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1.
Pan Afr Med J ; 39: 58, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34422181

RESUMO

The use of social media to increase awareness on mental health is rapidly gaining momentum globally. However, despite evidence of a growing trend in social media use in sub Saharan Africa, little has been reported on tapping the potential of social media within a mental health practice to not only increase awareness but also facilitate linkage to specialist care. We describe one such mental health practice and its process of integration of the different social media platforms to promote mental health and increase linkage to specialist care. We further highlight the challenges and practical implication of social media use in the Kenyan setting. We conclude by advocating for this integration to raise awareness and also encourage peer support for persons with mental health problems and recommend research that measures the impact of such interventions in sub-Saharan Africa.


Assuntos
Serviços de Saúde Mental/organização & administração , Saúde Mental , Mídias Sociais , Humanos , Quênia , Transtornos Mentais/terapia , Grupo Associado , Apoio Social
2.
BMC Public Health ; 21(1): 453, 2021 03 06.
Artigo em Inglês | MEDLINE | ID: mdl-33676479

RESUMO

BACKGROUND: Stress and burnout among healthcare workers has been recognized as a global crisis needing urgent attention. Yet few studies have examined stress and burnout among healthcare providers in sub-Saharan Africa, and even fewer among maternity providers who work under very stressful conditions. To address these gaps, we examined self-reported stress and burnout levels as well as stress-related physiologic measures of these providers, along with their potential predictors. METHODS: Participants included 101 maternity providers (62 nurses/midwives, 16 clinical officers/doctors, and 23 support staff) in western Kenya. Respondents completed Cohen's Perceived Stress Scale, the Shirom-Melamed Burnout scale, and other sociodemographic, health, and work-related items. We also collected data on heart rate variability (HRV) and hair cortisol levels to assess stress-related physiologic responses to acute and chronic stress respectively. Multilevel linear regression models were computed to examine individual and work-related factors associated with stress, burnout, HRV, and cortisol level. RESULTS: 85% of providers reported moderate stress and 11.5% high stress. 65% experienced low burnout and 19.6% high burnout. Average HRV (measured as the root mean square of differences in intervals between successive heart beats: RMSSD) was 60.5 (SD = 33.0) and mean cortisol was mean cortisol was 44.2 pg/mg (SD = 60.88). Greater satisfaction with life accomplishments was associated with reduced stress (ß = - 2.83; CI = -5.47; - 0.18), while motivation to work excessively (over commitment) was associated with both increased stress (ß = 0.61 CI: 0.19, 1.03) and burnout (ß = 2.05, CI = 0.91, 3.19). Female providers had higher burnout scores compared to male providers. Support staff had higher HRV than other providers and providers under 30 years of age had higher HRV than those 30 and above. Although no association between cortisol and any predictor was statistically significant, the direction of associations was consistent with those found for stress and burnout. CONCLUSIONS: Most providers experienced moderate to high levels of stress and burnout. Individuals who were more driven to work excessively were particularly at risk for higher stress and burnout. Higher HRV of support staff and providers under age 30 suggest their more adaptive autonomic nervous system response to stress. Given its impact on provider wellbeing and quality of care, interventions to help providers manage stress are critical.


Assuntos
Esgotamento Profissional , Adulto , Sistema Nervoso Autônomo , Esgotamento Profissional/epidemiologia , Feminino , Humanos , Hidrocortisona , Quênia/epidemiologia , Masculino , Gravidez , Estresse Fisiológico , Estresse Psicológico/epidemiologia
3.
PLoS Med ; 18(1): e1003468, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33428625

RESUMO

BACKGROUND: HIV-positive women suffer a high burden of mental disorders due in part to gender-based violence (GBV). Comorbid depression and posttraumatic stress disorder (PTSD) are typical psychiatric consequences of GBV. Despite attention to the HIV-GBV syndemic, few HIV clinics offer formal mental healthcare. This problem is acute in sub-Saharan Africa, where the world's majority of HIV-positive women live and prevalence of GBV is high. METHODS AND FINDINGS: We conducted a randomized controlled trial at an HIV clinic in Kisumu, Kenya. GBV-affected HIV-positive women with both major depressive disorder (MDD) and PTSD were randomized to 12 sessions of interpersonal psychotherapy (IPT) plus treatment as usual (TAU) or Wait List+TAU. Nonspecialists were trained to deliver IPT inside the clinic. After 3 months, participants were reassessed, and those assigned to Wait List+TAU were given IPT. The primary outcomes were diagnosis of MDD and PTSD (Mini International Neuropsychiatric Interview) at 3 months. Secondary outcomes included symptom measures of depression and PTSD, intimate partner violence (IPV), and disability. A total of 256 participants enrolled between May 2015 and July 2016. At baseline, the mean age of the women in this study was 37 years; 61% reported physical IPV in the past week; 91% reported 2 or more lifetime traumatic events and monthly income was 18USD. Multilevel mixed-effects logistic regression showed that participants randomized to IPT+TAU had lower odds of MDD (odds ratio [OR] 0.26, 95% CI [0.11 to 0.60], p = 0.002) and lower odds of PTSD (OR 0.35, [0.14 to 0.86], p = 0.02) than controls. IPT+TAU participants had lower odds of MDD-PTSD comorbidity than controls (OR 0.36, 95% CI [0.15 to 0.90], p = 0.03). Linear mixed models were used to assess secondary outcomes: IPT+TAU participants had reduced disability (-6.9 [-12.2, -1.5], p = 0.01), and nonsignificantly reduced work absenteeism (-3.35 [-6.83, 0.14], p = 0.06); partnered IPT+TAU participants had a reduction of IPV (-2.79 [-5.42, -0.16], p = 0.04). Gains were maintained across 6-month follow-up. Treatment group differences were observed only at month 3, the time point at which the groups differed in IPT status (before cross over). Study limitations included 35% attrition inclusive of follow-up assessments, generalizability to populations not in HIV care, and data not collected on TAU resources accessed. CONCLUSIONS: IPT for MDD and PTSD delivered by nonspecialists in the context of HIV care yielded significant improvements in HIV-positive women's mental health, functioning, and GBV (IPV) exposure, compared to controls. TRIAL REGISTRATION: Clinical Trials Identifier NCT02320799.


Assuntos
Transtorno Depressivo Maior/etiologia , Transtorno Depressivo Maior/terapia , Violência de Gênero/psicologia , Soropositividade para HIV , Psicoterapia Interpessoal , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/terapia , Adulto , Feminino , Humanos , Quênia/epidemiologia , Masculino
4.
Health Policy Plan ; 36(3): 298-311, 2021 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-33491086

RESUMO

Studies in low-resource settings have highlighted disparities in person-centred maternity care (PCMC)-respectful and responsive care during childbirth-based on women's socioeconomic status (SES) and other characteristics. Yet few studies have explored factors that may underlie these disparities. In this study, we examined implicit and explicit SES bias in providers' perceptions of women's expectations and behaviours, as well as providers' general views regarding factors influencing differential treatment of women. We conducted a convergent mixed-methods study with 101 maternity providers in western Kenya. Implicit SES bias was measured using an adaptation of the Implicit Association Test (IAT) and explicit SES bias assessed using situationally specific vignettes. Qualitative data provided additional details on the factors contributing to disparities. Results provide evidence for the presence of both implicit and explicit bias related to SES that might influence PCMC. Differential treatment was linked to women's appearance, providers' perceptions of women's attitudes, assumptions about who is more likely to understand or be cooperative, women's ability to advocate for themselves or hold providers accountable, ability to pay for services in a timely manner, as well as situational factors related to stress and burnout. These factors interact in complex ways to produce PCMC disparities, and providing better care to certain groups does not necessarily indicate preference for those groups or a desire to provide better care to them. The findings imply the need for multilevel approaches to addressing disparities in maternity care. This should include provider training on PCMC and their biases, advocacy for women of low SES, accountability mechanisms, and structural and policy changes within health care settings.


Assuntos
Serviços de Saúde Materna , Atitude do Pessoal de Saúde , Viés , Feminino , Pessoal de Saúde , Humanos , Quênia , Parto , Gravidez
5.
Artigo em Inglês | MEDLINE | ID: mdl-32742669

RESUMO

Background: Little data exists about the methodology of contextualizing version two of the Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) in resource-poor settings. This paper describes the contextualisation and pilot testing of the guide in Kilifi, Kenya. Methods: Contextualisation was conducted as a collaboration between the KEMRI-Wellcome Trust Research Programme (KWTRP) and Kilifi County Government's Department of Health (KCGH) between 2016 and 2018. It adapted a mixed-method design and involved a situational analysis, stakeholder engagement, local adaptation and pilot testing of the adapted guide. Qualitative data were analysed using content analysis to identify key facilitators and barriers to the implementation process. Pre- and post-training scores of the adapted guide were compared using the Wilcoxon signed-rank test. Results: Human resource for mental health in Kilifi is strained with limited infrastructure and outdated legislation. Barriers to implementation included few specialists for referral, unreliable drug supply, difficulty in translating the guide to Kiswahili language, lack of clarity of the roles of KWTRP and KCGH in the implementation process and the unwillingness of the biomedical practitioners to collaborate with traditional health practitioners to enhance referrals to hospital. In the adaptation process, stakeholders recommended the exclusion of child and adolescent mental and behavioural problems, as well as dementia modules from the final version of the guide. Pilot testing of the adapted guide showed a significant improvement in the post-training scores: 66.3% (95% CI 62.4-70.8) v. 76.6% (95% CI 71.6-79.2) (p < 0.001). Conclusion: The adapted mhGAP-IG version two can be used across coastal Kenya to train primary healthcare providers. However, successful implementation in Kilifi will require a review of new evidence on the burden of disease, improvements in the mental health system and sustained dialogue among stakeholders.

6.
BMC Psychiatry ; 19(1): 424, 2019 12 28.
Artigo em Inglês | MEDLINE | ID: mdl-31883526

RESUMO

BACKGROUND: Mental disorders are a leading cause of global disability, driven primarily by depression and anxiety. Most of the disease burden is in Low and Middle Income Countries (LMICs), where 75% of adults with mental disorders have no service access. Our research team has worked in western Kenya for nearly ten years. Primary care populations in Kenya have high prevalence of Major Depressive Disorder (MDD) and Posttraumatic Stress Disorder (PTSD). To address these treatment needs with a sustainable, scalable mental health care strategy, we are partnering with local and national mental health stakeholders in Kenya and Uganda to identify 1) evidence-based strategies for first-line and second-line treatment delivered by non-specialists integrated with primary care, 2) investigate presumed mediators of treatment outcome and 3) determine patient-level moderators of treatment effect to inform personalized, resource-efficient, non-specialist treatments and sequencing, with costing analyses. Our implementation approach is guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. METHODS/DESIGN: We will use a Sequential, Multiple Assignment Randomized Trial (SMART) to randomize 2710 patients from the outpatient clinics at Kisumu County Hospital (KCH) who have MDD, PTSD or both to either 12 weekly sessions of non-specialist-delivered Interpersonal Psychotherapy (IPT) or to 6 months of fluoxetine prescribed by a nurse or clinical officer. Participants who are not in remission at the conclusion of treatment will be re-randomized to receive the other treatment (IPT receives fluoxetine and vice versa) or to combination treatment (IPT and fluoxetine). The SMART-DAPPER Implementation Resource Team, (IRT) will drive the application of the EPIS model and adaptations during the course of the study to optimize the relevance of the data for generalizability and scale -up. DISCUSSION: The results of this research will be significant in three ways: 1) they will determine the effectiveness of non-specialist delivered first- and second-line treatment for MDD and/or PTSD, 2) they will investigate key mechanisms of action for each treatment and 3) they will produce tailored adaptive treatment strategies essential for optimal sequencing of treatment for MDD and/or PTSD in low resource settings with associated cost information - a critical gap for addressing a leading global cause of disability. TRIAL REGISTRATION: ClinicalTrials.gov NCT03466346, registered March 15, 2018.


Assuntos
Antidepressivos de Segunda Geração/administração & dosagem , Transtorno Depressivo Maior/terapia , Fluoxetina/administração & dosagem , Serviços de Saúde Mental , Psicoterapia/métodos , Transtornos de Estresse Pós-Traumáticos/terapia , Adulto , Assistência Ambulatorial/métodos , Assistência Ambulatorial/tendências , Instituições de Assistência Ambulatorial/tendências , Terapia Combinada/métodos , Terapia Combinada/tendências , Prestação Integrada de Cuidados de Saúde/métodos , Prestação Integrada de Cuidados de Saúde/tendências , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/psicologia , Feminino , Hospitais de Condado/tendências , Humanos , Quênia/epidemiologia , Masculino , Serviços de Saúde Mental/tendências , Setor Público/tendências , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Resultado do Tratamento
7.
J Loss Trauma ; 24(2): 129-142, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31598099

RESUMO

Female sex workers (FSW) residing in Kibra, Kenya experience elevated exposure to adverse events, yet the prevalence of parental bereavement is not well characterized. This cross-sectional pilot study on 301 FSWs residing in Kibra, Kenya found that 67.7% of these women were parentally bereaved. Significantly fewer parentally bereaved women reported historical use of condoms and emergency contraception compared to non-bereaved women, and older age of paternal bereavement was significantly associated with current contraceptive use. Prevalence rates of bereavement among this cohort are well over the national Kenyan average, and further research on the specific impact of bereavement is warranted.

8.
BMJ Open ; 9(7): e028029, 2019 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-31315866

RESUMO

INTRODUCTION: Among patients with psychotic disorders, the 'duration of untreated psychosis' (DUP) is a predictor of key outcomes such as symptom remission and quality of life. In sub-Saharan Africa, DUP is up to five times longer than in high-income countries, with many patients going without antipsychotic medication for 5 years or longer. One contributor to this high DUP may relate to cultural norms that drive use of alternative and complementary therapies (ACTs) as first-line treatment strategies, rather than biomedical care with antipsychotic medicine. We aim to1 determine the prevalence and factors associated with DUP and ACT use in Uganda, and2 Identify factors that drive patient and family choices to use ACT as a first-line treatment strategy. METHODS AND ANALYSIS: We will leverage on an ongoing cohort study at the national psychiatric and teaching hospital in Uganda. The parent study is an observational cohort design following antipsychotic naïve adults with a first episode of psychosis without substance use, HIV/AIDS or syphilis. The embedded study will use a mixed methods design including quantitative assessment of parent study participants with the Nottingham Onset Schedule-DUP to determine the DUP. Qualitative assessment will focus on patient and caregiver perceptions and use of ACT and its impact on DUP among patients with psychosis using in-depth interviews. ETHICS AND DISSEMINATION: The study has received ethical approval from the school of medicine research and ethics committee of the college of health sciences at Makerere University. It has also received institutional support to perform the study from the Infectious Diseases Institute and Butabika hospital. Besides publication of the work in reputable peer-reviewed journals, we hope that this work will lead to evidence-based discussions on the need for early interventions to reduce DUP in Uganda.


Assuntos
Antipsicóticos/uso terapêutico , Terapias Complementares/estatística & dados numéricos , Transtornos Psicóticos/terapia , Tempo para o Tratamento/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Psicóticos/tratamento farmacológico , Uganda , Adulto Jovem
9.
BMC Psychiatry ; 19(1): 137, 2019 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-31064338

RESUMO

BACKGROUND: Khat is an amphetamine like psychostimulant chewed by over 10 million people globally. Khat use is thought to increase the risk of psychosis among its chewers. The evidence around this however remains inconclusive stemming from the scanty number of studies in this area and small study sample sizes. We undertook a large household survey to determine the association between psychotic symptoms and khat chewing in a rural khat growing and chewing population in Kenya. METHODS: For this cross-sectional household survey, we randomly selected 831 participants aged 10 years and above residing in the Eastern region of Kenya. We used the psychosis screening questionnaire (PSQ) to collect information on psychotic symptoms and a researcher designed sociodemographic and clinical questionnaire to collect information on its risk factors. We used descriptive analysis to describe the burden of khat chewing and other substance use as well as rates and types of psychotic symptoms. Using a univariate and multivariate analyses with 95% confidence interval, we estimated the association between khat chewing and specific psychotic symptoms. RESULTS: The prevalence of current khat chewing in the region was at 36.8% (n = 306) with a male gender predominance (54.8%). At least one psychotic symptom was reported by 16.8% (n = 168) of the study population. Interestingly, psychotic symptoms in general were significantly prevalent in women (19.5%) compared to men (13.6%) (p = 0.023). Khat chewing was significantly associated with reported strange experiences (p = 0.024) and hallucinations (p = 0.0017), the two predominantly reported psychotic symptoms. In multivariate analysis controlling for age, gender, alcohol use and cigarette smoking, there was a positive association of strange experiences (OR, 2.45; 95%CI, 1.13-5.34) and hallucination (OR, 2.08; 95% C.I, 1.06-4.08) with khat chewing. Of note was the high concurrent polysubstance use among khat chewers specifically alcohol use (78.4%) and cigarette smoking (64.5%). CONCLUSIONS: Psychotic symptoms were significantly elevated in khat users in this population. Future prospective studies examining dose effect and age of first use may establish causality.


Assuntos
Catha , Estimulantes do Sistema Nervoso Central/farmacologia , Psicoses Induzidas por Substâncias/epidemiologia , Psicoses Induzidas por Substâncias/psicologia , População Rural/estatística & dados numéricos , Adolescente , Adulto , Estimulantes do Sistema Nervoso Central/administração & dosagem , Criança , Estudos Transversais , Feminino , Humanos , Quênia/epidemiologia , Masculino , Mastigação , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , Estudos Prospectivos , Inquéritos e Questionários , Adulto Jovem
10.
EBioMedicine ; 39: 369-376, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30552065

RESUMO

BACKGROUND: Both malaria and mental disorders are associated with immune changes. We have previously reported the associations between malaria and mental disorders. We now report associations between malaria, mental disorders and immunity. METHODS: A household survey of malaria, mental disorders and immunity was conducted in a health and demographic surveillance system's site of 70,000 population in an area endemic for malaria in western Kenya. A random sample of 1190 adults was selected and approached for consent, blood samples and structured interview. FINDINGS: We found marginally raised CD4/CD3 ratios of participants with malaria parasites, but no difference in CD4/CD3 ratios for participants with common mental disorder (CMD) or psychotic symptoms. People with psychotic symptoms had increased levels of IL-6, IL-8, and IL-10, and lower levels of IL-1beta. People with CMD had higher levels of IL-8 and IL-10. People with malaria had higher levels of IL-10 and lower levels of TNF-alpha. At the bivariate level, CMD was associated with log TNF-α levels using unadjusted odds ratios, but not after adjusting for malaria. Psychotic symptoms were associated with log IL-10 and log TNF-α levels at the bivariate level while in the adjusted analysis, log TNF-α levels remained highly significant.. INTERPRETATION: This is the first population based study of immune markers in CMD and psychotic symptoms, and the first to examine the 3 way relationship with malaria. Our findings suggest that TNF-α may mediate the relationship between malaria and CMD. FUND: The study was funded by UK Aid, Department for International Development, Kenya office.


Assuntos
Complexo CD3/metabolismo , Antígenos CD4/metabolismo , Malária Falciparum/imunologia , Transtornos Mentais/imunologia , Fator de Necrose Tumoral alfa/metabolismo , Adulto , Estudos Transversais , Doenças Endêmicas , Feminino , Humanos , Interleucinas/metabolismo , Quênia/epidemiologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Vigilância da População
11.
BMC Psychiatry ; 18(1): 318, 2018 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-30285745

RESUMO

BACKGROUND: Few longitudinal studies have examined associations between risk factors during pregnancy and mental health outcomes during the postpartum period. We used a cohort study design to estimate the prevalence, incidence and correlates of significant postpartum depressive symptoms in Kenyan women. METHODS: We recruited adult women residing in an urban, resource-poor setting and attending maternal and child health clinics in two public hospitals in Nairobi, Kenya. A translated Kiswahili Edinburgh Postpartum Depression Scale was used to screen for depressive symptoms at baseline assessment in the 3rd trimester and follow up assessment at 6-10 weeks postpartum. Information was collected on potential demographic, psychosocial and clinical risk variables. Potential risk factors for postpartum depression were evaluated using multivariate logistic regression analysis. RESULTS: Out of the 171 women who were followed up at 6-10 weeks postpartum, 18.7% (95% CI: 13.3-25.5) were found to have postpartum depression using an EPDS cut off of 10. In multivariate analyses, the odds of having postpartum depression was increased more than seven-fold in the presence of conflict with partner (OR = 7.52, 95% CI: 2.65-23.13). The association between antepartum and postpartum depression was quite strong but did not reach statistical significance (OR = 3.37, 95% CI: 0.98-11.64). CONCLUSIONS: The high prevalence of significant postnatal depressive symptoms among Kenyan women underscores the need for addressing this public health burden. Depression screening and psychosocial support interventions that address partner conflict resolution should be offered as part of maternal health care.


Assuntos
Depressão Pós-Parto/epidemiologia , Depressão Pós-Parto/psicologia , Período Pós-Parto/psicologia , População Urbana , Adulto , Estudos de Coortes , Depressão/diagnóstico , Depressão Pós-Parto/diagnóstico , Feminino , Seguimentos , Humanos , Quênia/epidemiologia , Estudos Longitudinais , Programas de Rastreamento/métodos , Gravidez , Terceiro Trimestre da Gravidez/psicologia , Prevalência , Escalas de Graduação Psiquiátrica , Fatores de Risco
14.
J Acquir Immune Defic Syndr ; 74(1): 52-55, 2017 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-27509254

RESUMO

For people living with HIV, exposure to sexual violence (SV) is associated with decreased adherence to antiretroviral medication, a primary predictor of their survival. Identification of risk factors for SV is a pressing issue in sub-Saharan Africa, where the global majority of HIV-positive women live and the prevalence of SV against women is high. We used qualitative data to examine SV against HIV-positive women enrolled in HIV care in Kenya. Respondents identified husbands as perpetrators of SV in the context of women's efforts to use condoms as directed by HIV care providers.


Assuntos
Preservativos/estatística & dados numéricos , Infecções por HIV , Delitos Sexuais , Adolescente , Adulto , Feminino , Humanos , Entrevistas como Assunto , Quênia , Cônjuges , Adulto Jovem
15.
J Clin Psychol ; 72(8): 779-83, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27463639

RESUMO

We examine the efficacy of nonspecialists delivering interpersonal psychotherapy (IPT) to HIV-positive (HIV+) women. We describe a case in which local personnel without prior mental health training delivered IPT for the treatment of depression and posttraumatic stress disorder in an HIV+ woman who reported experiencing gender-based violence and was enrolled in HIV care at the Family AIDS, Care, Education and Services program in Kisumu, Kenya.


Assuntos
Transtorno Depressivo Maior/terapia , Soropositividade para HIV/psicologia , Relações Interpessoais , Psicoterapia/métodos , Transtornos de Estresse Pós-Traumáticos/terapia , Adulto , Feminino , Humanos , Quênia
17.
Trials ; 17: 64, 2016 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-26841875

RESUMO

BACKGROUND: Mental disorders are the leading global cause of years lived with disability; the majority of this burden exists in low and middle income countries (LMICs). Over half of mental illness is attributable to depression and anxiety disorders, both of which have known treatments. While the scarcity of mental health care providers is recognized as a major contributor to the magnitude of untreated disorders in LMICs, studies in LMICs find that evidence-based treatments for depression and anxiety disorders, such as brief, structured psychotherapies, are feasible, acceptable and have strong efficacy when delivered by local non-specialist personnel. However, most mental health treatment studies using non-specialist providers in LMICs deploy traditional efficacy designs (T1) without the benefit of integrated mental health treatment models shown to succeed over vertical interventions or methods derived from new implementation science to speed policy change. Here, we describe an effectiveness-implementation hybrid study that evaluates non-specialist delivery of mental health treatment within an HIV clinic for HIV-positive (HIV+) women affected by gender- based violence (GBV) (HIV+ GBV+) in the Nyanza region of Kenya. METHODS/DESIGN: In this effectiveness-implementation hybrid type I design, 200 HIV+ women with major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) who are receiving care at a Family AIDS Care Education and Services (FACES)-supported clinic in Kisumu, Kenya will be randomized to: (1) interpersonal psychotherapy (IPT) + treatment as usual (TAU) or (2) TAU, both delivered within the HIV clinic. IPT will consist of 12 weekly 60-minute individual IPT sessions, delivered by non-specialists trained to provide IPT. Primary effectiveness outcomes will include MDD and PTSD diagnosis on the Mini International Diagnostic Interview (MINI). Primary implementation outcomes will include treatment cost-benefit, acceptability, appropriateness, feasibility and fidelity of the IPT delivery within an HIV clinic. DISCUSSION: This trial leverages newly defined effectiveness-implementation hybrid designs to gather data on mental health treatment implementation within an HIV care clinic, while testing the effectiveness of an evidence-based treatment for use with a large underserved population (HIV+ GBV+ women) in Kenya. CLINICAL TRIALS IDENTIFIER: NCT02320799, registered on 9 September 2014.


Assuntos
Protocolos Clínicos , Transtorno Depressivo Maior/terapia , Soropositividade para HIV/psicologia , Psicoterapia/métodos , Transtornos de Estresse Pós-Traumáticos/terapia , Interpretação Estatística de Dados , Feminino , Humanos , Serviços de Saúde Mental , Tamanho da Amostra
18.
BMC Psychiatry ; 15: 309, 2015 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-26651332

RESUMO

BACKGROUND: Repeat household surveys are useful to assess change in prevalence over time, but there have been no repeat surveys of common mental disorder (CMD) in Kenya, or indeed sub-Saharan Africa. Therefore a repeat household survey of CMD and its associated risk factors was conducted in Maseno area, Kisumu county in Kenya, using a demographic surveillance site as the sample frame, in order to test the hypotheses that (a) the prevalence of CMD would increase between 2004 and 2013 due to the intervening political, social and economic pressures; (b) as in 2004, there would be no gender difference in prevalence of CMD. METHODS: One thousand one hundred ninety households were selected, and 1158 adult participants consented to be interviewed with a structured epidemiological assessment while 32 refused to participate in the study interviews, giving a response rate of 97.3%. RESULTS: The study found that the overall prevalence of CMD in 2013 was 10.3%. However, there were significantly higher rates of having any CMD in 2013 if one was female (OR 6.2, p < 0.001), divorced/widowed (OR 2.5, p < 0.003), aged over 60 (OR 2.3, p = 0.052), either self-employed (OR 3.3 p < 0.001) or employed (OR 3.3, p < 0.001), or belonged to the lowest asset quintile (OR 2.5, p = .0.004) after adjusting for other variables significant at the bivariate level. The overall prevalence in 2013 was consistent with that found in 2004, despite intervening political and community turbulence. However, this apparent consistency masks the development of a striking difference in prevalence between the genders. Over the decade 2004-13, the prevalence for men dropped from 10.9 to 3.8% (P = 0.001) and the prevalence for women increased from 10.8 to 17.5% (p = 0.001). CONCLUSION: Common mental disorders continue to pose a significant public health burden in Kenya, and gender related vulnerability merits further research and is relevant for health worker training.


Assuntos
Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Saúde Mental/estatística & dados numéricos , População Rural/estatística & dados numéricos , Adulto , Características da Família , Feminino , Humanos , Quênia/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Adulto Jovem
19.
Int J Environ Res Public Health ; 12(10): 13494-509, 2015 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-26516877

RESUMO

This study aimed to assess the prevalence of probable post-traumatic stress disorder (PTSD), and its associated risk factors in a general household population in Kenya. Data were drawn from a cross-sectional household survey of mental disorders and their associated risk factors. The participants received a structured epidemiological assessment of common mental disorders, and symptoms of PTSD, accompanied by additional sections on socio-demographic data, life events, social networks, social supports, disability/activities of daily living, quality of life, use of health services, and service use. The study found that 48% had experienced a severe trauma, and an overall prevalence rate of 10.6% of probable PTSD, defined as a score of six or more on the trauma screening questionnaire (TSQ). The conditional probability of PTSD was 0.26. Risk factors include being female, single, self-employed, having experienced recent life events, having a common mental disorder (CMD)and living in an institution before age 16. The study indicates that probable PTSD is prevalent in this rural area of Kenya. The findings are relevant for the training of front line health workers, their support and supervision, for health management information systems, and for mental health promotion in state boarding schools.


Assuntos
Acontecimentos que Mudam a Vida , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Violência , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Quênia/epidemiologia , Masculino , Pessoa de Meia-Idade , Política , Prevalência , Fatores Sexuais , Transtornos de Estresse Pós-Traumáticos/etiologia , Adulto Jovem
20.
BMC Psychiatry ; 15: 230, 2015 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-26408143

RESUMO

BACKGROUND: Alcohol use and hazardous drinking have been studied in school children and in urban areas of Kenya, but there has been no adult survey of these issues in a rural household population. METHODS: This study reports the prevalence of alcohol consumption and hazardous drinking in a household survey of a demographic surveillance site in rural Kenya. Information collected included demographic characteristics, socio-economic factors, recent life events and perceived social support. Alcohol consumption was assessed by questions about quantity and frequency. The Alcohol Use Disorders Identification Test (AUDIT) measured hazardous alcohol use. The Clinical Interview Schedule- Revised assessed common mental disorder, and the Psychosis Screening Questionnaire indicated the presence of psychotic symptoms. RESULTS: The study found that lifetime and current alcohol consumption were 10.8% and 9.2% respectively. Current alcohol consumption was significantly higher in men (OR 0.4, p < 0.001 for women) and in the self-employed (OR 1.8, p = 0.013), after adjustment for factors significant at the bivariate level. Hazardous drinking was significantly higher in men (OR 0.3, p < 0.001 for women), people living in larger households (OR 1.8, p = 0.021), people who were single (OR 1.7, p = 0.093), and in those who are self-employed (OR 1.8, p = 0.036), after adjustment for factors significant at the bivariate level. CONCLUSION: This study suggests that alcohol consumption and hazardous drinking in the general population in a poor rural area in Nyanza Province is still relatively low. This represents an important public health educational opportunity to keep such rates low before increasing income and employment opportunities enable higher access to alcohol and other substances, and before the higher consumption found by studies on urban youth, especially neighbouring Kisumu town, spreads to the rural areas.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Inquéritos Epidemiológicos/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Criança , Pré-Escolar , Características da Família , Feminino , Humanos , Lactente , Quênia/epidemiologia , Acontecimentos que Mudam a Vida , Masculino , Pessoa de Meia-Idade , Vigilância da População , Prevalência , População Rural/estatística & dados numéricos , Distribuição por Sexo , Apoio Social , Fatores Socioeconômicos , Adulto Jovem
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