No abstract

Close to 14% of the global burden of disease can be attributed to neuropsychiatric disorders primarily related to the disabling nature of common mental disorders (CMDs), [1,2] which typically include depression, anxiety and psychoactive substance use or alcohol use disorder. A review and meta-analysis of studies between 1980 and 2013 established that 29.2% of individuals globally experienced CMDs at some point in their lifetime. [3] CMDs have been shown to contribute to the burden of disease in low-and middle-income countries, [4-6] and can variously compromise adherence to treatment, health behaviour change and self-management efforts. [7-9] In South Africa (SA), almost a third (30.3%) of the population has experienced a CMD in their lifetime, [10] with a 12-month prevalence estimate of 16.5% for CMDs (anxiety, mood and substance use disorders). [11] Although effective treatment for mental disorders is available [12,13] and can be delivered in routine primary healthcare (PHC), [14] only about half of patients with a depressive disorder in high-income settings are detected [15,16] and only 16.5% of all individuals with a 12-month major depressive disorder receive minimally adequate treatment. [17] In SA this gap is far greater, with only one in four people with a CMD reporting receiving treatment of any kind. [18] While integrating mental healthcare into existing health systems may be the most effective and cost-efficient approach to improve access to mental health services in SA, it requires addressing major knowledge gaps, inter alia the development and assessment of interventions that integrate mental health screening and treatment into existing health systems [8,19] as well as training lay counsellors in the identification of mental disorders. [20] However, screening that is integrated into routine care must use measures that can be administered by nonspecialist health staff, are brief and easy to administer, and promote high specificity given the meagre resources available to treat false positives. [21] Objectives This validation study was a substudy of the Southern African Mental Health Integration project on evaluating the scale-up of evidencebased packages for integration of mental healthcare in PHC settings for depression and alcohol use disorders into routine care that is part of the Mental Health Integration Programme (MhINT). Continuous This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Vitamin D insufficiency, as reflected by low 25(OH)D serum concentrations, was a universal finding in this group of women, suggesting the need for widespread education and intervention in this and other immigrant groups at northern latitudes.