Abstract
BackgroundThe 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.ResultsThe 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.ConclusionOur 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.
Highlights
The biggest barrier to treatment of common mental disorders in primary care settings is low recognition among health care providers
One of the biggest challenges to the effective treatment of the disorders at the primary care setting is the low rate of recognition of common mental disorders (CMD) by primary health care workers
We focused on describing the explanatory models of CMD among women and their association with maternal health and reproductive and sexual health
Summary
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. Previous authors have observed that somatization is a common phenomenon associated with CMD in non-western settings [7] This has been interpreted by some as suggesting that there is a denial among these cultures of the psychological origins of their illness experiences [8]. We focused on describing the explanatory models of CMD among women and their association with maternal health and reproductive and sexual health In these studies, we reported that women described a number of somatic complaints, there was no 'denial' of their social and emotional contexts [10,11]. We build on our previous work by extending our inquiry on the explanatory models of CMD among primary health care attendees of both genders by addressing the following questions: illness narrative: the experience of the illness, in particular of somatic and psychological phenomena; the history and course of the illness; and the causal explanations for the illness and its relationship to the social worlds of the participants
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