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Recognition of depression by primary care clinicians in rural Ethiopia

BACKGROUND: Depression is a common health condition affecting up to a third of patients attending primary care, where most of the care for people with depression is provided. Adequate recognition of depression is the critical step in the path to effective care, particularly in low income countries....

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Autores principales: Fekadu, Abebaw, Medhin, Girmay, Selamu, Medhin, Giorgis, Tedla W., Lund, Crick, Alem, Atalay, Prince, Martin, Hanlon, Charlotte
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5399858/
https://www.ncbi.nlm.nih.gov/pubmed/28431526
http://dx.doi.org/10.1186/s12875-017-0628-y
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author Fekadu, Abebaw
Medhin, Girmay
Selamu, Medhin
Giorgis, Tedla W.
Lund, Crick
Alem, Atalay
Prince, Martin
Hanlon, Charlotte
author_facet Fekadu, Abebaw
Medhin, Girmay
Selamu, Medhin
Giorgis, Tedla W.
Lund, Crick
Alem, Atalay
Prince, Martin
Hanlon, Charlotte
author_sort Fekadu, Abebaw
collection PubMed
description BACKGROUND: Depression is a common health condition affecting up to a third of patients attending primary care, where most of the care for people with depression is provided. Adequate recognition of depression is the critical step in the path to effective care, particularly in low income countries. As part of the Programme for Improving Mental healthcare (PRIME), a project supporting the implementation of integrated mental healthcare in primary care, we evaluated the level of recognition of depression by clinicians working in primary care in rural Ethiopia prior to in service training. We hypothesised that the detection rate of depression will be under 10% and that detection would be affected by gender, education and severity of depression. METHODS: Cross-sectional survey in eight health centres serving a population of over 160,000 people. A validated version of the 9-item patient health questionnaire (PHQ-9) was administered as an indicator of probable depression. In addition, primary care clinicians completed a clinician encounter form. Participants were consecutive primary care attendees aged 18 years and above. RESULTS: A total of 1014 participants were assessed. Primary care clinicians diagnosed 13 attendees (1.3%) with depression. The PHQ9 prevalence of depression at a cut-off score of ten was 11.5% (n = 117), of whom 5% (n = 6/117) had received a diagnosis of depression by primary care clinicians. Attendees with higher PHQ scores and suicidality were significantly more likely to receive a diagnosis of depression by clinicians. Women (n = 9/13) and participants with higher educational attainment were more likely to be diagnosed with depression, albeit non-significantly. All cases diagnosed with depression by the clinicians had presented with psychological symptoms. CONCLUSION: Although not based on a gold standard diagnosis, over 98% of cases with PHQ-9 depression were undetected. Failure of recognition of depression may pose a serious threat to the scale up of mental healthcare in low income countries. Addressing this threat should be an urgent priority, and requires a better understanding of the nature of depression and its presentation in rural low-income primary care settings.
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spelling pubmed-53998582017-04-24 Recognition of depression by primary care clinicians in rural Ethiopia Fekadu, Abebaw Medhin, Girmay Selamu, Medhin Giorgis, Tedla W. Lund, Crick Alem, Atalay Prince, Martin Hanlon, Charlotte BMC Fam Pract Research Article BACKGROUND: Depression is a common health condition affecting up to a third of patients attending primary care, where most of the care for people with depression is provided. Adequate recognition of depression is the critical step in the path to effective care, particularly in low income countries. As part of the Programme for Improving Mental healthcare (PRIME), a project supporting the implementation of integrated mental healthcare in primary care, we evaluated the level of recognition of depression by clinicians working in primary care in rural Ethiopia prior to in service training. We hypothesised that the detection rate of depression will be under 10% and that detection would be affected by gender, education and severity of depression. METHODS: Cross-sectional survey in eight health centres serving a population of over 160,000 people. A validated version of the 9-item patient health questionnaire (PHQ-9) was administered as an indicator of probable depression. In addition, primary care clinicians completed a clinician encounter form. Participants were consecutive primary care attendees aged 18 years and above. RESULTS: A total of 1014 participants were assessed. Primary care clinicians diagnosed 13 attendees (1.3%) with depression. The PHQ9 prevalence of depression at a cut-off score of ten was 11.5% (n = 117), of whom 5% (n = 6/117) had received a diagnosis of depression by primary care clinicians. Attendees with higher PHQ scores and suicidality were significantly more likely to receive a diagnosis of depression by clinicians. Women (n = 9/13) and participants with higher educational attainment were more likely to be diagnosed with depression, albeit non-significantly. All cases diagnosed with depression by the clinicians had presented with psychological symptoms. CONCLUSION: Although not based on a gold standard diagnosis, over 98% of cases with PHQ-9 depression were undetected. Failure of recognition of depression may pose a serious threat to the scale up of mental healthcare in low income countries. Addressing this threat should be an urgent priority, and requires a better understanding of the nature of depression and its presentation in rural low-income primary care settings. BioMed Central 2017-04-21 /pmc/articles/PMC5399858/ /pubmed/28431526 http://dx.doi.org/10.1186/s12875-017-0628-y Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Fekadu, Abebaw
Medhin, Girmay
Selamu, Medhin
Giorgis, Tedla W.
Lund, Crick
Alem, Atalay
Prince, Martin
Hanlon, Charlotte
Recognition of depression by primary care clinicians in rural Ethiopia
title Recognition of depression by primary care clinicians in rural Ethiopia
title_full Recognition of depression by primary care clinicians in rural Ethiopia
title_fullStr Recognition of depression by primary care clinicians in rural Ethiopia
title_full_unstemmed Recognition of depression by primary care clinicians in rural Ethiopia
title_short Recognition of depression by primary care clinicians in rural Ethiopia
title_sort recognition of depression by primary care clinicians in rural ethiopia
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5399858/
https://www.ncbi.nlm.nih.gov/pubmed/28431526
http://dx.doi.org/10.1186/s12875-017-0628-y
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