The Magnitude of Common Mental Disorders and Associated Factors Among Cancer Patients at Black Lion Specialized Hospital, Addis Ababa, Ethiopia: Cross- Sectional Study.

BACKGROUND: Common mental disorders (CMD) are the most usual reactions following cancer diagnosis causing significant psychological sufferings. Even though research-based evidence is necessary for mental health promotion and intervention activities, there is a scarcity of evidence in Ethiopia to assist policy makers' efforts in reforming mental health care particularly that of cancer patients. OBJECTIVE: The main objective of this research is to assess the magnitude of common mental disorders and associated factors among cancer patients who have a follow-up treatment at Black Lion Specialized Hospital, Addis Ababa, Ethiopia. METHOD: Institutional-based cross-sectional study was conducted from August 1 to September 30, 2020. A systematic random sampling technique was used to select 396 study participants. A Self-Reporting Questionnaire (SRQ-20) and interviewer-administered structured questionnaire were employed to collect data. Data were analyzed using descriptive statistics and logistic regression. Odds ratios with 95% confidence intervals was used to report the findings. RESULT: A total of 396(230 men and 160 women) participants took part in the study. The overall magnitude of CMD among cancer patients was found to be 70.3%, of which the rate was 73.5% among women and 67.8% among men, in the last 4 weeks. Being women (AOR = 1.74; 95%CI: 1.00, 3.02), unemployed (AOR = 3.035, 95% CI: 1.37, 6.72), average monthly income of less than 1600 Ethiopian Birr (AOR = 2.838; 95%CI: 1.58, 5.08), being on cancer treatment for more than 5 years (AOR = 2.653, 95% CI: 1.39, 5.03), poor social support (AOR = 3.618, 95% CI: 1.33, 9.80), and current use of substances (AOR = 6.852; 95% CI: 2.038, 23.034) were the factors significantly associated with CMD. CONCLUSION AND RECOMMENDATION: Common mental disorders are one of the major health concerns among cancer patients. Common mental disorders were found to be more common in females and among current users of a psychoactive substance. Therefore, cancer patients need special attention of not only physicians but also that of mental health professionals for possible detection and early treatment of mental disorders. Rendering social and economic support may reduce the negative effects of the illness.

Impact of integrated mental health care on food insecurity of households of people with severe mental illness in a rural African district: a community-based, controlled before-after study.

OBJECTIVES: To evaluate the impact of integrated mental health care upon food insecurity (FI) in households of people with severe mental illness (SMI) in a rural Ethiopian district, and to investigate mediation by improved work impairment and discrimination. METHODS: A community-based, controlled before-after study was conducted. People with probable SMI were identified in the community, diagnosed by primary healthcare workers, with diagnostic confirmation from a psychiatric nurse. Households of a person with SMI were matched to control households. District-wide integration of mental health care was implemented. Change in FI status over 12 months of follow-up was measured using the Household Food Insecurity Access Scale. Multivariable models were used to assess improvement in FI. Direct and indirect mediators of change in FI status were modelled using path analysis. RESULTS: A total of 239 (81.8%) people with SMI and 273 (96.5%) control households were assessed after 12 months. Maintenance of food security or improvement in food insecurity status was observed in 51.5% of households of a person with SMI vs. 39.7% of control households (adjusted risk ratio 1.41: 95% CI 1.11, 1.80). Reduction in symptom severity was indirectly associated with improved FI status via an impact on reducing work impairment and discrimination (P < 0.001). CONCLUSIONS: Improving access to mental health care may reduce food insecurity in households of people with SMI. Optimising engagement in care and adding interventions to improve work functioning and tackle discrimination may further reduce food insecurity.

OBJECTIFS: Evaluer l'impact des soins de santé mentale intégrés sur l'insécurité alimentaire (IA) dans les ménages de personnes souffrant de maladie mentale sévère (MMS) dans un district rural éthiopien, et investiguer sur la médiation en améliorant les perturbations au travail et la discrimination. MÉTHODES: Une étude communautaire contrôlée avant et après a été menée. Des personnes avec une MMS probable ont été identifiées dans la communauté, diagnostiquées par des agents de santé primaires, avec confirmation diagnostique d'une infirmière psychiatrique. Les ménages de personnes atteintes de MMS ont été appariés pour effectuer des ajustements sur les ménages. Une intégration des soins de santé mentale à l'échelle du district a été mise en œuvre. Le changement de statut de l'IA au cours un suivi de 12 mois a été mesuré à l'aide de l'Echelle d'Accès à l'Insécurité Alimentaire des ménages. Des modèles multivariés ont été utilisés pour évaluer l'amélioration de l'IA. Les médiateurs directs et indirects du changement de statut de l'IA ont été modélisés à l'aide d'une analyse de chemin. RÉSULTATS: Un total de 239 (81,8%) ménages de personnes avec une MMS et 273 (96,5%) ménages témoins ont été évaluées après 12 mois. Le maintien de la sécurité alimentaire ou l'amélioration de l'état d'insécurité alimentaire a été observé dans 51,5% des ménages d'une personne avec une MMS vs 39,7% des ménages témoins (rapport de risque ajusté: 1,41 ; IC95%: 1,11 à 1,80). La réduction de la sévérité des symptômes était indirectement associée à une amélioration du statut de l'IA via un impact sur la réduction des perturbations au travail et de la discrimination (p <0,001). CONCLUSIONS: L'amélioration de l'accès aux soins de santé mentale peut réduire l'IA dans les ménages de personnes atteintes de MMS. L'optimisation de l'engagement dans les soins et l'ajout d'interventions pour améliorer le fonctionnement au travail et lutter contre la discrimination peuvent encore réduire l'IA.

Mental health problems and socioeconomic disadvantage: a controlled household study in rural Ethiopia.

BACKGROUND: There is a lack of high quality population-based studies from low- and middle-income countries examining the relative economic status of households with and without a member with a mental health problem. The aim of the study was to explore the socio-economic status of households with a person with severe mental disorder (SMD; psychosis or bipolar disorder) or depression compared to households without an affected person. METHODS: A population-based, comparative, cross-sectional household survey was conducted in Sodo district, south Ethiopia, between January and November 2015. Two samples were recruited, each with its own comparison group. Sample (1): households of 290 community-ascertained persons with a clinician-confirmed diagnosis of SMD and a comparison group of 289 households without a person with SMD. Sample (2): households of 128 people who attended the primary health care centre and who were identified by primary care staff as having a probable diagnosis of depressive disorder; and comparison households of 129 patients who attended for other reasons and who did not receive a diagnosis of depression. Household socioeconomic status (household income, consumption and asset-based wealth) was assessed using a contextualized version of theWorld Health Organization (WHO) Study on global Ageing and adult health (SAGE) questionnaire. Each disorder group (SMD and depression) was further divided into higher and lower disability groups on the basis of median score on the WHO Disability Assessment Schedule. RESULTS: Households of a person with SMD who had higher disability were more likely to have a poorer living standard (no toilet facility; p < 0.001). Having a reliable source of regular income was significantly lower in households of a person with SMD (p = 0.008) or depression (p = 0.046) with higher disability than the comparison group. Households of persons with SMD with higher disability earned less (p = 0.005) and owned significantly fewer assets (p < 0.001) than households without SMD. Households including persons with depression who had higher disability had lower income (p = 0.042) and reduced consumption (p = 0.048). CONCLUSIONS: Households with a member who had either SMD or depression were socioeconomically disadvantaged compared to the general population. Moreover, higher disability was associated with worse socio-economic disadvantage. Prospective studies are needed to determine the direction of association. This study indicates a need to consider households of people with SMD or depression as a vulnerable group requiring economic support alongside access to evidence-based mental healthcare.

Functional impairment among people diagnosed with depression in primary healthcare in rural Ethiopia: a comparative cross-sectional study.

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.

Catastrophic health expenditure and impoverishment in households of persons with depression: a cross-sectional, comparative study in rural Ethiopia.

BACKGROUND: The extent of catastrophic health expenditure and impoverishment associated with depression in low-and middle-income countries is not known. The aim of this study was to estimate the incidence and intensity of catastrophic out-of-pocket (OOP) health expenditure, level of impoverishment and coping strategies used by households of persons with and without depression in a rural Ethiopian district. METHODS: A comparative cross-sectional survey was conducted, including 128 households of persons with depression and 129 households without. Depression screening was conducted using the Patient Health Questionnaire, nine item version (PHQ-9). People in the depression group were classified into high and low disability groups based on the median value on the World Health Organization Disability Assessment Schedule (WHODAS) polytomous summary score. Health expenditure greater than thresholds of 10 and 25% of total household consumption was used for the primary analyses. The poverty headcount, poverty gap and normalized poverty gap were estimated using retrospective recall of total household expenditure pre- and post-OOP payments for health care. Linear probability model using binreg command in STATA with rr option was used to estimate risk ratio for the occurrence of outcomes among households with and without depression based on level of disability. RESULTS: Catastrophic OOP payments at any threshold level for households with depression and high disability were higher than control households. At the 10% threshold level, 24.0% of households of persons with depression and high disability faced catastrophic payments compared with 15.3% for depression and low disability and 12.1% for control households (p = 0.041). Depression and high disability level was an independent predictor of catastrophic OOP payments: RR 2.1; 95% CI:1.1, 4.6. An estimated 5.8% of households of persons with depression and high disability were pushed into poverty because of paying for health care compared with 3.5% for households of persons with depression and low disability and 2.3% for control households (p = 0.039). CONCLUSIONS: Households of people with depression and high disability were more likely to face catastrophic expenditures and impoverishment from OOP payments. Financial protection interventions through prepayment schemes, exemptions and fee waiver strategies need to target households of persons with depression.

Catastrophic out-of-pocket payments for households of people with severe mental disorder: a comparative study in rural Ethiopia.

BACKGROUND: There are limited data on healthcare spending by households containing a person with severe mental disorder (SMD) in low- and middle-income countries (LMIC). This study aimed to estimate the incidence and intensity of catastrophic out-of-pocket (OOP) payments and coping strategies implemented by households with and without a person with SMD in a rural district of Ethiopia. METHODS: A comparative cross-sectional community household survey was carried out from January to November 2015 as part of the Emerald programme (emerging mental health systems in low- and middle-income countries). A sample of 290 households including a person with SMD and 289 comparison households without a person with SMD participated in the study. An adapted and abbreviated version of the World Health Organization SAGE (Study on global Ageing and adult health) survey instrument was used. Households were considered to have incurred catastrophic health expenditure if their annual OOP health expenditures exceeded 40% of their annual non-food expenditure. Multiple logistic regression was used to explore factors associated with catastrophic expenditure and types of coping strategies employed. RESULTS: The incidence of catastrophic OOP payments in the preceding 12 months was 32.2% for households of a person with SMD and 18.2% for comparison households (p = 0.006). In households containing a person with SMD, there was a significant increase in the odds of hardship financial coping strategies (p < 0.001): reducing medical visits, cutting down food consumption, and withdrawing children from school. Households of a person with SMD were also less satisfied with their financial status and perceived their household income to be insufficient to meet their livelihood needs (p < 0.001). CONCLUSIONS: Catastrophic OOP health expenditures in households of a person with SMD are high and associated with hardship financial coping strategies which may lead to poorer health outcomes, entrenchment of poverty and intergenerational disadvantage. Policy interventions aimed at financial risk pooling mechanisms are crucial to reduce the intensity and impact of OOP payments among vulnerable households living with SMD and support the goal of universal health coverage.

Food insecurity and work impairment in people with severe mental disorders in a rural district of Ethiopia: a cross-sectional survey.

PURPOSE: In this study, we aimed to identify factors associated with severe food insecurity and work impairment in people with severe mental disorders (SMD) in a rural African setting, with a view to identifying potential areas for intervention. METHODS: A community-based, cross-sectional survey was conducted in Sodo district, south central Ethiopia. Key informant-identified people with possible SMD were referred for assessment by trained primary care workers and received confirmatory psychiatric diagnoses from psychiatric nurses using a standardized clinical interview. Food insecurity was measured using a locally validated measure, the Household Food Insecurity Access Scale (HFIAS). Work impairment was assessed using the Longitudinal Interval Follow-up Evaluation-Range of Impaired Functioning Tool. Potential moderator variables were specified a priori. RESULTS: A total of 282 people with SMD participated in the study. The proportion of participants reporting severe food insecurity was 32.5% (n = 94), with 53.6% (n = 147) of participants reporting severe work impairment. In the multivariable model, severe food insecurity was associated with poor social support, experience of negative discrimination, higher disability and lower household annual income, but not with symptom severity or work impairment. Work impairment was associated significantly with symptom severity and disability. CONCLUSION: Work impairment and food insecurity were associated with distinct explanatory factors: predominantly social factors associated with food insecurity and clinical factors associated with work productivity. Longitudinal and intervention studies are needed to evaluate the extent to which clinical interventions need to be augmented by social interventions to alleviate food insecurity in people with SMD.