Abstract
BackgroundLarge scale efforts to expand access to mental healthcare in low- and middle-income countries have focused on integrating mental health services into primary care settings using a task sharing approach delivered by non-specialist health workers. Given the link between mental disorders and risk of suicide mortality, treating common mental disorders using this approach may be a key strategy to reducing suicidality.Methods and findingsThe Programme for Improving Mental Health Care (PRIME) evaluated mental health services for common mental disorders delivered by non-specialist health workers at ten primary care facilities in Chitwan, Nepal from 2014 to 2016. In this paper, we present the indirect impact of treatment on suicidality, as measured by suicidal ideation, among treatment and comparison cohorts for depression and AUD using multilevel logistic regression. Patients in the treatment cohort for depression had a greater reduction in ideation relative to those in the comparison cohort from baseline to three months (OR = 0.16, 95% CI: 0.05–0.59; p = 0.01) and twelve months (OR = 0.31, 95% CI: 0.08–1.12; p = 0.07), with a significant effect of treatment over time (p = 0.02). Among the AUD cohorts, there were no significant differences between treatment and comparison cohorts in the change in ideation from baseline to three months (OR = 0.64, 95% CI: 0.07–6.26; p = 0.70) or twelve months (OR = 0.46, 95% CI: 0.06–3.27; p = 0.44), and there was no effect of treatment over time (p = 0.72).ConclusionThe results provide evidence integrated mental health services for depression benefit patients by accelerating the rate at which suicidal ideation naturally abates over time. Integrated services do not appear to impact ideation among people with AUD, though baseline levels of ideation were much lower than for those with depression and may have led to floor effects. The findings highlight the importance of addressing suicidality as a specific target–rather than an indirect effect–of treatment in community-based mental healthcare programs.
Highlights
The Programme for Improving Mental Health Care (PRIME) evaluated mental health services for common mental disorders delivered by non-specialist health workers at ten primary care facilities in Chitwan, Nepal from 2014 to 2016
The results provide evidence integrated mental health services for depression benefit patients by accelerating the rate at which suicidal ideation naturally abates over time
More than 800,000 people die by suicide each year, with three quarters of suicides occurring in low- and middle-income countries (LMIC) [1] where scarce resources exist for mental health care and suicide prevention efforts [2]
Summary
More than 800,000 people die by suicide each year, with three quarters of suicides occurring in low- and middle-income countries (LMIC) [1] where scarce resources exist for mental health care and suicide prevention efforts [2]. The burden of suicide is increasingly shifting to Asia given population growth in this region and declining suicide rates in high-income Western countries [3]. The 11 countries in the World Health Organization (WHO) South-East Asia Region comprises approximately one quarter of the world’s population, yet account for 39% all suicides [1]. Large scale efforts to expand access to mental healthcare in low- and middle-income countries have focused on integrating mental health services into primary care settings using a task sharing approach delivered by non-specialist health workers. Given the link between mental disorders and risk of suicide mortality, treating common mental disorders using this approach may be a key strategy to reducing suicidality
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