Exploring depression symptoms in chronic care users in Dr Kenneth Kaunda for culturally relevant counselling.

Abstract

Background:  South Africa is faced with a mental health burden attributed to a large treatment gap for common mental disorders (CMDs), and a shortage of mental health professionals. Although comorbidity of CMDs with chronic diseases is common, chronic and non-communicable diseases may receive more attention than CMDs highlighting the need for contextually appropriate, culturally relevant counselling to increase access to mental healthcare for CMDs at primary health care (PHC).

Aim:  To explore the experiences of patients with comorbid chronic medical conditions and depression attending PHC, to inform the adaptation of an existing evidence-based lay counselling intervention developed in South Africa for human immunodeficiency virus (HIV)-positive patients.

Setting:  Dr Kenneth Kaunda district, North West province, South Africa.

Methods:  Semi-structured qualitative interviews were conducted with 16 Sestwana speaking adult chronic care patients with hypertension and HIV who screened positive for depressive symptoms using the Patient Health Questionnaire (PHQ-9), to explore their lived experiences of depression.

Results:  Poor understanding of depression and poor mental health literacy were highlighted. Depressive symptoms were commonly associated with social determinants including poverty, interpersonal conflict, stigma, illness and grief and bereavement. Most participants were unaware of available depression treatments.

Conclusion:  Psychoeducation to improve mental health literacy, cognitive behavioural interventions and problem-solving techniques using task sharing are recommended.Contribution: There is limited evidence of explanatory models for depression among this population in South Africa. To our knowledge, this is the only study that focused on a predominantly Setswana-speaking chronic care adult population with comorbid depression.