Prevalence and determinants of depression among patients under the care of traditional health practitioners in a Kenyan setting: Policy implications

Abstract

In Kenya, there is paucity of information on depression among traditional health practitioner (THP) patients, particularly in rural areas. The aim of this study was to estimate prevalence and identify determinants of major depressive disorder (MDD) among patients of THP in rural Kenya using the World Health Organization (WHO) Mental Health Gap Action Programme Intervention Guideline (mhGAP-IG). All adult patients seeking care from trained THPs (either traditional healers such as diviners and herbalists or faith healers, who use treatments such as prayers, laying hands on patients, or providing holy water and ash to their patients) over a period of 3 months (September 2014 to November 2014) were screened for depression using mhGAP-IG and their sociodemographic characteristics recorded. Overall, the prevalence of depression among THP patients was 22.9%. Being older, female, single, divorced or separated, as well as unemployment and lack of education were found to be significant determinants of depression. Patients with MDD frequently presented with suicidal behavior (32.9%, OR = 5.94, p < .0001) compared to those that had at least one psychotic symptom (26.3%, OR = 3.65, p < .0001). A measure of the accuracy of THPs’ assessment of MDD showed 86% specificity and 46% sensitivity and the area under receiver operating characteristics (ROC) curve was 0.686. Our findings shed light on the prevalence of depression among THP patients and thus highlight the need for further research on diagnostic tools for use among THPs in order to avoid substandard care and promote reliance on more evidence-based methods of care.

Keywords

depression determinants Kenya mhGAP-IG prevalence traditional health practitioner

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References

Abbo

Ekblad

Waako

Okello

Musisi

(2009) The prevalence and severity of mental illnesses handled by traditional healers in two districts in Uganda. African Health Sciences 9: S16–S22.

Akhtar-Danesh

Landeen

(2007) Relation between depression and sociodemographic factors. International Journal of Mental Health Systems 1. doi:10.1186/1752-4458-1-4.

American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders: DSM-IV-TR, 4th edition, Washington, DC: Author.

Appiah-Poku

Laugharne

Mensah

Osei

Burns

(2004) Previous help sought by patients presenting to mental health services in Kumasi, Ghana. Social Psychiatry and Psychiatric Epidemiology 39: 208–211.

Beaton, D., Bombardier, C., Guillemin, F., & Ferraz, M. B. (1998). Recommendations for the cross-cultural adaptation of health status measures. Retrieved from https://pdfs.semanticscholar.org/729b/fa6c68a48aafdf61e39e5f9992b155fb8147.pdf.

Buderer

(1996) Statistical methodology: I. Incorporating the prevalence of disease into the sample size calculation for sensitivity and specificity. Academic Emergency Medicine 3: 895–900.

Bulloch

Williams

Lavorato

Patten

(2009) The relationship between major depression and marital disruption is bidirectional. Depression and Anxiety 26: 1172–1177.

Coleman

(2013) Pre-selection of traditional medicine for clinical trials in developing countries through the use of information and communication technology (ICT): A case study of South Africa Health Department. Studies on Ethno-Medicine 7: 79–86.

Cukrowicz

K. C.

Poindexter

E. K.

(2014) Suicide. In: Richards

O’Hara

(eds) The Oxford handbook of depression and comorbidity, New York, NY: Oxford University Press, pp. 254–267.

10.

Fawcett

(2012) Diagnosis, traits, states, and comorbidity in suicide: The neurobiological basis of suicide. In: Dwivedi

(ed.) The neurobiological basis of suicide, Boca Raton, FL: CRC Press, pp. 1–10.

11.

Gaudiano

B. A.

Dalrymple

K. L.

Zimmerman

(2009) Prevalence and clinical characteristics of psychotic versus nonpsychotic major depression in a general psychiatric outpatient clinic. Depression and Anxiety 26: 54–64. doi:10.1002/da.20470.

12.

Glick

(2007) Translating evidence on depression and physical symptoms into effective clinical practice. Primary Care Companion to the Jorunal of Clinical Psychiatry 9: 295–302.

13.

Goud

Shanbhag

Wilson

Johnson

D’Souza

Sachdev

Nandish

(2014) Common mental illnesses among adult women in rural resource poor setting areas of Bangalore Urban District – A descriptive study. International Journal of Innovative Research & Studies 3: 715–724.

14.

Gureje

Acha

Odejide

(1995) Pathways to psychiatric care in Ibadan, Nigeria. Tropical and Geographical Medicine 47: 125–129.

15.

Havenaar

J. M.

Geerlings

M. I.

Vivian

L. M.

Collinson

Robertson

(2008) Common mental health problems in historically disadvantaged urban and rural communities in South Africa: Prevalence and risk factors. Social Psychiatry and Psychiatric Epidemiology 43: 209–215. doi:10.1007/s00127-007-0294-9.

16.

Hirschfeld

R. M. A.

Weissman

M. M.

(2002) Risk factors for major depression and bipolar disorder. In: Davis

K. L.

Charney

Coyle

J. T.

Nemeroff

(eds) Neuropsychopharmacology: The fifth generation of progress, Philadelphia, PA: Lippincott, Williams & Wilkins, pp. 1017–1025.

17.

International

Consortium of Psychiatric Epidemiology.

(2000) Cross-national comparisons of the prevalences and correlates of mental disorders. Bulletin of the World Health Organization 78: 413–426.

18.

Jefferis

Nazareth

Marston

Moreno-Kustner

Bellón

Svab

King

(2011) Associations between unemployment and major depressive disorder: Evidence from an international, prospective study (the predict cohort). Social Science and Medicine (1982) 73: 1627–1634.

19.

Johnson

Horwath

Weissman

(1991) The validity of major depression with psychotic features based on a community study. Archives of General Psychiatry 48: 1075–1081.

20.

Johnson-Bashua

(2012) Yoruba traditional healers and mental illness: Causes, diagnosis and treatment. In: Ihuah

A. S.

(ed.) Philosophy, religion and politics in Africa, Raleigh, NC: Lulu, pp. 34–46.

21.

Khasakhala

Ndetei

Mutiso

Mbwayo

Mathai

(2012) The prevalence of depressive symptoms among adolescents in Nairobi public secondary schools: Association with perceived maladaptive parental behaviour. African Journal of Psychiatry 15: 106–113.

22.

Kirmayer

L. J.

(2001) Cultural variations in the clinical presentation of depression and anxiety: Implications for diagnosis and treatment. The Journal of Clinical Psychiatry 62: 22–28.

23.

Kurihara

Kato

Reverger

Tirta

(2006) Pathway to psychiatric care in Bali. Psychiatry and Clinical Neurosciences 60: 204–210. doi:10.1111/j.1440-1819.2006.01487.x.

24.

Makueni

County.

(2013) First county integrated development plan 2013–2017, Makueni, Kenya: County Government of Makueni.

25.

Mathibela

M. K.

Egan

B. A.

Du Plessis

H. J.

Potgieter

M. J.

(2015) Socio-cultural profile of Bapedi traditional healers as indigenous knowledge custodians and conservation partners in the Blouberg area, Limpopo province, South Africa. Journal of Ethnobiology and Ethnomedicine 11. doi:10.1186/s13002-015-0025-3.

26.

Mbwayo

Ndetei

Mutiso

Khasakhala

(2013) Traditional healers and provision of mental health services in cosmopolitan informal settlements in Nairobi, Kenya. African Journal of Psychiatry 16: 134–140.

27.

Mhame, P., Busia, K., & Kasilo, O. (2010). Clinical practices of African traditional medicine. African Health Monitor, 13. Retrieved from https://www.aho.afro.who.int/en/ahm/issue/13/reports/clinical-practices-african-traditional-medicine.

28.

Mirowsky

Ross

(1992) Age and depression. Journal of Health and Social Behavior 33: 206–212.

29.

Mulrow

C. D.

Williams

J. W.

Gerety

M. B.

Ramirez

Montiel

O. M.

Kerber

(1995) Case-finding instruments for depression in primary care settings. Annals of Internal Medicine 122: 913–921.

30.

Musyimi

C. W.

Mutiso

V. N.

Nandoya

E. S.

Ndetei

D. M.

(2016) Forming a joint dialogue among faith healers, traditional healers and formal health workers in mental health in a Kenyan setting: Towards common grounds. Journal of Ethnobiology and Ethnomedicine 12. doi:10.1186/s13002-015-0075-6.

31.

Ndetei, D., Khasakhala, L., Kingori, J., Oginga, A., & Raja, S. (2008). The complementary role of traditional and faith healers and potential liaisons with Western-style mental health services in Kenya. Retrieved from https://profiles.uonbi.ac.ke/ndetei/publications/complementary-role-traditional-and-faith-healers-and-potential-liaisons-wester-0.

32.

Ndetei

Khasakhala

Nyabola

Ongecha-Owuor

Seedat

Mutiso

Odhiambo

(2008) The prevalence of anxiety and depression symptoms and syndromes in Kenyan children and adolescents. Journal of Child and Adolescent Mental Health 20: 33–51.

33.

Ngoma

M. C.

Prince

Mann

(2003) Common mental disorders among those attending primary health clinics and traditional healers in urban Tanzania. The British Journal of Psychiatry 183: 349–355.

34.

Ohayon

Schatzberg

(2002) Prevalence of depressive episodes with psychotic features in the general population. The American Journal of Psychiatry 159: 1855–1861.

35.

Oquendo

Baca-Garcia

(2014) Suicidal behavior disorder as a diagnostic entity in the DSM-5 classification system: Advantages outweigh limitations. World Psychiatry 13: 128–130.

36.

Othieno

Okoth

Peltzer

Pengpid

Malla

L. O.

(2014) Depression among university students in Kenya: Prevalence and sociodemographic correlates. Journal of Affective Disorders 165: 120–125.

37.

Ovuga

Boardman

Oluka

(1999) Traditional healers and mental illness in Uganda. Psychiatric Bulletin 23: 276–279.

38.

Owuor

B. O.

Kisangau

D. P.

(2006) Kenyan medicinal plants used as antivenin: A comparison of plant usage. Journal of Ethnobiology and Ethnomedicine 2. doi:10.1186/1746-4269-2-7.

39.

Posternak

Zimmerman

(2005) Elevated rates of psychosis among treatment-seeking Hispanic patients with major depression. The Journal of Nervous and Mental Disease 193: 66–69.

40.

Puckree

Mkhize

Mgobhozi

Lin

(2002) African traditional healers: What health care professionals need to know. International Journal of Rehabilitation Research 25: 247–251.

41.

Reddy

M. S.

(2010) Depression: The disorder and the burden. Indian Journal of Psychological Medicine 32: 1–2.

42.

Reynolds

Pietrzak

El-Gabalawy

Mackenzie

Sareen

(2015) The prevalence of psychiatric disorders in U.S. older adults: Findings from a nationally representative survey. World Psychiatry 14: 74–81.

43.

Schieffelin

E. L.

(1985) The cultural analysis of depressive affect: An example from New Guinea. In: Kleinman

Good

(eds) Culture and depression: Studies in the anthropology and cross-cultural psychiatry of affect and disorder, Berkeley: University of California Press, pp. 101–133.

44.

Sheehan

Lecrubier

Sheehan

Amorim

Janavs

Weiller

Dunbar

(1998) The Mini-International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. The Journal of Clinical Psychiatry 59: 22–33.

45.

Simon

VonKorff

Piccinelli

Fullerton

Ormel

(1999) An international study of the relation between somatic symptoms and depression. The New England Journal of Medicine 341: 1329–1335.

46.

Smith

Kim

Ganoczy

Stano

Pfeiffer

Valenstein

(2013) Suicide risk assessment received prior to suicide death by Veterans Health Administration patients with a history of depression. The Journal of Clinical Psychiatry 74: 226–232.

47.

Soares

Zitek

(2008) Reproductive hormone sensitivity and risk for depression across the female life cycle: A continuum of vulnerability? Journal of Psychiatry and Neuroscience 33: 331–343.

48.

Sorsdahl

Stein

D. J.

Grimsrud

Seedat

Flisher

A. J.

Williams

D. R.

Myer

(2009) Traditional healers in the treatment of common mental disorders in South Africa. The Journal of Nervous and Mental Disease 197: 434–441.

49.

Stahl

S. M.

(2002) The psychopharmacology of painful physical symptoms in depression. The Journal of Clinical Psychiatry 63: 382–383.

50.

Starkowitz, M. (2014). African traditional healers’ understanding of depression as a mental illness: Implications for social work practice (Master’s dissertation). Retrieved from UPSpace Institutional Repository at http://repository.up.ac.za/handle/2263/31576.

51.

Takahashi

(2001) Depression and suicide. The Journal of the Japan Medical Association 124: 359–363.

52.

Thielke

Diehr

Unutzer

(2010) The prevalence, incidence, and persistence of major depressive symptoms in the Cardiovascular Health Study. Aging and Mental Health 14: 168–176.

53.

Truter

(2007) African traditional healers: Cultural and religious beliefs intertwined in a holistic way. South African Pharmaceutical Journal 74: 56–60.

54.

World Health Organization (WHO). (2003). Traditional medicine (Fact sheet No. 134). Retrieved from http://www.who.int/mediacentre/factsheets/2003/fs134/en/.

55.

World Health Organization (WHO). (2008). The global burden of disease: 2004 update. Retrieved from http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf.

56.

World Health Organization (WHO). (2010). mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings: Mental Health Gap Action Programme (mhGAP). Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK138693/.

57.

World Health Organization (WHO). (2015). Process of translation and adaptation of instruments. Retrieved from http://www.who.int/substance_abuse/research_tools/translation/en/.

58.

Zivin

Kim

McCarthy

Austin

K. L.

Hoggatt

K. J.

Walters

Valenstein

(2007) Suicide mortality among individuals receiving treatment for depression in the Veterans Affairs Health System Associations with patient and treatment setting characteristics. American Journal of Public Health 97: 2193–2198.