Department of Mental Health, Ministry of Health, Av. Eduardo Mondlane/Av. Salvador Allende, P.O. Box 1613, Maputo, Mozambique.
Department of Psychiatry, Universidade Federal de São Paulo, Rua Major Maragliano, 241, São Paulo, São Paulo, Brasil.
Adm Policy Ment Health. 2023 Jan;50(1):33-42. doi: 10.1007/s10488-022-01221-2. Epub 2022 Oct 13.
In Mozambique, human and financial resources for public mental health services are extremely limited. Understanding the mental health needs of those seeking healthcare can inform efficient targeting of mental health services. We examined if the frequency of mental disorders in a health facility varied based on the level of specialization of such facility, from primary care without mental health specialists (PrCMH -), to those with mental health specialists (PrCMH +) and tertiary care (TerC), where both inpatient and outpatient mental health services are available. Participants were adults (convenience sample) seeking health or mental health services at six facilities (2 PrCMH + , 3 PrCMH -, and 1 TerC) in the cities of Maputo and Nampula in Mozambique. Mental disorders were assessed by the MINI International Neuropsychiatric Interview (MINI) 4.0.0. We compared the sociodemographic characteristics and MINI diagnoses across the three types of health facilities. Multiple logistic regression models determined the likelihood that a person seeking services at each type of facility would have any mental disorder, common mental disorders (CMD), severe mental disorders (SMD), substance use disorders (SUD), and moderate-to-high suicide risk, adjusting for sociodemographic factors. Of the 612 total participants, 52.6% (n = 322) were positive for at least one mental disorder: 37.1% were positive for CMD, 28.9% for SMD, 13.2% for SUD, and 10.5% had suicide risk. Presence of any mental disorder was highest in TerC (62.5%) and lowest in PrCMH - (48.4%). Adjusting for sociodemographic covariates, participants in PrCMH + were significantly more likely to have SMD (OR 1.85, 95%CI 1.10-3.11) and SUD (OR 2.79, 95%CI 1.31-5.94) than participants in PrCMH -; participants in TerC were more likely to have CMD (OR 1.70, 95%CI 1.01-2.87) and SUD (OR 2.57, 95%CI 1.14-5.79) than in PrCMH -. Suicide risk was the only condition that did not differ across facility types. As anticipated, people with mental disorders were more likely to be cared for at facilities with mental health specialists. However, our study detected in this convenience sample a remarkably high frequency of mental disorders across different types of facilities within the Mozambican healthcare system. These results, if confirmed in representative samples, suggest a need to increase mental health services at the primary care level.
在莫桑比克，公共精神卫生服务的人力和财力资源极其有限。了解寻求医疗保健者的精神卫生需求可以为精神卫生服务的有效定位提供信息。我们研究了卫生机构的专业化程度是否会影响其精神障碍的发生频率，这些机构从没有精神卫生专家的初级保健机构（PrCMH-）到有精神卫生专家的初级保健机构（PrCMH+）和三级保健机构（TerC）不等，后者提供住院和门诊精神卫生服务。参与者为在莫桑比克马普托和楠普拉市六家机构（2 家 PrCMH+、3 家 PrCMH-和 1 家 TerC）寻求健康或精神卫生服务的成年人（便利样本）。使用 MINI 国际神经精神访谈（MINI）4.0.0 评估精神障碍。我们比较了三种类型的卫生机构的社会人口统计学特征和 MINI 诊断结果。多变量逻辑回归模型确定了在每种类型的机构中寻求服务的人患有任何精神障碍、常见精神障碍（CMD）、严重精神障碍（SMD）、物质使用障碍（SUD）和中高度自杀风险的可能性，调整了社会人口统计学因素。在 612 名总参与者中，52.6%（n=322）至少有一种精神障碍呈阳性：37.1%为 CMD，28.9%为 SMD，13.2%为 SUD，10.5%有自杀风险。TerC 中任何精神障碍的患病率最高（62.5%），PrCMH-最低（48.4%）。在调整了社会人口统计学协变量后，与 PrCMH-相比，PrCMH+中的参与者更有可能患有 SMD（OR 1.85，95%CI 1.10-3.11）和 SUD（OR 2.79，95%CI 1.31-5.94）；TerC 中的参与者更有可能患有 CMD（OR 1.70，95%CI 1.01-2.87）和 SUD（OR 2.57，95%CI 1.14-5.79）。与 PrCMH-相比，自杀风险是唯一在不同设施类型中没有差异的疾病。正如预期的那样，患有精神障碍的人更有可能在有精神卫生专家的机构接受治疗。然而，我们的研究在这个便利样本中发现，在莫桑比克医疗保健系统内的不同类型的机构中，精神障碍的频率非常高。如果在代表性样本中得到证实，这些结果表明需要增加初级保健水平的精神卫生服务。
