Integrating depression care within NCD provision in Bangladesh and Pakistan : a qualitative study

Background Co-morbidity of depression with other non-communicable diseases (NCDs) worsens clinical outcomes for both conditions. Low- and middle-income countries need to strengthen mechanisms for detection and management of co-morbid depression within NCDs. The Behavioural Activation for Comorbid Depression in Non-communicable Disease (BEACON) study explored the acceptability and feasibility of integrating a brief depression intervention (behavioural activation, BA) into NCD services in healthcare facilities in Bangladesh and Pakistan. Methods Face-to-face qualitative interviews were conducted with 43 patients and 18 health workers attending or working in NCD centres in four healthcare facilities in Bangladesh and Pakistan, and with three policy makers in each country. The interviews addressed four research questions (1) how NCD care is delivered, (2) how NCD patients experience distress, (3) how depression care is integrated within NCD provision, and (4) the challenges and opportunities for integrating a brief depression intervention into usual NCD care. The data were analysed using framework analysis, organised by capability, opportunity and motivation factors, cross-synthesised across countries and participant groups. Results Patients and health workers described NCD centres as crowded and time pressured, with waiting times as long as five hours, and consultation times as short as five minutes; resulting in some patient frustration. They did not perceive direct links between their distress and their NCD conditions, instead describing worries about family and finance including affordability of NCD services. Health worker and policy maker accounts suggested these NCD centres lacked preparedness for treating depression in the absence of specific guidelines, standard screening tools, recording systems or training. Barriers and drivers to integrating a brief depression intervention reflected capability, opportunity and motivation factors for all participant groups. While generally valuing the purpose, significant challenges included the busy hospital environment, skill deficits and different conceptions of depression. Conclusions Given current resource constraints and priorities, integrating a brief psychological intervention at these NCD centres appears premature. An opportune first step calls for responding to patients’ expressed concerns on service gaps in provisioning steady and affordable NCD care. Acknowledging differences of conceptions of depression and strengthening psychologically informed NCD care will in turn be required before the introduction of a specific psychological intervention such as BA

Choir concert

Joseph HaydnRandall ThompsonIsadore FreedEugene ButlerWilliam SchumanWilliam ByrdJohannes BrahmsBenjamin BrittenAaron CoplandAndre ThomasJere HutchesonDavid Stocke

Indigenous indicators of health security in relation to climatic disasters in Bangladesh

Health is a core aspect of human security. Meanwhile human security is considered to reduce disaster risk. However, despite this logically derived association, we could find no studies that provide evidence of how people residing in the world's most environmentally at risk locations view health as a defence against disasters. This article therefore draws on findings from our research showing how people at risk of major climatic events in Bangladesh interpret disasters and accompanying health security indicators. The findings show that health is locally considered a protector against climate-related environmental hazards and that there are differences between individual and community level indicators. Health security in contexts of indigenously defined hazards and disasters at these study sites was based on a combination of economic and social processes related to food, livelihoods and finance. The study shows that health can underpin the means that a local community gains security in contexts of major climatic risks. The study shows the importance of a locally based and people-centred understanding of climatic hazards and disasters and the processes underlying health and wellbeing