Functional impairment among people diagnosed with depression in primary healthcare in rural Ethiopia: a comparative cross-sectional study
Abstract Background There have been few studies examining the functioning of clinically-diagnosed people with depression in primary healthcare (PHC) in low- and middle-income countries (LMICs). The aim of this study was to identify factors associated with functional impairment among people diagnosed...
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| Format: | Article |
| Language: | English |
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BMC
2019-07-01
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| Series: | International Journal of Mental Health Systems |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13033-019-0305-8 |
| _version_ | 1811292684775587840 |
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| author | Kassahun Habtamu Girmay Medhin Medhin Selamu Kebede Tirfessa Charlotte Hanlon Abebaw Fekadu |
| author_facet | Kassahun Habtamu Girmay Medhin Medhin Selamu Kebede Tirfessa Charlotte Hanlon Abebaw Fekadu |
| author_sort | Kassahun Habtamu |
| collection | DOAJ |
| description | Abstract Background There have been few studies examining the functioning of clinically-diagnosed people with depression in primary healthcare (PHC) in low- and middle-income countries (LMICs). The aim of this study was to identify factors associated with functional impairment among people diagnosed with depression in PHC in Ethiopia as part of implementation of a task-shared model of mental healthcare. Methods A comparative cross-sectional study was conducted. As part of the Programme for Improving Mental health carE (PRIME), PHC clinicians were trained to diagnose depression using an adapted version of the World Health Organization (WHO) mental health Gap Action Programme (mhGAP). A total of 2038 adult consecutive PHC attendees were screened for depressive symptoms using the 9-item Patient Health Questionnaire (PHQ-9). Those who scored five or above on the PHQ-9 (n = 131) were assessed by PHC workers. Of these, 92 were diagnosed to have depression (“PHC diagnosed cases”) and the remaining 39 people were PHQ positive but considered not to have depression (“non-diagnosed controls”). PHC diagnosed cases were also compared to a community representative sample of adult healthy controls (n = 197; “community controls”). The 12-item version of the WHO Disability Assessment Schedule (WHODAS-2.0) was used to assess functional impairment. Multivariable negative binomial regression models were fitted to examine the association of demographic, social, economic and clinical characteristics with functional impairment. Results No significant difference in functional impairment was found between diagnosed cases and non-diagnosed controls. PHC diagnosed cases were found to have higher depressive symptom severity and suicidality, but lower social support compared to non-diagnosed controls (P < 0.05). In the multivariable model, greater functional impairment was associated with higher depressive symptoms (RR = 1.04; 95% CI 1.02, 1.05) and lower social support (RR = 0.96; 95% CI 0.95, 0.98). Diagnosed cases were found to have higher functional impairment compared to community controls (RR = 1.91; 95% CI 1.74, 2.09). Conclusion In this study, PHC clinicians identified cases of depression with high symptom burden, suicidality and functional impairment. These findings support current initiatives to scale-up mental health services at the PHC level; and indicate that social support is an important target for intervention. |
| first_indexed | 2024-04-13T04:49:05Z |
| format | Article |
| id | doaj.art-b8c18f34ae0a4699bc32105452ceee80 |
| institution | Directory Open Access Journal |
| issn | 1752-4458 |
| language | English |
| last_indexed | 2024-04-13T04:49:05Z |
| publishDate | 2019-07-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal of Mental Health Systems |
| spelling | doaj.art-b8c18f34ae0a4699bc32105452ceee802022-12-22T03:01:44ZengBMCInternational Journal of Mental Health Systems1752-44582019-07-0113111210.1186/s13033-019-0305-8Functional impairment among people diagnosed with depression in primary healthcare in rural Ethiopia: a comparative cross-sectional studyKassahun Habtamu0Girmay Medhin1Medhin Selamu2Kebede Tirfessa3Charlotte Hanlon4Abebaw Fekadu5School of Psychology, College of Education and Behavioral Studies, Addis Ababa UniversityAklilu Lemma Institute of Pathobiology, Addis Ababa UniversityDepartment of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa UniversityDepartment of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa UniversityDepartment of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa UniversityDepartment of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa UniversityAbstract Background There have been few studies examining the functioning of clinically-diagnosed people with depression in primary healthcare (PHC) in low- and middle-income countries (LMICs). The aim of this study was to identify factors associated with functional impairment among people diagnosed with depression in PHC in Ethiopia as part of implementation of a task-shared model of mental healthcare. Methods A comparative cross-sectional study was conducted. As part of the Programme for Improving Mental health carE (PRIME), PHC clinicians were trained to diagnose depression using an adapted version of the World Health Organization (WHO) mental health Gap Action Programme (mhGAP). A total of 2038 adult consecutive PHC attendees were screened for depressive symptoms using the 9-item Patient Health Questionnaire (PHQ-9). Those who scored five or above on the PHQ-9 (n = 131) were assessed by PHC workers. Of these, 92 were diagnosed to have depression (“PHC diagnosed cases”) and the remaining 39 people were PHQ positive but considered not to have depression (“non-diagnosed controls”). PHC diagnosed cases were also compared to a community representative sample of adult healthy controls (n = 197; “community controls”). The 12-item version of the WHO Disability Assessment Schedule (WHODAS-2.0) was used to assess functional impairment. Multivariable negative binomial regression models were fitted to examine the association of demographic, social, economic and clinical characteristics with functional impairment. Results No significant difference in functional impairment was found between diagnosed cases and non-diagnosed controls. PHC diagnosed cases were found to have higher depressive symptom severity and suicidality, but lower social support compared to non-diagnosed controls (P < 0.05). In the multivariable model, greater functional impairment was associated with higher depressive symptoms (RR = 1.04; 95% CI 1.02, 1.05) and lower social support (RR = 0.96; 95% CI 0.95, 0.98). Diagnosed cases were found to have higher functional impairment compared to community controls (RR = 1.91; 95% CI 1.74, 2.09). Conclusion In this study, PHC clinicians identified cases of depression with high symptom burden, suicidality and functional impairment. These findings support current initiatives to scale-up mental health services at the PHC level; and indicate that social support is an important target for intervention.http://link.springer.com/article/10.1186/s13033-019-0305-8DepressionDepressive symptomsFunctional impairmentDisabilityPrimary health careLow- and middle-income countries |
| spellingShingle | Kassahun Habtamu Girmay Medhin Medhin Selamu Kebede Tirfessa Charlotte Hanlon Abebaw Fekadu Functional impairment among people diagnosed with depression in primary healthcare in rural Ethiopia: a comparative cross-sectional study International Journal of Mental Health Systems Depression Depressive symptoms Functional impairment Disability Primary health care Low- and middle-income countries |
| title | Functional impairment among people diagnosed with depression in primary healthcare in rural Ethiopia: a comparative cross-sectional study |
| title_full | Functional impairment among people diagnosed with depression in primary healthcare in rural Ethiopia: a comparative cross-sectional study |
| title_fullStr | Functional impairment among people diagnosed with depression in primary healthcare in rural Ethiopia: a comparative cross-sectional study |
| title_full_unstemmed | Functional impairment among people diagnosed with depression in primary healthcare in rural Ethiopia: a comparative cross-sectional study |
| title_short | Functional impairment among people diagnosed with depression in primary healthcare in rural Ethiopia: a comparative cross-sectional study |
| title_sort | functional impairment among people diagnosed with depression in primary healthcare in rural ethiopia a comparative cross sectional study |
| topic | Depression Depressive symptoms Functional impairment Disability Primary health care Low- and middle-income countries |
| url | http://link.springer.com/article/10.1186/s13033-019-0305-8 |
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