Epidemiological patterns of mental disorders and stigma in a community household survey in urban slum and rural settings in Kenya

Mutiso, Victoria; Musyimi, Christine; Tomita, Andrew; Loeffen, Lianne; Burns, Jonathan K.; Ndetei, David M.

doi:10.1177/0020764017748180

Cited by 26 publications

(27 citation statements)

References 38 publications

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“…Finally, by using the MICA - 4 , we were able to identify negative attitudes towards mental illness and the field of mental health among our sample, which are also common among other non-specialists working in LMICs [ 14 , 19 , 23 – 25 , 27 – 31 , 33 – 36 ]. While the MICA - 4 has been used in other contexts [ 35 , 36 , 85 – 90 ], internal consistency and some item-total correlations generated using the sixteen-item scale were poor in our sample.…”

Section: Discussionmentioning

confidence: 98%

“…First, non-specialists reported lacking specific knowledge about mental illness and suicide [ 11 – 15 ]. While non-specialists do see people presenting with mental health problems in consultation, the majority are not able to list or recognize symptoms attributable to mental illness [ 16 – 19 ]. Interestingly, this is also a reality observed with depression and anxiety [ 14 , 20 ], despite these being the most frequently reported and seen mental health problems in non-specialized settings [ 21 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

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Mental health knowledge, attitudes, and self-efficacy among primary care physicians working in the Greater Tunis area of Tunisia

Spagnolo¹,

Champagne²,

Leduc³

et al. 2018

Int J Ment Health Syst

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BackgroundNon-specialists’ involvement in mental health care is encouraged in the field of global mental health to address the treatment gap caused by mental illness, especially in low- and middle-income countries. While primary care physicians (PCPs) are involved in mental health care in Tunisia, a lower-middle-income country in North Africa, it is unclear to what extent they are prepared and willing to address mental health problems, substance use disorders, and suicide/self-harm. In this context, we aim (1) to report on mental health knowledge, attitudes, and self-efficacy among a sample of PCPs working in the Greater Tunis area, prior to the implementation of a mental health training program developed by the World Health Organization; and (2) to identify what characteristics are associated with these competencies.MethodsIn total, 112 PCPs completed questionnaires related to their socio-demographic and practice characteristics, as well as their mental health knowledge, attitudes, and self-efficacy. Descriptive analyses and regression models were performed.FindingsPCPs had more knowledge about depression, symptoms related to psychosis, and best practices after a suicide attempt; had favourable attitudes about distinctions between physical and mental health, learning about mental health, and the acceptance of colleagues with mental health issues; and believed most in their capabilities related to depression and anxiety. However, most PCPs had less knowledge about substance use disorders and myths about suicide attempts; had unfavorable attitudes about the dangerousness of people with mental health problems, personal disclosure of mental illness, non-specialists’ role in assessing mental health problems, and personal recovery; and believed the least in their capabilities related to substance use disorders, suicide/self-harm, and psychosis. Participation in previous mental health training, weekly hours (and weekly hours dedicated to mental health), weekly provision of psychoeducation, and certain work locations were associated with better mental health competencies, whereas mental health knowledge was negatively associated with weekly referrals to specialized services.ConclusionsFindings suggest that PCPs in our sample engage in mental health care, but with some gaps in competencies. Mental health training and increased interactions/involvement with people consulting for mental health issues may help further develop non-specialists’ mental health competencies, and integrate mental health into primary care settings.Electronic supplementary materialThe online version of this article (10.1186/s13033-018-0243-x) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Mental health knowledge, attitudes, and self-efficacy among primary care physicians working in the Greater Tunis area of Tunisia

Spagnolo¹,

Champagne²,

Leduc³

et al. 2018

Int J Ment Health Syst

View full text Add to dashboard Cite

show abstract

“…It can be administered by a trained lay person, who reads the questions up to 3 times and records the answers. It has good psychometric properties (Sheehan et al 1997) and has been validated and used in LMICs (Akena et al 2012; Nakimuli-Mpungu et al 2012; van Heyningen et al 2016) including Kenya by the same authors (Mutiso et al 2017). We used it as a confirmatory diagnosis on those participants who were referred on screening positive on mhGAP-IG.…”

Section: Methodsmentioning

confidence: 99%

Feasibility of WHO mhGAP-intervention guide in reducing experienced discrimination in people with mental disorders: a pilot study in a rural Kenyan setting

Mutiso

Pike

Musyimi

et al. 2018

Epidemiol Psychiatr Sci

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“…It is hoped that this will lead to more allocation of funds, given the high disability burden caused by mental disorders in particular depression [ 9 ]. For instance, our previous studies found the prevalence of depression in Kenya varies from 18.7% in household surveys [ 10 ] to 42% in populations attending general health facilities [ 11 ]. Up to 96% of cases of depression in populations in general health facilities go unrecognized [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…In addition to the poor funding for mental health [ 7 ], there are few mental health specialists, lack of awareness on mental disorders and stigma [ 3 , 10 , 12 ], all contributing to the existing large mental health treatment gap, to the extent that most of those in need of mental health services are unable to receive quality care [ 13 ]. In Kenya, health services are devolved to the 47 counties, who then prioritize the services according to their own context and needs while the Ministry of Health at national level gives overall guidance on county polices and technical advice.…”

Section: Introductionmentioning

confidence: 99%

A step-wise community engagement and capacity building model prior to implementation of mhGAP-IG in a low- and middle-income country: a case study of Makueni County, Kenya

Mutiso

Gitonga

Musau

et al. 2018

Int J Ment Health Syst

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BackgroundThe World Health Organization developed the Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) as guidelines for innovative utilization of available resources in low- and middle-income countries (LMICs) in order to accelerate the reduction of the mental health treatment gap. The mhGAP-IG calls for each country to contextualize the guide to their social, cultural and economic context. The objective of this paper is to describe a model for a stepwise approach for implementation of mhGAP-IG in a rural Kenyan setting using existing formal and informal community resources and health systems.MethodsWe conducted an analysis of mental health services in Makueni County, one of the 47 counties in Kenya, in order to understand the existing gaps and opportunities in a low-resource setting. We conducted stakeholder analysis and engagement through interactive dialogue in order for them to appreciate the importance of mental health to their communities. Through the process of participatory Theory of Change, the stakeholders gave their input on the process between the initiation and the end of the process for community mental health development, with the aim of achieving buy-in and collective ownership of the whole process. We adapted the mhGAP-IG to the local context and trained local human resources in skills necessary for the implementation of mhGAP-IG and for monitoring and evaluating the process using instruments with good psychometric properties that have been used in LMICs.ResultsWe were able to demonstrate the feasibility of implementing the mhGAP-IG using existing and trained community human resources using a multi-stakeholder approach. We further demonstrated the feasibility to transit seamlessly from research to policy and practice uptake using our approach.ConclusionsAn inclusive model for low resource settings is feasible and has the potential to bridge the gap between research, policy and practice. A major limitation of our study is that we did not engage a health economist from the beginning in order to determine the cost-effectiveness of our proposed model, occasioned by lack of resources to hire a suitable one.

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Epidemiological patterns of mental disorders and stigma in a community household survey in urban slum and rural settings in Kenya

Abstract: More research is needed into the factors explaining the observed differences in opinion about mental illness between the subgroups, and the impact of mental illness on stigma in Kenya in order to create an evidence-based approach against stigma.

Cited by 26 publications

References 38 publications

Mental health knowledge, attitudes, and self-efficacy among primary care physicians working in the Greater Tunis area of Tunisia

Mental health knowledge, attitudes, and self-efficacy among primary care physicians working in the Greater Tunis area of Tunisia

Feasibility of WHO mhGAP-intervention guide in reducing experienced discrimination in people with mental disorders: a pilot study in a rural Kenyan setting

A step-wise community engagement and capacity building model prior to implementation of mhGAP-IG in a low- and middle-income country: a case study of Makueni County, Kenya

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