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Outcome of common mental disorders in Harare, Zimbabwe

Published online by Cambridge University Press:  03 January 2018

Vikram Patel ,
Charles Todd ,
Mark Winston ,
Essie Simunyu ,
Fungisai Gwanzura ,
Wilson Acuda  and
Anthony Mann
Vikram Patel*
Affiliation:
Section of Epidemiology and General Practice, Institute of Psychiatry, London
Charles Todd
Affiliation:
Department of Community Medicine, University of Zimbabwe Medical School, Harare
Mark Winston
Affiliation:
Royal College of Psychiatrists Research Unit, St Tydfil's Hospital, Wales
Essie Simunyu
Affiliation:
Department of Psychiatry, University of Zimbabwe Medical School, Harare, Zimbabwe
Fungisai Gwanzura
Affiliation:
Department of Psychiatry, University of Zimbabwe Medical School, Harare, Zimbabwe
Wilson Acuda
Affiliation:
Department of Psychiatry, University of Zimbabwe Medical School, Harare, Zimbabwe
Anthony Mann
Affiliation:
Section of Epidemiology and General Practice, Institute of Psychiatry, London SE5 8AF
*
Dr Vikram Patel, Sangath Centre, 71 Defence Colony, Alto-Porvorim, Goa 403521, India. Fax: +91 832 217621. e-mail: [email protected]
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Abstract

Background

Little is known about the outcome of common mental disorders (CMD) in primary care attenders in low income countries.

Method

Two and 12 month (T1 and T2) follow-up of a cohort of cases of CMD (n=199) recruited from primary health, traditional medical practitioner, and general practitioner clinics in Harare, Zimbabwe. The Shona Symptom Questionnaire (SSQ) was the measure of caseness.

Results

The persistence of case level morbidity was recorded in 41% of subjects at 12 months. Of the 134 subjects interviewed at both follow-up points, 49% had recovered by T1 and remained well at T2 while 28% were persistent cases at both T1 and T2. Higher SSQ scores, a psychological illness model, bereavement and disability predicted a poor outcome at both times. Poorer outcome at T1 only was associated with a causal model of witch-craft and an unhappy childhood. Caseness at follow-up was associated with disability and economic deprivation.

Conclusions

A quarter of cases of CMD were likely to be ill throughout the 12 month follow-up period. Targeting risk groups for poor outcome for interventions and policy interventions to reduce the impact of economic deprivation may provide a way of tackling CMD in primary care in low income countries.

Type
Papers
Information
The British Journal of Psychiatry , Volume 172 , Issue 1 , January 1998 , pp. 53 - 57
Copyright
Copyright © 1998 The Royal College of Psychiatrists 

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Footnotes

∗

Related paper: Patel, V., Todd, C., Winston, M., et al (1997) Common mental disorders in primary care in Harare. Zimbabwe: associations and risk factors. British Journal of Psychiatry, 171, 60–64.

References

Chavunduka, G. L. (1978) Traditional Healers and the Shona Patient. Gwelo, Zimbabwe: Mambo Press.Google Scholar
Dowrick, C. & Buchan, I. (1995) Twelve month outcome of depression in general practice: does detection or disclosure make a difference? British Medical Journal, 311, 1274–1276.Google Scholar
Kleinman, A. (1980) Patients and Healers in the Context of Culture. Berkeley: University of California Press.Google Scholar
Mann, A., Jenkins, R. & Belsey, E. (1981) The twelve month outcome of patients with neurotic illness in general practice. Psychological Mediane. 11, 535–550.CrossRefGoogle ScholarPubMed
Mbizvo, M., Mashu, A., Chipato, T., et al (1996) Trends in HIV-1 and HIV-2 prevalence and risk factors in pregnant women in Harare, Zimbabwe. Central African Journal of Medicine, 42, 14–21.Google Scholar
Myambo, K. (1990) Social values and community development in rural Africa. International Journal of Psychology. 25, 767–777.Google Scholar
Ormel, J., Van Den Brink, W., Koeter, M., et al (1990) Recognition, management and outcome of psychological disorders in primary care: a naturalistic follow-up study. Psychological Medicine. 20, 909–923.Google Scholar
Ormel, J., Von Korff, M., Van Den Brink, W., et al (1993) Depression, anxiety, and social disability show synchrony of change in primary care patients. American Journal of Public Health, 83, 385–390.Google Scholar
Parry, C. (1996) A review of psychiatric epidemiology in Africa: strategies for increasing validity when using instruments transculturally. Transcultural Psychiatric Research Review, 33, 173–188.Google Scholar
Patel, V. (1995) Spiritual distress: an indigenous concept of non-psychotic mental disorder in Harare. Acta Psychiatrica Scandinavica, 92, 103–107.Google Scholar
Patel, V., Gwanzura, F., Simunyu, E., et al (1995a) The explanatory models and phenomenology of common mental disorder in Harare. Zimbabwe. Psychological Medicine, 25, 1191–1199.Google Scholar
Patel, V., Simunyu, E. & Gwanzura, F. (1995b) Kufungisisa (thinking too much): a Shona idiom for non-psychotic mental illness. Central African Journal of Medicine, 41, 209–215.Google Scholar
Patel, V., Simunyu, E. & Gwanzura, F., et al (1997a) The Shona Symptom Questionnaire: the development of an indigenous measure of non-psychotic mental disorder in Harare. Acta Psychiatrica Scandinavica, in press.Google Scholar
Patel, V., Todd, C. H., Winston, M., et al (1997b) Common mental disorders in primary care in Harare. Zimbabwe: associations and risk factors. British Journal of Psychiatry, 171, 60–64.Google Scholar
Von Korff, M., Ustun, T., Ormel, J., et al (1996) Self-report disability in an international primary care study of psychological illness. Journal of Clinical Epidemiology, 49, 297–303.CrossRefGoogle Scholar
Weich, S., Churchill, R., Lewis, G., et al (1997) Do socio-economic risk factors predict the incidence and maintenance of psychiatric disorder in primary care? Psychological Medicine, 27, 73–80.Google Scholar
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