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Performance of primary health care workers in detection of mental disorders comorbid with epilepsy in rural Ethiopia
- Source :
- BMC Family Practice, Vol 22, Iss 1, Pp 1-10 (2021), BMC Family Practice
- Publication Year :
- 2021
- Publisher :
- BMC, 2021.
-
Abstract
- BackgroundTimely detection and management of comorbid mental disorders in people with epilepsy is essential to improve outcomes. The objective of this study was to measure the performance of primary health care (PHC) workers in identifying comorbid mental disorders in people with epilepsy against a standardised reference diagnosis and a screening instrument in rural Ethiopia.MethodsPeople with active convulsive epilepsy were identified from the community, with confirmatory diagnosis by trained PHC workers. Documented diagnosis of comorbid mental disorders by PHC workers was extracted from clinical records. The standardized reference measure for diagnosing mental disorders was the Operational Criteria for Research (OPCRIT plus) administered by psychiatric nurses. The mental disorder screening scale (Self-Reporting Questionnaire; SRQ-20), was administered by lay data collectors. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of PHC worker diagnosis against the reference standard diagnosis was calculated. Logistic regression was used to examine the factors associated with misdiagnosis of comorbid mental disorder by PHC workers.ResultsA total of 237 people with epilepsy were evaluated. The prevalence of mental disorders with standardised reference diagnosis was 13.9% (95% confidence interval (CI) 9.6, 18.2%) and by PHC workers was 6.3% (95%CI 3.2, 9.4%). The prevalence of common mental disorder using SRQ-20 at optimum cut-off point (9 or above) was 41.5% (95% CI 35.2, 47.8%). The sensitivity and specificity of PHC workers diagnosis was 21.1 and 96.1%, respectively, compared to the standardised reference diagnosis. In those diagnosed with comorbid mental disorders by PHC workers, only 6 (40%) had SRQ-20 score of 9 or above. When a combination of both diagnostic methods (SRQ-20 score ≥ 9 and PHC diagnosis of depression) was compared with the standardised reference diagnosis of depression, sensitivity increased to 78.9% (95% (CI) 73.4, 84.4%) with specificity of 59.7% (95% CI 53.2, 66.2%). Only older age was significantly associated with misdiagnosis of comorbid mental disorders by PHC (adjusted odds ratio, 95% CI = 1.06, 1.02 to 1.11).ConclusionRoutine detection of co-morbid mental disorder in people with epilepsy was very low. Combining clinical judgement with use of a screening scale holds promise but needs further evaluation.
- Subjects :
- medicine.medical_specialty
Medicine (General)
Health Personnel
education
Primary health care
Mental disorders
Logistic regression
behavioral disciplines and activities
Epilepsy
Prevalence of mental disorders
R5-920
Humans
Medicine
Depression (differential diagnoses)
Aged
business.industry
Research
Odds ratio
medicine.disease
Confidence interval
Rural ethiopia
Detection
Family medicine
Africa
Ethiopia
Family Practice
business
Subjects
Details
- Language :
- English
- ISSN :
- 14712296
- Volume :
- 22
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- BMC Family Practice
- Accession number :
- edsair.doi.dedup.....3537c6d4e22fb7156364357e1f273245