Health facility determinants and trends of ICD-10 outpatient psychiatric consultations across Sofala, Mozambique: time-series analyses from 2012 to 2014

Abstract

BackgroundFew peer-reviewed publications have taken a longitudinal or systems approach to mental healthcare (MH) utilization in low- and middle-income countries. We analyzed: (1) outpatient ICD-10 diagnoses over time and by gender; and (2) health facility determinants of MH service utilization.MethodsWe reviewed a census of 15,856 outpatient psychiatric consultations conducted at Ministry clinics in Sofala province, Mozambique from January 2012-June 2014. Generalized estimating equations were used to model facility determinants of ICD-10 diagnoses.ResultsAcross the period, 48.9 % of consults were for epilepsy, 22.4 % for schizophrenia/delusional disorders, and 8.8 % for neurotic/stress-related disorders. The proportion of schizophrenia/delusional disorders has decreased over time (32 % in 2012; 13 % in 2014, p = 0.003), in favor of greater diversity of diagnoses. Epilepsy has increased significantly in absolute and proportional terms. Women are more likely to present for neurotic/stress-related conditions (12.8 % of consults for women, 5.7 % for men, p < 0.001), while men are more likely to present for substance use (1.9 % for women, 6.4 % for men, p < 0.001). Clinics with more psychiatric technicians have a 2.1-fold (CI: 1.2, 3.6) increased rate of schizophrenia/delusional disorder diagnoses. Rural clinics saw a higher proportion of epilepsy cases and a lower proportion of organic, substance use, schizophrenia, and mood disorder cases.Discussion and ConclusionsOutpatient MH service provision is increasing in Mozambique, although currently focuses on epilepsy and schizophrenia/delusional disorders. Mid-level psychiatric providers appear to be associated with a higher proportion of schizophrenia/delusional disorder diagnoses. Due to diagnostic or utilization differences, rural clinics may be missing important cases of organic, substance use, schizophrenia, and mood disorders. Models and decision-support tools for mental healthcare integration with primary care practice are needed in Mozambique to allow further scale-up of mental health services.

Depressive symptoms, suicidal ideation, and mental health care-seeking in central Mozambique

“…In 1994, the Ministry of Health implemented a task-shifting strategy through the development of a 30-month psychiatric technician training program, in which mid-level professionals are trained to provide mental health services in primary care settings [23]. This strategy has increased availability of mental health services, and this new cadre of health professionals currently provide the vast majority of psychiatric services nationwide [23,24]. Despite this strategy, there is a significant shortage of mental health professionals and limited health system capacity to bring evidence-based mental health interventions to scale.…”

Validity and item response theory properties of the Patient Health Questionnaire-9 for primary care depression screening in Mozambique (PHQ-9-MZ)

“…This is an urgent need in Mozambique, as the existing specialized psychiatric care system focuses almost exclusively on severe mental illness, including schizophrenia and epilepsy. Initial pilot work has shown that less than 3% of all mental health consultations across Sofala Province and less than 2% of all consultations at the Beira Central Hospital were for any mood disorder [23,24]. This suggests that a large burden of depression is missed in existing psychiatric care settings [25].…”

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

“…This is an urgent need in Mozambique, as the existing specialized psychiatric care system focuses almost exclusively on severe mental illness, including schizophrenia and epilepsy. Initial pilot work has shown that less than 3% of all mental health consultations across Sofala Province and less than 2% of all consultations at the Beira Central Hospital were for any mood disorder (22,23). This suggests that a large burden of depression is missed in existing psychiatric care settings.…”