Integration of mental health into primary healthcare in low-income countries: Avoiding medicalization

Ventevogel, Peter

doi:10.3109/09540261.2014.966067

Cited by 83 publications

(69 citation statements)

References 104 publications

(92 reference statements)

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“…Addressing mental health in this context ought to go beyond a biomedical approach of treating symptoms to the development of brief culturally adapted interventions that can be administered in resource poor settings and help women to develop coping strategies or resilience [86]. The availability of effective referral systems to community-based care ensures sustainability of interventions.…”

Section: Discussionmentioning

confidence: 99%

Mental ill health in structural pathways to women’s experiences of intimate partner violence

2017

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BackgroundDepression, post-traumatic stress disorder (PTSD), and binge drinking are among mental health effects of child abuse and intimate partner violence (IPV) experiences among women. Emerging data show the potential mediating role of mental ill health in the relationship of child abuse and IPV. There is evidence that PTSD, depression and alcohol abuse are comorbid common mental disorders and that a bidirectional relationship exists between depression and IPV in some settings. Furthermore, the temporal direction in the relationship of alcohol abuse and women’s IPV experiences from different studies is unclear. We undertook a study with women from the general population to investigate the associations of child abuse, mental ill health and IPV; and describe the underlying pathways between them.MethodsData is from a household survey employing a multi-stage random sampling approach with 511 women from Gauteng, South Africa. IPV was measured using the WHO Multi-country Study on Women's Health and Domestic Violence Questionnaire. Child abuse was measured using a short form of the Childhood Trauma Questionnaire. Depression was measured using the Centre for Epidemiologic Studies Depression Scale (CESD). PTSD symptoms were measured using the Harvard Trauma Questionnaire. Binge drinking was measured using the Alcohol Use Disorders Identification Test (AUDIT) scale. All data analyses were conducted in Stata 13. Regression modelling was used to test the association between variables. Structural equation modelling with full information maximum likelihood estimation accounting for missing data was done to analyse the underlying pathways between variables.ResultsFifty percent of women experienced IPV in their lifetime and 18% experienced IPV in the 12 months before the survey. Twenty three percent of women were depressed, 14% binge drank and 11.6% had PTSD symptoms. Eighty six percent of women had experienced some form of child abuse. Sociodemographic factors associated with recent IPV in multivariate models were younger age and foreign nationality. Depression, PTSD and binge drinking mediated the relationship of child abuse and recent IPV. Depression, PTSD and binge drinking were also effects of recent IPV. Other factors associated with recent IPV experience included relationship control, having a partner who regularly consumed alcohol and experiencing other life traumatic experiencesConclusionMental ill health plays a mediating role in the relationship of child abuse and recent IPV experiences among women. Conversely, IPV also negatively affects women’s mental health. Interventions to reducing the incidence of IPV could help alleviate the burden of mental ill health among women and vice versa. Effective integration of mental health services in primary health care, detection of symptoms, brief interventions and strengthened referral mechanisms for sustained community-based care are necessary in responding to victims of intimate partner violence. Response for abused children needs to take similar approaches and reduce the l...

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Section: Discussionmentioning

confidence: 99%

Mental ill health in structural pathways to women’s experiences of intimate partner violence

2017

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“…This community development approach does not see problems as inherent in individuals, but connects locally-based solutions to wider issues of power, participation, and social and economic justice. 2,3,4,5 TPA, CMC, and EHA utilise strategies that identify community strengths; uphold inclusive approaches; and value narrative, community connectedness, and a commitment to holistic well-being and development.…”

Section: Utilising Community Development Approachesmentioning

confidence: 99%

“…2 There is a growing body of literature that seeks to understand these aspects of lived experience through exploring supportive networks, social change, and promoting meaningmaking of experiences and pathways to participation. 2,3,4,5,6 However, these studies have been predominantly conducted in high-income countries, and there is very little evidence of the experience of people affected by psychosocial disability in LMICs. There remains a strong need for contextual experiences from LMICs to be recognised and to inform approaches to strengthen inclusion, both locally and globally.…”

Section: Introductionmentioning

confidence: 99%

Inclusion of people with psychosocial disability in low and middle income contexts: a practice review

Fernandes¹,

Cantrill²,

Kamal

et al. 2017

han-j-cjgh

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Much of the literature about mental illness in low and middle income countries (LMICs) focuses on prevalence rates, the treatment gap, and scaling up access to medical expertise and treatment. As a cause and consequence of this, global mental health programs have focused heavily on service delivery without due exploration of how programs fit into a broader picture of culture and community. There is a need for research which highlights approaches to broader inclusion, considering historical, cultural, social, and economic life contexts and recognises the community as a determinant of mental health-in prevention, recovery, resilience, and support of holistic wellness. The purpose of this practice review is to explore the experiences of three local organisations working with people with psychosocial disability living in LMICs: Afghanistan, India, and Nepal. All three organisations have a wealth of experience in implementing mental health programs, and the review brings together evidence of this experience from interviews, reports, and evaluations. Learnings from these organisations highlight both successful approaches to strengthening inclusion, and the challenges faced by people with psychosocial disability, their families and communities. The findings can largely be summarised in two categories, although both are very much intertwined: first, a broad advocacy, public health, and policy approach to inclusion; and second, more local, community-based initiatives. The evidence draws attention to the need to acknowledge the complexities surrounding mental health and inclusion, such as additional stigmatisation due to multidimensional poverty, gender inequality, security issues, natural disasters, and additional stressors associated with access. Organisational experiences also highlight the need to work with communities' strengths to increase capacity around inclusion and to apply community development approaches where space is created for communities to generate holistic solutions. Most significantly, approaches at all levels require efforts to ensure that people with psychosocial disability are given a voice and are included in shaping programs, policies, and appropriate responses.

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“…There is a tension between testing specific standardized interventions and isolating active ingredients in a methodologically sound manner on the one hand and to allow flexibility, adaptability, and culture-sensitivity on the other hand. Furthermore, promoting 'cookbook' psychiatry bears a risk of medicalization [51]. It is expected that the recent initiatives will provide sufficient evidence to convince policy makers in LAMICs to invest in building acceptable primary mental healthcare systems avoiding undesirable developments of high-income countries in the precommunity psychiatry era.…”

Section: Resultsmentioning

confidence: 99%

Mental health service provision in low and middle-income countries

Weinmann

Kösters²

2016

Current Opinion in Psychiatry

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It remains to be shown how the recent global mental health movement, beyond increasing international financial resources, will be helpful in finding locally and culturally sensitive solutions to reduce the mental health gap in LAMICs. Although concepts of a well designed mix of services are available, solutions to reduce implementation barriers must be local, and implementation strategies may vary considerably and still lack a sufficient evidence base.

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Integration of mental health into primary healthcare in low-income countries: Avoiding medicalization

Cited by 83 publications

References 104 publications

Mental ill health in structural pathways to women’s experiences of intimate partner violence

Mental ill health in structural pathways to women’s experiences of intimate partner violence

Inclusion of people with psychosocial disability in low and middle income contexts: a practice review

Mental health service provision in low and middle-income countries

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