Conceptual models for Mental Distress among HIV-infected and uninfected individuals: A contribution to clinical practice and research in primary-health-care centers in ZambiaReportar como inadecuado

Conceptual models for Mental Distress among HIV-infected and uninfected individuals: A contribution to clinical practice and research in primary-health-care centers in Zambia - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

BMC Health Services Research

, 11:7

Healthcare needs and demand


BackgroundMental distress is common in primary care and overrepresented among Human Immunodeficiency virus HIV-infected individuals, but access to effective treatment is limited, particularly in developing countries. Explanatory models EM are contextualised explanations of illnesses and treatments framed within a given society and are important in understanding an individual-s perspective on the illness. Although individual variations are important in determining help-seeking and treatment behaviour patterns, the ability to cope with an illness and quality of life, the role of explanatory models in shaping treatment preferences is undervalued. The aim was to identify explanatory models employed by HIV-infected and uninfected individuals and to compare them with those employed by local health care providers. Furthermore, we aimed to build a theoretical model linking the perception of mental distress to treatment preferences and coping mechanisms.

MethodsQualitative investigation nested in a cross-sectional validation study of 28 male and female attendees at four primary care clinics in Lusaka, Zambia, between December 2008 and May 2009. Consecutive clinic attendees were sampled on random days and conceptual models of mental distress were examined, using semi-structured interviews, in order to develop a taxonomic model in which each category was associated with a unique pattern of symptoms, treatment preferences and coping strategies.

ResultsMental distress was expressed primarily as somatic complaints including headaches, perturbed sleep and autonomic symptoms. Economic difficulties and interpersonal relationship problems were the most common causal models among uninfected individuals. Newly diagnosed HIV patients presented with a high degree of hopelessness and did not value seeking help for their symptoms. Patients not receiving anti-retroviral drugs ARV questioned their effectiveness and were equivocal about seeking help. Individuals receiving ARV were best adjusted to their status, expressed hope and valued counseling and support groups. Health care providers reported that 40% of mental distress cases were due to HIV infection.

ConclusionsPatient models concerning mental distress are critical to treatment-seeking decisions and coping mechanisms. Mental health interventions should be further researched and prioritized for HIV-infected individuals.

List of AbbreviationsSRQ-20Self-Reporting-Questionnaire 20

SRQ-10Self-Reporting-Questionnaire 10

SCLSymptom Check List

DSM-IVDiagnostic and Statistical Manual of Mental disorders, fourth edition

HIVHuman Immunodeficiency Virus

PLWHAPeople living with HIV-AIDS

ARVAntiretroviral drugs

IDIIn-depth Interviews

PHCPrimary Health Care

EMExplanatory Models

Peter J Chipimo, Mary Tuba and Knut Fylkesnes contributed equally to this work.

Download fulltext PDF

Autor: Peter J Chipimo - Mary Tuba - Knut Fylkesnes


Documentos relacionados