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Risk correlates for physical-mental multimorbidities in South Africa: a cross-sectional study

Published online by Cambridge University Press:  04 December 2017

I. Petersen ,
S. Rathod ,
T. Kathree ,
O. Selohilwe  and
A. Bhana
I. Petersen*
Affiliation:
Centre for Rural Health and School of Applied Human Sciences, University of KwaZulu- Natal, PR Bag X54001, Westville, 3630, South Africa
S. Rathod
Affiliation:
Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
T. Kathree
Affiliation:
Centre for Rural Health and School of Applied Human Sciences, University of KwaZulu- Natal, PR Bag X54001, Westville, 3630, South Africa
O. Selohilwe
Affiliation:
Centre for Rural Health and School of Applied Human Sciences, University of KwaZulu- Natal, PR Bag X54001, Westville, 3630, South Africa
A. Bhana
Affiliation:
Centre for Rural Health and School of Applied Human Sciences, University of KwaZulu- Natal, PR Bag X54001, Westville, 3630, South Africa Health Systems Research Unit, South African Medical Research Council, Durban, South Africa
*
*Address for correspondence: I. Petersen, Centre for Rural Health and School of Applied Human Sciences, University of KwaZulu- Natal, PR Bag X54001, Westville, 3630, South Africa. (Email: Peterseni@ukzn.ac.za)
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Abstract

Aims.

The aim of this study was to identify the risk correlates for coexisting common mental disorders (CMDs) in the chronic care population in South Africa, with the view to identifying particularly vulnerable patient populations.

Methods.

The sample comprised 2549 chronic care patients enrolled in the baseline and endline rounds of a facility detection survey conducted by the Programme for Improving Mental Health Care in three large facilities in the Dr Kenneth Kaunda district in the North West province of South Africa. Participants were screened for depression using the Patient Health Questionnaire (PHQ9) and for alcohol misuse using the Alcohol Use Disorders Identification Test (AUDIT). Data were analysed according to the number of morbidities, disorder type (physical or mental) and demographic variables. Multimorbidity was defined as the presence of two or more disorders (physical and/or mental).

Results.

Just over one-third of the sample reported two or more physical conditions. Women were more at risk of being depressed than were men, with men more at risk of alcohol misuse. Those who were employed were at lower risk of having coexisting CMDs, while being younger, HIV positive, and food deprived were all found to be associated with higher risk for having coexisting CMDs.

Conclusion.

In the face of the large treatment gap for CMDs in South Africa, and the role that coexisting CMDs can play in exacerbating the burden of chronic physical diseases, mental health screening and treatment interventions should target HIV-positive, younger patients living in circumstances where there is household food insecurity.

Keywords

Chronic conditionscommon mental disordersmultimorbidityrisk factors
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 28 , Issue 4 , August 2019 , pp. 418 - 426
Copyright
Copyright © Cambridge University Press 2017 

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References

Barnett, K, Mercer, SW, Norbury, M, Watt, G, Wyke, S, Guthrie, B (2012). Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 380, 37–43.Google Scholar
Blumberg, SJ, Bialostosky, K, Hamilton, WL, Briefel, RR (1999). The effectiveness of a short form of the Household Food Security Scale. American Journal of Public Health 89, 1231–1234.Google Scholar
Chishinga, N, Kinyanda, E, Weiss, HA, Patel, V, Ayles, H, Seedat, S (2011). Validation of brief screening tools for depressive and alcohol use disorders among TB and HIV patients in primary care in Zambia. BMC Psychiatry 11, 75.Google Scholar
Chisholm, D, Sweeny, K, Sheehan, P, Rasmussen, B, Smit, F, Cuijpers, P, Saxena, S (2016). Scaling-up treatment of depression and anxiety: a global return on investment analysis. Lancet Psychiatry 3, 415–424.Google Scholar
Cholera, R, Gaynes, BN, Pence, BW, Bassett, J, Qangule, N, Macphail, C, Bernhardt, S, Pettifor, A, Miller, WC (2014). Validity of the Patient Health Questionnaire-9 to screen for depression in a high-HIV burden primary healthcare clinic in Johannesburg, South Africa. Journal of Affective Disorders 167, 160–166.Google Scholar
Ciesla, JA, Roberts, JE (2001). Meta-analysis of the relationship between HIV infection and risk for depressive disorders. American Journal of Psychiatry 158, 725–730.Google Scholar
Dos Santos, MM, Kruger, P, Mellors, SE, Wolvaardt, G, van der Ryst, E (2014). An exploratory survey measuring stigma and discrimination experienced by people living with HIV/AIDS in South Africa: the People Living with HIV Stigma Index. BMC Public Health 14, 80.Google Scholar
Fairall, L, Bateman, E, Cornick, R, Faris, G, Timmerman, V, Folb, N, Bachmann, M, Zwarenstein, M, Smith, R (2015). Innovating to improve primary care in less developed countries: towards a global model. BMJ Innovations 1, 196–203.Google Scholar
Folb, N, Timmerman, V, Levitt, NS, Steyn, K, Bachmann, MO, Lund, C, Bateman, ED, Lombard, C, Gaziano, TA, Zwarenstein, M, Fairall, LR (2015). Multimorbidity, control and treatment of noncommunicable diseases among primary healthcare attenders in the Western Cape, South Africa. South African Medical Journal 105, 642–647.Google Scholar
Freeman, M, Nkomo, N, Kafaar, Z, Kelly, K (2007). Factors associated with prevalence of mental disorder in people living with HIV/AIDS in South Africa. AIDS Care 19, 1201–1209.Google Scholar
GBD 2013 Mortality and Causes of Death Collaborators (2015). Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 385, 117–171.Google Scholar
Gijsen, R, Hoeymans, N, Schellevis, FG, Ruwaard, D, Satariano, WA, van den Bos, GA (2001). Causes and consequences of comorbidity: a review. Journal of Clinical Epidemiology 54, 661–674.Google Scholar
Gonzalez, JS, Batchelder, AW, Psaros, C, Safren, SA (2011). Depression and HIV/AIDS treatment nonadherence: a review and meta-analysis. Journal of Acquired Immune Deficiency Syndrome 58, 181–187.Google Scholar
Grimsrud, A, Stein, DJ, Seedat, S, Williams, D, Myer, L (2009). The association between hypertension and depression and anxiety disorders: results from a nationally-representative sample of South African adults. PLoS ONE 4, e5552.Google Scholar
Grobler, WCJ (2016). Perceptions of poverty: a study of food secure and food insecure households in an urban area in South Africa. Procedia Economics and Finance 35, 224–231.Google Scholar
Hanlon, C, Luitel, NP, Kathree, T, Murhar, V, Shrivasta, S, Medhin, G, Ssebunnya, J, Fekadu, A, Shidhaye, R, Petersen, I, Jordans, M, Kigozi, F, Thornicroft, G, Patel, V, Tomlinson, M, Lund, C, Breuer, E, De Silva, M, Prince, M (2014). Challenges and opportunities for implementing integrated mental health care: a district level situation analysis from five low- and middle-income countries. PLoS ONE 9, e88437.Google Scholar
Kessler, RC, Bromet, EJ (2013). The epidemiology of depression across cultures. Annual Review of Public Health 34, 119–138.Google Scholar
Lonnroth, K, Williams, BG, Stadlin, S, Jaramillo, E, Dye, C (2008). Alcohol use as a risk factor for tuberculosis - a systematic review. BMC Public Health 8, 289.Google Scholar
Lund, C, Breen, A, Flisher, AJ, Kakuma, R, Corrigall, J, Joska, JA, Swartz, L, Patel, V (2010). Poverty and common mental disorders in low and middle income countries: a systematic review. Social Science & Medicine 71, 517–528.Google Scholar
Lund, C, De Silva, M, Plagerson, S, Cooper, S, Chisholm, D, Das, J, Knapp, M, Patel, V (2011). Poverty and mental disorders: breaking the cycle in low-income and middle-income countries. Lancet 378, 1502–1514.Google Scholar
Lund, C, Tomlinson, M, De Silva, M, Fekadu, A, Shidhaye, R, Jordans, M, Petersen, I, Bhana, A, Kigozi, F, Prince, M, Thornicroft, G, Hanlon, C, Kakuma, R, McDaid, D, Saxena, S, Chisholm, D, Raja, S, Kippen-Wood, S, Honikman, S, Fairall, L, Patel, V (2012). PRIME: a programme to reduce the treatment gap for mental disorders in five low- and middle-income countries. PLoS Medicine 9, e1001359.Google Scholar
Mahomed, OH, Asmall, S, Freeman, M (2014). An integrated chronic disease management model: a diagnonal approach to health systems strengthening in South Africa. Journal of Health Care for the Poor and Underserved 25, 1723–1729.Google Scholar
Mall, S, Lund, C, Vilagut, G, Alonso, J, Williams, DR, Stein, DJ (2015). Days out of role due to mental and physical illness in the South African stress and health study. Social Psychiatry and Psychiatric Epidemiology 50, 461–468.Google Scholar
Mayosi, BM, Lawn, JE, van Niekerk, A, Bradshaw, D, Abdool Karim, SS, Coovadia, HM (2012). Health in South Africa: changes and challenges since 2009. Lancet 380, 2029–2043.Google Scholar
Moussavi, S, Chatterji, S, Verdes, E, Tandon, A, Patel, V, Ustun, B (2007). Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet 370, 851–858.Google Scholar
Myer, L, Smit, J, Roux, LL, Parker, S, Stein, DJ, Seedat, S (2008). Common mental disorders among HIV-infected individuals in South Africa: prevalence, predictors, and validation of brief psychiatric rating scales. AIDS Patient Care and STDs 22, 147–158.Google Scholar
Nakimuli-Mpungu, E, Bass, JK, Alexandre, P, Mills, EJ, Musisi, S, Ram, M, Katabira, E, Nachega, JB (2011). Depression, alcohol Use and adherence to antiretroviral therapy in Sub-Saharan Africa: a systematic review. AIDS and Behavior 16, 2101–2118.Google Scholar
Naylor, C, Parsonage, M, McDaid, D, Knapp, M, Fossey, M, Galea, A (2012). Long-term Conditions and Mental Health. The Cost of co-Morbidities. The King's Fund: London.Google Scholar
Neuman, MG, Schneider, M, Nanau, RM, Parry, C (2012). Alcohol consumption, progression of disease and other comorbidities, and responses to antiretroviral medication in people living with HIV. AIDS Research and Treatment 2012, 751827.Google Scholar
Ngo, VK, Rubinstein, A, Ganju, V, Kanellis, P, Loza, N, Rabadan-Diehl, C, Daar, AS (2013). Grand challenges: integrating mental health care into the non-communicable disease agenda. PLoS Medicine 10, e1001443.Google Scholar
Petersen, I, Fairall, L, Bhana, A, Kathree, T, Selohilwe, O, Brooke-Sumner, C, Faris, G, Breuer, E, Sibanyoni, N, Lund, C, Patel, V (2016). Integrating mental health into chronic care in South Africa: the development of a district mental healthcare plan. British Journal of Psychiatry 208 (Suppl. 56), s29–s39.Google Scholar
Prince, M, Patel, V, Saxena, S, Maj, M, Maselko, J, Phillips, MR, Rahman, A (2007). No health without mental health. Lancet 370, 859–877.Google Scholar
Rao, D, Feldman, BJ, Fredericksen, RJ, Crane, PK, Simoni, JM, Kitahata, MM, Crane, HM (2012). A structural equation model of HIV-related stigma, depressive symptoms, and medication adherence. AIDS and Behavior 16, 711–716.Google Scholar
Seedat, S, Stein, DJ, Herman, A, Kessler, R, Sonnega, J, Heeringa, S, Williams, S, Williams, D (2008). Twelve-month treatment of psychiatric disorders in the South African Stress and Health Study (World Mental Health Survey Initiative). Social Psychiatry and Psychiatric Epidemiology 43, 889–897.Google Scholar
Seedat, S, Williams, DR, Herman, AA, Moomal, H, Williams, SL, Jackson, PB, Myer, L, Stein, DJ (2009). Mental health service use among South Africans for mood, anxiety and substance use disorders. South African Medical Journal 99, 346–352.Google Scholar
Sorsdahl, K, Sewpaul, R, Evans, M, Naidoo, P, Myers, B, Stein, DJ (2016). The association between psychological distress, alcohol use and physical non-communicable diseases in a nationally representative sample of South Africans. Journal of Health Psychology April 1:1359105316642832, 1–11.Google Scholar
Statistics South Africa Census (2011) Municipal report North West. Retrieved 4 April 2017 from http://www.statssa.gov.za/census/census_2011/census_products/NW_Municipal_Report.pdf.Google Scholar
Statistics South Africa General Household Survey (2015). Retrieved 4 April 2017 from http://www.statssa.gov.za/publications/P0318/P03182015.pdf.Google Scholar
Statistics South Africa Mid-year population estimates (2016a). Retrieved 4 April 2017 from https://www.statssa.gov.za/publications/P0302/P03022016.pdf.Google Scholar
Statistics South Africa Quarterly Labour Force Survey. Quarter 3: (2016b). Retrieved 4 April 2017 from http://www.statssa.gov.za/publications/P0211/P02113rdQuarter2016.pdf.Google Scholar
Tomlinson, M, Grimsrud, AT, Stein, DJ, Williams, DR, Myer, L (2009). The epidemiology of major depression in South Africa: results from the South African stress and health study. South African Medical Journal 99, 367–373.Google Scholar
UNAIDS. (2014). 90-90-90: An ambitious treatment target to help end the AIDS epidemic. Retrieved 1 February 2017 from http://www.unaids.org/sites/default/files/media_asset/90-90-90_en_0.pdf.Google Scholar
Whiteford, HA, Ferrari, AJ, Degenhardt, L, Feigin, V, Vos, T (2015). The global burden of mental, neurological and substance use disorders: an analysis from the Global Burden of Disease Study 2010. PLoS ONE 10, e0116820.Google Scholar
World Health Organization (2016). Global Tuberculosis Report 2016. World Health Organization: Geneva. Retrieved from 1 February 2017 http://www.who.int/tb/publications/global_report/en/.Google Scholar