Detecting Depression in Primary Care Clinics in Central Kenya: The Impact of a Brief Training Intervention

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Detecting Depression in Primary Care Clinics in Central Kenya: The Impact of a Brief Training Intervention

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Title: Detecting Depression in Primary Care Clinics in Central Kenya: The Impact of a Brief Training Intervention
Author: Alexander, Cynthia Lisette
Abstract: Depression is universally recognized as a significant public health problem, with a global burden rivaling that of any medical disorder. In developing countries such as Kenya, with a scarcity of both mental health specialists and funds devoted to mental health, detection and treatment of mental illness necessarily falls to primary care providers. The limited research conducted in developing countries has rarely focused on the experiences of private practitioners, especially those in rural areas. This dissertation reviews the challenges to improving mental health care in the developing world and the usefulness of Western diagnostic and treatment models, and discusses research challenges. The goal of the present study was to gather information about the diagnosis and treatment of depression by rural Kenyan primary care providers, and to assess the outcome of a brief training about depression screening on their comfort level and competence in recognizing depression. Participants were 44 providers, primarily private nurse practitioners, offering medical services in private clinics in rural Kenya. They were randomly assigned to intervention and wait-list control groups. Both groups completed the Depression Attitude Questionnaire (DAQ; Botega, Mann, Blizard, & Wilkinson, 1992) and a pre-test questionnaire designed to elicit information about their assessment methods and diagnostic hypotheses based on short live vignettes. The intervention group received 1 hour of training about depression screening using the Patient Health Questionnaire-9 (PHQ-9; Spitzer, Kroenke, & Williams, 1999) and Patient Health Questionnaire-2 (PHQ-2; Kroenke, Spitzer, & Williams, 2003). Two months later, 23 participants returned to complete both questionnaires again; the control group subsequently received the training. Results demonstrated that brief training about depression and access to diagnostic instruments increased providers' comfort level with both diagnosing and treating depression, although no group differences were found in ability to detect depression. Medication was by far their treatment of choice for depressed patients; a minority of participants indicated that they would offer counseling. Participants identified numerous barriers to treatment, including lack of resources, patient resistance, and lack of adequate provider training. This study represents a small, promising initial step in filling the gap that exists between mental health research and private practice in Kenya.
Description: Degree awarded: Ph.D. Psychology. The Catholic University of AmericaThis dissertation can be viewed by CUA users only.
Date: 2012-02-15

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