Impact of a district mental health care plan on suicidality among patients with depression and alcohol use disorder in Nepal

Luke R. Aldridge, Emily C. Garman, Nagendra P. Luitel, Mark J. D. Jordans

PLoS ONE

Published on: 7 April 2020

Background: Large scale efforts to expand access to mental healthcare in low- and middle-income countries have focused on integrating mental health services into primary care settings using a task sharing approach delivered by non-specialist health workers. Given the link between mental disorders and risk of suicide mortality, treating common mental disorders using this approach may be a key strategy to reducing suicidality.

Methods and findings: The Programme for Improving Mental Health Care (PRIME) evaluated mental health services for common mental disorders delivered by non-specialist health workers at ten primary care facilities in Chitwan, Nepal from 2014 to 2016. In this paper, we present the indirect impact of treatment on suicidality, as measured by suicidal ideation, among treatment and comparison cohorts for depression and AUD using multilevel logistic regression. Patients in the treatment cohort for depression had a greater reduction in ideation relative to those in the comparison cohort from baseline to three months (OR = 0.16, 95% CI: 0.05–0.59; p = 0.01) and twelve months (OR = 0.31, 95% CI: 0.08–1.12; p = 0.07), with a significant effect of treatment over time (p = 0.02). Among the AUD cohorts, there were no significant differences between treatment and comparison cohorts in the change in ideation from baseline to three months (OR = 0.64, 95% CI: 0.07–6.26; p = 0.70) or twelve months (OR = 0.46, 95% CI: 0.06–3.27; p = 0.44), and there was no effect of treatment over time (p = 0.72).

Conclusion: The results provide evidence integrated mental health services for depression benefit patients by accelerating the rate at which suicidal ideation naturally abates over time. Integrated services do not appear to impact ideation among people with AUD, though baseline levels of ideation were much lower than for those with depression and may have led to floor effects. The findings highlight the importance of addressing suicidality as a specific target– rather than an indirect effect–of treatment in community-based mental healthcare programs.

https://doi.org/10.1371/journal.pone.0231158

Head Office
  • Baluwatar, Kathmandu, Nepal
  • G.P.O Box 8974/C.P.C. Box 612
  • +977-01-4431717/4437124/4424082
  • tponepal@tponepal.org.np
Toll Free Number
1660 010 2005
हरेक दिन बिहान ८ बजे देखि साझ ६ बजे सम्म !! COVID-19 को मनोसामाजिक प्रभाव !!

यदि मनसँग सम्बन्धित समस्या भएमा मनोसामाजिक सहयोग तथा परामर्शका लागि यो नम्बरमा सम्पर्क गर्न सक्नुहुनेछ। NTC बाट यस नम्बरमा फोन गर्दा कुनै शुल्क लाग्दैन।

Every Day Form 8 AM to 6 PM COVID-19, Psychosocial Impact !!

Please call this number for psychosocial support and counseling/consultation. You can call this number free of cost from Nepal Telecom network.

Subscribe Us




    Connect With Us