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Depressive symptoms, suicidal ideation, and mental health care-seeking in central Mozambique

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Abstract

Purpose

There is scant research on depressive symptoms (DS), suicidal ideation (SI), and mental health care-seeking in Mozambique.

Methods

Generalized estimating equations were used to assess factors associated with DS, SI, and mental health care-seeking among 3080 individuals interviewed in a representative household survey in Sofala and Manica provinces, Mozambique.

Results

19% (CI 17–21%) of respondents reported DS in the past year and 17% (CI 15–18%) lifetime SI. Overall, only 10% (CI 8–11%) of respondents ever sought any care for mental illness, though 26% (CI 23–29%) of those reporting DS and/or SI sought care. 90% of those who sought care for DS received treatment; however, only 46% of those who sought care for SI received treatment. Factors associated with DS and SI include: female gender, divorced/separated, widowed, and > 55 years old. Respondents in the bottom wealth quintile reported lower DS, while those in upper wealth quintiles reported higher prevalence of SI. Individuals with DS or SI had significantly elevated measures of disability—especially in doing household chores, work/school activities, standing for long periods, and walking long distances. Factors associated with care-seeking include: female gender, rural residence, divorced/separated, and > 45 years old. Individuals in lower wealth quintiles and with no religious affiliation had lower odds of seeking care.

Conclusions

DS and SI are prevalent in central Mozambique and treatment gaps are high (68% and 89%, respectively). An urgent need exists for demand- and supply-side interventions to optimize the delivery of comprehensive community-based mental healthcare in Mozambique.

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Acknowledgements

This work was supported by the African Health Initiative of the Doris Duke Charitable Foundation. INCOMAS Study Team includes: Falume Chale; Alfredo Covele; Fatima Cuembelo; Stephen Gloyd; Catherine Henley; Leecreesha Hicks; Joaquim Lequechane; Arlete Mahumane; Nelia Manaca; Cathy Michel; Alberto Muanido; Miguel Nhumba; James Pfeiffer; and Lucia Vieira.

Funding

This study was supported by the Doris Duke Charitable Foundation’s African Health Initiative. Bradley H. Wagenaar was supported by Grant number K01MH110599 from the US National Institute of Mental Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Global Health, University of Washington, Seattle, WA, USA

    Sheldon Halsted, Kristjana H. Ásbjörnsdóttir, Bradley H. Wagenaar, Orvalho Augusto, Sarah Gimbel & Kenneth Sherr

  2. Health Alliance International, Seattle, WA, USA

    Kristjana H. Ásbjörnsdóttir, Bradley H. Wagenaar, Orvalho Augusto, Sarah Gimbel & Kenneth Sherr

  3. Sofala Provincial Health Directorate, Department of Mental Health, Ministry of Health, Beira, Mozambique

    Vasco Cumbe

  4. Eduardo Mondlane University, Maputo, Mozambique

    Orvalho Augusto

  5. School of Nursing, University of Washington, Seattle, WA, USA

    Sarah Gimbel

  6. Health Alliance International, Beira, Mozambique

    Nelia Manaca

  7. Beira Operations Research Center (Centro de Investigação Operacional da Beira, CIOB), Beira, Mozambique

    João Luis Manuel

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  1. Sheldon Halsted
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Consortia

with input from the INCOMAS Study Team

Contributions

BHW, KA, and SH conceived the idea. BHW, OA, SG, KS, KA and the INCOMAS Study Team collected the data. KA and SH designed the analysis with input from BHW. SH wrote the first draft of the manuscript under mentorship of KA and creative input from BHW. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Sheldon Halsted.

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Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval and consent to participate

The study was approved by the Institutional Bio-ethics Committee of the National Institute of Health in Mozambique. All survey respondents provided written informed consent. In cases where participant could not read or write, s/he provided a thumbprint.

Statement of Originality

The authors attest that all work is original and that it has not been published or submitted anywhere other than to Social Psychiatry and Psychiatric Epidemiology.

Appendix

Appendix

See Tables 5, 6, 7.

Table 5 Prevalence of Mental Health Care-seeking among 3080 individuals in the present study, 2016
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Table 6 Mental Health Care-seeking: multivariable analyses of individuals in the present study, 2016–2017
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Table 7 Multivariable analyses of individuals in the present study stratified by gender, 2016–2017
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Halsted, S., Ásbjörnsdóttir, K.H., Wagenaar, B.H. et al. Depressive symptoms, suicidal ideation, and mental health care-seeking in central Mozambique. Soc Psychiatry Psychiatr Epidemiol 54, 1519–1533 (2019). https://doi.org/10.1007/s00127-019-01746-2

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