Validation of a brief mental health screening tool for common mental disorders in primary healthcare

Abstract

Close to 14% of the global burden of disease can be attributed to neuropsychiatric disorders primarily related to the disabling nature of common mental disorders (CMDs), [1,2] which typically include depression, anxiety and psychoactive substance use or alcohol use disorder. A review and meta-analysis of studies between 1980 and 2013 established that 29.2% of individuals globally experienced CMDs at some point in their lifetime. [3] CMDs have been shown to contribute to the burden of disease in low-and middle-income countries, [4-6] and can variously compromise adherence to treatment, health behaviour change and self-management efforts. [7-9] In South Africa (SA), almost a third (30.3%) of the population has experienced a CMD in their lifetime, [10] with a 12-month prevalence estimate of 16.5% for CMDs (anxiety, mood and substance use disorders). [11] Although effective treatment for mental disorders is available [12,13] and can be delivered in routine primary healthcare (PHC), [14] only about half of patients with a depressive disorder in high-income settings are detected [15,16] and only 16.5% of all individuals with a 12-month major depressive disorder receive minimally adequate treatment. [17] In SA this gap is far greater, with only one in four people with a CMD reporting receiving treatment of any kind. [18] While integrating mental healthcare into existing health systems may be the most effective and cost-efficient approach to improve access to mental health services in SA, it requires addressing major knowledge gaps, inter alia the development and assessment of interventions that integrate mental health screening and treatment into existing health systems [8,19] as well as training lay counsellors in the identification of mental disorders. [20] However, screening that is integrated into routine care must use measures that can be administered by nonspecialist health staff, are brief and easy to administer, and promote high specificity given the meagre resources available to treat false positives. [21] Objectives This validation study was a substudy of the Southern African Mental Health Integration project on evaluating the scale-up of evidencebased packages for integration of mental healthcare in PHC settings for depression and alcohol use disorders into routine care that is part of the Mental Health Integration Programme (MhINT). Continuous This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Thoughts of self-harm in early and late pregnancy in urban South Africa: Investigating prevalence, predictors and screening options

“…[26] Regardless of this strong justification for supporting early screening, finding a balance between the need to screen and detect risk while limiting public healthcare burden, will likely be key to the acceptability and feasibility of increased screening in public healthcare clinical settings. Some research in SA has already advocated for ultra-short screening in primary healthcare settings, [27] and while we provide support for those calls, our findings suggests that focusing only on depressive screening items may have limitations. The results of the logistic regression models show that depression and anxiety are both strongly associated with later TSH.…”

Protective Behaviors and Secondary Harms Resulting From Nonpharmaceutical Interventions During the COVID-19 Epidemic in South Africa: Multisite, Prospective Longitudinal Study

“…Finally, for mental health, we asked primary respondents to answer the Generalized Anxiety Disorder 2-item (GAD-2) and Patient Health Questionnaire 2-item (PHQ-2) scales. GAD-2 and PHQ-2 scores of ≥3 were considered positive, as per the standard, South African–validated cutoffs [ 38 ]. The Cronbach α values in this study were .85 for the PHQ-2 and .91 for the GAD-2.…”

The treatment gap for mental disorders in adults enrolled in HIV treatment programmes in South Africa: a cohort study using linked electronic health records

“…Continued efforts to close the treatment gap for people with mental disorders are needed. Strategies to strengthen task-shifting, training and capacitation of primary health care staff, and models of referral and stepped-care will be crucial to closing the treatment gap (Bhana et al ., 2019 ; Petersen et al ., 2019 ).…”