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

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Version 2 2023-06-12, 09:33
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journal contribution
posted on 2023-06-12, 09:33 authored by Jerome Wright, Papiya Mazumdar, Deepa Barua, Silwa Lina, Humaira Bibi, Ateeqa Kanwal, Faiza Mujeeb, Qirat Naz, Rahim Safi, Baha Ul Haq, Rusham Zahra Rana, Papreen NaharPapreen Nahar, Hannah Jennings, Siham Sikander, Rumana Huque, Asad Nizami, Cath Jackson
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 and strengthening psychologically informed NCD care will in turn be required before the introduction of a specific psychological intervention such as BA.

History

Publication status

  • Published

File Version

  • Published version

Journal

International Journal of Mental Health Systems

ISSN

1752-4458

Publisher

BMC

Issue

1

Volume

14

Page range

1-13

Article number

a63

Event location

England

Department affiliated with

  • Global Health and Infection Publications

Full text available

  • Yes

Peer reviewed?

  • Yes

Legacy Posted Date

2020-10-29

First Open Access (FOA) Date

2020-10-29

First Compliant Deposit (FCD) Date

2020-10-29

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