Prevalence of Mental Disorders, Associated Co-morbidities, Health Care Knowledge and Service Utilization in Rwanda - Towards a Blueprint for Promoting Mental Health Care Services in Low- and Middle-income Countries?

Overview

Journal BMC Public Health

Publisher Biomed Central

Specialty Public Health

Date 2022 Oct 5

PMID 36199102

Authors

Yvonne Kayiteshonga

Vincent Sezibera

Lambert Mugabo

Jean Damascene Iyamuremye

Affiliations

Soon will be listed here.

Abstract

Background: In order to respond to the dearth of mental health data in Rwanda where large-scale prevalence studies were not existing, Rwanda Mental Health Survey was conducted to measure the prevalence of mental disorders, associated co-morbidities and knowledge and utilization of mental health services nationwide within Rwanda.

Methods: This cross-sectional study was conducted between July and August 2018, among the general population, including survivors of the 1994 Genocide against the Tutsi. Participants (14-65 years) completed the Mini-International Neuropsychiatric Interview (Version 7.0.2), sociodemographic and epilepsy-related questionnaires. General population participants were selected first by random sampling of 240 clusters, followed by systematic sampling of 30 households per cluster. Genocide survivors within each cluster were identified using the 2007-2008 Genocide Survivors Census.

Results: Of 19,110 general survey participants, most were female (n = 11,233; 58.8%). Mental disorders were more prevalent among women (23.2%) than men (16.6%) (p < 0.05). The most prevalent mental disorders were major depressive episode (12.0%), panic disorder (8.1%) and post-traumatic stress disorder (PTSD) (3.6%). Overall, 61.7% had awareness of mental health services while only 5.3% reported to have used existing services. Of the 1271 genocide survivors interviewed, 74.7% (n = 949) were female; prevalence of any mental disorder was 53.3% for women and 48.8% for men. Most prevalent disorders were major depressive episode (35.0%), PTSD (27.9%) and panic disorder (26.8%). Among genocide survivors, 76.2% were aware of availability of mental health services, with 14.1% reported having used mental health services.

Conclusions: Despite high prevalence of mental disorders among the general population and genocide survivors, utilization of available mental health services was low. A comprehensive approach to mental health is needed for prevention of mental illness and to promote mental healthcare services.

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References

Whiteford H, Degenhardt L, Rehm J, Baxter A, Ferrari A, Erskine H . Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet. 2013; 382(9904):1575-86. DOI: 10.1016/S0140-6736(13)61611-6. View

Rugema L, Krantz G, Mogren I, Ntaganira J, Persson M . "A constant struggle to receive mental health care": health care professionals' acquired experience of barriers to mental health care services in Rwanda. BMC Psychiatry. 2015; 15:314. PMC: 4682265. DOI: 10.1186/s12888-015-0699-z. View

Kessler R, Aguilar-Gaxiola S, Alonso J, Chatterji S, Lee S, Ustun T . The WHO World Mental Health (WMH) Surveys. Psychiatrie (Stuttg). 2010; 6(1):5-9. PMC: 2995950. View

Munyandamutsa N, Nkubamugisha P, Gex-Fabry M, Eytan A . Mental and physical health in Rwanda 14 years after the genocide. Soc Psychiatry Psychiatr Epidemiol. 2012; 47(11):1753-61. DOI: 10.1007/s00127-012-0494-9. View

Wainberg M, Scorza P, Shultz J, Helpman L, Mootz J, Johnson K . Challenges and Opportunities in Global Mental Health: a Research-to-Practice Perspective. Curr Psychiatry Rep. 2017; 19(5):28. PMC: 5553319. DOI: 10.1007/s11920-017-0780-z. View

Kakuma R, Kleintjes S, Lund C, Drew N, Green A, Flisher A . Mental health stigma: what is being done to raise awareness and reduce stigma in South Africa?. Afr J Psychiatry (Johannesbg). 2010; 13(2):116-24. DOI: 10.4314/ajpsy.v13i2.54357. View

Jenkins R, Baingana F, Ahmad R, McDaid D, Atun R . Mental health and the global agenda: core conceptual issues. Ment Health Fam Med. 2012; 8(2):69-82. PMC: 3178188. View

Pettersson A, Modin S, Wahlstrom R, Af Winklerfelt Hammarberg S, Krakau I . The Mini-International Neuropsychiatric Interview is useful and well accepted as part of the clinical assessment for depression and anxiety in primary care: a mixed-methods study. BMC Fam Pract. 2018; 19(1):19. PMC: 5781342. DOI: 10.1186/s12875-017-0674-5. View

Chibanda D, Bowers T, Verhey R, Rusakaniko S, Abas M, Weiss H . The Friendship Bench programme: a cluster randomised controlled trial of a brief psychological intervention for common mental disorders delivered by lay health workers in Zimbabwe. Int J Ment Health Syst. 2016; 9:21. PMC: 4940904. DOI: 10.1186/s13033-015-0013-y. View

10.

Bracke P, Delaruelle K, Verhaeghe M . Dominant Cultural and Personal Stigma Beliefs and the Utilization of Mental Health Services: A Cross-National Comparison. Front Sociol. 2021; 4:40. PMC: 8022809. DOI: 10.3389/fsoc.2019.00040. View

11.

Uddin M, Bhar S, Islam F . An assessment of awareness of mental health conditions and its association with socio-demographic characteristics: a cross-sectional study in a rural district in Bangladesh. BMC Health Serv Res. 2019; 19(1):562. PMC: 6692949. DOI: 10.1186/s12913-019-4385-6. View

12.

Sankoh O, Sevalie S, Weston M . Mental health in Africa. Lancet Glob Health. 2018; 6(9):e954-e955. DOI: 10.1016/S2214-109X(18)30303-6. View

13.

Schaal S, Weierstall R, Dusingizemungu J, Elbert T . Mental health 15 years after the killings in Rwanda: imprisoned perpetrators of the genocide against the Tutsi versus a community sample of survivors. J Trauma Stress. 2012; 25(4):446-53. DOI: 10.1002/jts.21728. View

14.

Heim L, Schaal S . Rates and predictors of mental stress in Rwanda: investigating the impact of gender, persecution, readiness to reconcile and religiosity via a structural equation model. Int J Ment Health Syst. 2015; 8:37. PMC: 4414000. DOI: 10.1186/1752-4458-8-37. View

15.

Susser E, Patel V . Psychiatric epidemiology and global mental health: joining forces. Int J Epidemiol. 2014; 43(2):287-93. DOI: 10.1093/ije/dyu053. View

16.

Kessler R, Angermeyer M, Anthony J, de Graaf R, Demyttenaere K, Gasquet I . Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization's World Mental Health Survey Initiative. World Psychiatry. 2008; 6(3):168-76. PMC: 2174588. View

17.

Rugema L, Mogren I, Ntaganira J, Krantz G . Traumatic episodes and mental health effects in young men and women in Rwanda, 17 years after the genocide. BMJ Open. 2015; 5(6):e006778. PMC: 4480039. DOI: 10.1136/bmjopen-2014-006778. View

18.

Bolton P, Neugebauer R, Ndogoni L . Prevalence of depression in rural Rwanda based on symptom and functional criteria. J Nerv Ment Dis. 2002; 190(9):631-7. DOI: 10.1097/00005053-200209000-00009. View

19.

Allen J, Balfour R, Bell R, Marmot M . Social determinants of mental health. Int Rev Psychiatry. 2014; 26(4):392-407. DOI: 10.3109/09540261.2014.928270. View

20.

Steel Z, Marnane C, Iranpour C, Chey T, Jackson J, Patel V . The global prevalence of common mental disorders: a systematic review and meta-analysis 1980-2013. Int J Epidemiol. 2014; 43(2):476-93. PMC: 3997379. DOI: 10.1093/ije/dyu038. View