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National Mental Health Survey found that in India, the point prevalence
of major depressive disorder (MDD) was 2.7% and the treatment gap was
85.2%, whereas in Madhya Pradesh the point prevalence of MDD was 1.4% and
the treatment gap was 80%.
To describe the baseline prevalence of depression among adults,
association of various demographic and socioeconomic variables with
depression and estimation of contact coverage for the same.
Population-based cross-sectional survey of 3220 adults in Sehore district
of Madhya Pradesh, India. The outcome of interest was a probable
diagnosis of depression that was measured using the Patient Health
Questionnaire (PHQ-9) and the proportion of individuals with depression
(PHQ-9>9) who sought care for the same. The data were analysed using
simple and multiple log-linear regression.
Low educational attainment, unemployment and indebtedness were associated
with both moderate/severe depression (PHQ-9 score >9) and severe
depression only (PHQ-9 score >14), whereas age, caste and marital
status were associated with only moderate or severe depression. Religion,
type of house, land ownership and amount of loan taken were not
associated with either moderate/severe or only severe depression. The
contact coverage for moderate/severe depression was 13.08% (95% CI
There is an urgent need to bridge the treatment gap by targeting
individuals with social vulnerabilities and integrating evidence-based
interventions in primary care.
The large treatment gap for mental disorders in India underlines the need for integration of mental health in primary care.
To operationalise the delivery of the World Health Organization Mental Health Gap Action Plan interventions for priority mental disorders and to design an integrated mental healthcare plan (MHCP) comprising packages of care for primary healthcare in one district.
Mixed methods were used including theory of change workshops, qualitative research to develop the MHCP and piloting of specific packages of care in a single facility.
The MHCP comprises three enabling packages: programme management, capacity building and community mobilisation; and four service delivery packages: awareness for mental disorders, identification, treatment and recovery. Challenges were encountered in training primary care workers to improve identification and treatment.
There are a number of challenges to integrating mental health into primary care, which can be addressed through the injection of new resources and collaborative care models.
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