Habtamu, Kassahun, Medhin, Grimay, Medhin, Selmau, Tirfessa, Kebede, Hanlon, Charlotte and Fekadu, Abebaw (2019) Functional impairment among people diagnosed with depression in primary healthcare in rural Ethiopia: a comparative cross‑sectional study. International Journal of Mental Health Systems, 13 (1). 50 1-12. ISSN 1752-4458

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Abstract

Background:
There have been few studies examining the functioning of clinically-diagnosed people with depression
in primary healthcare (PHC) in low- and middle-income countries (LMICs). The aim of this study was to identify
factors associated with functional impairment among people diagnosed with depression in PHC in Ethiopia as part of implementation of a task-shared model of mental healthcare.

Methods: A comparative cross-sectional study was conducted. As part of the Programme for Improving Mental
health carE (PRIME), PHC clinicians were trained to diagnose depression using an adapted version of the World Health Organization (WHO) mental health Gap Action Programme (mhGAP). A total of 2038 adult consecutive PHC attendees were screened for depressive symptoms using the 9-item Patient Health Questionnaire (PHQ-9). Those who scored five or above on the PHQ-9 (n = 131) were assessed by PHC workers. Of these, 92 were diagnosed to have depression (“PHC diagnosed cases”) and the remaining 39 people were PHQ positive but considered not to have depression (“non-diagnosed controls”). PHC diagnosed cases were also compared to a community representative sample of adult healthy controls (n = 197; “community controls”). The 12-item version of the WHO Disability Assessment Schedule (WHODAS-2.0) was used to assess functional impairment. Multivariable negative binomial regression models were fitted to examine the association of demographic, social, economic and clinical characteristics with functional impairment.
Results:
No significant difference in functional impairment was found between diagnosed cases and non-diagnosed
controls. PHC diagnosed cases were found to have higher depressive symptom severity and suicidality, but
lower social support compared to non-diagnosed controls (P < 0.05). In the multivariable model, greater functional impairment was associated with higher depressive symptoms (RR = 1.04; 95% CI 1.02, 1.05) and lower social support (RR = 0.96; 95% CI 0.95, 0.98). Diagnosed cases were found to have higher functional impairment compared to community controls (RR = 1.91; 95% CI 1.74, 2.09).

Conclusion:
In this study, PHC clinicians identified cases of depression with high symptom burden, suicidality and
functional impairment. These findings support current initiatives to scale-up mental health services at the PHC level; and indicate that social support is an important target for intervention.

Item Type:	Article
Keywords:	Depression, Depressive symptoms, Functional impairment, Disability, Primary health care, Low- and middle-income countries
Schools and Departments:	Brighton and Sussex Medical School > Global Health and Infection
Research Centres and Groups:	Wellcome Trust Brighton and Sussex Centre for Global Health Research
Depositing User:	Esther Garibay
Date Deposited:	23 Jul 2019 15:26
Last Modified:	06 Aug 2019 11:00
URI:	http://sro.sussex.ac.uk/id/eprint/85054

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