Abstract
Background: The Programme for Improving Mental Health Care (PRIME) sought to implement mental health care plans (MHCP) for four priority mental disorders (depression, alcohol use disorder, psychosis and epilepsy) into routine primary care in five low- and middle-income country districts. The impact of the MHCPs on disability was evaluated through establishment of priority disorder treatment cohorts. This paper describes the methodology of these PRIME cohorts.
Methods: One cohort for each disorder was recruited across some or all five districts: Sodo (Ethiopia), Sehore (India), Chitwan (Nepal), Dr. Kenneth Kaunda (South Africa) and Kamuli (Uganda), comprising 17 treatment cohorts in total (N =2182). Participants were adults residing in the districts who were eligible to receive mental health treatment according to primary health care staff, trained by PRIME facilitators as per the district MHCP. Patients who screened positive for depression or AUD and who were not given a diagnosis by their clinicians (N =709) were also recruited into comparison cohorts in Ethiopia, India, Nepal and South Africa. Caregivers of patients with epilepsy or psychosis were also recruited (N =953), together with or on behalf of the person with a mental disorder, depending on the district. The target sample size was 200 (depression and AUD), or 150 (psychosis and epilepsy) patients initiating treatment in each recruiting district. Data collection activities were conducted by PRIME research teams. Participants completed follow-up assessments after 3 months (AUD and depression) or 6 months (psychosis and epilepsy), and after 12 months. Primary outcomes were impaired functioning, using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS), and symptom severity, assessed using the Patient Health Questionnaire (depression), the Alcohol Use Disorder Identification Test (AUD), and number of seizures (epilepsy).
Discussion: Cohort recruitment was a function of the clinical detection rate by primary health care staff, and did not meet all planned targets. The cross-country methodology reflected the pragmatic nature of the PRIME cohorts: while the heterogeneity in methods of recruitment was a consequence of differences in health systems and MHCPs, the use of the WHODAS as primary outcome measure will allow for comparison of functioning recovery across sites and disorders.
| Original language | English |
|---|---|
| Article number | 61 |
| Journal | BMC Psychiatry |
| Volume | 18 |
| DOIs | |
| Publication status | Published - 06 Mar 2018 |
| Externally published | Yes |
Bibliographical note
Funding Information:This study was approved by the University of Cape Town’s Health Sciences Faculty Human Research Ethics committee (HREC REF: 412/2011), South Africa, and by the WHO Research Ethics Review Committee, Switzerland. Consent forms were translated in local languages and completed by all participants who agreed to participate, and/or by their caregivers, where appropriate. Each district also received Ethical approval from their relevant local Research Ethics Committees: Institutional Review Board of the College of Health Sciences of Addis Ababa University, Ethiopia; Sangath Institutional Review Board, India; Indian Council of Medical Research, India; Nepal Health
Funding Information:
This document is an output from the Programme for Improving Mental Health Care (PRIME). This work is supported by the UK Department for International Development [201446]. The views expressed here do not necessarily reflect the UK Government’s official policies.
Funding Information:
1Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road 7700 Rondebosch, Cape Town, South Africa. 2Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK. 3College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia. 4Centre for Global Mental Health, Health Services and Population Research Department, King’s College London, London, UK. 5Centre for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia. 6Global Health and Infection Department, Brighton and Sussex Medical School, University of Sussex, Brighton, UK. 7Butabika National Referral and Teaching Mental Hospital, Makerere University, Kampala, Uganda. 8Research and Development Department, HealthNet TPO, Amsterdam, the Netherlands. 9Center for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK. 10Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal. 11Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia. 12Sangath, Goa, India. 13Harvard Medical School, Boston, USA. 14Public Health Foundation of India, New Delhi, India. 15Centre for Rural Health, School of Nursing and Public Health and School of Applied Human Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa. 16Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India. 17CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands. 18Alan J Flisher Centre for Public Mental Health, Department of Psychology, Stellenbosch University, Stellenbosch, South Africa. 19Department of Population Health, Wellcome Trust, London, UK.
Publisher Copyright:
© 2018 The Author(s).
Keywords
- Alcohol dependence
- Cohort; depression
- Epilepsy
- Low-income populations
- Primary healthcare
- Psychosis
ASJC Scopus subject areas
- Psychiatry and Mental health
Access to Document
- Impact of district mental health care plans on symptom severity and functioning of patients with priority mental health conditions: the Programme for Improving Mental Health Care (PRIME) cohort protocol
Copyright 2022 the authors. This is an open access article published under a Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium, provided the author and source are cited.