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Abstract
ObjectiveTo describe the receipt of a diagnosis, referral and treatment for depression in people receiving antiretroviral therapy (ART), with depressive symptoms and attending primary care clinics in South Africa, and investigate factors associated with receiving these components of care.MethodsThis is a secondary analysis of data from a randomised controlled trial of an intervention intended to improve detection and treatment of depression in primary care patients receiving ART. In this analysis, we combined cross‐sectional and longitudinal data from the intervention and control arms. Using regression models and adjusting for intra‐cluster correlation of outcomes, we investigated associations between socioeconomic characteristics, depressive symptoms, stress, disability and stigma, and receipt of a diagnosis, referral and treatment for depression.ResultsOf 2002 participants enrolled, 18% reported a previous diagnosis of depression by a healthcare worker and 10% reported having received counselling from a specialist mental health worker. Diagnosis, referral and counselling during the follow‐up period were appropriately targeted, being independently more frequent in participants with higher enrolment scores for depressive symptoms, stress or disability. Participants with higher stigma scores at enrolment were independently less likely to receive counselling. Severe socio‐economic deprivation was common but was not associated with treatment.ConclusionWhile the receipt of a diagnosis, referral and treatment for depression were uncommon, they seemed to be appropriately targeted. Socio‐economic deprivation was not associated with treatment.
Highlights
Mental disorders contribute significantly to the burden of disease [1] but largely remain undiagnosed and untreated in low- and middle-income countries (LMICs) [2,3,4,5,6]
The aims of the present study were to carry out a secondary analysis of trial data in order to describe the receipt of a diagnosis, referral and treatment of depression in trial participants with depressive symptoms and receiving antiretroviral therapy (ART), and to investigate personal and health service factors associated with receiving each component of care, which were unaffected by the trial intervention
Individual health indicators used as potential explanatory variables included scores for depressive symptoms, stress, stigma and disability, and previous diagnosis of tuberculosis, hypertension and either heart attack or stroke as comorbid conditions
Summary
Mental disorders contribute significantly to the burden of disease [1] but largely remain undiagnosed and untreated in low- and middle-income countries (LMICs) [2,3,4,5,6]. Collaborative care is defined as cooperation regarding the diagnosis and/or treatment of an individual patient among two or more practitioners from different health fields [14]. These advances are important in LMICs. These advances are important in LMICs Zani et al Predictors of care for depression volume 00 no 00 that are short of mental health workers in primary care [15,16,17,18]
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