High burden of mental illness and low utilization of care among school-going youth in Central Haiti: A window into the youth mental health treatment gap in a low-income country

Abstract

Background The mental health treatment gap for youth in low- and middle-income countries (LMICs) is substantial; strategies for redress are urgently needed to mitigate the serious health and social consequences of untreated mental illness in youth. Aims To estimate the burden of major depressive episode (MDE) and posttraumatic stress disorder (PTSD) as well as utilization of care among Haitian youth in order to describe the mental health treatment gap in a LMIC setting. Methods We estimated the point prevalence of MDE, PTSD, and subthreshold variants in a school-based sample of youth (n=120, ages 18–22) using a modified SCID-based interview and examined treatment utilization among those receiving one of these diagnoses. We assessed additional psychopathology with self-report measures to examine validity of study diagnostic assignments. Results The combined prevalence of full-syndrome or subthreshold MDE or PTSD was high (36.7%). A large majority of affected individuals (88.6%) had accessed no mental health services in the health sector and 36.4% had accessed no care of any kind in either the health or folk sectors in the past year. Conclusions Findings demonstrate a high mental health burden among Haiti’s youth and that many youth with MDE and PTSD are not accessing mental health care.

Formative research on a teacher accompaniment model to promote youth mental health in Haiti: Relevance to mental health task-sharing in low-resource school settings

“…Following their ZL clinical assessment, 53 and 32 students, respectively, warranted a recommendation that follow-up mental health care or psychosocial support could be helpful; thus, 70.8% of students ( n =85) had an identified mental health need. In addition, we have previously reported that 36.7% of student participants were assigned a diagnosis of MDE, PTSD, or a subthreshold variant by research interview (Eustache et al, 2017b). …”

“…Baseline psychosocial assessments developed or adapted for the study, including a diagnostic interview, are described in detail elsewhere (Eustache et al, 2017b). …”

“…The former was recognized by a student’s meeting study criteria for a diagnosis of MDE, PTSD, or subthreshold MDE or PTSD during the SCID-based research interview assessment ( n =44; Eustache et al, 2017b). The latter was recognized by a written ZL clinical assessment recommending either a specific clinical intervention or some kind of psychosocial support for an identified mental health need (i.e., comprising respondents in either the first or second categories described above).…”

“… * SCID-based diagnoses and mental health and health services utilization reported previously in Eustache et al, 2017b. …”

A validation study of the Zanmi Lasante Depression Symptom Inventory (ZLDSI) in a school-based study population of transitional age youth in Haiti

“…Available evidence from Haiti supports a high prevalence of depression, PTSD, and suicidal ideation [15][16][17]; emotional distress related to violence and life stressors [18][19][20]; and exposure to traumatic events related to the 2010 earthquake [21][22][23]. Emotional distress and mental illness are frequently communicated through idioms of distress; patients and families often pursue religious and traditional healing resources for mental illness [24,25].…”