Screening and Intervention Outcomes for Depression at Primary Health Care Settings in Ogun State, Nigeria

Abstract

Depression is one of the most common conditions treated in primary health care (PHC), and nearly 10% of all primary care visits are depression related. Detection of cases of depression by PHC workers in developing countries is extremely low. Screening for depression at PHC level can improve the detection rate and may be useful in providing interventions for identified cases of depression. This study was undertaken to improve detection of depression through screening and providing interventions for patients presenting for health services at the PHC settings in Ogun state, Nigeria.

Methodology
The study was conducted at 20 PHC centres in two randomly selected senatorial districts (Ogun West and Ogun Central) in Ogun State, Nigeria.
Patient Health Questionnaire-2 (PHQ-2) and module on depression of mental health Gap Action Programme-IG (mhGAP-IG) guidelines were used in screening for depression among consenting patients who met inclusion criteria in the 20 designated PHC centres. For making diagnosis of depression, PHQ-9 scores of ≥ 10 confirmed the diagnosis. Interventions as specified in the depression module of mhGAP-IG were administered and patients were followed up for 6months. Data was analyzed using the Statistical Package for Social Sciences (SPSS) version 21.0. Frequency, mean, standard deviation and percentages were used to summarize descriptive statistics while the means of quantitative variables was compared with Independent T Test at level of statistical significance set at P<0.05

Results
Among the 493 patients screened for depression, 26.8% were confirmed for depression. Mean score (19.8) for depression at Ogun West where screening was done with PHQ-2 and mhGAP-IG was significantly higher than Ogun Central (14.5) at P=0.001. Majority of the cases of depression were mild cases (50.8%). Majority (62.3%) of the patients were females. All the patients received psychological treatment while 55.3% were placed on amitriptyline with mean (SD) dose of 43.2(3.4) mg. At the end of 6 months follow up, about 75.8% of the patients recovered from depression with PHQ-9 score <5.

Conclusion
This study has demonstrated the possibility of training non-physician primary health care workers to improve detection and intervention for depression at the primary health care settings in Ogun state, Nigeria. Strategies that will improve recognition and treatment of cases of depression like mental health training on depression and routine screening of patients for depression using the PHQ-2 , PHQ-9 tools and the mhGAP-IG should form part of routine service package at the primary health care settings as these will improve detection and intervention for depression.