Common mental disorders (CMDs) are an important cause of illness and disability in primary healthcare patients in Zimbabwe. For some it is a temporary condition while others will be persistently ill, placing a particular strain on healthcare resources. How can busy primary healthcare workers identify those most likely to be chronically ill?

Researchers from the UK Institute of Psychiatry and the University of Zimbabwe Medical School studied CMDs in Harare, Zimbabwe. They found that about 40 percent of cases of CMD are likely to be ill for a year or more. How can health systems target these persistently ill patients?

CMDs include depression and anxiety. They are most likely to be persistent in patients whose initial illness is particularly severe or disabling. This includes people whose CMD requires them to have a carer at home or has stopped them from working for at least 7 days in the last month. Certain life events are also associated with persistent CMD, including:

• sickness in the family
• conflict with in-laws
• infertility
• bereavement.

Persistent CMD is higher in people experiencing economic distress, and patients are less likely to have long-term illness once their economic problems resolve. High risk groups include those who:

• experience hunger due to lack of money to buy food
• owe money
• lack any savings.

Policy initiatives such as food subsidies and debt protection schemes that limit the impact of economic deprivation could reduce persistent CMD. The impact of limited resources for treating CMD in primary healthcare facilities could also be improved by:

• targeting risk groups for poor outcome, such as the most severely ill, the bereaved and those with a severe illness such as HIV
• increasing dialogue between biomedical and traditional healthcare providers
• combining techniques effective in developed countries (e.g. problem-solving and anti-depressants) with locally-generated interventions for culturally specific factors such as infertility and belief in witchcraft
• using locally relevant terminology.

Source(s):
‘Outcome of common mental disorders in Harare, Zimbabwe’ by V. Patel et al, British Journal of Psychiatry 172 (1998)

Funded by: The Beit Trust; International Development Research Centre, Canada

id21 Research Highlight: 24 January 2001

Further Information:
Vikram Patel
Sangath Centre,
841/1 Alto Porvorim,
Goa,
INDIA 403521

Tel: +91 832 413527
Fax: +91 832 415244
Contact the contributor: vikpat@goatelecom.com

Institute of Psychiatry, UK

Other related links:
WHO's Mental Health Program provides information on research and events as well as links to related resources.

World Health Day (7th April 2001) is a global advocacy and awareness raising event for mental health.

The Knowledge Exchange Network website holds information on a range of mental health issues.

Check the World Mental Health Bulletin for the latest research news.