World Health Organization Collaborating Centre for Research and Training in Mental Health, Neuroscience, and Substance Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria.
Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK.
Int J Geriatr Psychiatry. 2024 Sep;39(9):e6147. doi: 10.1002/gps.6147.
There is a large treatment gap for mental health conditions in sub-Saharan Africa where most patients who receive any care do so from lay primary health care workers (PHCW). We sought to examine the experiences of PHCW who provide care for older people with depression in Nigerian primary health care (PHC) settings.
Qualitative study design. A total of 24 PHCW participated. Using in-depth key informant interviews (KIIs), we explored the views of 15 PHCW selected from 10 rural and urban PHCs in South-Western Nigeria. An additional focus group discussion comprising nine participants was also conducted to discuss emerging themes from KIIs. Data were analysed using thematic analysis.
Three overall themes were identified: views about depression, treatment options, and community outreach implications. Participants perceived depression in older people as being characterised by a range of mood, behavioural, and cognitive symptoms which made clinical assessments particularly challenging. Common treatment options used by PHCW included general advice and counselling, as well as frequent need to prescribe mild analgesics, vitamins and occasional sedatives in line with patients' expectations. Antidepressants were rarely used even though PHCW are authorised. While home visits are part of their expected work schedule, PHCW rarely implemented these due to non-availability of transport facilities. Mobile technology was identified as a possible way of overcoming this constraint to providing community based mental healthcare for older people.
PHCWs perceived that patients' poor cognitive performance, expectations to prescribe sedatives, analgesics and vitamins, as well as non-existence of community-based services were existing barriers to providing evidenced based continued care for older people with depression in the study settings.
在撒哈拉以南非洲地区，精神健康状况的治疗缺口很大，大多数接受治疗的患者都是由非专业的基层卫生保健工作者（PHCW）提供护理。我们试图研究在尼日利亚基层医疗保健（PHC）环境中为老年抑郁症患者提供护理的 PHCW 的经验。
采用定性研究设计。共有 24 名 PHCW 参与。我们通过深入的关键知情人访谈（KII），从尼日利亚西南部 10 个农村和城市的 PHC 中选择了 15 名 PHCW 来探讨他们的观点。还进行了一次由 9 名参与者组成的焦点小组讨论，以讨论 KII 中出现的主题。使用主题分析进行数据分析。
确定了三个总体主题：对抑郁症的看法、治疗选择和社区外展的影响。参与者认为老年人的抑郁症表现为一系列情绪、行为和认知症状，这使得临床评估特别具有挑战性。PHCW 使用的常见治疗选择包括一般建议和咨询，以及根据患者的期望经常需要开轻度止痛药、维生素和偶尔的镇静剂。即使 PHCW 获得授权，也很少使用抗抑郁药。家访是他们预期工作安排的一部分，但由于没有交通工具，PHCW 很少实施。移动技术被确定为为老年人提供基于社区的精神卫生保健的一种可能方式，可以克服这一提供社区精神卫生保健的限制。
PHCW 认为，患者认知能力差、期望开镇静剂、止痛药和维生素，以及缺乏基于社区的服务，是在研究环境中为老年抑郁症患者提供基于证据的持续护理的现有障碍。
