Proactive community case-finding to facilitate treatment seeking for mental disorders, Nepal
Proactive community case-finding to facilitate treatment seeking for mental disorders, Nepal
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DOI：
10.2471/blt.16.189282
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发表时间：
2017-07-01
影响因子：
11.1
通讯作者：
Komproe, Ivan H.
中科院分区：
文献类型：
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作者：
Jordans, Mark J. D.;Kohrt, Brandon A.;Komproe, Ivan H.
对精神卫生服务利用不足是减少精神、神经和药物使用障碍所致疾病负担的主要障碍。以初级保健为基础的筛查，以发现患有精神障碍的人错过了人不经常访问医疗保健设施或谁缺乏获得服务的途径。方法在尼泊尔的两个地区，我们培训了非专业的社区信息员使用一种工具，以发现患有精神，神经和物质使用障碍的人在日常社区服务。社区线人检测工具由对背景敏感的小插图和识字率低的人口容易理解的图片组成。举报人将他们确定的使用该工具的人介绍给卫生保健设施。检测后三周，经过培训的研究助理会对人们进行访谈，以评估他们的求助行为以及是否接受过任何治疗。当地环境尼泊尔分散的精神卫生服务很少，很少有精神障碍患者寻求护理。相关变化在通过社区线人检测工具确定的509人中，三分之二的人（67%; 341）获得医疗服务，其中77%（264）的人开始接受心理健康治疗。农村Pyuthan区的人（268人中有208人）比Chitwan区的人（241人中有133人）更有可能获得医疗保健。这一工具在农村环境中似乎是有益的，那里的社区联系紧密，社区信息提供者熟悉那些需要心理健康服务的人。
Problem Underutilization of mental health services is a major barrier to reducing the burden of disease attributable to mental, neurological and substance-use disorders. Primary care-based screening to detect people with mental disorders misses people not frequently visiting health-care facilities or who lack access to services.Approach In two districts in Nepal, we trained lay community informants to use a tool to detect people with mental, neurological and substance-use disorders during routine community service. The community informant detection tool consists of vignettes, which are sensitive to the context, and pictures that are easy to understand for low literacy populations. Informants referred people they identified using the tool to health-tare facilities. Three weeks after detection, people were interviewed by trained research assistants to assess their help-seeking behaviour and whether they received any treatment.Local setting Decentralized mental health services are scarce in Nepal and few people with mental disorders are seeking care.Relevant changes Out of the 509 people identified through the community informant detection tool, two-thirds (67%; 341) accessed health services and 77% (264) of those individuals initiated mental health treatment. People in the rural Pyuthan district (208 out of 268) were more likely to access health care than those living in Chitwan district (133 out of 241).Lessons learnt The introduction of the tool increased the utilization of mental health services in a low-income country with few health resources. The tool seems beneficial in rural settings, where communities are close-knit and community informants are familiar with those in need of mental health services.