Traditional vs . non‐traditional healing for minor and major morbidities in India: uses, cost and quality comparisons

et al. 2020

Preprint

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.

Section: Strengths and Limitationssupporting

confidence: 90%

“…showing that the use of traditional healers is low relative to the use of allopathic care for all health conditions, even in rural areas (51). This suggests that engaging with or influencing the use of traditional services should not be a major policy focus in improving care for depression in this context.…”

Section: Use Of Traditional Servicesmentioning

confidence: 99%

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

Roberts¹,

et al. 2020

Preprint

Section: Strengths and Limitationssupporting

confidence: 90%

“…showing that the use of traditional healers is low relative to the use of allopathic care for all health conditions, even in rural areas (57). This suggests that engaging with or influencing the use of traditional services should not be a major policy focus in improving care for depression in this context.…”

Section: Use Of Traditional Servicesmentioning

confidence: 99%

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

Roberts¹,

et al. 2019

Preprint

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.

“…We also found that only a showing that the use of traditional healers is low relative to the use of allopathic care for all health conditions, even in rural areas (51). This suggests that engaging with or influencing the use of traditional services should not be a major policy focus in improving care for depression in this context.…”

Section: Use Of Traditional Servicesmentioning

confidence: 76%

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

Roberts¹,

et al. 2020

Preprint

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 conducted 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 using univariable regression. 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; 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 role of marriage in facilitating treatment-seeking.