Access to Care for Mental Health Problems in Afghanistan: A National Challenge

Abstract

Background: This paper describes the access to care for mental health problems in Afghanistan, according to the nature of the mental health problems and the service provider. Following the Andersen model, it evaluates the respective roles in access to care of "predisposing, " "needs, " "enabling" factors, and other "environmental" factors such as exposure to traumatic events and level of danger of the place of residence. Methods: Trans-sectional probability survey in general population by multistage sampling in 16 provinces, nationally representative: N = 4445 (15 years or older), participation rate of 81%. Face to face interviews using standardized measures of mental health (CIDI, Composite International Diagnostic Interview). Different logistic regression models are presented. Results: The 12-month rate of mental health help-seeking was 6.56% with substantial regional variation (2.35% to 12.65%). Providers were mainly from the health sector; the non-health sector (religious and healers) was also prevalent. Most consultations were held in private clinics (non-governmental organisation, NGO). The severity of mental health disorders as well as the perceived impairment due to mental health were independently very important: odds ratio (OR) = 6.04 for severe disorder, OR = 3.79 for perceived impairment. Living in a dangerous area decreased access to care: for high level of danger and for very high level: OR = 0.22. Gender, education and ethnicity were not associated with mental health help-seeking after controlling for exposure to trauma. Conclusion: Access to care for mental health problems depended mainly on the needs as defined as disorder severity level and impairment, and on environmental factors such as exposure to traumatic events. The system seems equitable; however, this is counterbalanced by a very challenging environment. This survey is a testimony to the hardship experienced by the Afghan population and by health professionals, and to the efforts to deliver organized mental healthcare in a challenging situation. This research may inform and support policy-makers and NGOs in other countries undergoing similar challenges.

Associations between traumatic event experiences, psychiatric disorders, and suicidal behavior in the general population of Afghanistan: findings from Afghan National Mental Health Survey

“…Furthermore, the provincial public health directorate also conducted supervisory visits from the data collection process. Details of the study design and methodology can be found elsewhere (Kovess-Masfety et al 2021a , b ).…”

“…Indeed, the population of Afghanistan has endured more than three decades of exposure to international and civil war and violence, resulting in ubiquitous exposure to often extreme levels of stress and bereavement, as well as strain due to destruction of economic, social, and cultural infrastructure (Alemi et al 2014 ; Silove and Ventevogel 2022 ). Existing population-based research in Afghanistan is limited, but what has been done demonstrates a high burden of psychiatric disorders and traumatic event exposure (Kovess-Masfety et al 2021a , b ). Studies of suicidal behavior in Afghanistan are limited, in part perhaps due to the stigmatized nature of suicide.…”

Interventions and participatory clinical research for the enhancement of health systems interfacing with displaced Afghan women

“…These and other demographic factors influence the type of medical and mental health services sought, how readily they are pursued, and whether these services are of a public or private nature (and thus the financial burden incurred). They may also constrain the degree to which a woman may pursue services rendered via a male provider (Kabeer & Khan, 2014;Kovess-Masfety et al, 2021;Mayhew et al, 2008;Newbrander, 2008;Schweinhart et al, 2021;Shahram et al, 2015;Steinhardt et al, 2008). In terms of gender circumscribing experiences, Rasmussen et al (2014) write, "Men and women inhabit different social and emotional spaces in Afghanistan, with downstream implications for psychosocial and physiological well-being" (p.8).…”

Association of Multidimensional Poverty With Dementia in Adults Aged 50 Years or Older in South Africa

“… 33 Estimates from studies conducted in South Africa indicate that the prevalence of dementia ranges from 3.8% to 11.0% for adults aged 65 years or older. 33 , 34 , 35 In this study, we examined multidimensional poverty and dementia in older adults in Soweto, South Africa. Our objective was to examine the association between multidimensional poverty and dementia and the role of various dimensions of deprivation in overall poverty.…”