Impact of integrated district level mental health care on clinical and functioning outcomes of people with depression and alcohol use disorder in Nepal: a non-randomised controlled study

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dc.contributor.authorJordans, M J D
dc.contributor.authorGarman, E C
dc.contributor.authorLuitel, N P
dc.contributor.authorKohrt, B A
dc.contributor.authorLund, C
dc.contributor.authorPatel, V
dc.contributor.authorTomlinson, M
dc.date.accessioned2021-06-23T11:26:35Z
dc.date.available2021-06-23T11:26:35Z
dc.date.issued2020-09-14
dc.date.updated2020-09-20T03:29:21Z
dc.description.abstractAbstract Background Integration of mental health services into primary healthcare is proliferating in low-resource countries. We aimed to evaluate the impact of different compositions of primary care mental health services for depression and alcohol use disorder (AUD), when compared to usual primary care services. Methods We conducted a non-randomized controlled study in rural Nepal. We compared treatment outcomes among patients screening positive and receiving: (a) primary care mental health services without a psychological treatment component (TG); (b) the same services including a psychological treatment (TG + P); and (c) primary care treatment as usual (TAU). Primary outcomes included change in depression and AUD symptoms, as well as disability. Disability was measured using the 12-item WHO Disability Assessment Schedule. Symptom severity was assessed using the 9-item Patient Health Questionnaire for depression, the 10-item Alcohol Use Disorders Identification Test for AUD. We used negative binomial regression models for the analysis. Results For depression, when combining both treatment groups (TG, n = 77 and TG + P, n = 60) compared to TAU (n = 72), there were no significant improvements. When only comparing the psychological treatment group (TG + P) with TAU, there were significant improvements for symptoms and disability (aβ = − 2.64; 95%CI − 4.55 to − 0.74, p = 0.007; aβ = − 12.20; 95%CI − 19.79 to − 4.62; p = 0.002, respectively). For AUD, when combining both treatment groups (TG, n = 92 and TG + P, n = 80) compared to TAU (n = 57), there were significant improvements in AUD symptoms and disability (aβ = − 15.13; 95%CI − 18.63 to − 11.63, p < 0.001; aβ = − 9.26; 95%CI − 16.41 to − 2.12, p = 0.011; respectively). For AUD, there were no differences between TG and TG + P. Patients’ perceptions of health workers’ skills in common psychological factors were associated with improvement in depression patient outcomes (β = − 0.36; 95%CI − 0.55 to − 0.18; p < 0.001) but not for AUD patients. Conclusion Primary care mental health services for depression may only be effective when psychological treatments are included. Health workers’ competencies as perceived by patients may be an important indicator for treatment effect. AUD treatment in primary care appears to be beneficial even without additional psychological services.
dc.identifier.apacitationJordans, M. J. D., Garman, E. C., Luitel, N. P., Kohrt, B. A., Lund, C., Patel, V., & Tomlinson, M. (2020). Impact of integrated district level mental health care on clinical and functioning outcomes of people with depression and alcohol use disorder in Nepal: a non-randomised controlled study. <i>BMC Psychiatry</i>, 20(1), 451. http://hdl.handle.net/11427/33379en_ZA
dc.identifier.chicagocitationJordans, M J D, E C Garman, N P Luitel, B A Kohrt, C Lund, V Patel, and M Tomlinson "Impact of integrated district level mental health care on clinical and functioning outcomes of people with depression and alcohol use disorder in Nepal: a non-randomised controlled study." <i>BMC Psychiatry</i> 20, 1. (2020): 451. http://hdl.handle.net/11427/33379en_ZA
dc.identifier.citationJordans, M.J.D., Garman, E.C., Luitel, N.P., Kohrt, B.A., Lund, C., Patel, V. & Tomlinson, M. 2020. Impact of integrated district level mental health care on clinical and functioning outcomes of people with depression and alcohol use disorder in Nepal: a non-randomised controlled study. <i>BMC Psychiatry.</i> 20(1):451. http://hdl.handle.net/11427/33379en_ZA
dc.identifier.ris TY - Journal Article AU - Jordans, M J D AU - Garman, E C AU - Luitel, N P AU - Kohrt, B A AU - Lund, C AU - Patel, V AU - Tomlinson, M AB - Abstract Background Integration of mental health services into primary healthcare is proliferating in low-resource countries. We aimed to evaluate the impact of different compositions of primary care mental health services for depression and alcohol use disorder (AUD), when compared to usual primary care services. Methods We conducted a non-randomized controlled study in rural Nepal. We compared treatment outcomes among patients screening positive and receiving: (a) primary care mental health services without a psychological treatment component (TG); (b) the same services including a psychological treatment (TG + P); and (c) primary care treatment as usual (TAU). Primary outcomes included change in depression and AUD symptoms, as well as disability. Disability was measured using the 12-item WHO Disability Assessment Schedule. Symptom severity was assessed using the 9-item Patient Health Questionnaire for depression, the 10-item Alcohol Use Disorders Identification Test for AUD. We used negative binomial regression models for the analysis. Results For depression, when combining both treatment groups (TG, n = 77 and TG + P, n = 60) compared to TAU (n = 72), there were no significant improvements. When only comparing the psychological treatment group (TG + P) with TAU, there were significant improvements for symptoms and disability (aβ = − 2.64; 95%CI − 4.55 to − 0.74, p = 0.007; aβ = − 12.20; 95%CI − 19.79 to − 4.62; p = 0.002, respectively). For AUD, when combining both treatment groups (TG, n = 92 and TG + P, n = 80) compared to TAU (n = 57), there were significant improvements in AUD symptoms and disability (aβ = − 15.13; 95%CI − 18.63 to − 11.63, p < 0.001; aβ = − 9.26; 95%CI − 16.41 to − 2.12, p = 0.011; respectively). For AUD, there were no differences between TG and TG + P. Patients’ perceptions of health workers’ skills in common psychological factors were associated with improvement in depression patient outcomes (β = − 0.36; 95%CI − 0.55 to − 0.18; p < 0.001) but not for AUD patients. Conclusion Primary care mental health services for depression may only be effective when psychological treatments are included. Health workers’ competencies as perceived by patients may be an important indicator for treatment effect. AUD treatment in primary care appears to be beneficial even without additional psychological services. DA - 2020-09-14 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - BMC Psychiatry KW - Primary health care KW - Community mental health KW - Nepal KW - Low and middle income countries KW - Psychological treatment LK - https://open.uct.ac.za PY - 2020 T1 - Impact of integrated district level mental health care on clinical and functioning outcomes of people with depression and alcohol use disorder in Nepal: a non-randomised controlled study TI - Impact of integrated district level mental health care on clinical and functioning outcomes of people with depression and alcohol use disorder in Nepal: a non-randomised controlled study UR - http://hdl.handle.net/11427/33379 ER - en_ZA
dc.identifier.urihttps://doi.org/10.1186/s12888-020-02832-5
dc.identifier.urihttp://hdl.handle.net/11427/33379
dc.identifier.vancouvercitationJordans MJD, Garman EC, Luitel NP, Kohrt BA, Lund C, Patel V, et al. Impact of integrated district level mental health care on clinical and functioning outcomes of people with depression and alcohol use disorder in Nepal: a non-randomised controlled study. BMC Psychiatry. 2020;20(1):451. http://hdl.handle.net/11427/33379.en_ZA
dc.language.rfc3066en
dc.rights.holderThe Author(s)
dc.sourceBMC Psychiatry
dc.source.journalissue1
dc.source.journalvolume20
dc.source.pagination451
dc.source.urihttps://bmcpsychiatry.biomedcentral.com/
dc.subjectPrimary health care
dc.subjectCommunity mental health
dc.subjectNepal
dc.subjectLow and middle income countries
dc.subjectPsychological treatment
dc.titleImpact of integrated district level mental health care on clinical and functioning outcomes of people with depression and alcohol use disorder in Nepal: a non-randomised controlled study
dc.typeJournal Article
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