Musyimi Christine W, Mutiso Victoria N, Musau Abednego M, Matoke Lydia K, Ndetei David M
Africa Mental Health Foundation, Kenya.
National Traditional Health Practitioners Association, Kenya.
Transcult Psychiatry. 2017 Jun;54(3):285-303. doi: 10.1177/1363461517705590. Epub 2017 May 18.
In Kenya, there is paucity of information on depression among traditional health practitioner (THP) patients, particularly in rural areas. The aim of this study was to estimate prevalence and identify determinants of major depressive disorder (MDD) among patients of THP in rural Kenya using the World Health Organization (WHO) Mental Health Gap Action Programme Intervention Guideline (mhGAP-IG). All adult patients seeking care from trained THPs (either traditional healers such as diviners and herbalists or faith healers, who use treatments such as prayers, laying hands on patients, or providing holy water and ash to their patients) over a period of 3 months (September 2014 to November 2014) were screened for depression using mhGAP-IG and their sociodemographic characteristics recorded. Overall, the prevalence of depression among THP patients was 22.9%. Being older, female, single, divorced or separated, as well as unemployment and lack of education were found to be significant determinants of depression. Patients with MDD frequently presented with suicidal behavior (32.9%, OR = 5.94, p < .0001) compared to those that had at least one psychotic symptom (26.3%, OR = 3.65, p < .0001). A measure of the accuracy of THPs' assessment of MDD showed 86% specificity and 46% sensitivity and the area under receiver operating characteristics (ROC) curve was 0.686. Our findings shed light on the prevalence of depression among THP patients and thus highlight the need for further research on diagnostic tools for use among THPs in order to avoid substandard care and promote reliance on more evidence-based methods of care.
在肯尼亚，关于传统保健从业者（THP）的患者中抑郁症的信息匮乏，尤其是在农村地区。本研究的目的是使用世界卫生组织（WHO）精神卫生差距行动计划干预指南（mhGAP-IG）来估计肯尼亚农村地区THP患者中重度抑郁症（MDD）的患病率，并确定其决定因素。在3个月（2014年9月至2014年11月）期间，所有向经过培训的THP（包括占卜师和草药师等传统治疗师或信仰治疗师，他们使用祈祷、为患者抚摸、或为患者提供圣水和香灰等治疗方法）寻求治疗的成年患者，均使用mhGAP-IG进行抑郁症筛查，并记录其社会人口学特征。总体而言，THP患者中抑郁症的患病率为22.9%。年龄较大、女性、单身、离异或分居，以及失业和缺乏教育被发现是抑郁症的重要决定因素。与至少有一种精神病症状的患者相比，MDD患者经常出现自杀行为（32.9%，OR = 5.94，p <.0001）（26.3%，OR = 3.65，p <.0001）。THP对MDD评估的准确性测量显示特异性为86%，敏感性为46%，受试者工作特征（ROC）曲线下面积为0.686。我们的研究结果揭示了THP患者中抑郁症的患病率，从而突出了对THP使用的诊断工具进行进一步研究的必要性，以避免护理不达标，并促进对更多循证护理方法的依赖。
