Integrating depression care within NCD provision in Bangladesh and Pakistan: a qualitative study

Abstract

Background: Co-morbidity of depression with other non-communicable diseases (NCDs) worsens clinical outcomes for both conditions. Low-and middle-income countries need to strengthen mechanisms for detection and management of co-morbid depression within NCDs. The Behavioural Activation for Comorbid Depression in Non-communicable Disease (BEACON) study explored the acceptability and feasibility of integrating a brief depression intervention (behavioural activation, BA) into NCD services in healthcare facilities in Bangladesh and Pakistan. Methods: Face-to-face qualitative interviews were conducted with 43 patients and 18 health workers attending or working in NCD centres in four healthcare facilities in Bangladesh and Pakistan, and with three policy makers in each country. The interviews addressed four research questions (1) how NCD care is delivered, (2) how NCD patients experience distress, (3) how depression care is integrated within NCD provision, and (4) the challenges and opportunities for integrating a brief depression intervention into usual NCD care. The data were analysed using framework analysis, organised by capability, opportunity and motivation factors, cross-synthesised across countries and participant groups. Results: Patients and health workers described NCD centres as crowded and time pressured, with waiting times as long as five hours, and consultation times as short as five minutes; resulting in some patient frustration. They did not perceive direct links between their distress and their NCD conditions, instead describing worries about family and finance including affordability of NCD services. Health worker and policy maker accounts suggested these NCD centres lacked preparedness for treating depression in the absence of specific guidelines, standard screening tools, recording systems or training. Barriers and drivers to integrating a brief depression intervention reflected capability, opportunity and motivation factors for all participant groups. While generally valuing the purpose, significant challenges included the busy hospital environment, skill deficits and different conceptions of depression. Conclusions: Given current resource constraints and priorities, integrating a brief psychological intervention at these NCD centres appears premature. An opportune first step calls for responding to patients' expressed concerns on service gaps in provisioning steady and affordable NCD care. Acknowledging differences of conceptions of depression

Living with depression and diabetes: A qualitative study in Bangladesh and Pakistan

“…While the findings of the research highlight the need for integrated care, and that BA may be acceptable, the huge logistical constraints and potential for added work for an already over-stretched service were highlighted as a major barrier to the introduction of a new intervention. Indeed, in an earlier study some of the authors were involved in (HJ, FA) looking at the potential for BA in NCD care we considered it somewhat premature to integrate BA in this setting given the current restraints on health systems in Bangladesh and Pakistan [ 33 ]. We maintain this will be a major challenge.…”

Protocol for integrating mental health services into primary healthcare facilities: a qualitative study of the perspectives of patients, family members and healthcare providers in rural Bangladesh

“…30 A sister project of the current study titled 'Behavioural Activation for Comorbid Depression in Non-communicable Disease (BEACON)' reported about the lack of preparedness of NCD centres for managing the treatment of CMDs such as depression and the absence of guidelines, proper recording systems and training. 31 Family members often play a critical role in the care of patients and have a different perspective to that of the patient. 32 The family members of mentally ill patients are often socially isolated due to their relatives' condition.…”

It's About Time: A Study of Rheumatology Patient Consultation Times

“…The current situation in South Asia is not any better than in the rest of the world, where a study on non-communicable diseases (NCDs) done in Pakistan and Bangladesh revealed that wait times could exceed more than five hours while the consultation could be only five minutes [ 16 ]. Furthermore, there is a paucity of data on the consultation times of specialists.…”