Devassy Saju Madavanakadu, Scaria Lorane, Cheguvera Natania
Department of Social Work, Rajagiri College of Social Sciences (Autonomous), Rajagiri P.O, Kalamassery, Cochin, Kerala, India.
Rajagiri International Centre for Consortium Research in Social care (ICRS), Rajagiri P.O, Kalamassery, Cochin, Kerala, India.
Pilot Feasibility Stud. 2022 Aug 30;8(1):192. doi: 10.1186/s40814-022-01159-0.
This study is a low-cost community mental health task-sharing model driven by university students to strengthen the mental health workforce in poor resource settings. This article presents the feasibility of a stepped referral model using the community health workforce and university students. The primary feasibility objective is to detect and refer people with mental illness from the community using a task-sharing approach.
We tested the model using a cross-sectional, one-phase door-knock survey in three geographically defined locations in Kerala, India, between May and July 2019. Students surveyed 549 residents above 18 years of age who consented to participate in the study to detect depressive symptoms and suicidality. The feasibility of the current model was evaluated based on four criteria: (a) identification and deployment of untapped human resources, (b) coordination of community health resources, (c) the acceptability of stepped referral pathways, and (d) identification of implementation challenges.
The mean age of the participants was 38.8, and more than 62% of the respondents were women. The results showed that 11.29%, 8.38%, and 4.91% of people reported mild, moderate, and severe levels of depression, respectively, and suicidal thoughts were found in 6.9% and suicidal ideation in 1.8%. The odds of depression were higher among females compared to males (OR: 1.64 (0.75-2.52), poor people (OR: 2.01 (1.14-2.88), and people with chronic illnesses (OR: 2.03 (1.24-2.81). The agreement of the findings with professional-administered research validated the strategy's efficiency. Twenty-seven patients with severe/extreme degrees of depression were sent for high-intensity interventions led by the mental health team, whereas 135 individuals with mild and above depression were referred for low-intensity interventions.
The newly recruited mental health workforce-driven screenings were acceptable and effective in detecting mental illness in the community population. We tested the care coordination systems and processes in creating referral pathways for the detected patients. Further, task-sharing stepped referral model will be tested in five panchayats (the lowest tier of local self-government) before replicating the model across India through Unnat Bharat Abhiyan (UBA) scheme.
本研究是一种由大学生推动的低成本社区心理健康任务分担模式，旨在加强资源匮乏地区的心理健康服务队伍。本文介绍了一种利用社区卫生工作者和大学生的分级转诊模式的可行性。主要可行性目标是通过任务分担方法从社区中发现并转诊患有精神疾病的人。
2019年5月至7月期间，我们在印度喀拉拉邦三个地理区域进行了一项横断面、单阶段挨家挨户调查，对该模式进行了测试。学生们对549名18岁以上同意参与研究的居民进行了调查，以检测抑郁症状和自杀倾向。基于以下四个标准评估当前模式的可行性：（a）识别和部署未开发的人力资源；（b）协调社区卫生资源；（c）分级转诊途径的可接受性；（d）识别实施挑战。
参与者的平均年龄为38.8岁，超过62%的受访者为女性。结果显示，分别有11.29%、8.38%和4.91%的人报告有轻度、中度和重度抑郁水平，6.9%的人有自杀念头，1.8%的人有自杀意念。女性患抑郁症的几率高于男性（比值比：1.64（0.75 - 2.52）），贫困人口（比值比：2.01（1.14 - 2.88））和慢性病患者（比值比：2.03（1.24 - 2.81））。研究结果与专业管理研究的一致性验证了该策略的有效性。27名重度/极重度抑郁症患者被送去接受由心理健康团队主导的高强度干预，而135名轻度及以上抑郁症患者被转诊接受低强度干预。
新招募的心理健康服务队伍推动的筛查在检测社区人群中的精神疾病方面是可接受且有效的。我们测试了为检测出的患者创建转诊途径的护理协调系统和流程。此外，在通过“Unnat Bharat Abhiyan（UBA）”计划在印度全国推广该模式之前，将在五个村委会（地方自治的最基层）对任务分担分级转诊模式进行测试。
