This week we are highlighting an article from our most recent journal issue, Vol. 41 Issue 3, entitled Mental Health Outcomes of Psychosocial Intervention Among Traditional Health Practitioner Depressed Patients in Kenya, by Christine Musyimi, Victoria Mutiso, David Ndetei, David Henderson, and Joske Bunders. Their study aims to determine the outcomes of using the evidence-based mental health Global Action Programme Intervention Guide to provide psychosocial interventions among depressed patients seeking care from Traditional health Practitioners (THPs). Their work is the first documented interventional study to investigate the outcomes of psychosocial interventions among THPs’ patients in Kenya. The authors argue that it is crucial to engage THPs in the care of patients with depression and other mental disorders in order to establish and maintain collaboration between THPs and conventional health workers to promote evidence-based care among marginalized populations.

During this study, Traditional health Practitioners (THPs) were trained to deliver psychosocial interventions to their patients screening positive for mild to severe depression on Beck’s Depression Inventory (BDI). The authors emphasize that THPs are trusted by community members and appropriately understand the community cultural and social norms due to their interaction with different individuals in their routine practice and the nature of traditional systems of care. Additionally, THPs’ services are usually more easily accessible and cost effective.

According to the authors, task-shifting can be defined as the rational redistribution of tasks among health workforce teams with an aim of making efficient use of available human resources for health. This approach has proved to be a very strong potential strategy for reducing global mental health challenges through identification and appropriate management of mental disorders. In a task-shifting model, THPs classified as traditional and faith healers may be incorporated into existing mental health services by using their cultural acceptability to deliver treatment. They may also be used as a way to mitigate the shortage of mental health specialists. THPs are widespread in Africa and are consulted for psychosocial problems.

Previous studies have shown that THPs use prayer, holy water, morality-based guidance, dietary advice, massage, and herbs as common treatment modalities. THPs have furthermore demonstrated willingness to collaborate with “conventional” workers in mental health care. For the authors, this willingness offers an excellent opportunity since consulting THPs is considered a more popular choice of first help-seeking contact for patients. Often, THPs do home visits, which is more convenient and acceptable to patients and family members. In addition, the consultation fee for THPs’ patients is either waived, paid in kind, in installments, or on recovery. As a result, THPs are considered to be reliable source for care and can still be sought in a more difficult financial situation.

The mental health Global Action Programme Intervention guide (mhGAP-IG) is a model-guide and helps non-specialists to identify and manage priority mental health problems, such as depression, psychosis, bipolar disorder, epilepsy, developmental disorders, behavioral disorders, dementia, alcohol use disorders, drug use disorders, suicide, and self-harm. Its efficacy has also been tested among non-specialized health workers, including traditional and faith healers in Africa, and shows a statistically significant improvement in knowledge among participants after training. The authors maintain that this is promising evidence that non-specialized health-care providers can be successfully trained to deliver a basic package of interventions for providing care and treatment for people with mental, neurological and substance use disorders.

This study involved training THPs to identify and deliver evidence-based mhGAP-IG psychosocial interventions to their patients screening positive for depression. A total of 377 patients screened positive for mild to severe depression using BDI were recruited into the study. Psychosocial interventions, such as cognitive behavior therapy or problem solving, were then described in detail to THPs. This gave the THPs an understanding of what to do, as listed under mhGAP-IG, in the depression component at the initial contact and one or two subsequent visits, depending on the severity of the patient’s symptoms. The outcomes of the intervention among THPs’ patients were measured at 6 weeks and 12 weeks from the initial assessment by determining the change in their depressive scores using BDI. Overall, the BDI mean score was 26.52 before intervention, and reduced significantly at 6 (13%) and 12 (35%) weeks after intervention.

Based on their research, the authors argue that patients seeking care from THPs are responsive to psychosocial interventions as delivered by the healers. Patients recovered symptomatically, showing significant improvements at all time points after treatment. The authors state that consistent with other studies, psychosocial interventions have been shown to reduce depressive symptoms in primary care settings.

The authors conclude that the overall improvement of the patients in their study at 3 months is higher than the response rates seen among depressed outpatients followed over a period of one year in public sector clinics in the United States. A systematic review on enhancing antidepressant therapy with non-pharmacological interventions directed at improving the treatment of depression by Oestergaard and Møldrup (2011), has demonstrated that psychosocial interventions such as psychotherapy produce superior results at follow-up in terms of preventing recurrence and yields effects that cannot be detected by antidepressants including the quality of interpersonal relationships and coping skills.

References Cited:

Oestergaard, S., and C. Møldrup

2011        Improving Outcomes for Patients with Depression by Enhancing Antidepressant Therapy with Non-pharmacological Interventions: A Systematic Review of Reviews. Public Health 125: 357–367.