WHO-mhGAP Training in Mexico: Increasing Knowledge and Readiness for the Identification and Management of Depression and Suicide Risk in Primary Care

Abstract

In order to reduce the treatment gap of mental disorders, the World Health Organization (WHO) has proposed the mhGAP guidelines to be implemented globally. To examine the effectivity of a training course based on the WHO-mhGAP guidelines to increase knowledge and readiness for identification and management of depression and suicide risk in primary care (PC) in Mexico. PC clinicians were invited to participate in a traning course; before and after it, all completed an evaluation of knowledge of mhGAP and depression (0-10 points), and self-efficacy in suicide risk management (0-40 points), and were classified according to Prochaska and Diclemente transtheorical model in their particular stage of readiness for identification and management of these conditions. The sample included 60 health professionals. Before training, clinicians had adequate knowledge of depression and its treatment (8.1±1.66), but not on the mhGAP model and/or suicide risk management, which increased by the end of training (mhGAPpre:7.91±2.19 vs. mhGAPpost:8.77±1.34, p=0.01; SuicidePRE:29.16±9.35 vs. SuicidePOST:39.24±6.83, p=0.0001). Before training, most clinicians were at the contemplation stage (42.6% vs. 37.7% at the action and 19.7% at the precontemplation stage). By the end of the training, a decrease in the number of clinicians at both the contemplation and precontemplation stages (to 36.1% and to zero, respectively) and a significant increase of clinicians at the action stage (to 63.9%) was observed. A training course based on the WHO-mhGAP could be an effective tool for increasing PC clinicians' willingness to implement mental health services.