Ali, Naureen Akber

Khoja, Adeel

English

eCommons@AKU

eCommons@AKU School of Nursing & Midwifery Faculty of Health Sciences 4-2020 Leveraging the use of mHealth in patients with depression among low- and middle- income countries Naureen Akber Ali Aga Khan University, naureen.akberali@aku.edu Adeel Khoja Aga Khan University, adeel.khoja@aku.edu Follow this and additional works at: https://ecommons.aku.edu/pakistan_fhs_son  Part of the Health Information Technology Commons, Nursing Midwifery Commons, and the Public Health Education and Promotion Commons Recommended Citation Ali, N. A., Khoja, A. (2020). Leveraging the use of mHealth in patients with depression among low- and middle- income countries. Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 30(4), 458-458. Available at: https://ecommons.aku.edu/pakistan_fhs_son/371 LETTER TO THE EDITORJournal  of  the College of  Physicians and Surgeons Pakistan 2020,  Vol.  30(4):  458 458Leveraging the Use of mHealthin Patients with Depressionamong Low- and Middle-Income CountriesSir,Low-  and  middle-income  countries  (LMIC)  usually  suffer  fromburden of mental disorders, fundamentally because of underde-veloped healthcare systems.1 Around 90% of people residing inLMICs  having  mental  disorders  receive  no  mental  healthcareservices.1 Over the past few decades, depression is found to be ahighly prevalent mental health disorder.2 In developing countries,50.8 million people have depression, while 10 to 44% suffer fromdepressive disorders.2,3 The situation is quite serious in Karachi,Pakistan, where approximately 36%  of people suffer from depres-sion,  which  is  in  alignment  to  the  World  Health  Organization(WHO) estimates.2 It is estimated to be the 10th leading cause ofdisability-adjusted life years (DALYs) lost both nationally and glob-ally.4LMICs are faced with significant barriers that limit access to health-care services, including high illiteracy levels, lack of finances, lackof awareness (stigma and social exclusion); and dearth of mentalhealthcare professionals that further add to the disease burden.1The proportion of mental health professionals to the general popu-lation is expected to be nearly 200 times higher in high-incomenations than resource-limited countries.1 In countries like  Chad,Liberia, and Rwanda, only one or two psychiatrists are availablefor the whole country!1,5 Moreover, less than US $2 per capita perannum is spent on mental health services in LMICs.5 In Pakistan,healthcare  expenditure  budget  is  less  than  1%  of  the  grossnational product (GNP); and unfortunately, only 0.4% of the totalbudget is allocated to mental health, which significantly affectsthe  underprivileged  communities  of  the  society.  This,  in  turnreflects, that the patients have to pay out of their pockets  for theirmental health treatment as the  coverage by companies is limitedwith  only  a  few  insurance  companies  in  the  market  with  lowpremium policies.2 In order to cater this high demand of mentalhealth, innovative approaches that are accessible, less time-con-suming, and cost-effective are urgently needed.Leveraging the digital technology, i.e. mobile phones, may indi-cate a viable solution for dealing with high burden of mental disor-ders. Mobile health (mHealth) refers to the utilisation of mobiletechnology in healthcare delivery system.1,6 Mobile phones havebreached  all  the  geospatial  boundaries,  particularly  in  LMICswhere  accessibility  is  a  major  concern.  Recently,  WHO  hasdesigned a “step-by-step” application that offers psychoeduca-tion to depressive patients and provides training in behaviouralactivation.5 Similarly, another application entitled “global actionintervention guide” launched by WHO, recently scaled up in 90countries, is used to build capacity of physicians in LMICs to diag-nose and manage high-risk mental health conditions like depres-sion based on standard guidelines and protocols.6 Thus, mHealthtechnology can provide accurate and timely diagnosis, and simul-taneously improving prognosis of depression.LMICs continue to grapple with scarce resources and wide treat-ment gap; mHealth can facilitate in bridging this gap and offerways to overcome barriers, irrespective of geopolitical borders,time zones, and cost. It facilities in building capacity of mentalhealth workforce as well as strengthens the existing healthcaresystem. Furthermore, a public-private partnership approach isneeded to integrate mHealth in mental healthcare services andoverall in healthcare systems, particularly in LMICs.CONFLICT OF INTEREST:Authors declared no conflict of interest.AUTHORS’ CONTRIBUTION:NA: Contributed in drafting the entire manuscript.AK: Finalized the draft and has given critical feedback.REFERENCESNaslund JA, Aschbrenner KA, Araya R, Marsch LA, Unützer J,1.Patel V, et al. Lancet Psychiatry 2017; 4:486-500.Ahmed B, Enam SF, Iqbal Z, Murtaza G, Bashir S. Depression2.and anxiety  a  snapshot  of  the  situation  in  Pakistan.  Int  JNeurosci and Behav Sci 2016; 4:32-6.World Health Organization (WHO, 2001). World Health Report3.Geneva, Switzerland.World Health Organization (WHO, 2019). Depression available4.online:http://www.emro.who.in/health-topics/depression/index.html.Carswell K, Harper-Shehadeh M, Watts S, van’t Hof E, Ramia5.JA,  Heim E, et al.  Step-by-step a new WHO digital  mentalhealth intervention for depression. Mhealth 2018; 4:34.Keynejad RC, Dua T, Barbui C, Thornicroft G. WHO mental6.health gap action programme (mhGAP) intervention guide asystematic review of evidence from low and middle-incomecountries. Evid Based Ment Health 2018; 21:30-4.Naureen  Akber  Ali1  and  Adeel  Khoja2..................................................................................1School  of  Nursing  and  Midwifery,  The  Aga  Khan  UniversityHospital,  Karachi,  Pakistan2Department  of  Medicine,  The  Aga  Khan  University,  Karachi,Pakistan..................................................................................Correspondence  to:  Dr.  Naureen  Akber  Ali,  School  of  Nursingand  Midwifery,  The  Aga  Khan  University  Hospital,  StadiumRoad,  Karachi,  PakistanE-mail:  naureen.akberali@aku.edu...................................................................Received: June 21, 2019;   Revised: July 10, 2019;Accepted:  August  08,  2019DOI:  https://doi.org/10.29271/jcpsp.2020.4.458

Leveraging the use of mHealth in patients with depression among low- and middle- income countries

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Leveraging the use of mHealth in patients with depression among low- and middle- income countries

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