Browsing by Author "Garman, Emily"

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    Associations between HIV, TB and psychological distress among a sub-sample of a nationally representative study of South African adults: a secondary data analysis
    (2022) de Wit, Marizanne; Garman, Emily; Lund, Crick
    Introduction: South Africa faces an immense burden of disease, considering that it is the epicentre of the global HIV and TB pandemics. Moreover, the burden of mental ill-health is a growing concern due to its prominent association with infectious diseases. While global research evidence hasshed some light on the effects of psychological distress on communicable diseases such as HIV and TB and vice versa, including the effects of distress on medication adherence, the association between psychological distress and HIV and TB co-morbidity among South African adults remains elusive. Aims: This study aims to determine the prevalence of psychological distress among South Africans adults, what socio-demographic factors are associated with psychological distress, whether HIV or comorbid TB and HIV is associated with psychological distress and finally, to investigate the association between depression and non-adherence among adults who live with HIV or those who have both HIV/TB. Methods: This study made use of cross-sectional data collected in 2017 as part of the fifth wave of nationally representative surveys from the South African National HIV Prevalence, Incidence, Behaviour and Communication Survey (SABSSM). Only participants between the ages of 18-60 who had data on HIV, TB and psychological distress were included (N=20208). Current HIV status, and TB status in the past year was self-reported; however, final HIV status was confirmed via dry blood spot tests. The Kessler-10 screening tool was administered to obtain information on psychological distress using the recommended cut-off score of >16 to indicate the presence of psychological distress and ≤16 to indicate the absence thereof. Descriptive statistics were used to report weighted socio-demographic-, psychological distress, and HIV and TB- characteristics of the sample. Descriptive statistics were also used to report the point prevalence of psychological distress, HIV and HIV/TB comorbidity. Logistic Regression analyses were conducted to assess the associations between demographic factors, socio-economic characteristics, HIV, TB, and psychological distress. Demographic and socioeconomic factors which were significantly associated with psychological distress in univariate analyses were included in subsequent adjusted multilevel logistic regressions to assess the association between HIV, TB, and psychological distress. The association between psychological distress and adherence was assessed among a subsample of participants with HIV using a logistical regression analysis, adjusting for significantly associated demographic and socio-economic factors. All analyses were adjusted for clustering at the small area layer to account for sampling design. Results: The prevalence of psychological distress in this sample was 33.7% (n=6479). A total of 22.2% (n=4851) were HIV positive, 0,08% (n=140) had been diagnosed with TB in the past year and 0,04% (n=84) had co-morbid HIV/TB. Age, race, gender, marital status and education were found to be associated with psychological distress. After controlling for these variables, participants living with HIV were 1.13 times as likely (95%CI=1.01-1.27) to suffer from psychological distress compared to people who did not have HIV, while participants with comorbid TB and HIV were 2.31 times as likely (95%CI=1.16-4.60) to have psychological distress. No association between psychological distress and medication adherence was found (OR=0.75, 95%CI=0.39-1.43). Conclusion: Unemployed black women who are divorced, separated, or widowed, and who have no education are most likely to suffer from psychological distress. Having a positive HIV status is associated with a greater likelihood of being psychologically distressed, which is concerning given the high prevalence of people living with HIV in South Africa. When people living with HIV also develop TB disease, their likelihood of suffering from psychological distress considerably increases compared to people who are not living with HIV. Current mental health services are grossly inadequate to meet the mental health needs of this particularly vulnerable group of public healthcare patients. Integration of mental healthcare in the public health setting is integral in addressing South Africa's mental health needs.
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    Barriers and facilitators of retention to a psychosocial intervention among adolescents with common mental disorders in Harare: a qualitative study
    (2019) Beji-Chauke, Rhulani Tsakani; Garman, Emily; Davies Claire; Chibanda, Dixon
    Background: Common mental disorders, which account for a major proportion of disease burden globally, can have an onset in childhood and adolescence. The Friendship Bench is a psychosocial intervention aimed at reducing and treating common mental disorders and is provided at 42 City health department clinics in Harare, Zimbabwe. Yet research and anecdotal evidence suggests that adolescents do not remain engaged in this intervention. Reasons for lack of engagement often include demographic, psychosocial, logistical and cultural factors. Understanding the barriers and facilitators to retention amongst adolescents would help to improve retention and mental health outcomes among this vulnerable population. The aim of this study is to explore the barriers and facilitators that adolescents with common mental disorders experience in retention to the Friendship Bench. Methods: A qualitative study was conducted among adolescents who were aged 15-17 years at the time of accessing the Friendship Bench service. Twelve adolescents who visited the Friendship Bench between June 2016 and December 2017 were recruited using purposive sampling. Theoretical saturation was not reached due to recruitment barriers. The adolescents were recruited from five primary care clinics which were selected based on ease of access to the researcher. Semi-structured interviews with open-ended questions were employed to explore the barriers and facilitators adolescents faced in accessing the service, guided by Andersen’s Behavioural Model of Health services use. The interviews were conducted in a space convenient to the participant or at the participant’s local clinic grounds, and they lasted approximately 30 minutes. The adolescents were interviewed by two qualitative researchers and given the option on whether to be interviewed in Shona or English. Data was analysed using thematic analysis with NVivo 12. Results: Barriers to returning to the service included lack of privacy, school or work commitments, poor social support systems, and lack of a nearby clinic, resulting in having to travel far to access clinic services. Some participants who felt better saw no need to continue coming for sessions. Other emerging barriers found included lay health workers’ (LHWs’) attributes and forgetfulness. Important facilitators to retention included knowledge of what depression is, family support, experience with depressive symptoms, a nearby clinic, having other reasons to visit the clinic, and LHW attributes. Discussion: Given the study’s findings, it is recommended that mobile Friendship Benches and phonebased counselling applications be introduced, in addition to recruiting younger LHWs and male LHWs in order to improve retention. Provision should be made to locate Friendship Benches in more private or youth friendly spaces, to raise awareness on mental health issues in schools and communities and to involve parents and caregivers in the intervention development process. Further investigation into barriers and facilitators into psychosocial interventions is required, particularly with LHWs in order to get their perspective. Conclusion: By identifying barriers and facilitators that adolescents experience, this study contributes towards improving access and retention of adolescents to the Friendship Bench, as well as other psychosocial interventions aimed at adolescents in Zimbabwe.
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    Exploring nurses? experiences in community mental health care delivery during the covid-19 pandemic: a qualitative study in the Accra metropolis
    (2023) Morson, Nana; Garman, Emily
    Mental health care in Ghana recently shifted from a focus on institutional care to the inclusion of community-based care. This shift helped to broaden the scope of mental health care in the country through the establishment of community psychiatric units in most regional and district health facilities across the country. Mental health nurses are posted to these units, and their work includes visiting clients in their homes for reviews (a formal assessment and evaluation of the patient's health, progress, and medication) and follow-ups, health education and case finding. The COVID-19 pandemic however affected the activities of the community mental health nurses due to the implementation of lockdowns and other restrictions. This study explored the experiences of community mental health nurses during the COVID-19 pandemic. The objectives of the study were to investigate nurses' perspectives on how the COVID-19 pandemic has affected community mental health care delivery, to assess the nurses' views on the barriers and facilitators of mental health care delivery during the pandemic and to explore the nurses' recommendations for improving community mental health care (CMHC) in the context of the COVID-19 pandemic and beyond. Fifteen community mental health nurses from five health facilities in the Accra metropolis were interviewed. Thematic analysis of the data was conducted using NVivo software. Findings suggested that the nurses had to suspend most direct-contact community-based activities and instead conducted patient reviews via telephone. They also maintained a limited amount of clinic-based care. COVID-19 had a major impact on CMHC delivery through the suspension of health education and home visits, the move towards clinic-based only reviews, financial constraints, the unavailability of medicines and the reassigning of staff to provide COVID support. The nurses mentioned several barriers to CMHC, both prior to and during the pandemic, including financial and logistical constraints such as lack of transportation, infrastructure and inadequate personal protective equipment (PPE). These challenges were overcome through the nurses' commitment and dedication to their work, as well as the provision of periodic support from the health facilities. The nurses however recommended that there should be sustained logistic and health systems support, an increase in the use of technology, provision of medical aid for mental health, increased mental health education and promotion and incentives for community health workers to help improve CMHC amid any pandemic. In conclusion, the COVID-19 pandemic served to highlight pre-existing issues with CMHC in Ghana. To improve these services, it may be appropriate to take the following steps, among others: increasing funding for mental healthcare in the midst of any pandemic; training more mental health professionals and integrating mental healthcare into primary care. Additionally, it is recommended that further research on community mental healthcare and issues related to it may help to increase access to care and prepare the CMHC system for any potential pandemics.
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    Group problem solving therapy for perinatal depression in primary health care settings in rural Uganda: an intervention cohort study
    (2021-08-25) Nakku, Juliet E. M.; Nalwadda, Oliva; Garman, Emily; Honikman, Simone; Hanlon, Charlotte; Kigozi, Fred; Lund, Crick
    Background Perinatal depression is of substantial public health importance in low and middle income countries. The study aimed to evaluate the impact of a mental health intervention delivered by non-specialist health workers on symptom severity and disability in women with perinatal depression in Uganda. Methods Pregnant women in the second and third trimester were consecutively screened using the Luganda version of the 9-item Patient Health Questionnaire (PHQ-9). Women who scored ≥5 on the PHQ-9 and who were confirmed to have depression by a midwife were recruited into a treatment cohort and offered a psychological intervention in a stepped care fashion. Women were assessed with PHQ-9 and WHODAS-2.0 at baseline and again at 3 and 6 months after the intervention. Negative regression analysis was done to examine change in PHQ-9 and WHODAS-2.0 scores from baseline to end line. Data were analysed using STATA version 14. Results A total of 2652 pregnant women (98.3%) consented to participate in the study and 153 (5.8%) were diagnosed as depressed. Over a quarter (28.8%) reported having experienced physical interpersonal violence (IPV) while (25.5%) reported sexual IPV in the past year. A third (34.7%) of women diagnosed with depression received 4 or more group PST sessions. There was a mean reduction in PHQ-9 score of 5.13 (95%CI − 6.79 to − 3.47, p < 0.001) and 7.13 (95%CI − 8.68 to − 5.59, p < 0.001) at midline and endline, respectively. WHODAS scores reduced significantly by − 11.78 points (CI 17.64 to − 5.92, p < 0.001) at midline and − 22.92 points (CI 17.64 to − 5.92, p < 0.001) at endline. Clinical response was noted among 69.1% (95%CI 60.4–76.6%) and 93.7% (95%CI 87.8–96.8%) of respondents at midline and endline, respectively. Conclusion An evidence based psychological intervention implemented in primary antenatal care by trained and supervised midwives in a real-world setting may lead to improved outcomes for women with perinatal depression. Future randomised studies are needed to confirm the efficacy of this intervention and possibility for scale up.
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    Treatment coverage, barriers to care and factors associated with help-seeking behaviour of adults with depression and alcohol use disorder in Chitwan district, Nepal
    (2020) Luitel, Nagendra Prasad; Lund, Christopher; Garman, Emily
    Introduction: Globally, there is a substantial gap between the number of individuals in need of mental health care and those who receive treatment. It is reported that 86.3% people with anxiety, mood, or substance disorders in low and middle-income countries (LMICs) received no treatment in the 12 months preceding the survey. The Programme for improving mental health care (PRIME) aims to generate new evidence on implementation and scale up of mental health programs in primary health care settings to minimize this enormous treatment gap on mental health care, especially in the LMICs. The aim of this study was to report on the change in treatment coverage, barriers and other factors associated with help-seeking behaviour of adults with depression and alcohol use disorder (AUD) in Chitwan district, Nepal before and three years after implementation of the PRIME district mental health care plan (MHCP). Methods: The study was conducted in 10 Village Development Committees of Chitwan district in southern Nepal. The repeat population-based cross-sectional community survey applied a random sampling technique to select 1983 and 1499 adults in the baseline and the follow-up survey, respectively. The Patient Health Questionnaire (PHQ-9) and Alcohol Use Disorder Identification Test (AUDIT) were used to screen people with depression and AUD. Barriers for seeking mental health care were assessed by using a standardized tool, the Barriers to Care Evaluation Scale (BACE). Results: Overall, 11.7% (n=13) people with depression in the follow-up survey reported that they had received mental health treatment from any provider in the 12 months preceding the survey; this proportion was not significantly different from the proportion reported at the baseline (n=18; 8.1%;χ2=1.02, p=0.424). Similarly, the proportion of the participants receiving treatment for AUD from any provider at the follow-up survey (n=9; 10.3%) was also not significantly different than that found at baseline (n=5; 5.1%; χ2=1.68, p=0.235). Significant reductions were found in the overall BACE score (p=0.004) and the specific BACE domains scores pertaining to financial barriers (p<0.001); stigma (p=0.004) and lack of support (p<0.001) in the follow-up survey among participants with depression. In the AUD group, there was also a significant reduction between the baseline and follow-up survey in the overall BACE score (p=0.011) and the specific BACE domains scores pertaining to financial barriers (p<0.001) and lack of support (p<0.001). There was no association between socio-demographic characteristics and help seeking behaviour of the participants at the follow-up survey. Participants who reported greater cultural practices and beliefs were less likely (OR 0.65, 95% CI 0.46 – 0.92) to receive mental health care compared to those who reported less cultural beliefs and practices (p=0.015). Conclusion: The study found non-significant improvements in treatment coverage and significant reductions in barriers to mental health care following implementation of the PRIME district mental health care plan. The non-significant improvements in the treatment coverage could be explained by a number of potential factors, including lack of targeted community level interventions for specific barriers in the PRIME MHCP, the distal nature of the outcome in relation to the intervention, and the small number of screen positive participants. The key areas for improvement in the implementation of the district mental health care plan include establishment of confidential place for consultation in each health facility and targeted community awareness and sensitization programmes to improve help-seeking attitudes, intention and behaviour.
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    Video-based health professional education for postpartum psychosis: acceptability and changes in knowledge amongst primary care workers in Thyolo, Malawi
    (2023) Kalolo, Gloria; Garman, Emily
    INTRODUCTION Postpartum psychosis is a severe mental health condition that affects women soon after they give birth, and is characterised by disturbances in thought pattern, abnormal behaviour and mood disruption. It is life threatening as women presenting with this condition are at a high risk of suicide and infanticide. Good outcomes such as reduced rate of relapse and better quality of life are expected if pharmacological and psychosocial treatments are initiated early. Stigma by healthcare workers in low- and middle-income countries, including in Malawi, leads to non-identification, late treatment and poor clinical and social outcomes. A video-based educational tool, which includes a narrative of a patient with lived experience of postpartum psychosis was created by the ‘Strengthening the Network for Studying Psychological Resilience in Low-And Middle-income Countries Project (NESP)', for potential use in training professional primary healthcare workers in identification and referral of postpartum psychosis. The aim of this study was to assess change in knowledge of and attitudes towards postpartum psychosis in professional primary healthcare workers in Malawi after watching this video, and to explore their perceptions on the usefulness of the video in their training and daily work. METHOD We conducted a mixed methods study evaluating the effects of a video- based educational tool on knowledge and attitudes of professional primary healthcare workers in Thyolo, Malawi. The Mental Health Knowledge Schedule (MAKS) was used to assess knowledge and Mental Illness Clinicians Attitudes Scale (MICA) was used to assess attitudes before and after exposure to the video. Convenience sampling was used to select 20 out of 28 health centres in Thyolo district. All professional primary healthcare workers at each sampled health centre were invited to participate in the study. A total of 126 participants were recruited and 96 of them completed both pre and post-tests. Then two separate focus group discussions were held with a total of 11 participants attending out of 12 sampled. SPSS version 28 was used to analyse quantitative data: a paired sample t-test was used to assess the unadjusted change in MAKS and MICA scores. A repeated measures ANOVA controlling a priori for age, number of days between pre-post-test and experience with treating PPP was then performed. NVivo 12 was used in the thematic analysis of transcribed qualitative data. RESULTS The results showed significantly higher MAKS (knowledge) scores in the post-test (mean = 23.1, SD = 2.5) compared to the pre-test (mean = 21.9, SD= 2.9) (mean difference = -1.2, t = -3.5, p =