Global research challenges and opportunities for mental health and substance-use disorders

Baingana, Florence; Al’Absi, Mustafa; Becker, Anne E.; Pringle, Beverly

doi:10.1038/nature16032

Cited by 105 publications

(93 citation statements)

References 60 publications

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“…Such a situation just confirms a well known fact that mental health services have been widely neglected in low and middle income countries compared to other services [27, 31]. In South Africa for example, barriers to the financing and development of mental health services resulted in psychiatric hospitals remaining outdated, falling into despair, and often unfit for human use [26, 32].…”

Section: Discussionmentioning

confidence: 75%

“…The shortage contributes to having the majority of people with mental disorders not receiving evidence-based care, leading to chronicity, suffering, and increased costs of care [12]. Many strategies have been proposed to address this problem including task shifting and prioritizing organization and ways of delivering community-based mental health services [27]. …”

Section: Discussionmentioning

confidence: 99%

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Mental health care and delivery system at Temeke hospital in Dar es Salaam, Tanzania

Ambikile

Iseselo

2017

BMC Psychiatry

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BackgroundLow and middle income countries face many challenges in meeting mental health needs in their regions. Treatment of patients with mental disorders is inadequate in most of these countries and majority of individuals with severe mental disorders remain untreated. The bad news is that mental health problems in these countries are on the rise due to socioeconomic challenges being faced. Regardless of guidelines and directives provided by WHO for organizing mental health services, these countries continue to face many challenges in the effort to cater for mental health needs. Such challenges include lack of human resource for mental health especially at primary health care level, inadequate training of human resource for mental health, misplacement of human resource for mental health, lack of drugs, wrong priorities, problematic insurance coverage for mental disorders, and stigma. This study aimed at exploring mental health care and delivery system at Temeke district hospital, and how services were organized to meet the increasing mental health needs of its population.MethodsA qualitative study was conducted at Temeke hospital in Dar es Salaam, involving 7 in-depth interviews with mental health care providers, 7 in-depth interviews with mentally ill patients, and 2 focus group discussions with caregivers. A convenient sampling procedure was used to select participants for the study. All interviews were audio-recorded in Kiswahili and transcribed. A qualitative Content Analysis was used to analyze data after translation with the aid of Nvivo 10 software.ResultsThree main themes were identified. These were resource challenges, environmental/system challenges, and satisfaction with mental health services. Temeke health facility faced resource and environmental/system challenges, and there were mixed feelings on satisfaction with services. Funding and priority issues were found to mainly affect delivery of appropriate services to clients.ConclusionHealth facilities that provide mental health services in the community need to be well equipped with necessary resources to meet the vast needs of people they serve. Having a political will, improving the health systems governance for mental health, and priority setting, are necessary to address the challenges experienced in the delivery of mental health services.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Mental health care and delivery system at Temeke hospital in Dar es Salaam, Tanzania

Ambikile

Iseselo

2017

BMC Psychiatry

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“…Drug dependence produces serious mental and physical health burdens especially in low-and middle-income countries (1). It has been reported that khat users, typically men, get together with their peers in the afternoon and chew khat for several hours, leading to financial and familial problems (35).…”

Section: Discussionmentioning

confidence: 99%

“…The burden of addiction and mental health problems continues to increase globally (1,2). Khat is used commonly in East Africa and the Arabian Peninsula (3), with reports indicating that 80-90% of East African males use khat daily and 10-60% of East African females use khat daily (4,5).…”

Section: Introductionmentioning

confidence: 99%

Level of khat dependence, use patterns, and psychological correlates in Yemen: a cross-sectional investigation

Nakajima¹,

Hoffman²,

Al’Absi³

2017

East Mediterr Health J

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Chronic khat use is associated with negative health consequences. However, no study has fully characterized individuals who are khat dependent. This paper examines socio-demographic and psychosocial correlates of adult khat dependence. A total of 270 khat users (129 women) in Yemen completed face-to-face interviews and provided demographic information and data on patterns of khat use, subjective mood, and sleep quality. The Severity of Dependence Scale-Khat (SDS-khat) was used to assess level of khat dependence. A series of analysis of variance was conducted. Khat users, on average, used khat for 5.2 hours a day (SD = 2.3) for 5.7 days a week (SD = 2.0). Individuals who screened positive for khat dependence reported longer duration of khat sessions per day, higher frequency of khat use per week, greater levels of negative mood and sleep disturbances, and were more likely to endorse physical symptoms after khat use (P < 0.05). Future research should elucidate mechanisms responsible for khat dependence symptomatology. Niveau de dépendance au khat, modes de consommation, et corrélats psychosociaux au Yémen : enquête transversaleRÉSUMÉ La consommation chronique de khat est associée à des conséquences néfastes sur le plan de la santé. Cependant, aucune étude n'a permis une caractérisation complète des individus dépendants au khat. Le présent article se penche sur les corrélats socio-démographiques et psychosociaux de la dépendance au khat chez l'adulte. Au total, 270 consommateurs de khat (129 femmes) au Yémen se sont soumis à des entretiens en face à face et ont fourni des informations démographiques et des données sur les modes de consommation, l'humeur subjective et la qualité du sommeil. L'Échelle de la sévérité de la dépendance pour le khat a été utilisée pour évaluer le niveau de dépendance à cette substance. Une série d'analyses de variance a été réalisée. Les utilisateurs de khat en consommaient, en moyenne, pendant 5,2 heures par jour (ET = 2,3) 5,7 jours par semaine (ET = 2,0). Les individus dépistés positifs pour la dépendance au khat signalaient des séances de consommation de khat de durée plus longue par jour, une fréquence plus élevée de consommation par semaine, des niveaux plus importants d'humeur négative et de troubles du sommeil, et étaient davantage susceptibles de ressentir des symptômes physiques après en avoir consommé (p < 0,05). La recherche future devrait s'efforcer de déterminer les mécanismes responsables de la symptomatologie de la dépendance au khat.

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“…Frameworks for research-capacity building at the individual, institutional, and national levels have been described [6] and the international scientific community can play important roles in fostering these processes. The challenges and opportunities ahead are significant [3,12], but the scientific synergies created by networks, mentoring, and research collaborations have huge potentials to promote learning, growth and development, for all parties involved. Children across the globe will appreciate it.…”

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confidence: 99%

Development of national capabilities in low and middle income countries for research in child mental health

Polanczyk

2016

Eur Child Adolesc Psychiatry

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key to promote worldwide improvements [1,6]. The current issue of the European Child and Adolescent Psychiatry brings three examples of two upper middle income countries-Brazil and Mexico-where local research groups have been producing novel and relevant findings to the international community and influencing organization of local health systems and policymakers.In Brazil, the National Institute of Developmental Psychiatry for Children and Adolescents (http://inpd.org.br) congregates researchers from different universities who together have launched cross-sectional studies, a large community cohort with extensive phenotype data and neuroimaging and genomic information, a birth cohort, and a home-visiting intervention for high-risk pregnant youth. In this issue, two studies from the Brazilian Institute illustrate their work. Fortes et al. [8] studied prevalence and correlates of specific learning disorders (SLDs) in 1618 children and adolescents from four different cities, each one in a different geographic area of Brazil (which differs markedly between them in broad socioeconomic and cultural aspects). Prevalence estimates found were 7.6 % for SLD with global impairment, 5.4 % for SLD with impairment in writing, 6.0 % for SLD with impairment in arithmetic, and 7.5 % for SLD with impairment in reading. ADHD was the only comorbid mental disorder significantly more frequent in children with SLD with global impairment, and among other SLDs, only SLD with impairment in arithmetic presented higher rates of comorbidity, specifically of anxiety disorders. Rates of SLD with global impairment were associated with age, sex, SES, and the city, and estimates based on DSM-IV criteria were lower than those based on DSM-5 criteria. This study suggests that commonalities and specificities on SLDs are identified across different regions within the country and according to the literature, between countries. To further understand the nature of these findings Worldwide estimates indicate that 13 % of children and adolescents suffer from impairing mental disorders [14] and approximately 60 % of adolescents report significant levels of symptoms [10]. Most of what we know about these disorders come from high-income countries (HICs), home of only approximately 10 % of the total population of children in the world [12]. Despite only a partial picture of the global child mental health scenario, built with data from the more affluent environments [4], it is now possible to conclude that mental and substance use disorders are the leading cause of disability in children and adolescents [7]. The complete picture, with national data from low and middle income countries (LMICs) included, would certainly depict a more vulnerable scenario. In fact, due to population growth and under-resourced health care systems, the burden of mental health and substance-use disorders is expected to further increase worldwide in the next decades, and the steepest rise is predicted to occur in LMICs [7].Considering the evolving adverse scenario of child mental he...

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Global research challenges and opportunities for mental health and substance-use disorders

Cited by 105 publications

References 60 publications

Mental health care and delivery system at Temeke hospital in Dar es Salaam, Tanzania

Mental health care and delivery system at Temeke hospital in Dar es Salaam, Tanzania

Level of khat dependence, use patterns, and psychological correlates in Yemen: a cross-sectional investigation

Development of national capabilities in low and middle income countries for research in child mental health

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