Mental health service preferences of patients and providers: a scoping review of conjoint analysis and discrete choice experiments from global public health literature over the last 20 years (1999–2019)

Abstract: Background: In designing, adapting, and integrating mental health interventions, it is pertinent to understand patients’ needs and their own perceptions and values in receiving care. Conjoint analysis (CA) and discrete choice experiments (DCEs) are survey-based preference-elicitation approaches that, when applied to healthcare settings, offer opportunities to quantify and rank the healthcare-related choices of patients, providers, and other stakeholders. However, a knowledge gap exists in characterizing the extent to which DCEs/CA have been used in designing mental health services for patients and providers. Methods: We performed a scoping review from the past 20 years (2009–2019) to identify and describe applications of conjoint analysis and discrete choice experiments. We searched the following electronic databases: Pubmed, CINAHL, PsychInfo, Embase, Cochrane, and Web of Science to identify stakehold,er preferences for mental health services using Mesh terms. Studies were categorized according to pertaining to patients, providers and parents or caregivers. Results: Among the 30 studies we reviewed, most were published after 2010 (24/30, 80%), the majority were conducted in the United States (11/30, 37%) or Canada (10/30, 33%), and all were conducted in high-income settings. Studies more frequently elicited preferences from patients or potential patients (21/30, 70%) as opposed to providers. About half of the studies used CA while the others utilized DCEs. Nearly half of the studies sought preferences for mental health services in general (14/30, 47%) while a quarter specifically evaluated preferences for unipolar depression services (8/30, 27%). Most of the studies sought stakeholder preferences for attributes of mental health care and treatment services (17/30, 57%)

Personality traits as markers of psychosis risk in Kenya: Assessment of temperament and character

Specific personality traits have been proposed as a schizophrenia-related endophenotype and confirmed in siblings at risk for psychosis. The relationship of temperament and character with psychosis has not been previously investigated in Africa. The study was conducted in Kenya, and involved participants at clinical high-risk (CHR) for psychosis

Prevalence and risk factors associated with depression in pregnant adolescents in Nairobi, Kenya

Background: Adolescent parenthood can be associated with a range of adverse outcomes for young mothers such as depression, substance abuse, and posttraumatic stress disorder. Identification of depression and understanding risk factors among pregnant adolescents is important for development of appropriate interventions and programs focused on adolescent mental health. This paper reports on the findings of the prevalence of depression and its associated risk factors among pregnant adolescents in Nairobi, Kenya. Methods: We recruited 153 pregnant adolescent (14-18 years) who were accessing maternal health services in one of two Nairobi County primary health care facilities in the cross-sectional survey conducted in 2021. The Patient Health Questionnaire 9 was used to screen for depression. Multivariate Stepwise linear regression modelling was used to identify key predictors of depression. Results: Using a cut off of 10 and above on PHQ-9, we found that 43.1% of the respondents were depressed. Depressive symptoms in were independently associated with being in school, experience of intimate partner violence, substance use within the family and having experienced pressure to use substances by family or peers. Limitations: Cross-sectional by design and the applications of our findings are limited to settings that are similar to our study population. The PHQ-9 used has not been psychometrically validated locally in this sample. Conclusion: We found a high prevalence of depressive symptoms among respondents. These risk factors identified merit further investigation. Comprehensive mental health screening needs to be integrated in primary and community health services on the possible presence of depression

Validation of the English and Swahili Adaptation of the Patient Health Questionnaire–9 for Use Among Adolescents in Kenya

Purpose: Our study aimed to validate culturally adapted English and Swahili versions of the Patient Health Questionnairee9 (PHQ-9) for use with adolescents in Kenya. Criterion validity was determined with clinician-administered diagnostic interviews using the Kiddie Schedule of Affective Disorders and Schizophrenia. Methods: A total of 250 adolescents comprising 148 (59.2%) females and 102 (40.8%) males aged 10e19 years (mean ¼ 14.76; standard deviation ¼ 2.78) were recruited. The PHQ-9 was administered to all respondents concurrently in English and Swahili. Adolescents were later interviewed by clinicians using Kiddie Schedule of Affective Disorders and Schizophrenia to determine the presence or absence of current symptoms of major depressive disorder. Sensitivity specificity, positive predictive value (PPV) and negative predictive value (NPV), and likelihood ratios for various cut-off scores for PHQ-9 were analyzed using receiver operating characteristic curves. Results: The internal consistency (Cronbach’s a) for PHQ-9 was 0.862 for the English version and 0.834 for Swahili version. The area under the curve was 0.89 (95% confidence interval, 0.84e0.92) and 0.87 (95% confidence interval, 0.82e0.90) for English and Swahili version, respectively, on receiver operating characteristic analysis. A cut-off of 9 on the English-language version had a sensitivity of 95.0%, specificity of 73.0%, PPV of 0.23, and NPV of 0.99; a cut-off of 9 on the Swahili version yielded a sensitivity of 89.0%, specificity of 70.0%, PPV of 0.20, and NPV of 0.9

Using the WHO-AIMS to inform development of mental health systems: the case study of Makueni County, Kenya

Background In order to develop a context appropriate in mental health system, there is a need to document relevant existing resources and practices with a view of identifying existing gaps, challenges and opportunities at baseline for purposes of future monitoring and evaluation of emerging systems. The World Health Organization Assessments Instrument for Mental Health Systems (WHO-AIMS) was developed as a suitable tool for this purpose. Our overall objective of this study, around which research questions and specific aims were formulated, was to establish a baseline on mental health system as at the time of the study, at Makueni County in Kenya, using the WHO-AIMS. Methods To achieve our overall objective, answer our research questions and achieve specific aims, we conducted a mixed methods approach in which we did an audit of DHIS records and county official records, and conducted qualitative interviews with the various officers to establish the fidelity of the data according to their views. The records data was processed via the prescribed WHO-Aims 2.2 excel spreadsheet while the qualitative data was analyzed thematically. This was guided by the six domains stipulated in the WHO AIMS. Results We found that at the time point of the study, there were no operational governance, policy or administrative structures specific to mental health, despite recognition by the County Government of the importance of mental health. The identified interviewees and policy makers were cooperative and participatory in identifying the gaps, barriers and potential solutions to those barriers. The main barriers and gaps were human and financial resources and low prioritization of mental health in comparison to physical conditions. The solutions lay in bridging of the gaps and addressing the barriers. Conclusion There is a need to address the identified gaps and barriers and follow up on solutions suggested at the time of the study, if a functional mental health system is to be achieved at Makueni County

Unemployment in women with psychosocial disabilities during the COVID-19 pandemic: Lessons from Tana River County, Kenya

In low-income settings, the informal economy is a practical alternative to work and employment for persons with disabilities. However, the COVID-19 pandemic negatively affected the informal economy. This study aimed to explore the experiences of women with psychosocial disabilities in Kenya during the pandemic. We found that the pandemic worsened their experiences of work and employment, and they did not receive any social welfare or support from the government. Our findings suggest that pandemic management must adopt inclusive and context-sensitive approaches that support persons with psychosocial disabilities. Social welfare and protection for persons with disabilities are relevant for socio-economic empowerment and inclusion

Exploring the correlates of mental healthcare approaches and employment status among persons with depression and anxiety: A secondary data analysis of a global survey

Background: Anxiety and depression are highly prevalent among working age population, and these conditions have been associated with employment disadvantages. Global understanding of correlates of employment status of persons living with anxiety and depression is necessary to develop and implement policies and interventions to promote better employment outcomes. We aimed to investigate the association between sociodemographic factors, mental healthcare approaches and employment status among persons who experience anxiety and depression. Method: We used data from the 2020 Wellcome Global Monitor survey to explore the correlates of employment status among persons with Depression and Anxiety globally. Multivariable logistic regression analysis and Chi square test were conducted to evaluate the relationships between socio-demographic factors, mental healthcare approach such as self-management, professional care, religious and social support on employment status of people with anxiety and depression. Findings: Employment status significantly varied by socio-demographic factors, per capita income of countries, and the type of mental health care approach they used to alleviate anxiety and depression. Older participants, those with college degrees, those who talked to mental health professionals, those who improved on their healthy lifestyle behaviors, those who made a change to their work situation, spent time in nature or outdoors when anxious/ depressed were more likely to be employed as compared to those who did not use approaches. Interpretation: Our findings highlight important connections between mental healthcare and employment, prioritizing these connections in policies and intervention can help curb the economic and personal burden of anxiety and depression

Improving work and employment opportunities for women with psychosocial disabilities:An action research protocol

In Kenya, employment rates for persons with disabilities are very low and those with psychosocial disabilities have even more dismal rates of employment. This situation has negative impact on the individual’s recovery, quality of life, mental and physical health. The systemic exclusion of persons with psychosocial disabilities in work and employment disproportionately affects women. The aim of this study is to test the feasibility of disability inclusion training to improve work and employment opportunities for women with psychosocial disabilities in Tana River County, Kenya. The study will adopt a mixed methods research design using action research approach. A sample of women with psychosocial disabilities will be trained using a researcher designed disability inclusion training manual, while employers and other stakeholders will be trained on inclusive employment. Trainings will be tailored to suit different employers and for different types of psychosocial disabilities. Interactive learning and linking sessions involving the two groups and process evaluations will be conducted at different time points to measure the impact of the intervention. Findings from this pilot study will inform future research on work and employability programs for rural women with psychosocial disabilities. The study protocol was approved by Maseno University Ethics Review Committee (MUERC/00851/20). Findings from this study will be disseminated through conference presentations and scientific publications in peer reviewed journals

Unemployment in women with psychosocial disabilities during the COVID-19 pandemic:Lessons from Tana River County, Kenya

In low‐income settings, the informal economy is a practical alternative to work and employment for persons with disabilities. However, the COVID‐19 pandemic negatively affected the informal economy. This study aimed to explore the experiences of women with psychosocial disabilities in Kenya during the pandemic. We found that the pandemic worsened their experiences of work and employment, and they did not receive any social welfare or support from the government. Our findings suggest that pandemic management must adopt inclusive and context‐sensitive approaches that support persons with psychosocial disabilities. Social welfare and protection for persons with disabilities are relevant for socio‐economic empowerment and inclusion

Epidemiological patterns and correlates of mental disorders among orphans and vulnerable children under institutional care

Purpose: The objective of the study was to estimate the prevalence, comorbidity and socio-demographic correlates of common mental disorders among orphan and vulnerable children (OVCs) in residential care. Methods: The Youth Self Report (YSR) instrument was adapted for use and administered to 630 OVCs aged 10–18 years in four institutions operating within the Eastern province of Kenya. We estimated the prevalence of YSR syndromes and used logistic regression analyses to examine socio-demographic factors associated with each disorder. Results: The prevalence of any mental disorder according to YSR syndrome scale was 30.8% (95% CI 27.1–34.6). Female gender and older children were less likely to be associated with risk of scoring in the clinical range of the mental disorders. The presence of multiple mental problems was seen among 16.7% of the children. Of the 16.7%, 5.6% had one comorbid mental disorder and 11.1% had three to eight mental disorders. Conclusion: We found a high prevalence of mental disorders and co-occurring disorders among the OVCs in residential institutions in Kenya. There is need for an alternative approach that can reach out to critical numbers of children for screening and public health, rather than purely clinical approach. The capacity for these institutions should also be regulated and more efforts focusing on improving the quality of care in the facilities taken into account at all times