Trained lay health workers reduce common mental disorder symptoms of adults with suicidal ideation in Zimbabwe: a cohort study

Abstract

BackgroundSuicidal ideation may lead to deliberate self-harm which increases the risk of death by suicide. Globally, the main cause of deliberate self-harm is depression. The aim of this study was to explore prevalence of, and risk factors for, suicidal ideation among men and women with common mental disorder (CMD) symptoms attending public clinics in Zimbabwe, and to determine whether problem solving therapy delivered by lay health workers can reduce common mental disorder symptoms among people with suicidal ideation, using secondary analysis of a randomised controlled trial.MethodsAt trial enrolment, the Shona Symptom Questionnaire (SSQ) was used to screen for CMD symptoms. In the intervention arm, participants received six problem-solving therapy sessions conducted by trained and supervised lay health workers, while those in the control arm received enhanced usual care. We used multivariate logistic regression to identify risk factors for suicidal ideation at enrolment, and cluster-level logistic regression to compare SSQ scores at endline (6 months follow-up) between trial arms, stratified by suicidal ideation at enrolment.ResultsThere were 573 participants who screened positive for CMD symptoms and 75 (13.1%) reported suicidal ideation at baseline. At baseline, after adjusting for confounders, suicidal ideation was independently associated with being aged over 24, lack of household income (household income yes/no; adjusted odds ratio 0.52 (95% CI 0.29, 0.95); p = 0.03) and with having recently skipped a meal due to lack of food (adjusted odds ratio 3.06 (95% CI 1.81, 5.18); p < 0.001). Participants who reported suicidal ideation at enrolment experienced similar benefit to CMD symptoms from the Friendship Bench intervention (adjusted mean difference − 5.38, 95% CI −7.85, − 2.90; p < 0.001) compared to those who had common mental disorder symptoms but no suicidal ideation (adjusted mean difference − 4.86, 95% CI −5.68, − 4.04; p < 0.001).ConclusionsProblem-solving therapy delivered by trained and supervised lay health workers reduced common mental disorder symptoms among participants with suicidal thoughts who attended primary care facilities in Zimbabwe.Trial registrationpactr.org ldentifier: PACTR201410000876178

Community Interventions to Promote Mental Health and Social Equity

“…The community interventions above (Appendix A ), drawn from a larger selection (Appendix B ), highlight the successes and promise of these interventions to promote mental health and broader outcomes at all social-ecological levels: individual, interpersonal/family, organizational/institutional, community, and policy [ 3 ]. Community involvement is represented in varied ways in the form of individuals (lay health workers), settings (churches, schools), leaders (community-based participatory research), and multi-sector coalitions [ 35 •, 37 , 38 , 39 •, 85 •, 86 – 90 , 91 •, 103 •]. Many studies examined the interplay among mental health services, social and structural determinants, and mental health outcomes.…”

“…We reviewed community interventions in international settings, acknowledging the shared social, structural, and mental health challenges that exist across nations. Many of the reviewed studies involve lay health worker (LHW) interventions [ 85 •, 86 – 90 ]. Barnett et al in their 2018 review of LHW interventions describe that LHWs elevate demand for services by increasing awareness of services and mental health literacy and by reducing stigma and barriers to care [ 85 •].…”

Mental health in elite athletes: International Olympic Committee consensus statement (2019)

“…A core challenge in developing this consensus statement was that the evidence comes predominantly from high income countries, which have more health services compared with low and middle income countries41–43 where many athletes reside. There is debate concerning the range of ways in which mental health symptoms and disorders can be managed in culturally appropriate ways, drawing on resources from other health sectors and community carers, for example,44–46 with increasing evidence that intervening in ways that support existing community strengths may be of benefit to people with these conditions 47 48. It is important to consider this global context throughout this statement.…”

A structural equation modelling of the buffering effect of social support on the report of common mental disorders in Zimbabwean women in the postnatal period

“…The FB concept is in keeping with the buffering hypothesis which postulates that increased SS is associated with improved mental health [14, 15]. The FB has been successfully implemented in mitigating the effects of social stigma in individuals suffering from CMDs in the Zimbabwean context [44], and we believe the concept can be successfully integrated into routine postnatal care.…”