There is a need to develop strategies for recognition and appropriate intervention for antenatal depression, in the context of locally relevant risk factors, so as to improve both maternal and child outcomes.
ObjectiveTo compare and contrast three models of community mental health services in low-income settings.Data Sources/Study SettingPrimary and secondary data collected before, during, and after site visits to mental health programs in Nigeria, the Philippines, and India.Study DesignQualitative case study methodology.Data CollectionData were collected through interviews and observations during site visits to the programs, as well as from reviews of documentary evidence.Principal FindingsA set of narrative topics and program indicators were used to compare and contrast three community mental health programs in low-income countries. This allowed us to identify a diversity of service delivery models, common challenges, and the strengths and weaknesses of each program. More definitive evaluations will require the establishment of data collection methods and information systems that provide data about the clinical and social outcomes of clients, as well as their use of services.ConclusionsCommunity mental health programs in low-income countries face a number of challenges. Using a case study methodology developed for this purpose, it is possible to compare programs and begin to assess the effectiveness of diverse service delivery models.
A large majority of the sample in an area of South India screened positive for CMD 9-11 months after the tsunami. These data served as an impetus in planning a long-term, five-year post-disaster intervention. Accurate longitudinal data about risk and protective factors after a disaster are needed to plan medium- and long-term interventions.
Objective
Depression is an easily treatable yet frequently underdiagnosed affliction in palliative population with deleterious implications on their quality of life. It has been studied poorly in developing countries like India.
Methods
A cross‐sectional study was done with 234 consenting subjects attending a palliative care unit. Patient Health Questionnaire‐9 (PHQ‐9), World Health Organization Quality of Life (WHOQOL‐BREF), and semi‐structured proforma were used by trained nonmental health professional to collect data.
Results
The prevalence of major depression was 70%. Being a resident of nuclear family (p = .004), absence of insurance coverage (p = .01), presence of financial difficulties (p = .002), and absence of cancer recurrence (p = .001) were significantly associated with major depression in univariate analysis. In multivariate analysis, presence of financial difficulties (OR = 3.9; 95% CI, 2.00‐7.61) and absence of health insurance (OR = 1.92; 95% CI, 1.02‐3.7) were independently associated with major depression. The presence of depression showed significant negative correlation with physical health (p = .03), psychological health (p = .002), and environmental (p = .002) domains of the WHOQOL‐BREF.
Conclusion
This study brings to the fore the high rates of depression and its negative impact on the quality of life of terminally ill cancer patients. An improvement in their quality of life requires measures to reduce the rate of underdiagnosed psychiatric morbidities, especially in those who are financially burdened and lack insurance coverage.
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