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

Halsted, Sheldon; Ásbjörnsdóttir, Kristjana; Wagenaar, Bradley H.; Cumbe, Vasco; Augusto, Orvalho; Gimbel, Sarah; Manaca, Nelia; Manuel, José; Sherr, Kenneth

doi:10.1007/s00127-019-01746-2

Cited by 24 publications

(13 citation statements)

References 63 publications

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“…Although the nationwide prevalence of mental illness is not well established in Mozambique, previous research has demonstrated rates of depressive symptoms in the population between 14% and 19% (17,18). The difference in estimated prevalence in the general population and our study sample is consistent with reports from other countries that people with MDD are more likely to seek general health services.…”

Section: Mental Disorders In the Study Populationsupporting

confidence: 86%

A Multi-Site Study of Mental Disorders in the Mozambican Health Care System

Gouveia

Lovero

Fumo

et al. 2020

Preprint

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BackgroundIn Mozambique, human and financial resources for public mental health services are extremely limited. Understanding the mental health needs of those seeking healthcare can inform efficient targeting of mental health services. We examined if the frequency of mental disorders in a health facility varied based on the level of specialization of such facility, from primary care without mental health specialists (PrCMH-), to those with mental health specialists (PrCMH+) and tertiary care (TerC), where both inpatient and outpatient mental health services are available.MethodsParticipants were adults seeking health or mental health services at six facilities (2 PrCMH+, 3 PrCMH-, and 1 TerC) in the cities of Maputo and Nampula in Mozambique. Mental disorders were assessed by the MINI International Neuropsychiatric Interview (MINI) 4.0.0. We compared the sociodemographic characteristics and MINI diagnoses across the three types of health facilities. Multiple logistic regression models determined the likelihood that a person seeking services at each type of facility would have any mental disorder, common mental disorders (CMD), severe mental disorders (SMD), substance use disorders (SUD), and moderate-to-high suicide risk, adjusting for sociodemographic factors. ResultsOf the 612 total participants, 52.6% (n=322) were positive for at least one mental disorder: 37.1% were positive for CMD, 28.9% for SMD, 13.2% for SUD, and 10.5% had suicide risk. Presence of any mental disorder was highest in TerC (62.5%) and lowest in PrCMH- (48.4%). Adjusting for sociodemographic covariates, participants in PrCMH+ were significantly more likely to have SMD (OR: 1.85, 95%CI: 1.10-3.11) and SUD (OR: 2.79, 95%CI: 1.31-5.94) than participants in PrCMH-; participants in TerC were more likely to have CMD (OR: 1.70, 95%CI: 1.01-2.87) and SUD (OR: 2.57, 95%CI: 1.14-5.79) than in PrCMH-. Suicide risk was the only condition that did not differ across facility types.ConclusionsAs anticipated, people with mental disorders were more likely to be cared for at facilities with mental health specialists. However, our study suggests there is a remarkably high frequency of mental disorders across different types of facilities within the Mozambican healthcare system. These results suggest a need to increase mental health services at the primary care level.

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Section: Mental Disorders In the Study Populationsupporting

confidence: 86%

A Multi-Site Study of Mental Disorders in the Mozambican Health Care System

Gouveia

Lovero

Fumo

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…This suggests that a large burden of depression is missed in existing psychiatric care settings. A recent population-based survey of over 3,000 households conducted by our group additionally showed the high rates of mental health stigma in central Mozambique, as well as treatment gaps for depressive symptoms and suicidal ideation of almost 70% and 90%, respectively (24,25).…”

Section: Introductionmentioning

confidence: 59%

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

Cumbe

Muanido

Manaca

et al. 2020

Preprint

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Background: Depression is one of the leading causes of disability in Mozambique; however, few patients with depression are identified in primary care. To our knowledge, there are no validated tools for depression screening in Mozambique. The aim of this study was to validate the Patient Health Questionnaire-9 (PHQ-9) for use in primary care settings in Mozambique. Methods: The PHQ-9 was adapted using a structured multi-phase process led by a team of bilingual experts followed by a review by lay individuals and pilot-testing including cognitive interviews. The final Mozambican PHQ-9 (PHQ-9-MZ) was applied among 503 individuals randomly selected from antenatal, postpartum, and general outpatient consultations in three Ministry of Health primary healthcare clinics in Sofala Province, Mozambique. The PHQ-9-MZ was evaluated against the MINI 5.0-MZ as a gold standard diagnostic tool. Results: The majority of participants were female (74%), with a mean age of 28. Using the MINI 5.0-MZ, 43 (9%) of the sample tested positive for major depressive disorder. Items of the PHQ-9-MZ showed good discrimination and factor loadings. One latent factor of depression explained 54% of the variance in scores. Questions 3 (sleep) and 5 (appetite) had the lowest item discrimination and factor loadings. The PHQ-9-MZ showed good internal consistency, with a Cronbach’s alpha of 0.84, and an area under the receiver operating characteristic curve (AUROC) of 0.81 (95% CI: 0.73, 0.89). The PHQ-2-MZ had an AUROC of 0.78 (95% CI: 0.70, 0.85). Using a cut-point of ≥9, the PHQ-9-MZ had a sensitivity of 46.5% and a specificity of 93.5%. Using a cut-point of ≥2, the PHQ-2-MZ had a sensitivity of 74.4% and a specificity of 71.7%. Increasing the cut-point to ≥3, the PHQ-2-MZ has a sensitivity of 32.6% and a specificity of 94.6%. Conclusions: The PHQ-9-MZ and PHQ-2-MZ emerge as two valid alternatives for screening for depression in primary health care settings in Mozambique. Depending on program needs and weighing the value of minimizing false positives and false negatives, the PHQ-9-MZ can be employed with cut-points ranging from ≥8 to ≥11, and the PHQ-2-MZ with cut-points ranging from ≥2 to ≥3.

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“…This suggests that a large burden of depression is missed in existing psychiatric care settings [ 25 ]. A recent population-based survey of over 3000 households conducted by our group additionally showed the high rates of mental health stigma in central Mozambique, as well as treatment gaps for depressive symptoms and suicidal ideation of almost 70 and 90%, respectively [ 26 , 27 ].…”

Section: Introductionmentioning

confidence: 99%