Evaluation of the integration of mental health services into the primary and community healthcare system in Nepal

Globally, there is a huge gap between the number of people who need mental health care and those who receive it. In recent years, a large body of evidence has been generated indicating the effectiveness of the task-shifting approach where mental health services are delivered by primary and community health care providers. In the task-sharing approach, mental health specialists are involved in designing and managing mental health services, building clinical capacity of the primary health care providers, and providing supervision and quality assurance. The World Health Organization (WHO) advocates integration of mental health services into the primary health care system as a practical and effective means to lower the treatment gap on mental health care. In this direction, WHO has developed the Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) to help to facilitate the effective integration of mental health services into the primary health care system, particularly in low-and-middle income countries. Although integration of mental health services into primary health care has been widely advocated, this has not been systematically evaluated in a real-world setting. This dissertation presents studies conducted to generate new evidence in implementation and evaluation of mental health services in the primary and community health care system in Nepal

Developing Culturally Contextualised Mathematics Resource Materials: Capturing Local Practices of Tamang and Gopali Communities

Setting out to develop culturally contextualised curriculum support materials for teachers and students and a material for parental awareness, the project produced five sets of support materials incorporating the cultural practices of Tamang and Gopali communities. By following a two-phase procedural strategy the project demonstrated a unique possibility of integrating Nepali local cultural practices in school mathematics curriculum

Probability of major depression classification based on the SCID, CIDI, and MINI diagnostic interviews: A synthesis of three individual participant data meta-analyses

Introduction: Three previous individual participant data meta-analyses (IPDMAs) reported that, compared to the Structured Clinical Interview for the DSM (SCID), alternative reference standards, primarily the Composite International Diagnostic Interview (CIDI) and the Mini International Neuropsychiatric Interview (MINI), tended to misclassify major depression status, when controlling for depression symptom severity. However, there was an important lack of precision in the results. Objective: To compare the odds of the major depression classification based on the SCID, CIDI, and MINI. Methods: We included and standardized data from 3 IPDMA databases. For each IPDMA, separately, we fitted binomial generalized linear mixed models to compare the adjusted odds ratios (aORs) of major depression classification, controlling for symptom severity and characteristics of participants, and the interaction between interview and symptom severity. Next, we synthesized results using a DerSimonian-Laird random-effects meta-analysis. Results: In total, 69,405 participants (7,574 [11%] with major depression) from 212 studies were included. Controlling for symptom severity and participant characteristics, the MINI (74 studies; 25,749 participants) classified major depression more often than the SCID (108 studies; 21,953 participants; aOR 1.46; 95% confidence interval [CI] 1.11-1.92]). Classification odds for the CIDI (30 studies; 21,703 participants) and the SCID did not differ overall (aOR 1.19; 95% CI 0.79-1.75); however, as screening scores increased, the aOR increased less for the CIDI than the SCID (interaction aOR 0.64; 95% CI 0.52-0.80). Conclusions: Compared to the SCID, the MINI classified major depression more often. The odds of the depression classification with the CIDI increased less as symptom levels increased. Interpretation of research that uses diagnostic interviews to classify depression should consider the interview characteristics. © 202