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Patient-level predictors of detection of depressive symptoms, referral, and uptake of depression counseling among chronic care patients in KwaZulu-Natal, South Africa
- Source :
- Global Mental Health
- Publication Year :
- 2020
-
Abstract
- Background Integration of depression treatment into primary care could improve patient outcomes in low-resource settings. Losses along the depression care cascade limit integrated service effectiveness. This study identified patient-level factors that predicted detection of depressive symptoms by nurses, referral for depression treatment, and uptake of counseling, as part of integrated care in KwaZulu-Natal, South Africa. Methods This was an analysis of baseline data from a prospective cohort. Participants were adult patients with at least moderate depressive symptoms at primary care facilities in Amajuba, KwaZulu-Natal, South Africa. Participants were screened for depressive symptoms prior to routine assessment by a nurse. Generalized linear mixed-effects models were used to estimate associations between patient characteristics and service delivery outcomes. Results Data from 412 participants were analyzed. Nurses successfully detected depressive symptoms in 208 [50.5%, 95% confidence interval (CI) 38.9–62.0] participants; of these, they referred 76 (36.5%, 95% CI 20.3–56.5) for depression treatment; of these, 18 (23.7%, 95% CI 10.7–44.6) attended at least one session of depression counseling. Depressive symptom severity, alcohol use severity, and perceived stress were associated with detection. Similar factors did not drive referral or counseling uptake. Conclusions Nurses detected patients with depressive symptoms at rates comparable to primary care providers in high-resource settings, though gaps in referral and uptake persist. Nurses were more likely to detect symptoms among patients in more severe mental distress. Implementation strategies for integrated mental health care in low-resource settings should target improved rates of detection, referral, and uptake.
- Subjects :
- Chronic care
medicine.medical_specialty
Referral
business.industry
Service delivery framework
HIV
Chronic disease
Confidence interval
030227 psychiatry
Integrated care
Original Research Paper
primary health care
South Africa
03 medical and health sciences
Mental distress
0302 clinical medicine
depression
Emergency medicine
medicine
030212 general & internal medicine
Policy and Systems
business
Prospective cohort study
Depression (differential diagnoses)
integrated care
Subjects
Details
- Language :
- English
- ISSN :
- 20544251
- Database :
- OpenAIRE
- Journal :
- Global Mental Health
- Accession number :
- edsair.doi.dedup.....f09bba840959f7f0c42fb32a294c2cd1