Impact of a district mental health care plan on suicidality among patients with depression and alcohol use disorder in Nepal

Abstract

Background Large scale efforts to expand access to mental healthcare in low-and middle-income countries have focused on integrating mental health services into primary care settings using a task sharing approach delivered by non-specialist health workers. Given the link between mental disorders and risk of suicide mortality, treating common mental disorders using this approach may be a key strategy to reducing suicidality. Methods and findings The Programme for Improving Mental Health Care (PRIME) evaluated mental health services for common mental disorders delivered by non-specialist health workers at ten primary care facilities in Chitwan, Nepal from 2014 to 2016. In this paper, we present the indirect impact of treatment on suicidality, as measured by suicidal ideation, among treatment and comparison cohorts for depression and AUD using multilevel logistic regression. Patients in the treatment cohort for depression had a greater reduction in ideation relative to those in the comparison cohort from baseline to three months (OR = 0.16, 95% CI: 0.05-0.59; p = 0.01) and twelve months (OR = 0.31, 95% CI: 0.08-1.12; p = 0.07), with a significant effect of treatment over time (p = 0.02). Among the AUD cohorts, there were no significant differences between treatment and comparison cohorts in the change in ideation from baseline to three months (OR = 0.64, 95% CI: 0.07-6.26; p = 0.70) or twelve months (OR = 0.46, 95% CI: 0.06-3.27; p = 0.44), and there was no effect of treatment over time (p = 0.72). Conclusion The results provide evidence integrated mental health services for depression benefit patients by accelerating the rate at which suicidal ideation naturally abates over time. Integrated services do not appear to impact ideation among people with AUD, though baseline levels of ideation were much lower than for those with depression and may have led to floor

Educational and Training Interventions Aimed at Healthcare Workers in the Detection and Management of People With Mental Health Conditions in South and South-East Asia: A Systematic Review

“…The content of interventions were highly heterogenous. Twelve (31%) studies adapted WHO mhGAP guidelines (24, 25, 28, 33, 42, 44-46, 49, 53, 56, 70) of which six studies (15%) were conducted under the auspices of the PRIME program (33,42,(44)(45)(46)49) and one integrated the RESHAPE module (3%) (45). Three studies (5%) conducted the THP training (52,54,71), two studies (5%) delivered the SMART module (28,67).…”

“…Aldridge et al (42) evaluated the indirect impact of PRIME on suicidal ideation among individuals diagnosed with depression (n = 137 treatment; n = 75 control) and alcohol use disorder (AUD) (n = 175 treatment; n = 57 comparison). Participants in the treatment group received psychotropic medication, psychosocial support, and psychoeducation according to mhGAP-IG clinical decision algorithm.…”

“…Twenty-one quantitative studies had a prepost-design, of which 10 were appraised with high risk of bias (25,43,49,51,(55)(56)(57)(67)(68)(69), followed by moderate (n = 6) (26,27,30,34,40,53), critical (n = 4) (36,37,50,58) and low risk (n = 1) (45). Two quasi-experimental studies (24, 28) and one case-control studies (42) were assessed as moderate risk of bias.…”

“…We found only a few studies (26,28,34,38,42,47,48,51,52,67,69,70) that evaluated the impact of training in terms of patient outcome. Most studies focused on the initial three stages (reaction, learning, and behaviour) developed by Kirkpatrick and Kirkpatrick (98) in evaluating impact of training.…”

Adaptation of the World Health Organization Electronic Mental Health Gap Action Programme Intervention Guide App for Mobile Devices in Nepal and Nigeria: Protocol for a Feasibility Cluster Randomized Controlled Trial

“…Suicidal ideation and behavior: Suicidal ideation and behavior will be assessed, in Nepal only, using suicidality questions adapted from the Composite International Diagnostic Interview suicidality module [ 57 ]. This tool has been widely used in Nepal [ 58 ]. We will ask participants whether they had thought of taking their own life in the past 12 months.…”