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Ndlovu JT, Mokwena KE. Burden of Care of Family Caregivers for People Diagnosed with Serious Mental Disorders in a Rural Health District in Kwa-Zulu-Natal, South Africa. Healthcare (Basel) 2023; 11:2686. [PMID: 37830723 PMCID: PMC10572910 DOI: 10.3390/healthcare11192686] [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: 08/05/2023] [Revised: 09/26/2023] [Accepted: 09/29/2023] [Indexed: 10/14/2023] Open
Abstract
An estimated 6% of the world population has serious mental illness, with one in four families having a member with some form of psychiatric disorder, who is mostly cared for by their relatives within a family setting. Although care-giving in a home setting is reported to be associated with significant mental distress, the burden of such distress is rarely measured. The purpose of this study was to quantify the burden of care among family caregivers of relatives with serious mental disorders, as well as to explore possible associations between the caregiver burden of care and a range of caregiver and Mental Health Care User (MHCU) variables in a rural district in Kwa-Zulu Natal, South Africa. The Zarit Burden Interview (ZBI) scale was used to collect data from 357 caregivers, and STATA 14 was used to analyze data. The ages of the sample ranged from 18 to 65 years, with a mean of 50.29, and the majority (86%) were female and unemployed (83%). The ZBI scores ranged from 8 to 85, with a mean of 41.59. The majority (91%) were found to be affected by family caregiver burden, which ranged from mild to severe. Using the Pearson Chi-square test of association (p = 0.05), variables that were significantly associated with the burden of care were clinically related (caregiver self-reported depression, MHCU diagnosis, recent relapse of the MHCU), socio-economic (caregiver family monthly income, MHCU disability grant status and MHCU employment status) and socio-demographic (MHCU gender and MHCU level of education). The prevalence of the burden of care is high and severe, and the scarcity of resources in families and communities contributes to the high burden of care in these rural communities.
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Affiliation(s)
- Jabulile Thembelihle Ndlovu
- Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria, Ga-Rankuwa 0204, South Africa;
| | - Kebogile Elizabeth Mokwena
- Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria, Ga-Rankuwa 0204, South Africa;
- Substance Abuse and Population Mental Health, Sefako Makgatho Health Sciences University, Pretoria, Ga-Rankuwa 0204, South Africa
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MacDougall AG, Krupa T, Lysaght R, Mutiso V, Casey R, Le Ber MJ, Ruhara R, Price E, Kidd S, Ndetei DM. The CREATE strategy of rehabilitation and recovery for mental illness in low resource settings: Development processes and evaluation from a proof of concept study in Kenya. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2021. [DOI: 10.1080/00207411.2021.1926725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Arlene G. MacDougall
- Departments of Psychiatry and Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Terry Krupa
- School of Rehabilitation Therapy, Queen's University, London, Ontario, Canada
| | - Rosemary Lysaght
- School of Rehabilitation Therapy, Queen's University, London, Ontario, Canada
| | - Victoria Mutiso
- Department of Research, Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Regina Casey
- Department of Psychology, Douglas College, New Westminster, British Columbia, Canada
| | - Marlene J. Le Ber
- Brescia University College, Western University, London, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Ruth Ruhara
- Department of Research, Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | | | - Sean Kidd
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - David M. Ndetei
- Department of Research, Africa Mental Health Research and Training Foundation, Nairobi, Kenya
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Raitt JM, Thielman SB, Pfefferbaum B, Narayanan P, North CS. Psychosocial Effects on US Government Personnel of Exposure to the 1998 Terrorist Attack on the US Embassy in Nairobi. Psychiatry 2021; 84:165-181. [PMID: 33929919 PMCID: PMC8356642 DOI: 10.1080/00332747.2021.1907931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: The mental health effects of major terrorist attacks on diplomatic government personnel have not been well studied. This study examined the psychiatric and psychosocial effects of the 1998 terrorist bombing of the US Embassy in Nairobi, Kenya, on US government personnel exposed to the bombing. Method: At 8-10 months after the bombing, 179 US government employees (53 Americans, 126 Kenyans, 53% male, age mean = 40.6 and SD = 8.4 years ranging 21-65) were assessed with the Diagnostic Interview Schedule for DSM-IV for disaster-related psychiatric diagnoses and the Disaster Supplement Interview and Questionnaire about their immediate disaster experiences, subjective responses, mental health interventions/treatment, safety perceptions, and coping. Results: About one-third (32%) of these US government personnel developed postdisaster psychiatric disorders, mostly bombing-related PTSD (20%), but few received psychiatric treatment. Prevalence rates of all postdisaster psychiatric disorders, including bombing-related PTSD, were similar between subgroups of Americans and Kenyans, despite the Kenyans reporting more direct disaster trauma exposures, subjective postdisaster distress, and posttraumatic stress symptoms. These US government personnel had fewer psychiatric consequences of the Nairobi bombing than their previously studied civilian counterparts. Conclusions: Possible explanatory factors in the lower prevalence of postdisaster psychopathology in these government personnel compared to the civilians are selection for greater personal resilience for government employment and stigma-based underreporting of mental health needs in governmental workplaces. Stigma is a potential barrier to psychiatric treatment that needs to be addressed in government workplaces.
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Affiliation(s)
- Josh M. Raitt
- The Altshuler Center for Education & Research (ACER), Metrocare Services, 1250 Mockingbird Ln., Suite 330, Dallas, TX, 75247, USA,Division of Trauma & Disaster Psychiatry, Department of Psychiatry, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Suite NE5.102, Dallas, TX, 75390, USA,Corresponding author.
| | - Samuel B. Thielman
- Social & Community Psychiatry, Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Duke University Medical Center Box 3950, Durham, North Carolina, 27710, USA
| | - Betty Pfefferbaum
- Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Oklahoma Health Sciences Center, 920 Stanton L. Young Blvd., WP3217, Oklahoma City, OK, 73104, USA
| | - Pushpa Narayanan
- Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Oklahoma Health Sciences Center, 920 Stanton L. Young Blvd., WP3217, Oklahoma City, OK, 73104, USA
| | - Carol S. North
- The Altshuler Center for Education & Research (ACER), Metrocare Services, 1250 Mockingbird Ln., Suite 330, Dallas, TX, 75247, USA,Division of Trauma & Disaster Psychiatry, Department of Psychiatry, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Suite NE5.102, Dallas, TX, 75390, USA
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Mutiso VN, Pike KM, Musyimi CN, Rebello TJ, Tele A, Gitonga I, Thornicroft G, Ndetei DM. Changing patterns of mental health knowledge in rural Kenya after intervention using the WHO mhGAP-Intervention Guide. Psychol Med 2019; 49:2227-2236. [PMID: 30345938 DOI: 10.1017/s0033291718003112] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Despite the high prevalence of mental disorders, mental health literacy has been comparatively neglected. People's symptom-management strategies will be influenced by their mental health literacy. This study sought to determine the feasibility of using the World Health Organization mhGAP-Intervention Guide (IG) as an educational tool for one-on-one contact in a clinical setting to increase literacy on the specified mental disorders. METHODS This study was conducted in 20 health facilities in Makueni County, southeast Kenya which has one of the poorest economies in Kenya. It has no psychiatrist or clinical psychologist. We recruited 3267 participants from a community that had already been exposed to community mental health services. We used Mental Health Knowledge Schedule to measure the changing patterns of mental health knowledge after a period of 3 months, following a training intervention using the WHO mhGAP-IG. RESULTS Overall, there was a significant increase in mental health related knowledge [mean range 22.4-23.5 for both post-test and pre-test scores (p < 0.001)]. This increase varied with various socio-demographic characteristics such as sex, marital status, level of education, employment status and wealth index. CONCLUSIONS mhGAP-IG is a feasible tool to increase mental health literacy in low-resource settings where there are no mental health specialists. Our study lends evidence that the WHO Mental Health Action Plan 2013-2020 and reduction of the treatment gap may be accelerated by the use of mhGAP-IG through improving knowledge about mental illness and potentially subsequent help seeking for early diagnosis and treatment.
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Affiliation(s)
- V N Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - K M Pike
- Columbia University, Global Mental Health Program, New York, USA
| | - C N Musyimi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - T J Rebello
- Columbia University, Global Mental Health Program, New York, USA
| | - A Tele
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - I Gitonga
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - G Thornicroft
- Institute of Psychiatry, King's College London, London, UK
| | - D M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
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Ayalew M, Workicho A, Tesfaye E, Hailesilasie H, Abera M. Burden among caregivers of people with mental illness at Jimma University Medical Center, Southwest Ethiopia: a cross-sectional study. Ann Gen Psychiatry 2019; 18:10. [PMID: 31285750 PMCID: PMC6591984 DOI: 10.1186/s12991-019-0233-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 06/11/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Burden of caregivers of people with mental illness (PWMI) is considered to be a negative impact of the care provided by the family to the patient. However, little is known about the extent of the burden among caregivers of PWMI in Ethiopia. The aim of this study, therefore, is to assess the magnitude and associated factors of burden among caregivers of PWMI at Jimma University Medical Center, 2017. METHODS Institution-based cross-sectional study design was employed among 406 conveniently selected caregivers of PWMI and interviewed using a structured questionnaire. Family burden interview schedule (FBIS) was used to assess burden of caregivers. Bivariate and multivariable linear regression analyses were performed to determine the predictors of burden among caregivers. RESULTS Nearly two-thirds [264 (65.0%)] of the participants were male with a mean age of 38.45 ± 12.03 years. The mean score for burden among caregivers on family burden interview schedule was 23.00 ± 10.71. Age of the caregivers (β = 0.18, p < 0.001), being female caregiver (β = 2.68, p < 0.01), duration of contact hours with the patient per day (β = 0.74, p < 0.001), perceived stigma by the caregiver (β = 0.47, p < 0.001), and providing care for patients who had history of substance use in life (β = 1.52, p < 0.05) were positive predictors of higher burden among caregivers. Whereas, caregivers' income (β = 7.25, p < 0.001), caregivers who had no formal education (β = 4.65, p < 0.01), and caregivers' social support (β = 0.78, p < 0.001) were negatively associated with higher burden among caregiver. CONCLUSION Caregivers of people with mental illness experience enormous burden during providing care for their relatives with mental illness. Therefore, creating community awareness and targeted interventions in the area of treatment access, stigma, financial, and other social support for people with mental illness and their caregivers would help out to reduce these burdens.
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Affiliation(s)
- Mohammed Ayalew
- Department of Psychiatry Nursing, School of Nursing, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Abdulhalik Workicho
- Department of Epidemiology, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Elias Tesfaye
- Department of Psychiatry, Institute of Health, Jimma University, Jimma, Ethiopia
| | | | - Mubarek Abera
- Department of Psychiatry, Institute of Health, Jimma University, Jimma, Ethiopia
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Molebatsi K, Ndetei DM, Opondo PR. Caregiver burden and correlates among caregivers of children and adolescents with psychiatric morbidity: a descriptive cross sectional study. J Child Adolesc Ment Health 2017; 29:117-127. [DOI: 10.2989/17280583.2017.1340301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
| | - David M. Ndetei
- Department of Psychiatry, University of Nairobi; Africa Mental Health Foundation. Nairobi, Kenya
| | - Phillip R. Opondo
- Department of Psychiatry, University of Botswana, Gaborone, Botswana
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