BackgroundThere is limited evidence that interventions for depression and other common mental disorders (CMD) can be integrated sustainably into primary health care in Africa. We aimed to pilot a low-cost multi-component 'Friendship Bench Intervention' for CMD, locally adapted from problem-solving therapy and delivered by trained and supervised female lay workers to learn if was feasible and possibly effective as well as how best to implement it on a larger scale.MethodWe trained lay workers for 8 days in screening and monitoring CMD and in delivering the intervention. Ten lay workers screened consecutive adult attenders who either were referred or self-referred to the Friendship Bench between July and December 2007. Those scoring above the validated cut-point of the Shona Symptom Questionnaire (SSQ) for CMD were potentially eligible. Exclusions were suicide risk or very severe depression. All others were offered 6 sessions of problem-solving therapy (PST) enhanced with a component of activity scheduling. Weekly nurse-led group supervision and monthly supervision from a mental health specialist were provided. Data on SSQ scores at 6 weeks after entering the study were collected by an independent research nurse. Lay workers completed a brief evaluation on their experiences of delivering the intervention.ResultsOf 395 potentially eligible, 33 (8%) were excluded due to high risk. Of the 362 left, 2% (7) declined and 10% (35) were lost to follow-up leaving an 88% response rate (n = 320). Over half (n = 166, 52%) had presented with an HIV-related problem. Mean SSQ score fell from 11.3 (sd 1.4) before treatment to 6.5 (sd 2.4) after 3-6 sessions. The drop in SSQ scores was proportional to the number of sessions attended. Nine of the ten lay workers rated themselves as very able to deliver the PST intervention.ConclusionWe have found preliminary evidence of a clinically meaningful improvement in CMD associated with locally adapted problem-solving therapy delivered by lay health workers through routine primary health care in an African setting. There is a need to test the effectiveness of this task-shifting mental health intervention in an appropriately powered randomised controlled trial.Trial registrationISRCTN: ISRCTN25476759

BackgroundMental health service resources are inadequate in low-income countries, and families are frequently expected to provide care for their relative with a mental disorder. However, research on the consequences of caregiving has been limited in low-income countries, including Zimbabwe.ObjectiveThe study explored the perceived impact of mental illness, reported coping strategies and reported needs of the family members of persons diagnosed with bipolar affective disorder or schizophrenia attending a psychiatric hospital in Harare, Zimbabwe.MethodsA purposive sample of 31 family members participated in in-depth interviews and focus group discussions using standardised study guides. Participants were also screened for common mental disorders (CMDs) using the 14-item Shona Symptom Questionnaire. Qualitative data were analysed thematically using NVivo 8 qualitative data analysis software. Statistical Package for Social Sciences (SPSS version 16) was used for descriptive quantitative data analysis.ResultsCaregivers experienced physical, psychological, emotional, social and financial burdens associated with caregiving. They used both emotion-focused and problem-focused coping strategies, depending on the ill family members’ behaviours. Seeking spiritual assistance emerged as their most common way of coping. Twenty-one (68%) of the caregivers were at risk of CMDs (including three participants who were suicidal) and were referred to a psychiatrist for further management. Caregivers required support from healthcare professionals to help them cope better.ConclusionCaregivers of patients attending psychiatry hospitals in Zimbabwe carry a substantial and frequently unrecognised burden of caring for a family member with a mental disorder. Better support is needed from health professionals and social services to help them cope better. Further research is required to quantitatively measure caregiver burden and evaluate potential interventions in Zimbabwe.

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The World Health Organisation has made recommendations for partnerships between indigenous healing (IH) and biomedical therapy (BT) in the delivery of health services as a way of creating cultural sensitivity in mental health care (Bank, 2001). Yet, literature on prevalence, distribution, burden, and unmet needs for treatment of the mental disorders often exclude the role played by indigenous healing practitioners (IHPs). This study aimed to analyze mental health care from the perspective of communities on mental health care by IHPs to reveal their possible role in the surveillance studies of mental disorders in a settlement northeast of Harare in Zimbabwe through an exploratory qualitative methodology. Thirty in-depth interviews and three focus group discussions with key-informants were conducted to gather community perceptions of the nature of mental disorders treated by IHPs in Zimbabwe. Gathered data were coded using Constant Comparison Method with multiple members of the research team, enhancing validity and reliability. The results of the study reveal that while some patients presented with some mental disorders that were consistent with the BT diagnoses such as schizophrenia (Chirwere chepfungwa), depression (Kufungisisa), anxiety (Buka), post-traumatic stress disorder (Kurotomoka) somatisation (shungu), etc., other patients reported the disorders that were not recognised from a biomedical point of view such as the supernatural, cultural or social problems in IH. The findings were similar to the results of the first 17 world mental health surveys which show that the mental disorders are commonly occurring in all participating countries. This implied that the IHPs were treating common mental disorders reported in the low-income countries. More importantly, the IHPs treated a unique category which affected the majority of Zimbabwean patients. This study highlights the importance of the IHPs as complementary to

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