Scaling up care for perinatal depression for improved maternal and infant health (SPECTRA)

Evidence indicates that with training, providers of maternal care at primary care levels can offer effective treatment for perinatal depression conditions which impact women’s health and child care. The scaling up care for perinatal depression for improved maternal and infant health (SPECTRA) aim is to reduce the burden of perinatal depression and improve maternal and child health. System-level barriers and facilitators to the delivery of effective intervention for perinatal depression have been identified. The presentation for the West African Health Organization (WAHO) workshop suggests approaches to the dissemination of information through community leaders, service users and caregivers

Adolescent perinatal depression : a neglected public health issue

The presentation reports on a study regarding perinatal depression, with findings that show the rate of perinatal depression is much higher among adolescents compared to adults. A suggested course of action is reviewed: “Responding to the challenge of Adolescent Perinatal Depression (RAPiD).” Pregnant adolescents are often ostracized and receive little or no support from family members. The RAPiD programme provides training and resources for pregnant teenagers. This is a global health issue: WHO estimates 11% of all births are to girls aged 15-19 years. The highest rates are in sub-Saharan Africa (30% of live births are to girls under 18 years of age).Grand Challenges CanadaGlobal Affairs CanadaCanadian Institutes of Health Researc

Gait speed and cognitive decline over 2 years in the Ibadan study of aging

AbstractBackgroundThe evidence suggesting that gait speed may represent a sensitive marker for cognitive decline in the elderly requires support from diverse racial groups.ObjectiveWe investigated the relationship between gait speed and cognitive decline over 2 years in a community dwelling sample of elderly Africans.MethodsData are from the Ibadan study of aging (ISA) conducted among a household multi-stage probability sample of 2149 Yoruba Nigerians aged 65 years or older. Gait speed was measured as the time taken to complete a 3 or 4m distance at normal walking speed. We assessed cognitive functions with a modified version of the 10-word learning list and delay recall test, and examined the relationship between baseline gait speed, as well as gait speed changes, and follow-up cognition using multiple linear regression and longitudinal analyses using random effects.ResultsApproximately 71% of 1461 participants who were dementia free and who had their gait speed measured at baseline (2007) were successfully followed up in two waves (2008 and 2009). Along with increasing age, poor health and economic status, a slower baseline gait speed was independently associated with poorer follow-up cognition in both linear regression (1.2 words, 95% CI=0.48–2.0) and longitudinal analyses (0.8 words, 95% CI=0.44–1.2). Also, a greater change in gait speed between 2007 and 2009 was associated with the worst follow-up cognition (0.3 words, 95% CI=0.09–0.51).ConclusionThe finding that a substantial change in gait speed was associated with reduced cognitive performance is of potential importance to efforts aimed at early identification of cognitive disorders in this population

A cluster randomized clinical trial of a stepped care intervention for depression in primary care (STEPCARE)--study protocol.

BACKGROUND: Depression constitutes a significant public health burden and is associated is with high level of individual suffering. Insufficient human and material resources impede the provision of adequate care for persons with the condition in low- and middle-income countries. It is commonly recognized that, to bridge this treatment gap, it is essential to integrate the treatment of depression into primary health care system. METHODS/DESIGN: STEPCARE is a two-arm parallel cluster randomized controlled trial to compare a stepped-care intervention package for depression in primary health care with care as usual in Nigeria. Randomization was conducted at the level of the participating primary health care clinics, while interventions are delivered to consenting individual participants who screen positive on the 9-item patient health questionnaire (PHQ-9 score ≥ 11) and fulfil the DSM-IV criteria for major depression. Intervention delivered by trained primary health care workers (PHCW) supported by general physicians and psychiatrists as needed is in 3 steps determined by response to treatment. Each step consists of psychological interventions (including psychoeducation, activity scheduling, social network reactivation and problem solving treatment) offered to all participants and, depending on severity and response, medication. Primary outcome, assessed at 12 months following recruitment into the trial, is recovery from depression as shown by a PHQ-9 score of less than 6. Secondary outcomes include changes in disability, quality of life and service utilization assessed at 6 and 12 months. DISCUSSION: The stepped care model examines the effectiveness of an intervention package for depression in which the intensity of treatment is determined by the clinical need of the patients. This approach is designed to make the most efficient use of available resources. TRIAL REGISTRATION: ISRCTN46754188 (ISRTCN registry at isrtcn.com; registered 23 September 2013)

On the need for epidemiology in psychiatric sciences

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Sustainable financing mechanisms for strengthening mental health systems in Nigeria

Background and aims: Current coverage of mental health care in low- and middle-income countries is limited, not only in terms of access to services but also in terms of financial protection of persons in need of care and treatment. This is especially pertinent considering the established relationship between mental illness and poverty and the need to ensure the financial risk protection of persons with mental disorders and their families as part of country's efforts to attain universal health coverage. This study set out to review the health and socio-economic contexts of Nigeria as well as to generate strategies for sustainable mental health financing that will be feasible, within the specific context of the country.Methods: A multi-methods approach was developed and applied, consisting of three steps: a situational analysis of Nigeria's health system, macro-fiscal economic profile, and socio-political status, including a strengths, weaknesses, opportunities and threats (SWOT) analysis of the Nigerian socio-economic, general and mental health context; key informant interviews with 12 expert stakeholders drawn from state and non-state actors in the health and financial sectors; and a policy analysis of sustainable financing options.Results: Key challenges identified were: poor funding; reduced access to care, resulting in a huge treatment gap; and out of pocket payment for services—leading to impoverishment. Comprehensive coverage of mental health conditions within the ongoing health insurance reforms was identified as a key strategy for moving towards sustainable mental health financing in Nigeria. Other identified strategies include enhanced integration of mental health into primary care; incorporation of mental health into other strategic and currently funded programmes; adoption of performance-based financing measures; and renewed engagement with stakeholders, including external donor institutions.Conclusions: A suite of feasible and actionable measures can be implemented to increase mental health service financing, reduce health-related financial burden on households, increase help-seeking and access to quality mental health care and, ultimately, reduce the large treatment and financing gap for mental disorders in Nigeria

Multidisciplinary contributions towards an evolutive interpretation of bipolar disorders: Could it be the pathological drift of a potentially adaptive condition?

This paper tries to summarize the results of studies from different areas of knowledge supporting the idea that temperamental traits, such as "reckless/hyper-exploratory"attitudes, commonly believed to be associated with psychopathology, surprisingly turn out as adaptive under specific stress conditions. In particular, this paper analyzes an ethologic line of research on primates suggesting models for a sociobiological interpretation of mood disorders in humans; a study that found high frequencies of a genetic variance associated with bipolar disorder in people without bipolar disorder but with hyperactivity/novelty-seeking traits; the outcomes of socio-anthropological-historical surveys on the evolution of mood disorders in Western countries in the last centuries; surveys on changing societies in Africa and African migrants in Sardinia; and studies that found higher frequencies of mania and subthreshold mania among Sardinian immigrants in Latin American megacities. Although it is not unequivocally accepted that the prevalence of mood disorders has increased, it would be logical to suppose that a nonadaptive condition should have disappeared over time; mood disorders, on the contrary, persist and their prevalence might have even increased. This new interpretation could lead to counter discrimination and stigma towards people suffering from the disorder and would be a central point in psychosocial treatments in addition to pharmacological therapy. Our aim is to hypothesize that bipolar disorder, strongly characterized by these traits, may be the result of the interaction between genetic characteristics, not necessarily pathological, and specific environmental conditions rather than a mere product of an aberrant genetic profile. If mood disorders were mere nonadaptive conditions, they would have disappeared over time; however, their prevalence paradoxically persists if not even increases over time. The hypothesis that bipolar disorder may result from the interaction between genetic characteristics, not necessarily pathological, and specific environmental factors seems more credible than considering bipolar disorder as a mere product of an aberrant genetic profile

The Mental Health Leadership and Advocacy Program (mhLAP): a pioneering response to the neglect of mental health in Anglophone West Africa

Developing countries in Africa and other regions share a similar profile of insufficient human resources for mental health, poor funding, a high unmet need for services and a low official prioritisation of mental health. This situation is worsened by misconceptions about the causes of mental disorders, stigma and discrimination that frequently result in harmful practices against persons with mental illness. Previous explorations of the required response to these challenges have identified the need for strong leadership and consistent advocacy as potential drivers of the desired change. The Mental Health Leadership and Advocacy Program (mhLAP) is a project that aims to provide and enhance the acquisition of skills in mental health leadership, service development, advocacy and policy planning and to build partnerships for action. Launched in 2010 to serve the Anglophone countries of The Gambia, Ghana, Liberia, Nigeria, Sierra Leone, this paper describes the components of the program, the experience gained since its initiation, and the achievements made during the three years of its implementation. These achievements include: 1) the annual training in mental health leadership and advocacy which has graduated 96 participants from 9 different African countries and 2) the establishment of a broad coalition of service user groups, non-governmental organizations, media practitioners and mental health professionals in each participating country to implement concerted mental health advocacy efforts that are focused on country-specific priorities. © 2014 Abdulmalik et al.; licensee BioMed Central Ltd

Health systems thinking: A new generation of research to improve healthcare quality.

Hannah Leslie and colleagues of the High-Quality Health Commission discuss in an Editorial the findings from their report that detail the improvements needed to prevent declines in individuals' health as the scope and quality of health systems increase. Patient-centered care at the population level, improved utility of research products, and innovative reporting tools to help guide the development of new methods are key to improved global healthcare