Health service utilization by patients with common mental disorder identified by the SRQ-20 in a primary care setting in Zomba, Malawi : a descriptive study

[摘要] ENGLISH ABSTRACT: Background: Health service utilization by people with mental health problems seem to be a large public health issue, especially in low-income countries. In Malawi, the situation is not different from other developing countries in Sub-Saharan Africa as far as access to services for people with mental health problems is concerned. Non specialized health care workers provide mental health services in the primary care settings in Malawi and, given the workload at primary health care (PHC) setting level, little time is available to screen for mental disorders, hence these may go unrecognized. Therefore, there is a possibility that a significant proportion of patients attending primary care in Malawi may have common mental disorders (CMD) and may be deprived of routine screening. Consequently, the possibility of misdiagnosis may lead to higher service utilization by people with common mental health problems. However, no study has been carried out to assess the health service utilization by people with common mental disorders in Malawi.Aim: The aim of the study was to evaluate health services utilization patterns of patients with CMDs in primary care clinics.Methods: This was a quantitative study employing a cross-sectional descriptive design. The study was conducted in two primary health care clinics in one of the 28 districts in Malawi. The study included all consecutive patients aged 18 years and older who attended the primary health care clinics for any reason. Face-to-face interviews using the Self-Reporting Questionnaires (SRQ-20) were conducted in a sample of 323 primary health care attendees.Findings: The prevalence of probable CMD was 20.1%. People with CMD had a higher average number of health facility visits in the previous three months compared to those without probable CMD thus 1.6 vs. 1.19 (p-value 0.02). There was no significant difference in the average number of traditional healer visits in the previous three months between those with probable CMD and those without thus 0.05 vs. 0.08 (p-value = 0.565). The total average number of both health facility and traditional healer visits was 1.68 vs. 1.24 (p-value 0. 019), people with probable CMD having a higher average compared to those without a probable CMD. It was found that people who have visited the health care facility repeatedly in the past 3 months were likely to be suffering from CMD. The odds of probable CMD increased with each visit to a health facility by 1.2 (p-value=0.024). Almost all those who had probable CMD had no treatment prescribed for CMD by PHC clinicians.Conclusion: The study reveals high utilization of health services for people with CMD, as well as a treatment gap of mental health care in primary care settings. PHC workers are misdiagnosing patients with CMDs leading to high utilization of PHC services. There is need for PHC workers to improve skills in diagnosing patients with CMD to make PHC services more effective by reducing re-attendances and improving patient outcomes. There is also need to direct effort towards creating awareness about mental health and encourage patient disclosure of psychological or mental health problems.

[发布机构] Stellenbosch University