Patterns of concordances in mhGAP-IG screening and DSM-IV/ICD10 diagnoses by trained community service providers in Kenya: a pilot cross-sectional study
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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.
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.
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.
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.
KeywordsScreening Concordance Mental health Policy Primary healthcare
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.
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.
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.
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