of antidepressant prescription was similar in clinics with and without CSC, patients without any diagnosis were more likely to receive a prescription (OR 2.20 95% CI 1.03-4.70) in the usual care clinics. About 47% of patients adhered to antidepressant treatment for one month or more and adherence was significantly better among older adults (OR 3.92; 95% CI 1.70-8.93) and those who received antidepressant as part of the CSC treatment model (OR 6.10 95% CI 3.67-10.14) compared with those attending the usual care clinic. CONCLUSION Antidepressants were widely prescribed following screening in primary care, but prescription patterns were in poor accord with WHO recommendations. The data suggest under-prescription for people with moderate/severe depression; over-prescription for people with mild depression or non-depression diagnoses; and over-prescription for people with no disorders. For all diagnoses adherence was low, especially in usual care clinics. To address these concerns, there is an urgent need to study and develop strategies in primary care practices to limit unnecessary antidepressant prescriptions, target prescription for those patients who clearly benefit, and to improve adherence to antidepressant treatment. ClinicalTrials.gov Identifier: NCT00446407.
Collapse
Affiliation(s)
- Aravind Pillai
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Katherine M. Keyes
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Ezra Susser
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, United States of America
- New York State Psychiatric Institute, New York, New York, United States of America
| |
Collapse
|
31
|
Math SB, Thippaiah SM, Nanjappa MS. Lessons learnt from the National Mental Health Programme (NMHP): A guide to success for the National Health Programme for Non-Communicable Diseases. Indian J Med Res 2021; 154:416-421. [PMID: 34854429 PMCID: PMC9131796 DOI: 10.4103/ijmr.ijmr_2518_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Indexed: 11/26/2022] Open
Affiliation(s)
- Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health & Neuro Sciences (Institute of National Importance), Bengaluru 560 029, Karnataka, India
| | | | | |
Collapse
|
32
|
Smith C, Goss HR, Issartel J, Belton S. Health Literacy in Schools? A Systematic Review of Health-Related Interventions Aimed at Disadvantaged Adolescents. CHILDREN-BASEL 2021; 8:children8030176. [PMID: 33668861 PMCID: PMC7996245 DOI: 10.3390/children8030176] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/18/2021] [Accepted: 02/23/2021] [Indexed: 02/08/2023]
Abstract
Socioeconomically disadvantaged populations are at greater risk of adopting unhealthy behaviours and developing chronic diseases. Adolescence has been identified as a crucial life stage to develop lifelong healthy behaviours, with schools often suggested as the ideal environment to foster healthy habits. Health literacy (HL) provides a possible solution to promote such healthy behaviours. The aim of this study was to review school-based HL-related interventions targeting socioeconomically disadvantaged adolescents and to identify effective intervention strategies for this population. Searches were performed in six databases. Inclusion criteria included age: 12–16; the implementation of a school-based intervention related to HL aimed at socioeconomically disadvantaged populations; an intervention focused on: physical activity (PA), diet, mental health, substance abuse or sleep. Forty-one articles were included, with the majority focusing on PA and diet (n = 13), PA (n = 9) or mental health (n = 7). Few interventions focused solely on substance abuse (n = 2) or sleep (n = 1), and none targeted or assessed HL as an outcome measure. There was huge heterogeneity in study design, outcomes measures and effectiveness reported. Effective intervention strategies were identified that can be used to guide future interventions, including practical learning activities, peer support and approaches targeting the school environment, the parents or that link the intervention to the community.
Collapse
|
33
|
Powell TM, Li SJ, Hsiao Y, Thompson M, Farraj A, Abdoh M, Farraj R. An integrated physical and mental health awareness education intervention to reduce non-communicable diseases among Syrian refugees and Jordanians in host communities: A natural experiment study. Prev Med Rep 2021; 21:101310. [PMID: 33532176 PMCID: PMC7823201 DOI: 10.1016/j.pmedr.2021.101310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 12/11/2020] [Accepted: 12/29/2020] [Indexed: 12/28/2022] Open
Abstract
The Syrian crisis has had a devastating impact on displaced populations and among host communities in neighboring countries such as Jordan. Many of these individuals are at risk for non-communicable diseases (NCD) and mental health disorders, yet do not have access to services designed to manage or prevent these conditions. The purpose of this study was to examine the efficacy of a non-communicable disease (NCD) awareness educational intervention and an integrated NCD and mental health education intervention on reducing cardiovascular disease (CVD) risk among Jordanians and displaced Syrians. This natural experiment study was conducted in three health centers in Irbid, Jordan with 213 Syrian participants and 382 Jordanians. Participants were assigned to one of three study conditions: the Healthy Community Clinic (HCC), a non-communicable disease educational intervention; the HCC with added mental health awareness sessions; standard healthcare. CVD risk factors were assessed at baseline, 12 and 18 months. The HCC education group yielded significant improvements in three CVD risk factors including: body mass index (BMI) -1.91 (95% CI: -2.09, -1.73); systolic blood pressure (SBP) -12.80 mmHg (95% CI: -16.35, -9.25); and diastolic blood pressure (DBP) -5.78 mmHg (95% CI: -7.96, -3.60) compared to standard care. The HCC-mental health treatment arm also demonstrated significant improvements in BMI, SBP, and DBP compared to standard care. Significant improvements in fasting blood glucose -20.32 (CI: -28.87, -11.77) and HbA1c -0.43 (-0.62, -0.24) were also illustrated in the HCC-mental health treatment arm. The HCC-mental health group sustained greater reductions in CVD risk than the HCC education group at 18-months. This study is among the first to our knowledge illustrating an integrated health and mental health educational intervention can reduce CVD risk among Syrian refugees and Jordanians. Continued investment and research in CVD prevention interventions is needed to enhance health, reduce costs, and have lasting benefits for conflict-affected individuals and communities.
Collapse
Affiliation(s)
- Tara M Powell
- University of Illinois, School of Social Work 1010 West Nevada Street, University of Illinois Urbana-Champaign, 61801, United States
| | - Shang-Ju Li
- Americares, 88 Hamilton Avenue, Stamford, CT 06902, United States
| | - Yuan Hsiao
- Department of Sociology, University of Washington, 211 Savery Hall, Box 353340, Seattle, WA 98195-3340, United States
| | | | | | | | | |
Collapse
|
34
|
Digital Interventions for Psychological Comorbidities in Chronic Diseases-A Systematic Review. J Pers Med 2021; 11:jpm11010030. [PMID: 33418971 PMCID: PMC7825345 DOI: 10.3390/jpm11010030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/21/2020] [Accepted: 12/30/2020] [Indexed: 12/13/2022] Open
Abstract
Chronic diseases represent one of the main causes of death worldwide. The integration of digital solutions in clinical interventions is broadly diffused today; however, evidence on their efficacy in addressing psychological comorbidities of chronic diseases is sparse. This systematic review analyzes and synthesizes the evidence about the efficacy of digital interventions on psychological comorbidities outcomes of specific chronic diseases. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search of PubMed, PsycInfo, Scopus and Web of Science databases was conducted. Only Randomized Controlled Trials (RCTs) were considered and either depression or anxiety had to be assessed to match the selection criteria. Of the 7636 identified records, 17 matched the inclusion criteria: 9 digital interventions on diabetes, 4 on cardiovascular diseases, 3 on Chronic Obstructive Pulmonary Disease (COPD) and one on stroke. Of the 17 studies reviewed, 14 found digital interventions to be effective. Quantitative synthesis highlighted a moderate and significant overall effect of interventions on depression, while the effect on anxiety was small and non-significant. Design elements making digital interventions effective for psychological comorbidities of chronic diseases were singled out: (a) implementing a communication loop with patients and (b) providing disease-specific digital contents. This focus on “how” to design technologies can facilitate the translation of evidence into practice.
Collapse
|
35
|
Endomba FT, Mazou TN, Bigna JJ. Epidemiology of depressive disorders in people living with hypertension in Africa: a systematic review and meta-analysis. BMJ Open 2020; 10:e037975. [PMID: 33303433 PMCID: PMC7733170 DOI: 10.1136/bmjopen-2020-037975] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 11/12/2020] [Accepted: 11/17/2020] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Better knowledge of epidemiology of depressive disorders in people living with hypertension can help to implement pertinent strategies to address its burden. The objective was to estimate the prevalence of depressive disorders and symptoms in people living with hypertension in Africa. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, EMBASE, African Index Medicus, African Journals OnLine were searched up to 31 January 2020, regardless of the language of publication. ELIGIBILITY CRITERIA We included studies conducted among adult patients with hypertension (≥18 years) living in Africa and reporting the prevalence of depressive disorders and symptoms. DATA EXTRACTION AND SYNTHESIS Two independent investigators selected studies, extracted data and assessed the methodological quality of included studies by using the tools developed by Joanna Briggs Institute. Multivariate random-effects meta-analysis served to pool data by considering the variability between diagnostic tools used to identify patients with depressive disorders or symptoms. RESULTS We included 11 studies with 5299 adults with hypertension. Data were collected between 2002 and 2017, from South Africa, Nigeria, Ghana, Ethiopia and Burkina Faso. The mean age varied between 50.3 years and 59.6 years. The proportion of men ranged from 28% to 54%. The adjusted prevalence of depressive disorders taking into account the variance between diagnostic tools was 17.9% (95% CI 13.0% to 23.4%). The prevalence of depressive symptoms and major depressive symptoms was 33.3% (95% CI 9.9% to 61.6%) and 7.8% (95% CI 3.0% to 14.5%), respectively. There was heterogeneity attributable to the diagnostic tools for depressive disorders and symptoms. There was no publication bias. CONCLUSION Notwithstanding the representativeness lack of some (sub) regions of Africa, weakening the generalisability of findings to the entire region; depressive disorders and symptoms are prevalent in people living with hypertension in Africa, indicating that strategies from clinicians, researchers and public health makers are needed to reduce its burden in the region.
Collapse
Affiliation(s)
- Francky Teddy Endomba
- Health Economics and Policy Research and Evaluation for Development Results Group, Yaounde, Cameroon
- Psychiatry Internship Program, Université de Bourgogne, Dijon, Bourgogne, France
| | - Temgoua Ngou Mazou
- Health Economics and Policy Research and Evaluation for Development Results Group, Yaounde, Cameroon
| | - Jean Joel Bigna
- Department of Epidemiology and Public Health, Centre Pasteur du Cameroun, Yaounde, Cameroon
| |
Collapse
|
36
|
Dowrick C, Kassai R, Lam CLK, Lam RW, Manning G, Murphy J, Ng CH, Thuraisingham C. The APEC Digital Hub-WONCA Collaborative Framework on Integration of Mental Health into Primary Care in the Asia Pacific. J Multidiscip Healthc 2020; 13:1693-1704. [PMID: 33268991 PMCID: PMC7701136 DOI: 10.2147/jmdh.s271070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/20/2020] [Indexed: 12/11/2022] Open
Abstract
Mental ill health affects individual well-being and national economic prosperity and makes up a substantial portion of the burden of disease globally, especially in the Asia-Pacific region. Integrating mental health into primary care is widely considered a key strategy to improve access to mental health care. Integration, however, is a complex process that needs to be addressed at multiple levels. A collaboration between the Asia-Pacific Economic Cooperation (APEC) Digital Hub for Mental Health and the World Organization of Family Doctors (WONCA) is described in this paper, which outlines a framework and next steps to improve the mental health of communities in APEC economies. This paper notes gaps related to the integration of mental health into primary care across the region and identifies enablers and current best practices from several APEC economies. The potential of digital technology to benefit primary mental health care for populations in the APEC region, including delivery of training programs for healthcare staff and access to resources for patients, is described. Finally, key next steps are proposed to promote enhanced integration into primary care and improve mental health care throughout the APEC region.
Collapse
Affiliation(s)
- Chris Dowrick
- Department of Primary Care and Public Health, University of Liverpool, Liverpool, UK.,World Organization of Family Doctors (WONCA), Bangkok, Thailand
| | - Ryuki Kassai
- World Organization of Family Doctors (WONCA), Bangkok, Thailand.,Department of Community and Family Medicine, Fukushima Medical University, Fukushima, Japan
| | - Cindy L K Lam
- World Organization of Family Doctors (WONCA), Bangkok, Thailand.,Department of Family Medicine & Primary Care, The University of Hong Kong, Hong Kong
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Asia-Pacific Economic Cooperation (APEC) Digital Hub for Mental Health, Vancouver, BC, Canada
| | - Garth Manning
- World Organization of Family Doctors (WONCA), Bangkok, Thailand
| | - Jill Murphy
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Asia-Pacific Economic Cooperation (APEC) Digital Hub for Mental Health, Vancouver, BC, Canada
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Australia.,Asia-Pacific Economic Cooperation(APEC) Digital Hub for Mental Health, Melbourne, Australia
| | - Chandramani Thuraisingham
- World Organization of Family Doctors (WONCA), Bangkok, Thailand.,Department of Family Medicine, International Medical University, Kuala Lumpur, Malaysia
| |
Collapse
|
37
|
Udedi M, Pence BW, Stewart RC, Muula AS. Detection and prevalence of depression among adult type 2 diabetes mellitus patients attending non-communicable diseases clinics in Lilongwe, Malawi. Int J Ment Health Syst 2020; 14:79. [PMID: 33292422 PMCID: PMC7640665 DOI: 10.1186/s13033-020-00413-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/29/2020] [Indexed: 01/05/2023] Open
Abstract
Background Depression is associated with chronic physical illnesses and negatively affects health outcomes. However, it often goes undiagnosed and untreated. We investigated the prevalence of depression among adult type 2 diabetes mellitus (T2DM) patients attending non-communicable diseases (NCD) clinics in Lilongwe, Malawi, and estimated the level of routine detection by NCD clinicians. This study set out to determine the prevalence of major depression and its detection among adult type 2 diabetes mellitus (T2DM) patients attending NCD clinics in Lilongwe, Malawi. Methods In a cross-sectional study design, 323 T2DM patients aged ≥ 18 years were screened for depression with the Patient Health Questionnare-9 (PHQ-9) followed by diagnostic assessment with the Structured Clinical Interview for DSM-IV (SCID). We analysed the association between presence of major depression and sociodemographic factors using logistic regression. Results Three quarters of the participants (76%) were females. The participants’ ages ranged from 21–79 years. Of the 323 participants, 58 (18%) met criteria for DSM-IV major depression. None of the cases of major depression had been identified by the NCD clinicians. Major depression was found not to be significantly associated with any of the sociodemographic factors. Conclusions We found that depression is common among NCD clinic attendees with T2DM in Malawi, and poorly detected by NCD clinicians. Given the high prevalence and challenges in clinical identification, integration of depression screening with a standardized validated tool should be a high priority so as to link patients to appropriate services.
Collapse
Affiliation(s)
- Michael Udedi
- Department of Mental Health, College of Medicine, University of Malawi, Chichiri, P/Bag 360, Blantyre 3, Malawi. .,Department of Clinical Services, Ministry of Health, P. O. Box 30377, Capital City, Lilongwe 3, Malawi. .,Department of Public Health, College of Medicine, University of Malawi, Chichiri, P/Bag 360, Blantyre 3, Malawi.
| | - Brian W Pence
- Epidemiology Department, University of North Carolina At Chapel Hill Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
| | - Robert C Stewart
- Department of Mental Health, College of Medicine, University of Malawi, Chichiri, P/Bag 360, Blantyre 3, Malawi.,Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Morningside Park, Edinburgh, EH10 5HF, UK.,Malawi Epidemiology and Intervention Research Unit (MEIRU), Box 148, Lilongwe 3, Malawi
| | - Adamson S Muula
- Department of Public Health, College of Medicine, University of Malawi, Chichiri, P/Bag 360, Blantyre 3, Malawi.,Africa Center of Excellence in Public Health and Herbal Medicine, College of Medicine, University of Malawi, Chichiri, P/Bag 360, Blantyre 3, Malawi
| |
Collapse
|
38
|
Powell TM, Shin OJ, Li SJ, Hsiao Y. Post-traumatic stress, social, and physical health: A mediation and moderation analysis of Syrian refugees and Jordanians in a border community. PLoS One 2020; 15:e0241036. [PMID: 33095832 PMCID: PMC7584168 DOI: 10.1371/journal.pone.0241036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 10/07/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES This study examined the mediating or moderating relationship of social health on physical health and post-traumatic stress symptoms among displaced Syrians and Jordanians at high risk for physical and mental health ailments. Frequency of mental health symptoms stratified by demographic factors was also explored. We hypothesized social health would mediate and/or moderate the relationship between physical and post-traumatic stress symptoms (PTSS). METHODS This cross-sectional study includes 598 adults between 18 and 75 years old recruited from three health centers in the city of Irbid, Jordan, 20 km away from the Syrian border. Post-traumatic stress symptoms (PTSS) were measured through the primary care post-traumatic stress disorder checklist. Physical and social health were assessed through the Duke Health Profile. One-way ANOVA and independent samples T-tests examined mean scores of social health, PTSS, physical health stratified by age, gender, nationality, education level, and trauma exposure. Bivariate correlations explored the relationship between social health, PTSS, and physical health. PROCESS macro tested social health as a moderator and mediator on the association of the physical health and PTSS. RESULTS Social health moderated and mediated the relationship between physical health and PTSS. Males reported (t = 2.53, p < .05) better physical health scores than females. Those who had less than a high school education reported lower social health (F = 13.83, p < .001); higher PTSS (F = 5.83, p < .001); and lower physical health (F = 5.76, p < .01) than more educated individuals. Syrians reported significantly higher PTSS (F = 4.13, p < .05) than Jordanians, however, there was no significant differences between nationality for physical or social health. Social health was positively associated with better physical health (r = 0.10, p < .01) and negatively with PTSS (r = -.293, p < .01). CONCLUSIONS Our results support our primary hypothesis suggesting social health mediates and moderates PTSS and physical health. Secondary findings illustrate gender, educational, and income differences in physical health and PTSS. CLINICAL TRIALS REGISTRY NCT03721848.
Collapse
Affiliation(s)
- Tara M. Powell
- School of Social Work, University of Illinois Urbana-Champaign, Urbana, Illinois, United States of America
- * E-mail:
| | - Oe Jin Shin
- School of Social Work, University of Illinois Urbana-Champaign, Urbana, Illinois, United States of America
| | - Shang-Ju Li
- Evaluation Department, Americares, Stamford, Connecticut, United States of America
| | - Yuan Hsiao
- Department of Sociology, University of Washington, Seattle, Washington, United States of America
| |
Collapse
|
39
|
Sorsdahl K, Naledi T, Lund C, Levitt NS, Joska JA, Stein DJ, Myers B. Integration of mental health counselling into chronic disease services at the primary health care level: Formative research on dedicated versus designated strategies in the Western Cape, South Africa. J Health Serv Res Policy 2020; 26:172-179. [DOI: 10.1177/1355819620954232] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective To explore health care providers’ views on the acceptability and feasibility of two models for integrating facility-based counsellor delivered mental health counselling into chronic disease care, and how such an approach could be improved in South Africa. Methods Fourteen focus group discussions and 25 in-depth individual interviews were conducted with 109 health care workers and facility managers from 24 primary health clinics in the Western Cape, South Africa. Results Findings suggested that despite recent efforts to integrate mental health counselling into chronic disease services for common mental disorders, there remains limited availability of psychosocial and psychological counselling. Feedback on the two models of integration suggested equipoise and the potential of a hybrid approach where these approaches may be tailored to the specific needs and available resources of each facility. Participants identified constraints within the health system and broader social context that require consideration for integrating mental health counselling into chronic disease care. Conclusion Although study participants unanimously agreed that counselling for common mental disorders should be integrated into chronic disease services, they had differing views on the type of model that should be adopted. There is a need for further testing of the two models and aspects of the health service that may require strengthening to implement any such model.
Collapse
Affiliation(s)
- Katherine Sorsdahl
- Co-Director, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry & Mental Health, University of Cape Town, South Africa
| | - Tracey Naledi
- Senior Lecturer, Public Health Medicine, School of Public Health & Family Medicine, University of Cape Town, South Africa
| | - Crick Lund
- Professor of Public Mental Health, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry & Mental Health, University of Cape Town, South Africa
| | - Naomi S Levitt
- Head of HIV and Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - John A Joska
- Head of Department, Department of Psychiatry and Mental Health, University of Cape Town, South Africa & SA MRC Unit on Risk & Resilience in Mental Disorders, Cape Town, South Africa
| | - Dan J Stein
- Head of Department, Department of Psychiatry and Mental Health, University of Cape Town, South Africa & SA MRC Unit on Risk & Resilience in Mental Disorders, Cape Town, South Africa
| | - Bronwyn Myers
- Deputy Director, Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council & Department of Psychiatry & Mental Health, University of Cape Town, South Africa
| |
Collapse
|
40
|
Mood Disorders and Increased Risk of Noncommunicable Disease in Adults With HIV. J Acquir Immune Defic Syndr 2020; 83:397-404. [PMID: 32097195 DOI: 10.1097/qai.0000000000002269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND People living with HIV (PLWH) experience high rates of mood disorders (major depression and bipolar affective disorder) which in the general population have been associated with noncommunicable disease (NCD) risk. We examined whether prevalent mood disorders are associated with incident NCDs and multimorbidity (accumulation of ≥2 NCDs) in PLWH. SETTING Adult HIV clinic cohort in Nashville, Tennessee, between 1998 and 2015. METHODS PLWH with ≥1 year of follow-up in the clinic were assessed for cardiovascular disease, metabolic syndrome (any 3 of hypertension, hyperlipidemia, diabetes, or obesity), chronic kidney and liver disease, non-AIDS-defining cancers, and dementia. Only mood disorders documented during the first year of care were included. Cumulative incidence and adjusted subhazard ratios (aSHRs) were calculated for risk of NCDs and multimorbidity with death as a competing risk. Multivariable Cox models estimated mortality risk after multimorbidity. RESULTS Of 4140 adults, 24% had a mood disorder diagnosed in the first year of care, 51% had ≥1 NCD at baseline, and there were 2588 incident NCDs during the study period. Mood disorders were associated with increased risk of first NCD (aSHR = 1.29, 95% confidence interval: 1.06 to 1.57), incident multimorbidity (aSHR ranging from 1.04 to 1.42), and metabolic syndrome (aSHR = 1.29, 95% confidence interval: 1.02 to 1.64). Mood disorders were not conclusively associated with mortality risk after multimorbidity. CONCLUSIONS PLWH with mood disorders were at increased risk of incident NCDs and multimorbidity, particularly metabolic syndrome. Focused prevention and treatment of NCDs may reduce the burden of multimorbidity in this high-risk group.
Collapse
|
41
|
Maconick L, Ansbro É, Ellithy S, Jobanputra K, Tarawneh M, Roberts B. "To die is better for me", social suffering among Syrian refugees at a noncommunicable disease clinic in Jordan: a qualitative study. Confl Health 2020; 14:63. [PMID: 32905304 PMCID: PMC7465779 DOI: 10.1186/s13031-020-00309-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/25/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The conflict in Syria has required humanitarian agencies to implement primary-level services for non-communicable diseases (NCDs) in Jordan, given the high NCD burden amongst Syrian refugees; and to integrate mental health and psychosocial support into NCD services given their comorbidity and treatment interactions. However, no studies have explored the mental health needs of Syrian NCD patients. This paper aims to examine the interaction between physical and mental health of patients with NCDs at a Médecins Sans Frontières (MSF) clinic in Irbid, Jordan, in the context of social suffering. METHODS This qualitative study involved sixteen semi-structured interviews with Syrian refugee and Jordanian patients and two focus groups with Syrian refugees attending MSF's NCD services in Irbid, and eighteen semi-structured interviews with MSF clinical, managerial and administrative staff. These were conducted by research staff in August 2017 in Irbid, Amman and via Skype. Thematic analysis was used. RESULTS Respondents describe immense suffering and clearly perceived the interconnectedness of their physical wellbeing, mental health and social circumstances, in keeping with Kleinman's theory of social suffering. There was a 'disconnect' between staff and patients' perceptions of the potential role of the NCD and mental health service in alleviating this suffering. Possible explanations identified included respondent's low expectations of the ability of the service to impact on the root causes of their suffering, normalisation of distress, the prevailing biomedical view of mental ill-health among national clinicians and patients, and humanitarian actors' own cultural standpoints. CONCLUSION Syrian and Jordanian NCD patients recognise the psychological dimensions of their illness but may not utilize clinic-based humanitarian mental health and psychosocial support services. Humanitarian agencies must engage with NCD patients to elicit their needs and design culturally relevant services.
Collapse
Affiliation(s)
- Lucy Maconick
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, LSHTM, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Éimhín Ansbro
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, LSHTM, 15-17 Tavistock Place, London, WC1H 9SH UK
| | | | | | | | - Bayard Roberts
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, LSHTM, 15-17 Tavistock Place, London, WC1H 9SH UK
| |
Collapse
|
42
|
Wright J, Mazumdar P, Barua D, Lina S, Bibi H, Kanwal A, Mujeeb F, Naz Q, Safi R, Ul Haq B, Rana RZ, Nahar P, Jennings H, Sikander S, Huque R, Nizami A, Jackson C. Integrating depression care within NCD provision in Bangladesh and Pakistan: a qualitative study. Int J Ment Health Syst 2020; 14:63. [PMID: 32831905 PMCID: PMC7422526 DOI: 10.1186/s13033-020-00399-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/05/2020] [Indexed: 11/15/2022] Open
Abstract
Background Co-morbidity of depression with other non-communicable diseases (NCDs) worsens clinical outcomes for both conditions. Low- and middle-income countries need to strengthen mechanisms for detection and management of co-morbid depression within NCDs. The Behavioural Activation for Comorbid Depression in Non-communicable Disease (BEACON) study explored the acceptability and feasibility of integrating a brief depression intervention (behavioural activation, BA) into NCD services in healthcare facilities in Bangladesh and Pakistan. Methods Face-to-face qualitative interviews were conducted with 43 patients and 18 health workers attending or working in NCD centres in four healthcare facilities in Bangladesh and Pakistan, and with three policy makers in each country. The interviews addressed four research questions (1) how NCD care is delivered, (2) how NCD patients experience distress, (3) how depression care is integrated within NCD provision, and (4) the challenges and opportunities for integrating a brief depression intervention into usual NCD care. The data were analysed using framework analysis, organised by capability, opportunity and motivation factors, cross-synthesised across countries and participant groups. Results Patients and health workers described NCD centres as crowded and time pressured, with waiting times as long as five hours, and consultation times as short as five minutes; resulting in some patient frustration. They did not perceive direct links between their distress and their NCD conditions, instead describing worries about family and finance including affordability of NCD services. Health worker and policy maker accounts suggested these NCD centres lacked preparedness for treating depression in the absence of specific guidelines, standard screening tools, recording systems or training. Barriers and drivers to integrating a brief depression intervention reflected capability, opportunity and motivation factors for all participant groups. While generally valuing the purpose, significant challenges included the busy hospital environment, skill deficits and different conceptions of depression. Conclusions Given current resource constraints and priorities, integrating a brief psychological intervention at these NCD centres appears premature. An opportune first step calls for responding to patients’ expressed concerns on service gaps in provisioning steady and affordable NCD care. Acknowledging differences of conceptions of depression and strengthening psychologically informed NCD care will in turn be required before the introduction of a specific psychological intervention such as BA.
Collapse
Affiliation(s)
- Jerome Wright
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD UK
| | - Papiya Mazumdar
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD UK
| | - Deepa Barua
- ARK Foundation, House No 6, Road No 109, Gulshan 2, Dhaka, Bangladesh
| | - Silwa Lina
- ARK Foundation, House No 6, Road No 109, Gulshan 2, Dhaka, Bangladesh
| | - Humaira Bibi
- Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, 46000 Pakistan
| | - Ateeqa Kanwal
- Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, 46000 Pakistan
| | - Faiza Mujeeb
- Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, 46000 Pakistan
| | - Qirat Naz
- Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, 46000 Pakistan
| | - Rahim Safi
- Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, 46000 Pakistan
| | - Baha Ul Haq
- Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, 46000 Pakistan
| | - Rusham Zahra Rana
- Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, 46000 Pakistan
| | - Papreen Nahar
- Brighton and Sussex Medical School, Medical Research Building, University of Sussex, Falmer, Brighton, BN1 9PX UK
| | - Hannah Jennings
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD UK
| | - Siham Sikander
- Health Services Academy, Islamabad, PM Health Complex, Chak Shahzad, Islamabad, 44000 Pakistan
| | - Rumana Huque
- ARK Foundation, House No 6, Road No 109, Gulshan 2, Dhaka, Bangladesh
| | - Asad Nizami
- Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, 46000 Pakistan
| | - Cath Jackson
- Valid Research Ltd, Suite 19, Sandown House, Sandbeck Way, Wetherby, LS22 7DN UK
| | | |
Collapse
|
43
|
Uphoff E, Pires M, Barbui C, Barua D, Churchill R, Cristofalo D, Ekers D, Fottrell E, Mazumdar P, Purgato M, Rana R, Wright J, Siddiqi N. Behavioural activation therapy for depression in adults with non-communicable diseases. Cochrane Database Syst Rev 2020; 8:CD013461. [PMID: 32841367 PMCID: PMC8094508 DOI: 10.1002/14651858.cd013461.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Depression is common in people with non-communicable diseases (NCDs) such as cardiovascular disease, diabetes, cancer, and chronic respiratory conditions. The co-existence of depression and NCDs may affect health behaviours, compliance with treatment, physiological factors, and quality of life. This in turn is associated with worse outcomes for both conditions. Behavioural activation is not currently indicated for the treatment of depression in this population in the UK, but is increasingly being used to treat depression in adults. OBJECTIVES To examine the effects of behavioural activation compared with any control group for the treatment of depression in adults with NCDs. To examine the effects of behavioural activation compared with each control group separately (no treatment, waiting list, other psychological therapy, pharmacological treatment, or any other type of treatment as usual) for the treatment of depression in adults with NCDs. SEARCH METHODS We searched CCMD-CTR, CENTRAL, Ovid MEDLINE, Embase, four other databases, and two trial registers on 4 October 2019 to identify randomised controlled trials (RCTs) of behavioural activation for depression in participants with NCDs, together with grey literature and reference checking. We applied no restrictions on date, language, or publication status to the searches. SELECTION CRITERIA We included RCTs of behavioural activation for the treatment of depression in adults with one of four NCDs: cardiovascular disease, diabetes, cancer, and chronic respiratory conditions. Only participants with a formal diagnosis of both depression and an NCD were eligible. Studies were included if behavioural activation was the main component of the intervention. We included studies with any comparator that was not behavioural activation, and regardless of reported outcomes. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane, including independent screening of titles/abstracts and full-text manuscripts, data extraction, and risk of bias assessments in duplicate. Where necessary, we contacted study authors for more information. MAIN RESULTS We included two studies, contributing data from 181 participants to the analyses. Both studies recruited participants from US hospital clinics; one included people who were recovering from a stroke and the other women with breast cancer. For both studies, the intervention consisted of eight weeks of face-to-face behavioural therapy, with one study comparing to poststroke treatment as usual and the other comparing to problem-solving therapy. Both studies were at risk of performance bias and potential conflict of interest arising from author involvement in the development of the intervention. For one study, risks of selection bias and reporting bias were unclear and the study was judged at high risk of attrition bias. Treatment efficacy (remission) was greater for behavioural activation than for comparators in the short term (risk ratio (RR) 1.53, 95% confidence interval (CI) 0.98 to 2.38; low-certainty evidence) and medium term (RR 1.76, 95% CI 1.01 to 3.08; moderate-certainty evidence), but these estimates lacked precision and effects were reduced in the long term (RR 1.42, 95% CI 0.91 to 2.23; moderate-certainty evidence). We found no evidence of a difference in treatment acceptability in the short term (RR 1.81, 95% CI 0.68 to 4.82) and medium term (RR 0.88, 95% CI 0.25 to 3.10) (low-certainty evidence). There was no evidence of a difference in depression symptoms between behavioural activation and comparators (short term: MD -1.15, 95% CI -2.71 to 0.41; low-certainty evidence). One study found no difference for quality of life (short term: MD 0.40, 95% CI -0.16 to 0.96; low-certainty evidence), functioning (short term: MD 2.70, 95% CI -6.99 to 12.39; low-certainty evidence), and anxiety symptoms (short term: MD -1.70, 95% CI -4.50 to 1.10; low-certainty evidence). Neither study reported data on adverse effects. AUTHORS' CONCLUSIONS Evidence from this review was not sufficient to draw conclusions on the efficacy and acceptability of behavioural activation for the treatment of depression in adults with NCDs. A future review may wish to include, or focus on, studies of people with subthreshold depression or depression symptoms without a formal diagnosis, as this may inform whether behavioural activation could be used to treat mild or undiagnosed (or both) depressive symptoms in people with NCDs. Evidence from low-resource settings including low- and middle-income countries, for which behavioural activation may offer a feasible alternative to other treatments for depression, would be of interest.
Collapse
Affiliation(s)
- Eleonora Uphoff
- Cochrane Common Mental Disorders, University of York, York, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Malini Pires
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Corrado Barbui
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | | | - Rachel Churchill
- Cochrane Common Mental Disorders, University of York, York, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Doriana Cristofalo
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - David Ekers
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
- Lanchester Road Hospital, Tees, Esk and Wear Valleys NHS Foundation Trust, Durham, UK
| | - Edward Fottrell
- Centre for Health Policy, Institute of Global Health Innovation, University College London, London, UK
| | - Papiya Mazumdar
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Marianna Purgato
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Rusham Rana
- Institute of Psychiatry, Benazir Bhutto Hospital, Rawalpindi, Pakistan
| | - Judy Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Najma Siddiqi
- Department of Health Sciences, Hull York Medical School, University of York, York, UK
| |
Collapse
|
44
|
Castillo-Carandang NT, Buenaventura RD, Chia YC, Do Van D, Lee C, Duong NL, Ng CH, Robles YR, Santoso A, Sigua HS, Sukonthasarn A, Tan R, Viora E, Zakaria H, Brizuela GE, Ratnasingham P, Thomas M, Majumdar A. Moving Towards Optimized Noncommunicable Disease Management in the ASEAN Region: Recommendations from a Review and Multidisciplinary Expert Panel. Risk Manag Healthc Policy 2020; 13:803-819. [PMID: 32765135 PMCID: PMC7371561 DOI: 10.2147/rmhp.s256165] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/12/2020] [Indexed: 12/31/2022] Open
Abstract
Introduction Noncommunicable diseases (NCDs) are the leading cause of morbidity and mortality in the Association of Southeast Asian Nations (ASEAN) member states. Progress has been slow despite the World Health Organization action plan for the prevention and control of NCDs in the region. This paper presents recommendations focused on practical strategies for optimizing NCD management in the ASEAN region. Methods A multidisciplinary group of experts from six ASEAN member states convened for two face-to-face meetings to discuss barriers and possible recommendations for optimizing NCD management, focused on cardiovascular diseases and mental disorders, in the region. Multiple approaches, ie, analysis of insights from the meetings and a review of existing literature on NCD programs in the ASEAN region were followed. The proposed recommendations were also based on selected successful interventions in ASEAN member states, thus providing actionable strategies. Results The gaps identified in NCD management for cardiovascular diseases and mental disorders in the ASEAN region were classified into gaps relating to policies and to clinical and public health practice. The proposed solutions addressing policy gaps include fostering multisectoral public–private partnerships, employing “whole-of-government” and “whole-of-society” approaches and promoting “health-in-all policies approach” to manage issues with financing, accessibility, efficiency and quality of health services. Whereas proposed solutions to bridge clinical and public health practice gaps entail strengthening primary care services, building the capacity of trained healthcare workers and employing collaborative care for holistic management of patients. Conclusion The scale of premature and preventable deaths from NCDs in the ASEAN region remains a serious public health concern and requires a “whole-of-system approach”. The interventions proposed in this paper build on regional collaborations and knowledge sharing to help develop a concerted and targeted response to NCDs.
Collapse
Affiliation(s)
- Nina T Castillo-Carandang
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines; and Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila, Manila, Philippines
| | - Robert D Buenaventura
- Department of Psychiatry, Manila Theological College - College of Medicine, Manila, Philippines
| | - Yook-Chin Chia
- Department of Medical Sciences, School of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Selangor, Malaysia
| | - Dung Do Van
- The University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Cheng Lee
- National Addictions Management Service, Institute of Mental Health, Singapore
| | - Ngoc Long Duong
- Department of Research, Education and Technology, Vietnam National Heart Institute, Hanoi, Vietnam
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, VIC, Australia
| | - Yolanda R Robles
- College of Pharmacy, University of the Philippines Manila, Manila, Philippines
| | - Anwar Santoso
- Department of Cardiology, Vascular Medicine, National Cardiovascular Centre - Harapan Kita Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Helen S Sigua
- University of the Philippines Open University, Laguna, Philippines
| | - Apichard Sukonthasarn
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Roger Tan
- Roger Kidney Clinic, Gleneagles Hospital, Singapore
| | - Eka Viora
- Indonesia Psychiatrist Association, Jakarta, Indonesia
| | - Hazli Zakaria
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Grace E Brizuela
- Research, Development and Medical, Pfizer Upjohn, Manila, Philippines
| | | | | | | |
Collapse
|
45
|
Tonelli M, Tang KC, Forest PG. Canada needs a "Health in All Policies" action plan now. CMAJ 2020; 192:E61-E67. [PMID: 31959656 DOI: 10.1503/cmaj.190517] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Marcello Tonelli
- Cumming School of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Health Promotion Unit (Tang [retired]), World Health Organization, Geneva, Switzerland; School of Public Policy (Forest), University of Calgary, Calgary, Alta.
| | - Kwok-Cho Tang
- Cumming School of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Health Promotion Unit (Tang [retired]), World Health Organization, Geneva, Switzerland; School of Public Policy (Forest), University of Calgary, Calgary, Alta
| | - Pierre-Gerlier Forest
- Cumming School of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Health Promotion Unit (Tang [retired]), World Health Organization, Geneva, Switzerland; School of Public Policy (Forest), University of Calgary, Calgary, Alta
| |
Collapse
|
46
|
Linares DE, Azuine RE, Singh GK. Social Determinants of Health Associated with Mental Health Among U.S. Mothers with Children Aged 0-5 Years. J Womens Health (Larchmt) 2020; 29:1039-1051. [PMID: 32456536 DOI: 10.1089/jwh.2019.8111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Maternal mental illness is a significant public health problem during the perinatal period and beyond. Little is known about how social determinants of health (SDOH) affect maternal mental health. Materials and Methods: We used cross-sectional data from the 2016 to 2017 National Survey of Children's Health with 19,127 mothers of a nationally representative sample of U.S. children aged 0-5. We estimated the prevalence of poor reported mental health (reported as "fair"/"poor") among mothers with children aged 0-5 by SDOH. Multivariable logistic regression was used to examine factors associated with poor maternal mental health. Results: Approximately 4.5% of mothers with children aged 0-5 reported having poor mental health in 2016-2017. Postadjustment and mothers' poor mental health were significantly associated with age (adjusted odds ratio [AOR]: 18-20 years: 2.77, 95% confidence interval [CI]: 1.35-5.67; 21-24 years AOR: 2.14, 95% CI: 1.22-3.73, and 30-34 years AOR: 1.97, 95% CI: 1.13-3.43), U.S.-born status (AOR: 2.31, 95% CI: 1.48-3.63), poor physical health (AOR: 8.69, 95% CI: 5.81-13.02), having a child with a special health care need (AOR: 1.65, 95% CI: 1.03-2.64), experiencing food insecurity (afford enough food, yet, unhealthy [AOR: 2.74, 95% CI: 1.59-4.70] and sometimes/often not afford enough food [AOR: 3.20, 95% CI: 1.76-5.84]), and low social capital (AOR: 1.97, 95% CI: 1.04-3.73). Conclusion: Mothers with children aged 0-5 who had poor physical health and experienced food insecurity were at the greatest risk for poor mental health. Integrated perinatal and behavioral health models, screening, and referrals may help identify and treat mothers experiencing these issues.
Collapse
Affiliation(s)
- Deborah E Linares
- Division of Research, Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, Maryland, USA
| | - Romuladus E Azuine
- Division of Research, Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, Maryland, USA
| | - Gopal K Singh
- Office of Health Equity, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, Maryland, USA
| |
Collapse
|
47
|
Akiba CF, Zimba CC, Thom A, Matewere M, Go V, Pence B, Gaynes BN, Masiye J. The role of patient-provider communication: a qualitative study of patient attitudes regarding co-occurring depression and chronic diseases in Malawi. BMC Psychiatry 2020; 20:243. [PMID: 32429877 PMCID: PMC7236218 DOI: 10.1186/s12888-020-02657-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 05/11/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Globally, depression is a leading cause of morbidity and mortality particularly in Low and Middle-Income Countries (LMICs). The burden of non-communicable diseases (NCDs) are also increasing in LMICs, the conditions frequently co-occur and exacerbate NCD outcomes. Depression interventions alone are not effective at improving NCD outcomes, resulting in wide-reaching calls for integrated services. Integrated services are in a nascent phase in LMICs in general and in Malawi in particular. This manuscript serves to clarify Malawian patients' attitudes and perceptions towards depression integration into routine NCD services. METHODS Ten District Hospitals were selected for data collection and 2 participants were interviewed from each site (N = 20). An iterative approach to concept-driven coding was applied to facilitate the formation of similarities, differences, and connections between codes. RESULTS While patients infrequently described moderate depression as a medical condition, and held various attitudes regarding treatments, they agreed on the appropriateness of integrated services. Patients' respect for their providers led them to support integration. Patients discussed how medical knowledge is highly regarded, revealing a power dynamic with their providers. Patients further acknowledged the importance of a provider's communication in shaping a patient's feelings about depression. CONCLUSIONS Training and interventions that facilitate providers' abilities to transfer their medical knowledge, use strategies to channel their power, and engage patients in a meaningful and collaborative relationship will be key to successfully integrating depression treatment into Malawian NCD clinics. TRIAL REGISTRATION This work served as part of formative data collection for National Institute of Mental Health (NIMH) Trail NCT03711786 registered on 10th October, 2018.
Collapse
Affiliation(s)
- Christopher F Akiba
- Department of Health Behavior, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 363 Rosenau Hall, CB# 7440, Chapel Hill, NC, 27599, USA.
| | - Chifundo C Zimba
- University of North Carolina Project Malawi, Tidziwe Center, 100 Mzimba Road, Private Bag A, /104, Lilongwe, Malawi
| | - Annie Thom
- University of North Carolina Project Malawi, Tidziwe Center, 100 Mzimba Road, Private Bag A, /104, Lilongwe, Malawi
| | - Maureen Matewere
- University of North Carolina Project Malawi, Tidziwe Center, 100 Mzimba Road, Private Bag A, /104, Lilongwe, Malawi
| | - Vivian Go
- Department of Health Behavior, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 363 Rosenau Hall, CB# 7440, Chapel Hill, NC, 27599, USA
| | - Brian Pence
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 2103C McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC, 27599, USA
| | - Bradley N Gaynes
- Department of Psychiatry, University of North Carolina at Chapel Hill, School of Medicine, 101 Manning Drive, Chapel Hill, NC, 27514, USA
| | - Jones Masiye
- Malawi Ministry of Health and Population, Non-communicable Diseases and Mental Health Clinical Services, P.O Box 30377, Lilongwe, 3, Malawi
| |
Collapse
|
48
|
Pati MK, Swaroop N, Kar A, Aggarwal P, Jayanna K, Van Damme W. A narrative review of gaps in the provision of integrated care for noncommunicable diseases in India. Public Health Rev 2020; 41:8. [PMID: 32435518 PMCID: PMC7222468 DOI: 10.1186/s40985-020-00128-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 04/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low- and middle-income countries (LMICs) account for a higher burden of noncommunicable diseases (NCD) and home to a higher number of premature deaths (before age 70) from NCDs. NCDs have become an integral part of the global development agenda; hence, the scope of action on NCDs extends beyond just the health-related sustainable development goal (SDG 3). However, the organization and integration of NCD-related health services have faced several gaps in the LMIC regions such as India. Although the national NCD programme of India has been in operation for a decade, challenges remain in the integration of NCD services at primary care. In this paper, we have analysed existing gaps in the organization and integration of NCD services at primary care and suggested plausible solutions that exist. METHOD The identification of gaps is based out of a review of peer-reviewed articles, reports on national and global guidelines/protocols. The gaps are organized and narrated at four levels such as community, facility, health system, health policy and research, as per the WHO Innovative Care for Chronic Conditions framework (WHO ICCC). RESULT The review found that challenges in the identification of eligible beneficiaries, shortage and poor capacity of frontline health workers, poor functioning of community groups and poor community knowledge on NCD risk factors were key gaps at the community level. Challenges at facility level such as poor facility infrastructure, lack of provider knowledge on standards of NCD care and below par quality of care led to poor management of NCDs. At the health system level, we found, organization of care, programme management and monitoring systems were not geared up to address NCDs. Multi-sectoral collaboration and coordination were proposed at the policy level to tackle NCDs; however, gaps remained in implementation of such policies. Limited research on the effect of health promotion, prevention and, in particular, non-medical interventions on NCDs was found as a key gap at the research level. CONCLUSION This paper reinforces the need for an integrated comprehensive model of NCD care especially at primary health care level to address the growing burden of these diseases. This overarching review is quite relevant and useful in organizing NCD care in Indian and similar LMIC settings.
Collapse
Affiliation(s)
- Manoj Kumar Pati
- Karnataka Health Promotion Trust, IT Park, 5th floor, 1-4, Rajajinagar Industrial Area behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka 560044 India
| | - N. Swaroop
- Karnataka Health Promotion Trust, IT Park, 5th floor, 1-4, Rajajinagar Industrial Area behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka 560044 India
| | - Arin Kar
- Karnataka Health Promotion Trust, IT Park, 5th floor, 1-4, Rajajinagar Industrial Area behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka 560044 India
| | | | - Krishnamurthy Jayanna
- Karnataka Health Promotion Trust, IT Park, 5th floor, 1-4, Rajajinagar Industrial Area behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka 560044 India
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Wim Van Damme
- Health Policy Department, Institute of Tropical Medicine, Antwerp, Belgium
| |
Collapse
|
49
|
Marais DL, Quayle M, Petersen I. Making consultation meaningful: Insights from a case study of the South African mental health policy consultation process. PLoS One 2020; 15:e0228281. [PMID: 31995612 PMCID: PMC6988953 DOI: 10.1371/journal.pone.0228281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 01/12/2020] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND It is widely recognised that mental health policies should be developed in consultation with those tasked with their implementation and the users affected by them. In the South African legislative context public participation in policymaking is assumed, with little guidance on how to conduct consultation processes, nor how to use consultation inputs in policy decisions. METHODS The South African Mental Health Policy Framework and Strategic Plan was adopted in 2013 after an extensive consultation process. Focussing on the 2012 provincial and national consultation summit, this case-study conducted key informant interviews and undertook documentary analysis to explore the process through which consultation inputs were-or were not-transferred to inform this policy. Between 2013 and 2016 seven interviews were conducted, and 11 documents (policy drafts and summit outputs) and transcripts of 23 audio-recorded sessions from the national summit were analysed. RESULTS Findings revealed that no substantive changes were made to the mental health policy following the consultation summits. There do not seem to have been systematic processes for facilitating and capturing knowledge inputs, or for transferring these inputs between provincial and national levels. There was also no further consultation regarding priorities identified for implementation prior to finalisation of the policy, with participants highlighting concerns about policy implementation at local levels as a result. This represents a lost opportunity for greater involvement of service users in policy development. CONCLUSIONS Together with poor service-user representation, the format of the consultation process limited participant interaction and the possibility for engagement with, or uptake of, more experiential forms of knowledge. Several procedural elements were found to limit the elicitation and transference of consultation contributions for uptake into policy. Recommendations for future policy consultations include adapting the format of participatory processes to enable optimal use of participant knowledge, as well as greater service-user participation.
Collapse
Affiliation(s)
- Debra Leigh Marais
- Undergraduate Research Office, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Michael Quayle
- Centre for Social Issues Research, Department of Psychology, University of Limerick, Limerick, Ireland
- Department of Psychology, School of Applied Human Sciences University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Inge Petersen
- Centre for Rural Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
50
|
Haldane V, Singh SR, Srivastava A, Chuah FLH, Koh GCH, Chia KS, Perel P, Legido-Quigley H. Community involvement in the development and implementation of chronic condition programmes across the continuum of care in high- and upper-middle income countries: A systematic review. Health Policy 2019; 124:419-437. [PMID: 31837832 DOI: 10.1016/j.healthpol.2019.11.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 11/10/2019] [Accepted: 11/29/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Community involvement is an important component of health programme development and implementation, including those focused on chronic condition treatment and management. Yet, few studies explore the manifestations of community involvement in chronic care programmes. Our review aims to examine the evidence on how communities are involved in planning and implementing chronic condition programmes in high and upper-middle income countries. METHODS Eligible studies included those that involved the community in the planning, implementation, monitoring and evaluation of health services, policy or health interventions. We searched Medline, Embase, Global Health, Scopus, and LILACs from 2000 to 2016, independently screened articles for inclusion, conducted data extraction, and assessed studies for risk of bias. RESULTS 27,232 records were identified and after screening, 32 met inclusion criteria. We conducted a narrative synthesis to report on the forms and processes of community involvement used across mental health programmes and contrast this with the paucity of evidence on comparable programmes addressing other chronic conditions. Challenges reported included user factors, organisational factors, and social challenges such as stigma. CONCLUSION Our review adds to the evidence supporting community involvement in chronic condition management and the processes that contribute to successful and sustainable involvement. We report on a model, derived from inductive analysis, that considers social and cultural components, organisational factors and stakeholder relationships as underpinning the development of community interventions across the care continuum.
Collapse
Affiliation(s)
- Victoria Haldane
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Tahir Foundation Building, 117549, Singapore
| | - Shweta R Singh
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Tahir Foundation Building, 117549, Singapore
| | - Aastha Srivastava
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Tahir Foundation Building, 117549, Singapore
| | - Fiona L H Chuah
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Tahir Foundation Building, 117549, Singapore
| | - Gerald C H Koh
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Tahir Foundation Building, 117549, Singapore
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Tahir Foundation Building, 117549, Singapore
| | - Pablo Perel
- London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK; World Heart Federation, Geneva, Switzerland
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Tahir Foundation Building, 117549, Singapore; London School of Hygiene and Tropical Medicine, WC1H 9SH, UK; Department of Nursing and Physiotherapy, University of Lleida, Spain.
| |
Collapse
|