The onset of common mental disorders in primary care attenders in Harare, Zimbabwe.

BACKGROUND: This study aimed to investigate the onset and predictors of common mental disorders (CMD) in primary-care attenders in Harare, Zimbabwe. METHOD: Two (T1) and 12-month (T2) follow-up of a cohort of primary-care attenders without a common mental disorder (N = 197) as defined by the Shona Symposium Questionnaire (SSQ), recruited from primary health care clinics, traditional medical practitioner clinics and general practitioner surgeries. Outcome measure was caseness as determined by scores on the SSQ at follow-up. RESULTS: Follow-up rate was 86% at 2 months and 75% at 12 months. Onset of CMD was recorded in 16% at T1 and T2. Higher psychological morbidity scores at recruitment, death of a first-degree relative and disability predicted the presence of a CMD at both follow-up points. While female gender and economic difficulties predicted onset only in the short-term, belief in supernatural causation was strongly predictive of CMD at T2. Caseness at both follow-up points was associated with economic problems and disability at those follow-up points. CONCLUSIONS: Policy initiatives to reduce economic deprivation and targeting interventions to primary-care attenders who are subclinical cases and those who have been bereaved or who are disabled may reduce the onset of new cases of CMD. Closer collaboration between biomedical and traditional medical practitioners may provide avenues for developing methods of intervention for persons with supernatural illness models.

Predicting postnatal mental disorder with a screening questionnaire: a prospective cohort study from Zimbabwe.

BACKGROUND: Postnatal mental disorders are common causes of morbidity but are rarely diagnosed or treated in busy primary care clinics in developing countries. OBJECTIVE: To determine whether a brief psychiatric screening questionnaire used in the 8th month of pregnancy can predict postnatal mental disorder. STUDY DESIGN: Prospective cohort study. SITE: A peri-urban settlement in Zimbabwe. POPULATION: 500 women in the 8th month of pregnancy identified by traditional birth attendants and primary care clinics. SAMPLE: "High risk" cohort consisted of all women who scored 8 or more on the Shona Symptom Questionnaire (SSQ), an indigenous psychiatric questionnaire (n = 95). Low risk cohort consisted of 105 women randomly selected from the remainder of the sampling frame. OUTCOME MEASURE: Revised Clinical Interview Schedule at six to eight weeks postpartum; scores of 14 or more indicate psychiatric caseness. RESULTS: The prevalence of postnatal mental illness was 16%. Odds ratios (95% confidence intervals) for high risk women becoming cases in the postnatal period were 10.6, 4.8, 23.9, p < 0.0001 after adjustment for age, marital status, and occupation. CONCLUSIONS: A brief method of detecting women at high risk of developing a postnatal mental disorder can be used with reasonable accuracy in the 8th month of pregnancy. Further research is needed to determine whether interventions applied to this high risk group can reduce their postnatal morbidity.

Outcome of common mental disorders in Harare, Zimbabwe.

BACKGROUND: Little is known about the outcome of common mental disorders (CMD) in primary care attenders in low income countries. METHOD: Two and 12 month (T1 and T2) follow-up of a cohort of cases of CMD (n = 199) recruited from primary health, traditional medical practitioner, and general practitioner clinics in Harare, Zimbabwe. The Shona Symptom Questionnaire (SSQ) was the measure of caseness. RESULTS: The persistence of case level morbidity was recorded in 41% of subjects at 12 months. Of the 134 subjects interviewed at both follow-up points, 49% had recovered by T1 and remained well at T2 while 28% were persistent cases at both T1 and T2. Higher SSQ scores, a psychological illness model, bereavement and disability predicted a poor outcome at both times. Poorer outcome at T1 only was associated with a causal model of witch-craft and an unhappy childhood. Caseness at follow-up was associated with disability and economic deprivation. CONCLUSIONS: A quarter of cases of CMD were likely to be ill throughout the 12 month follow-up period. Targeting risk groups for poor outcome for interventions and policy interventions to reduce the impact of economic deprivation may provide a way of tackling CMD in primary care in low income countries.

Common mental disorders in primary care in Harare, Zimbabwe: associations and risk factors.

BACKGROUND: This study aimed to investigate the associations for common mental disorders (CMD) among primary care attenders in Harare. METHOD: This was an unmatched case-control study of attenders at primary health clinics, general practitioner surgeries and traditional medical practitioner clinics; 199 cases with CMD as identified by an indigenously developed case-finding questionnaire, and 197 controls (non-cases), were interviewed using measures of sociodemographic data, disability, care-giver diagnoses and treatment, explanatory models, life events and alcohol use. RESULTS: CMD was associated with female gender (P = 0.04) and older age (P = 0.02). After adjustment for age, gender and site of recruitment, CMD was significantly associated with chronicity of illness; number of presenting complaints; beliefs in "thinking too much" and witchcraft as a causal model; economic impoverishment; infertility; recent unemployment; an unhappy childhood for females; disability; and consultations with traditional medical practitioners and religious priests. CONCLUSIONS: Mental disorders are associated with female gender, disability, economic deprivation, and indigenous labels of distress states.

A case of the frontal lobe syndrome following head injury in Harare, Zimbabwe.

A 51 year old male, presented with recurrent outbursts of aggression, hypersexuality, sexual indiscretion and hoarding litter following a head injury sustained in a road traffic accident. His premorbid personality was described as energetic but quick tempered. He had no delusions or perceptual disturbances and cognitive functions were intact. Physical and detailed neurological examination were essentially normal, with the exception of disuse atrophy of the lower limb muscles. He lacked insight into his problems. This case illustrates the need for a multidisciplinary approach to assessment, management and rehabilitation of such cases.