Impact of district mental health care plans on symptom severity and functioning of patients with priority mental health conditions: the Programme for Improving Mental Health Care (PRIME) cohort protocol

BMC Psychiatry

Girmay Medhin¹  Emily C. Baron²  Crick Lund²  Mark Tomlinson²  Fred Kigozi³  Juliet Nakku³  Joshua Ssebunnya³  Rahul Shidhaye⁴  Martin Prince⁵  Abebaw Fedaku⁶  One Selohilwe⁷  Inge Petersen⁷  Charlotte Hanlon⁸  Sujit D. Rathod⁹  Mary De Silva^1,10  Nagendra P. Luitel^1,11  Mark Jordans^1,12  Vaibhav Murhar^1,13  Vikram Patel^1,13 

[1] Aklilu Lemma Institute of Pathobiology, Addis Ababa University;Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town;Butabika National Referral and Teaching Mental Hospital, Makerere University;Centre for Chronic Conditions and Injuries, Public Health Foundation of India;Centre for Global Mental Health, Health Services and Population Research Department, King’s College London;Centre for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University;Centre for Rural Health, School of Nursing and Public Health and School of Applied Human Sciences, University of KwaZulu-Natal;College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University;Department of Population Health, London School of Hygiene and Tropical Medicine;Department of Population Health, Wellcome Trust;Research Department, Transcultural Psychosocial Organization (TPO) Nepal;Research and Development Department, HealthNet TPO;Sangath;

关键词: Cohort;    depression;    Alcohol dependence;    Psychosis;    Epilepsy;    Low-income populations;    Primary healthcare;   

DOI  :  10.1186/s12888-018-1642-x

来源: DOAJ

【 摘 要 】

Abstract Background The Programme for Improving Mental Health Care (PRIME) sought to implement mental health care plans (MHCP) for four priority mental disorders (depression, alcohol use disorder, psychosis and epilepsy) into routine primary care in five low- and middle-income country districts. The impact of the MHCPs on disability was evaluated through establishment of priority disorder treatment cohorts. This paper describes the methodology of these PRIME cohorts. Methods One cohort for each disorder was recruited across some or all five districts: Sodo (Ethiopia), Sehore (India), Chitwan (Nepal), Dr. Kenneth Kaunda (South Africa) and Kamuli (Uganda), comprising 17 treatment cohorts in total (N = 2182). Participants were adults residing in the districts who were eligible to receive mental health treatment according to primary health care staff, trained by PRIME facilitators as per the district MHCP. Patients who screened positive for depression or AUD and who were not given a diagnosis by their clinicians (N = 709) were also recruited into comparison cohorts in Ethiopia, India, Nepal and South Africa. Caregivers of patients with epilepsy or psychosis were also recruited (N = 953), together with or on behalf of the person with a mental disorder, depending on the district. The target sample size was 200 (depression and AUD), or 150 (psychosis and epilepsy) patients initiating treatment in each recruiting district. Data collection activities were conducted by PRIME research teams. Participants completed follow-up assessments after 3 months (AUD and depression) or 6 months (psychosis and epilepsy), and after 12 months. Primary outcomes were impaired functioning, using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS), and symptom severity, assessed using the Patient Health Questionnaire (depression), the Alcohol Use Disorder Identification Test (AUD), and number of seizures (epilepsy). Discussion Cohort recruitment was a function of the clinical detection rate by primary health care staff, and did not meet all planned targets. The cross-country methodology reflected the pragmatic nature of the PRIME cohorts: while the heterogeneity in methods of recruitment was a consequence of differences in health systems and MHCPs, the use of the WHODAS as primary outcome measure will allow for comparison of functioning recovery across sites and disorders.

【 授权许可】

Unknown