Evaluation of district mental healthcare plans: The PRIME consortium methodology

Background.Depression is a common disorder characterized by delayed help-seeking, often remaining undetected and untreated.Objectives.We sought to estimate the proportion of adults in Kamuli District with depressive symptoms and to assess their help-seeking behaviour.Methods.This was a population-based cross-sectional study conducted in a rural district in Uganda. Sampling of study participants was done using the probability proportional to size method. Screening for depression was done using Patient Health Questionnaire (PHQ-9). The participants who screened positive also reported on whether and where they had sought treatment. Data collected using PHQ-9 was used both as a symptom-based description of depression and algorithm diagnosis of major depression. All data analysis was done using STATA version 13.Results.With a cut-off score of ⩾10, 6.4% screened positive for current depressive symptoms and 23.6% reported experiencing depressive symptoms in the past 12 months. The majority of individuals who screened positive for current depression (75.6%) were females. In a crude analysis, people with lower education, middle age and low socio-economic status were more likely to have depressive symptoms. Help-seeking was low, with only 18.9% of the individuals who screened positive for current depression having sought treatment from a health worker.Conclusion.Depressive symptoms are common in the study district with low levels of help-seeking practices. People with lower levels of education, low socio-economic status and those in middle age are more likely to be affected by these symptoms. Most persons with current depression had past history of depressive symptoms.

show abstract

“…Changes in treatment coverage were to be evaluated through a follow-up community-based survey in the same district (De Silva et al . 2016). …”

Section: Methodsmentioning

confidence: 99%

Prevalence, correlates and help-seeking behaviour for depressive symptoms in rural Uganda: a population-based survey

et al. 2019

View full text Add to dashboard Cite

show abstract

“…They also screened patients in Community Health Centres. The study area (20), Mental Health Care Plan (21), and PRIME evaluation plan (22) have been described in more detail elsewhere. The term "implementation area" will be used to refer to those villages where MHCP activities were fully implemented.…”

Section: Methods Settingmentioning

confidence: 99%

“…The study design, sampling plan, and data collection have been described in detail elsewhere (21,22). Briefly, data collection for the first round took place prior to Mental Health Care Plan implementation, in two waves (May-June 2013 and January-March 2014), and the second round after implementation of the plan (October-December 2016).…”

Section: Samplementioning

confidence: 99%

Health care use and treatment-seeking for depression symptoms in rural India: A descriptive cross-sectional analysis

Roberts¹,

Shidhaye

Patel

et al. 2019

Preprint

Self Cite

View full text Add to dashboard Cite

BackgroundThere is a large "treatment gap" for depression worldwide. This study aimed to better understand the treatment gap in rural India by describing health care use and treatment-seeking for depression. MethodsData were analysed from a two round cross-sectional community survey carried out in rural Madhya Pradesh between May 2013 and December 2016. We examined the proportion of individuals with probable depression who sought treatment in different sectors, for depression symptoms and for any reason, and compared the latter with health service use by non-depressed individuals. We showed the frequency with which barriers to healthcare utilisation were reported by adults with probable depression, and examined differences in the proportion of adults who sought treatment for depression by predisposing, enabling and need factors. Results86% of adults with probable depression reported seeking no depression treatment. However, 66% had used health services for any reason in the past 3 months, compared to 46% of those without depression (p<0.0001). Private providers were most frequently consulted by adults with probable depression (32%), while only 19% consulted traditional providers. Structural barriers to healthcare use such as cost and distance to services were frequently reported (54% and 52%, respectively) but were not associated with treatment-seeking for depression. The following factors were found to be positively associated with treatment-seeking for depression: higher symptom severity; reporting lack of energy, lack of interest/pleasure, low self-esteem, or slow movements/restlessness on more than 7 days in the past 2 weeks; being married; having discussed depression symptoms; and reporting problems with medication availability and supply as a barrier to healthcare. No evidence was found for an association between treatment-seeking for depression and most socio-economic, demographic or attitudinal factors. Discussion and conclusionsThe majority of adults with probable depression actively seek healthcare, but not specifically for 3 depression symptoms, indicating the need to improve detection of depression during consultations about other complaints. Private providers should be included in programmes to improve the detection and treatment of depression. Unmarried individuals may experience greater difficulties in accessing care in this setting. Further research should test the hypotheses generated in this descriptive study.

show abstract

“…General health indicators are below the national average (19), literacy rates are 81% for males and 58% for females (17), and 88% of residents have completed only primary education or less (20). (14), and PRIME evaluation plan (15) have been described in more detail elsewhere. The term "implementation area" will be used to refer to those villages where MHCP activities were fully implemented.…”

Section: Settingmentioning

confidence: 99%

Health care use and treatment-seeking for depression symptoms in rural India: An exploratory cross-sectional analysis

Roberts¹,

Shidhaye

Patel

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

Background There is a large “treatment gap” for depression worldwide. This study aimed to better understand the treatment gap in rural India by describing health care use and treatment-seeking for depression. Methods Data were analysed from a two round cross-sectional community survey carried out in rural Madhya Pradesh between May 2013 and December 2016. We examined the proportion of individuals who screened positive for depression (≥10) on the Patient Health Questionnaire (PHQ-9) who sought treatment in different sectors, for depression symptoms and for any reason, and compared the latter with health service use by screen-negative individuals. We analysed the frequency with which barriers to healthcare utilisation were reported by screen-positive adults. We also analysed the association between seeking treatment for depression and various predisposing, enabling and need factors. Results 86% of screen-positive adults reported seeking no depression treatment. However, 66% had used health services for any reason in the past 3 months, compared to 46% of screen-negative individuals (p<0.0001). Private providers were most frequently consulted by screen-positive adults (32%), while only 19% consulted traditional providers. Structural barriers to healthcare use such as cost and distance to services were frequently reported (54% and 52%, respectively) but were not associated with treatment-seeking for depression. The following factors were found to be positively associated with treatment-seeking for depression: higher symptom severity; reporting lack of energy, lack of interest/pleasure, low self-esteem, or slow movements/restlessness on more than 7 days in the past 2 weeks; being married; having discussed depression symptoms; and reporting problems with medication availability and supply as a barrier to healthcare. No evidence was found for an association between treatment-seeking for depression and most socio-economic, demographic or attitudinal factors. Conclusions These findings suggest that the majority of adults who screen positive for depression seek healthcare, although not primarily for depression symptoms, indicating the need to improve detection of depression during consultations about other complaints. Private providers may need to be considered in programmes to improve depression treatment in this setting. Further research should test the hypotheses generated in this descriptive study, such as the potential protective role of marriage in facilitating treatment-seeking.

show abstract

Evaluation of district mental healthcare plans: The PRIME consortium methodology

Cited by 100 publications

References 34 publications

Prevalence, correlates and help-seeking behaviour for depressive symptoms in rural Uganda: a population-based survey

Prevalence, correlates and help-seeking behaviour for depressive symptoms in rural Uganda: a population-based survey

Health care use and treatment-seeking for depression symptoms in rural India: A descriptive cross-sectional analysis

Health care use and treatment-seeking for depression symptoms in rural India: An exploratory cross-sectional analysis

Contact Info

Product

Resources

About