Declaration on mental health in Africa: moving to implementation

Daar, Abdallah S.; Jacobs, Marian; Wall, Stig; Groenewald, Johann; Eaton, Julian; Patel, Vikram; Santos, Palmira dos; Kagee, Ashraf; Gevers, Aní­k; Sunkel, Charlene; Andrews, Gavin J.; Daniels, Ingrid; Ndetei, David M.

doi:10.3402/gha.v7.24589

Cited by 29 publications

(19 citation statements)

References 2 publications

(4 reference statements)

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“…It specifically targets several priority disorders: psychosis, epilepsy, depression, and substance use disorders. The mental health strategy is considered to be a good template that could potentially be utilised by other countries in Africa ( 27 ). The strategy encourages the involvement of informal sectors to support mental health care in the community, specifically through the involvement of teachers, nongovernmental organisations (NGOs), and especially traditional and religious leaders.…”

Section: Resultsmentioning

confidence: 99%

Global mental health: perspectives from Ethiopia

Fekadu

Thornicroft

2014

Global Health Action

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BackgroundGlobal mental health (GMH) advocates for access to and the equitable provision of mental health care. Although the treatment gap is a useful construct to measure access and equitability of care, it fails to communicate the real-life consequences of the treatment gap and the urgent need to address care disparities.ObjectiveThe aim of this article is to present a perspective on the practical application of the principles of GMH to understand the real-life impact of the treatment gap and the approaches taken to improve treatment coverage in Ethiopia.DesignA case study method is used.ResultsMultiple international collaborations undertaken in Ethiopia and facilitated by GMH to improve care, capacity, and the evidence base for increased treatment coverage are described briefly. A series of steps taken at the local and national levels to address the treatment gap are highlighted. The stories of two patients are also presented to illustrate the real-life consequences of the treatment gap and the potential transformational impact of addressing the treatment gap on patients, families, and communities.ConclusionsGMH has a key role to play in addressing the treatment gap, which improves the life of people with mental disorders, their families, and their communities. However, national-level policy support and coordination are essential for any realistic improvement in treatment coverage. The reflections offered through the case examples may have utility in similar low-income settings.

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Section: Resultsmentioning

confidence: 99%

Global mental health: perspectives from Ethiopia

Fekadu

Thornicroft

2014

Global Health Action

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“…However, fundamental research on the linkages between mental and physical health in low-income contexts is lacking, and the high physical requirements of daily life may lead to an amplification of the association between physical and mental health in SSA. A better understanding of the health of mature adults, including how it is affected by DA and other noncommunicable diseases, is therefore critical (Chisholm et al 2016; Daar et al 2014). Indeed, mature adults constitute an economically important subset of society: they have almost universal labor force participation in Malawi (98 % at ages 50–64, and 90 % at age 65+) (Malawi National Statistical Office 2010), make important contributions to intergenerational transfers to both children and elderly parents (Kohler et al 2012), and have pivotal caretaking roles in families affected by HIV/AIDS (Reijer 2013).…”

Section: Gaps In Understanding the Demography Of Depression And Anxiementioning

confidence: 99%

The Demography of Mental Health Among Mature Adults in a Low-Income, High-HIV-Prevalence Context

Kohler

Payne²,

Bandawe

et al. 2017

Demography

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Very few studies have investigated mental health in sub-Saharan Africa (SSA). Using data from Malawi, this article provides a first picture of the demography of depression and anxiety (DA) among mature adults (aged 45 or older) in a low-income country with high HIV prevalence. DA are more frequent among women than men, and individuals affected by one are often affected by the other. DA are associated with adverse outcomes, such as poorer nutrition intake and reduced work efforts. DA also increase substantially with age, and mature adults can expect to spend a substantial fraction of their remaining lifetime—for instance, 52 % for a 55-year-old woman—affected by DA. The positive age gradients of DA are not due to cohort effects, and they are in sharp contrast to the age pattern of mental health that has been shown in high-income contexts, where older individuals often experience lower levels of DA. Although socioeconomic and risk- or uncertainty-related stressors are strongly associated with DA, they do not explain the positive age gradients and gender gap in DA. Stressors related to physical health, however, do. Hence, our analyses suggest that the general decline of physical health with age is the key driver of the rise of DA with age in this low-income SSA context.

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“…For example, many health workers in LMICs are not trained and/or do not have time to screen for common mental disorders such as depression when seeing patients -a substantial barrier to integrating screening into routine practice and ensuring patients living with depression receive the care they need (15,16). Further, given limited financial and human resources, there is often limited availability of on-the-job training, re-training, and supervision for primary care staff in many LMICs.…”

Section: Introductionmentioning

confidence: 99%

Validity and Item Response Theory Properties of the Patient Health Questionnaire-9 for Primary Care Depression Screening in Mozambique (PHQ-9-MZ)

Cumbe

Muanido

Manaca

et al. 2020

Preprint

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Background: Depression is one of the leading causes of disability in Mozambique; however, few patients with depression are identified in primary care. To our knowledge, there are no validated tools for depression screening in Mozambique. The aim of this study was to validate the Patient Health Questionnaire-9 (PHQ-9) for use in primary care settings in Mozambique. Methods: The PHQ-9 was adapted using a structured multi-phase process led by a team of bilingual experts followed by a review by lay individuals and pilot-testing including cognitive interviews. The final Mozambican PHQ-9 (PHQ-9-MZ) was applied among 503 individuals randomly selected from antenatal, postpartum, and general outpatient consultations in three Ministry of Health primary healthcare clinics in Sofala Province, Mozambique. The PHQ-9-MZ was evaluated against the MINI 5.0-MZ as a gold standard diagnostic tool. Results: The majority of participants were female (74%), with a mean age of 28. Using the MINI 5.0-MZ, 43 (9%) of the sample tested positive for major depressive disorder. Items of the PHQ-9-MZ showed good discrimination and factor loadings. One latent factor of depression explained 54% of the variance in scores. Questions 3 (sleep) and 5 (appetite) had the lowest item discrimination and factor loadings. The PHQ-9-MZ showed good internal consistency, with a Cronbach’s alpha of 0.84, and an area under the receiver operating characteristic curve (AUROC) of 0.81 (95% CI: 0.73, 0.89). The PHQ-2-MZ had an AUROC of 0.78 (95% CI: 0.70, 0.85). Using a cut-point of ≥9, the PHQ-9-MZ had a sensitivity of 46.5% and a specificity of 93.5%. Using a cut-point of ≥2, the PHQ-2-MZ had a sensitivity of 74.4% and a specificity of 71.7%. Increasing the cut-point to ≥3, the PHQ-2-MZ has a sensitivity of 32.6% and a specificity of 94.6%. Conclusions: The PHQ-9-MZ and PHQ-2-MZ emerge as two valid alternatives for screening for depression in primary health care settings in Mozambique. Depending on program needs and weighing the value of minimizing false positives and false negatives, the PHQ-9-MZ can be employed with cut-points ranging from ≥8 to ≥11, and the PHQ-2-MZ with cut-points ranging from ≥2 to ≥3.

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Declaration on mental health in Africa: moving to implementation

Cited by 29 publications

References 2 publications

Global mental health: perspectives from Ethiopia

Global mental health: perspectives from Ethiopia

The Demography of Mental Health Among Mature Adults in a Low-Income, High-HIV-Prevalence Context

Validity and Item Response Theory Properties of the Patient Health Questionnaire-9 for Primary Care Depression Screening in Mozambique (PHQ-9-MZ)

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