Mental Disorders in Primary Health Care Centers in Khartoum State

Abstract

This is a descriptive study carried out at four primary health centers (PHC) in Khartoum State. Aiming to provide epidemiological data on mental disorders in primary health care settings and to validate the use of the Self Reporting Questionnaire – 20 (SRQ-20). A total of 220 primary health care attenders, aged 18 years and above were interviewed using the SRQ-20, in-depth clinical examination was conducted using the Structured Clinical Interview for DSM IV axis 1 disorders (SCID-1). Sociodemographic data and help seeking behaviour were also reported. The prevalence of mental disorders among PHC attenders was found to be 60%. Statistically significant association was found between mental disorder and the following: sex: 65.6% of the females qualified a diagnosis of mental disorder compared to 47.8% of the males (P = 0.017); age group 18-47 years compared to age group 48 years and above (P = 0.017); below and above average standard of living as compared to the average standard of living (P = 0.042); use of traditional medicine (P = 0.035); eight or more visits to health facilities per year (P=0.027) and; quoting three or more complaints (P=0.007). Major depressive disorder was diagnosed in 32 attenders (14.6%), adjustment disorder in 24 attenders (10.9%), generalized anxiety disorder in 16 attenders (7.3%). Schizophrenia was diagnosed in 6 attenders (2.7%). More than four-fifth of the mental disorders encountered fell in three main categories. These were: mood disorders (34.5%), anxiety disorders (32.4%) and adjustment disorders (17.3%). Of the 132 (60%) attenders who qualified a diagnosis of mental disorders only one case was detected by PHC providers. The cut-off point 4/5 on the SRQ-20 provided a balanced sensitivity and specificity 90.9% and 86.36%, respectively. The estimated prevalence of mental disorders at cut-off point 4/5 was equal to the prevalence detected clinically. The prevalence of mental disorders among PHC attenders in Khartoum State is high. Primary mental health care is almost completely overlooked. The SRQ-20 is a valid tool for screening in PHC. There is an urgent need for a national mental health policy in Sudan.