Recognition of depression by primary care clinicians in rural Ethiopia

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dc.contributor.authorFekadu, Abebaw
dc.contributor.authorMedhin, Girmay
dc.contributor.authorSelamu, Medhin
dc.contributor.authorGiorgis, Tedla W
dc.contributor.authorLund, Crick
dc.contributor.authorAlem, Atalay
dc.contributor.authorPrince, Martin
dc.contributor.authorHanlon, Charlotte
dc.date.accessioned2021-10-08T06:20:21Z
dc.date.available2021-10-08T06:20:21Z
dc.date.issued2017
dc.description.abstractBACKGROUND: 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.
dc.identifier.apacitationFekadu, A., Medhin, G., Selamu, M., Giorgis, T. W., Lund, C., Alem, A., ... Hanlon, C. (2017). Recognition of depression by primary care clinicians in rural Ethiopia. <i>BMC Family Practice</i>, 18(1), 174 - 177. http://hdl.handle.net/11427/34259en_ZA
dc.identifier.chicagocitationFekadu, Abebaw, Girmay Medhin, Medhin Selamu, Tedla W Giorgis, Crick Lund, Atalay Alem, Martin Prince, and Charlotte Hanlon "Recognition of depression by primary care clinicians in rural Ethiopia." <i>BMC Family Practice</i> 18, 1. (2017): 174 - 177. http://hdl.handle.net/11427/34259en_ZA
dc.identifier.citationFekadu, A., Medhin, G., Selamu, M., Giorgis, T.W., Lund, C., Alem, A., Prince, M. & Hanlon, C. et al. 2017. Recognition of depression by primary care clinicians in rural Ethiopia. <i>BMC Family Practice.</i> 18(1):174 - 177. http://hdl.handle.net/11427/34259en_ZA
dc.identifier.issn1471-2296
dc.identifier.ris TY - Journal Article AU - Fekadu, Abebaw AU - Medhin, Girmay AU - Selamu, Medhin AU - Giorgis, Tedla W AU - Lund, Crick AU - Alem, Atalay AU - Prince, Martin AU - Hanlon, Charlotte AB - 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. DA - 2017 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - BMC Family Practice LK - https://open.uct.ac.za PY - 2017 SM - 1471-2296 T1 - Recognition of depression by primary care clinicians in rural Ethiopia TI - Recognition of depression by primary care clinicians in rural Ethiopia UR - http://hdl.handle.net/11427/34259 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/34259
dc.identifier.vancouvercitationFekadu A, Medhin G, Selamu M, Giorgis TW, Lund C, Alem A, et al. Recognition of depression by primary care clinicians in rural Ethiopia. BMC Family Practice. 2017;18(1):174 - 177. http://hdl.handle.net/11427/34259.en_ZA
dc.language.isoeng
dc.publisher.departmentDepartment of Psychiatry and Mental Health
dc.publisher.facultyFaculty of Health Sciences
dc.sourceBMC Family Practice
dc.source.journalissue1
dc.source.journalvolume18
dc.source.pagination174 - 177
dc.source.urihttps://dx.doi.org/10.1186/s12875-017-0628-y
dc.subject.otherDetection of depression
dc.subject.otherDeveloping country
dc.subject.otherEthiopia
dc.subject.otherIntegrated mental healthcare
dc.subject.otherPrimary care
dc.titleRecognition of depression by primary care clinicians in rural Ethiopia
dc.typeJournal Article
uct.type.publicationResearch
uct.type.resourceJournal Article
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