The phenomenology and explanatory models of common mental disorder: A study in primary care in Harare, Zimbabwe

Department of Psychiatry, University of Zimbabwe Medical School, Harare, Zimbabwe.
Psychological Medicine (Impact Factor: 5.94). 12/1995; 25(6):1191-9. DOI: 10.1017/S003329170003316X
Source: PubMed


In order to describe the explanatory models and the etic and emic phenomena of common mental disorder in Harare, Zimbabwe, 110 subjects were selected by general nurses in three clinics and by four traditional healers from their current clients. The subjects were interviewed using the Explanatory Model Interview and the Revised Clinical Interview Schedule. Mental disorder most commonly presented with somatic symptoms, but few patients denied that their mind or soul was the source of illness. Spiritual factors were frequently cited as causes of mental illness. Subjects who were selected by traditional healer, reported a greater duration of illness and were more likely to provide a spiritual explanation for their illness. The majority of subjects were classified as 'cases' by the etic criteria of the CISR. Most patients, however, showed a mixture of psychiatric symptoms that did not fall clearly into a single diagnostic group. Patients from a subgroup with a spiritual model of illness were less likely to conform to etic criteria of 'caseness' and they may represent a unique category of psychological distress in Zimbabwe. A wide variety of emic phenomena were elicited that have been incorporated in an indigenous measure of non-psychotic mental disorder. Kufungisisa, or thinking too much, seemed to be the Shona term closest to the Euro-American concept of neurotic illness.

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    • "Goldberg introduced the term ‘common mental disorder’ to denote any depressive or anxiety disorder (including PTSD) [34,35]. In Africa, the term ‘common mental disorder’ has been used, for example in adult populations in Zimbabwe [36,37] and Ethiopia [38]. For children in Africa, the concept of ‘common mental disorder’ has not been not been widely used, and there has been no research into a single questionnaire to identify children with mental disorder in need of assistance. "
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    ABSTRACT: In Sub Saharan Africa, there has been limited research on instruments to identify specific mental disorders in children in conflict-affected settings. This study evaluates the psychometric properties of three self-report scales for child mental disorder in order to inform an emerging child mental health programme in post-conflict Burundi. Trained lay interviewers administered local language versions of three self-report scales, the Depression Self-Rating Scale (DSRS), the Child PSTD Symptom Scale (CPSS) and the Screen for Child Anxiety Related Emotional Disorders (SCARED-41), to a sample of 65 primary school children in Burundi. The test scores were compared with an external 'gold standard' criterion: the outcomes of a comprehensive semistructured clinical psychiatric interview for children according the DSM-IV criteria (the Schedule for Affective Disorders and Schizophrenia for School-Age Children - K-SADS-PL). The DSRS has an area under the curve (AUC) of 0.85 with a confidence interval (c.i.) of 0.73-0.97. With a cut-off point of 19, the sensitivity was 0.64, and the specificity was 0.88. For the CPSS, with a cut-off point of 26, the AUC was 0.78 (c.i.: 0.62-0.95) with a sensitivity of 0.71 and a specificity of 0.83. The AUC for the SCARED-41, with a cut-off point of 44, was 0.69 (c.i.: 0.54-0.84) with a sensitivity of 0.55 and a specificity of 0.90. The DSRS and CPSS showed good utility in detecting depressive disorder and posttraumatic stress disorder in Burundian children, but cut-off points had to be put considerably higher than in western norm populations. The psychometric properties of the SCARED-41 to identify anxiety disorders were less strong. The DSRS and CPSS have acceptable properties, and they could be used in clinical practice as part of a two-stage screening procedure in public mental health programmes in Burundi and in similar cultural and linguistic settings in the African Great Lakes region.
    BMC Psychiatry 02/2014; 14(1):36. DOI:10.1186/1471-244X-14-36 · 2.21 Impact Factor
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    • "In support of this hypothesis is the fact that the relationship between SD and depression and anxiety is both strong and universal, demonstrated in a range of settings and countries. There is robust literature , from LMIC and HIC, that patients possess awareness of psychological symptoms but choose to present only somatic symptoms or somatic components of psychological symptoms when seeking help (Parker et al., 2001; Patel et al., 1995, 1997, 1998). The second plausible mechanism is that the association is explained due to shared risk factors. "
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    ABSTRACT: Background: Across cultures, women are more likely than men to report somatoform disorders (SD), depression and anxiety. The aim of this article is to describe the co-morbidity of SD with depression/anxiety and to investigate the possible mechanisms of this relationship in women in low and middle income countries (LMIC). Methods: We reviewed two data-bases: MEDLINE and PsycINFO from 1994 to 2012 for studies which assessed the association between any SD and depression/ anxiety in women from LMIC. Our focus was on community and primary healthcare based studies. Both quantitative and qualitative studies were included. Results: A total of 21 studies covering eight LMICs were included in our analysis. Our fi ndings suggest a strong association between SD and depression/anxiety (with odds ratios ranging from 2.5 – 3.5), though we also observed that the majority of women with SD did not have depression/anxiety. The likely mecha-nisms for this association are multidimensional, and may include shared aetiologies, that both conditions are in fact variants of the same primary mental disorder, and that one disorder is a risk factor for the other. Anthropological research offers a number of frameworks through which we can view these mechanisms. Conclusion: The current evidence indicates that service providers at the primary care level should be sensitized to consider SD in women as variants of CMD (Common Mental Disorders) and address both groups of disorders concurrently. Further research should explicitly seek to unpack the mechanisms of the relationship between SD and CMD.
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    • "We believe such a paradigm shift would bring the conceptualization of CMD in line with the epidemiological and ethnographic findings in South Asia and thereby potentially enhance the recognition and management of the disorders and reduce the risk of stigmatization and expectations of specialist care which often accompanies the 'mental disorder' label. Our findings are consistent with those from other non-Western regions of the world, such as sub-Saharan Africa [21,22], suggesting that they may have more global generalizability than those imposed on primary care by contemporary psychiatric classifications and nosology. "
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    ABSTRACT: The biggest barrier to treatment of common mental disorders in primary care settings is low recognition among health care providers. This study attempts to explore the explanatory models of common mental disorders (CMD) with the goal of identifying how they could help in improving the recognition, leading to effective treatment in primary care. The paper describes findings of a cross sectional qualitative study nested within a large randomized controlled trial (the Manas trial). Semi structured interviews were conducted with 117 primary health care attendees (30 males and 87 females) suffering from CMD. Main findings of the study are that somatic phenomena were by far the most frequent presenting problems; however, psychological phenomena were relatively easily elicited on probing. Somatic phenomena were located within a biopsychosocial framework, and a substantial proportion of informants used the psychological construct of 'tension' or 'worry' to label their illness, but did not consider themselves as suffering from a 'mental disorder'. Very few gender differences were observed in the descriptions of symptoms but at the same time the pattern of adverse life events and social difficulties varied across gender. Our study demonstrates how people present their illness through somatic complaints but clearly link their illness to their psychosocial world. However they do not associate their illness to a 'mental disorder' and this is an important phenomenon that needs to be recognized in management of CMD in primary settings. Our study also elicits important gender differences in the experience of CMD.
    BMC Research Notes 09/2012; 5(1):499. DOI:10.1186/1756-0500-5-499
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