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Social Psychiatry and Psychiatric Epidemiology

, Volume 53, Issue 11, pp 1277–1287 | Cite as

Patterns of concordances in mhGAP-IG screening and DSM-IV/ICD10 diagnoses by trained community service providers in Kenya: a pilot cross-sectional study

  • Victoria N. Mutiso
  • Christine W. Musyimi
  • Tahilia J. Rebello
  • Isaiah Gitonga
  • Albert Tele
  • Kathleen M. Pike
  • David M. NdeteiEmail author
Original Paper

Abstract

Purpose

The objective of this study was to determine the extent of concordance between positive screens for mental disorders by various trained community-based health workers using the WHO mental health Gap Action Programme Intervention Guide (mhGAP-IG) and independently confirmed DSM-IV/ICD-10 diagnoses.

Methods

This was a cross-sectional study conducted in Makueni County, Kenya. 40 nurses/clinical officers, 60 Community Health Workers (CHWs), 51 Faith Healers (FHs), and 59 Traditional Healers (THs) from 20 facilities were trained to screen and refer patients with eight priority mental health conditions using the mhGAP-IG. These referrals, as well as referrals from friends or family members, and self-referrals were assessed using the Mini International Neuropsychiatric Instrument (M.I.N.I.) Plus. Concordance between positive screens and M.I.N.I. Plus diagnoses was investigated.

Results

15,078 community members agreed to participate in screening. Of these 12,170 (81%) screened positive for a mental disorder and were referred to their local clinics/hospitals. 8333 (68.5%) of those who were referred went for independent diagnostic assessment at the nearest facility. Positive predictive values varied with different providers and for different conditions. There was over 80% concordance between the initial screen and the M.I.N.I. Plus diagnoses across the different health providers and across all diagnoses.

Conclusion

Both formal and informal mental health providers can be trained to successfully and accurately screen for mental health disorders using the mhGAP-IG symptoms. This suggests that community-based non-specialist providers may play a key role in decreasing the mental health treatment gap. Further policy implications are discussed.

Keywords

Screening Concordance Mental health Policy Primary healthcare 

Notes

Acknowledgements

Grand Challenges Canada for funding the project, the Government of Makueni County for all ground logistics, Ian Rodgers and Sherin Asiimwe from the Columbia University Global Mental Health Program for their review and editorial inputs.

Author contributions

VM—conception of the study, study design, implementation and interpretation of data; approval of the final draft; KP—study design; CM and TR—research design, field work, ethics oversight, data quality control, interpretation of the data, initial drafting; IG—field supervision and literature review, reading the manuscript; AT—data analysis and interpretation and DMN—conception of the study, study design, implementation, interpretation of data; drafting and revising the paper, approval of the final draft, overall oversight.

Funding

This study was funded by Grand Challenges Canada (GCC), Grant #0739-05 granted to the Africa Mental Health Foundation (AMHF).

Compliance with ethical standards

Conflict of interest

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

Data sharing and availability

The data for this paper will be made available upon written request to the corresponding author detailing the specific parts of the data to be shared and the intended purpose. The data legally belongs to Africa Mental Health Foundation (AMHF). If for publication, the authorship will be agreed upfront using the AMHF data sharing policy. All ethical considerations on human subject data will apply.

References

  1. 1.
    World Health Organization (2013) WHO Mental Health Action Plan 2013–2020Google Scholar
  2. 2.
    World Health Organization (2010) mhGAP Intervention Guide for mental, neurological and substance use disorders in non-specialized health settings. pp 1–121Google Scholar
  3. 3.
    Steel Z, Marnane C, Iranpour C et al (2014) The global prevalence of common mental disorders: a systematic review and meta-analysis 1980–2013. Int J Epidemiol 43:476–493CrossRefGoogle Scholar
  4. 4.
    Ndetei DM, Khasakhala LI, Kuria MW et al (2009) The prevalence of mental disorders in adults in different level general medical facilities in Kenya: a cross-sectional study. Ann Gen Psychiatry 8:1.  https://doi.org/10.1186/1744-859X-8-1 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Shidhaye R, Lund C, Chisholm D (2015) Closing the treatment gap for mental, neurological and substance use disorders by strengthening existing health care platforms: strategies for delivery and integration of evidence-based interventions. Int J Ment Health Syst 9:1.  https://doi.org/10.1186/s13033-015-0031-9 CrossRefGoogle Scholar
  6. 6.
    Patel V (2007) Mental health in low- and middle-income countries. Br Med Bull 81–82:81–96.  https://doi.org/10.1093/bmb/ldm010 CrossRefGoogle Scholar
  7. 7.
    Scott KM, Lim C, Al-Hamzawi A et al (2016) Association of mental disorders with subsequent chronic physical conditions: world mental health surveys from 17 countries. JAMA Psychiatry 73:150–158CrossRefGoogle Scholar
  8. 8.
    Meade CS, Bevilacqua LA, Key MD (2012) Bipolar disorder is associated with HIV transmission risk behavior among patients in treatment for HIV. AIDS Behav 16:2267–2271CrossRefGoogle Scholar
  9. 9.
    Grover S, Sahoo S, Goyal MK (2017) Schizophrenia with comorbid idiopathic parkinson’s disease: a difficult clinical management scenario. Indian J Psychol Med 39:823CrossRefGoogle Scholar
  10. 10.
    Naushad N, Dunn LB, Muñoz RF et al (2018) Depression increases subjective stigma of chronic pain. J Affect DisordGoogle Scholar
  11. 11.
    Mendenhall E, Kohrt BA, Norris SA et al (2017) Non-communicable disease syndemics: poverty, depression, and diabetes among low-income populations. Lancet 389:951–963CrossRefGoogle Scholar
  12. 12.
    Denckla CA, Ndetei DM, Mutiso VN et al (2017) Psychometric properties of the Ndetei–Othieno–Kathuku (NOK) Scale: a mental health assessment tool for an African setting. J Child Adolesc Ment Health.  https://doi.org/10.2989/17280583.2017.1310729 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Jenkins R, Kiima D, Okonji M et al (2010) Integration of mental health into primary care and community health working in Kenya: context, rationale, coverage and sustainability. Ment Health Fam Med 7:37–47PubMedPubMedCentralGoogle Scholar
  14. 14.
    Nortje G, Oladeji B, Gureje O et al (2016) Effectiveness of traditional healers in treating mental disorders: a systematic review. Lancet Psychiatry 3:154–170.  https://doi.org/10.1016/S2215-0366(15)00515-5 CrossRefPubMedGoogle Scholar
  15. 15.
    Gitonga C (2013) The state of the health referral system in Kenya: results from a baseline study on the functionality of the health referral system in eight counties. NairGoogle Scholar
  16. 16.
    AMREF (2015) AMREF’ s position on the role and services of traditional birth attendants. pp 1–2Google Scholar
  17. 17.
    Mwai GW, Mburu G, Torpey K et al (2013) Role and outcomes of community health workers in HIV care in sub-Saharan Africa: a systematic review. J Int AIDS Soc 16CrossRefGoogle Scholar
  18. 18.
    Musyimi CW, Mutiso VN, Nandoya ES et al (2016) Forming a joint dialogue among faith healers, traditional healers and formal health workers in mental health in a Kenyan setting: towards common grounds. J Ethnobiol Ethnomed 12:4.  https://doi.org/10.1186/s13002-015-0075-6 CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Musyimi CW, Mutiso V, Ndetei DM et al (2017) Mental health outcomes of psychosocial intervention among traditional health practitioner depressed patients in Kenya. Cult Med Psychiatry  https://doi.org/10.1007/s11013-017-9527-x CrossRefPubMedGoogle Scholar
  20. 20.
    Sheehan DV, Lecrubier Y, Sheehan KH et al (1998) The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59(Suppl 2):22–33Google Scholar
  21. 21.
    Sheehan DV, Lecrubier Y, Sheehan KH et al (1997) The validity of the Mini International Neuropsychiatric Interview (MINI) according to the SCID-P and its reliability. Eur Psychiatry 12:232–241CrossRefGoogle Scholar
  22. 22.
    Myer L, Smit J, Roux L, Le et al (2008) Common mental disorders among HIV-infected individuals in South Africa: prevalence, predictors, and validation of brief psychiatric rating scales. AIDS Patient Care STDS 22:147–158.  https://doi.org/10.1089/apc.2007.0102 CrossRefPubMedGoogle Scholar
  23. 23.
    Pinninti NR, Madison H, Musser E et al (2003) MINI international neuropsychiatric schedule: clinical utility and patient acceptance. Eur Psychiatry 18:361–364.  https://doi.org/10.1016/j.eurpsy.2003.03.004 CrossRefGoogle Scholar
  24. 24.
    Kaminer D, Stein DJ, Mbanga I et al (2001) The truth and reconciliation commission in South Africa: relation to psychiatric status and forgiveness among survivors of human rights abuses. Br J Psychiatry 178:373–377.  https://doi.org/10.1192/BJP.178.4.373 CrossRefGoogle Scholar
  25. 25.
    Chishinga N, Kinyanda E, Weiss HA et al (2011) Validation of brief screening tools for depressive and alcohol use disorders among TB and HIV patients in primary care in Zambia. BMC Psychiatry 11:75.  https://doi.org/10.1186/1471-244X-11-75 CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Government of Makueni County (2018) http://www.makueni.go.ke/. Accessed 23 Mar 2018
  27. 27.
    Makueni County. Department of Health Services (2018) https://www.makueni.go.ke/health-services. Accessed 23 Mar 2018
  28. 28.
    Sharpe D (2015) Your chi-square test is statistically significant: now what? Pract Assess Res Eval 20Google Scholar
  29. 29.
    Keppel G, Wickens TD (2004) Simultaneous comparisons and the control of type I errorsGoogle Scholar
  30. 30.
    Keynejad RC, Dua T, Barbui C et al (2017) WHO Mental Health Gap Action Programme (mhGAP) Intervention Guide: a systematic review of evidence from low and middle-income countries. Evid Based Ment HealthGoogle Scholar
  31. 31.
    Bertakis KD, Azari R, Helms LJ et al (2000) Gender differences in the utilization of health care services. J Fam Pract 49:147PubMedGoogle Scholar
  32. 32.
    Galdas PM, Cheater F, Marshall P (2005) Men and health help-seeking behaviour: literature review. J Adv Nurs 49:616–623CrossRefGoogle Scholar
  33. 33.
    Rowe SY, Kelly JM, Olewe MA et al (2007) Effect of multiple interventions on community health workers’ adherence to clinical guidelines in Siaya district, Kenya. Trans R Soc Trop Med Hyg 101:188–202CrossRefGoogle Scholar
  34. 34.
    Mendenhall E, Omondi GB, Bosire E et al (2015) Stress, diabetes, and infection: syndemic suffering in an urban public hospital clinic in Kenya. Soc Sci Med 146:11–20.  https://doi.org/10.1016/j.socscimed.2015.10.015 CrossRefPubMedGoogle Scholar
  35. 35.
    Musyimi CW, Mutiso VN, Haji ZR et al (2016) Mobile based mhGAP-IG depression screening in Kenya. Commun Ment Health J.  https://doi.org/10.1007/s10597-016-0072-9 CrossRefGoogle Scholar
  36. 36.
    Ndetei DM, Kathuku DMOC (2000) Substance abuse among outpatients attending rural and urban health centres in Kenya. East Afr Med J 77:592–595PubMedGoogle Scholar
  37. 37.
    Ndetei DM, Khasakhala LI, Mutiso V, Ongecha-Owuor FA, Kokonya DA (2009) Patterns of drug abuse in public secondary schools in Kenya. J Subst Abuse 30:69–78CrossRefGoogle Scholar
  38. 38.
    Saeed K, Gater R, Hussain A et al (2000) The prevalence, classification and treatment of mental disorders among attenders of native faith healers in rural Pakistan. Soc Psychiatry Psychiatr Epidemiol 35:480–485CrossRefGoogle Scholar
  39. 39.
    Patel V (1998) Outcome of common mental disorders in Harare, Zimbabwe. Br J Psychiatry.  https://doi.org/10.1192/bjp.172.1.53 CrossRefGoogle Scholar
  40. 40.
    Fernando S (2014) Mental health worldwide: culture, globalization and development. Springer, New YorkCrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Victoria N. Mutiso
    • 1
  • Christine W. Musyimi
    • 1
    • 2
  • Tahilia J. Rebello
    • 3
  • Isaiah Gitonga
    • 1
  • Albert Tele
    • 1
  • Kathleen M. Pike
    • 3
  • David M. Ndetei
    • 1
    • 4
    Email author
  1. 1.Africa Mental Health FoundationNairobiKenya
  2. 2.Vrije UniversiteitAmsterdamThe Netherlands
  3. 3.Global Mental Health ProgramColumbia UniversityNew YorkUSA
  4. 4.Department of PsychiatryUniversity of Nairobi and Founding Director of Africa Mental Health FoundationNairobiKenya

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