The effectiveness and cost-effectiveness of integrating mental health services in primary care in low- and middle-income countries : systematic review

Q1Artículo original1-13Aims and method This systematic review examines the effectiveness and costeffectiveness of behavioural health integration into primary healthcare in the management of depression and unhealthy alcohol use in low- and middle-income countries. Following PRISMA guidelines, this review included research that studied patients aged ≥18 years with unhealthy alcohol use and/or depression of any clinical severity. An exploration of the models of integration was used to characterise a typology of behavioural health integration specific for low- and middle-income countries. Results Fifty-eight articles met inclusion criteria. Studies evidenced increased effectiveness of integrated care over treatment as usual for both conditions. The economic evaluations found increased direct health costs but cost-effective estimates. The included studies used six distinct behavioural health integration models. Clinical implications Behavioural health integration may yield improved health outcomes, although it may require additional resources. The proposed typology can assist decision-makers to advance the implementation of integrated models

Possibilities for the future of global mental health: a scenario planning approach.

BACKGROUND: Global mental health is a widely used term describing initiatives in policies, research and practice to improve the mental health of people worldwide. It has been gaining momentum over the last 10 years, reflected in increasing funding opportunities, training programmes, and publications. In light of the rising importance of global mental health and the various uncertainties about its future directions, this paper explores what the future may hold for global mental health in 30 years' time. METHOD: A scenario planning method was used, involving a workshop with experts from four continents and a range of backgrounds, including clinical and academic psychiatry, psychology, art and music therapy, service user advisory role, funder of global health research and post-graduate students. RESULTS: Six distinct scenarios that describe potential future situations were developed: universal standards for care; worldwide coordination of research; making use of diversity; focus on social factors; globalised care through technology; mental health as a currency in global politics. CONCLUSIONS: These scenarios consider different social, economic, scientific and technological drivers and focus on distinct aspects. Some reflect a global application of possible trends in mental health, whilst others apply general global developments to mental health care. They are not fixed forecasts, but instead may help to promote discussion and debate about further developments and decisions

Psychometric performance of the Mental Health Implementation Science Tools (mhIST) across six low- and middle-income countries

Background Existing implementation measures developed in high-income countries may have limited appropriateness for use within low- and middle-income countries (LMIC). In response, researchers at Johns Hopkins University began developing the Mental Health Implementation Science Tools (mhIST) in 2013 to assess priority implementation determinants and outcomes across four key stakeholder groups—consumers, providers, organization leaders, and policy makers—with dedicated versions of scales for each group. These were field tested and refined in several contexts, and criterion validity was established in Ukraine. The Consumer and Provider mhIST have since grown in popularity in mental health research, outpacing psychometric evaluation. Our objective was to establish the cross-context psychometric properties of these versions and inform future revisions. Methods We compiled secondary data from seven studies across six LMIC—Colombia, Myanmar, Pakistan, Thailand, Ukraine, and Zambia—to evaluate the psychometric performance of the Consumer and Provider mhIST. We used exploratory factor analysis to identify dimensionality, factor structure, and item loadings for each scale within each stakeholder version. We also used alignment analysis (i.e., multi-group confirmatory factor analysis) to estimate measurement invariance and differential item functioning of the Consumer scales across the six countries. Results All but one scale within the Provider and Consumer versions had Cronbach’s alpha greater than 0.8. Exploratory factor analysis indicated most scales were multidimensional, with factors generally aligning with a priori subscales for the Provider version; the Consumer version has no predefined subscales. Alignment analysis of the Consumer mhIST indicated a range of measurement invariance for scales across settings (R2 0.46 to 0.77). Several items were identified for potential revision due to participant nonresponse or low or cross- factor loadings. We found only one item, which asked consumers whether their intervention provider was available when needed, to have differential item functioning in both intercept and loading. Conclusion We provide evidence that the Consumer and Provider versions of the mhIST are internally valid and reliable across diverse contexts and stakeholder groups for mental health research in LMIC. We recommend the instrument be revised based on these analyses and future research examine instrument utility by linking measurement to other outcomes of interest

The ecology of peace : preparing Colombia for new political and planetary climates

ABSTRACT: Colombia, one of the world’s most species-rich nations, is currently undergoing a profound social transition: the end of a decadeslong conflict with the Revolutionary Armed Forces of Colombia, known as FARC. The peace agreement process will likely transform the country’s physical and socioeconomic landscapes at a time when humans are altering Earth’s atmosphere and climate in unprecedented ways. We discuss ways in which these transformative events will act in combination to shape the ecological and environmental future of Colombia. We also highlight the risks of creating perverse development incentives in these critical times, along with the potential benefits – for the country and the world – if Colombia can navigate through the peace process in a way that protects its own environment and ecosystems

Red de actores involucrados en la identificación, cuidado y seguimiento del uso nocivo de alcohol en atención primaria en Colombia

Este artículo explora la estructura de una red de actores involucrados en el cuidado de individuos con consumo no saludable de alcohol (CNA) en cinco centros de atención primaria en Colombia entre los años 2017 y 2018. Se utilizó el Actor-Network Theory Framework (ANT), marco teórico que propone que los resultados en salud son producto de una multitud de relaciones entre distintos actores. Este artículo se enfoca en la red de configuración desarrollada entre actores y sus efectos en el proceso de identificación, cuidado y seguimiento de personas con CNA. Los datos provienen de cinco centros de salud que participaron en la fase piloto de implementación de un proyecto de investigación que busca aplicar intervenciones basadas en la evidencia para la detección y tratamiento de la depresión y el uso riesgoso de alcohol. Se condujeron entrevistas semiestructuradas y grupos focales con pacientes y personal médico y administrativo. Las entrevistas fueron transcritas y codificadas utilizando N-Vivo. El análisis identifica las maneras en las que los actores se vinculan a la red. Los resultados de este acercamiento cualitativo basado en ANT presentan a los actores identificados en una red no linear con distintas dimensiones.Q3This article explores the structure of the network of actors involved in the care of individuals with unhealthy alcohol use (UAU) at the primary care level in five primary care centers in Colombia between 2017 and 2018. We use the Actor-Network Theory Framework (ANT) which posits that health outcomes are a product of a multitude of relationships between different stakeholders. The article focuses on the network configuration that develops between the actors and its effects on the processes of identification, care, and follow-up of people with UAU. The data come from five care centers that participated in the pilot phase of an implementation research project that seeks to apply evidence-based interventions for the detection and treatment of depression and unhealthy alcohol use. Semi-structured interviews and focus groups were conducted with patients, health and administrative staff, and users from Alcoholics Anonymous. The interviews were transcribed and coded using N-Vivo. The analysis identified the ways in which actors are linked by the community to UAU. The results of this qualitative approach based on ANT present the actors identified in a non-linear network with different dimensions.https://orcid.org/0000-0002-9132-0557https://orcid.org/0000-0003-4284-7886https://orcid.org/0000-0002-9013-5384Revista Nacional - Indexad

Presenteeism, absenteeism, and lost work productivity among depressive patients from five cities of Colombia

Q215-19Pacientes adultos diagnosticados con depresión mayor o dobleObjectives To estimate productivity losses due to absenteeism and presenteeism and their determinants in patients with depression from five Colombian cities. Methods We used data from a multicenter, mixed-methods study of adult patients diagnosed with major depressive disorder or double depression (major depressive disorder plus dysthymia) during 2010. The World Health Organization’s Health and Work Performance Questionnaire was used to assess absenteeism and presenteeism. We explored the determinants of productivity losses using a two-part model. We also used a costing model to calculate the corresponding monetary losses. Results We analyzed data from 107 patients employed in the last 4 weeks. Absenteeism was reported by 70% of patients; presenteeism was reported by all but one. Half of the patients reported a level of performance at work at least 50% below usual. Average number of hours per month lost to absenteeism and presenteeism was 43 and 51, respectively. The probability of any absenteeism was 17 percentage points lower in patients rating their mental health favorably compared with those rating it poorly (standard error [SE] 0.09; P < 0.10) and 19 percentage points higher in patients with at least one comorbidity compared with patients with none (SE 0.10; P < 0.10). All other covariates showed no significant associations on hours lost to absenteeism. Patients with favorable mental health self-ratings had 16.4 fewer hours per month of presenteeism compared with those with poor self-ratings (SE 4.52; P < 0.01). The 2015 monetary value of productivity losses amounted to US $840 million. Conclusions This study in a middle-income country confirms the high economic burden of depression. Health policies and workplace interventions ensuring adequate diagnosis and treatment of depression are recommended

Listening and support groups in a teaching hospital as a model of intervention for healthcare workers during the COVID-19 pandemic

Background: Healthcare workers facing the COVID-19 pandemic have experienced unexpectedly traumatic situations associated with concerns about the possibility of acquiring the infection, excessive workloads, and the increased inpatient mortality rates. TheQ3Revista Nacional - IndexadaCN

Implementing Technology-Supported Care for Depression and Alcohol Use Disorder in Primary Care in Colombia : Preliminary Findings

Q2Q1Artículo completo1-6Objective: Depression and alcohol use disorder are among the most common causes of disability and death worldwide. Health care systems are seeking ways to leverage technology to screen, evaluate, and treat these conditions, because workforce interventions alone, particularly in low- and middle-income countries, are insufficient. This article reports data from the first year of implementation of a technology-supported, systematic approach to identify and care for persons with these disorders in primary care in Colombia. Methods: A care process that includes waiting room kiosks to screen primary care patients, decision support tablets to guide doctors in diagnosis and treatment, and access to digital therapeutics as a treatment option was implemented in two primary care clinics, one urban and one in a small town. The project collected data on the number of people screened, diagnosed, and engaged in the research and their demographic characteristics. Results: In the first year, 2,656 individuals were screened for depression and unhealthy alcohol use in the two clinics. Primary care doctors increased the percentage of patients diagnosed as having depression and alcohol use disorder from next to 0% to 17% and 2%, respectively. Conclusions: Early experience with implementing technology-supported screening and decision support for depression and alcohol use disorder into theworkflowof busy primary care clinics in Colombia indicates that this caremodel is feasible and leads to dramatically higher rates of diagnoses of these conditions. Diagnosis in these settings appeared to be easier for depression than for alcohol use disorder

Addressing harmful alcohol use in primary care in Colombia : understanding the sociocultural context

Harmful alcohol use is a public health problem worldwide, contributing to an estimated 5.1% of the global burden of illness. Screening and addressing at-risk drinking in primary care settings is an empirically supported health care intervention strategQ3Q3Revista Nacional - Indexada