Two recent studies from the University of Washington School of Public Health highlight the challenges of meeting the mental health care needs in Mozambique, which was recently estimated to have Africa’s highest suicide rate.
[Photo: Dr. Bradley Wagenaar]
A study in the journal BMC Psychiatry estimates that mood disorders such as depression, anxiety, and bipolar go largely undiagnosed, while follow-up visits for schizophrenia, delusional, and epileptic disorders occupy much of the limited specialist resources. “This could have major implications for suicide prevention as individuals with bipolar disorder are estimated to have 60 times the risk of suicide compared to the general population,” said lead author Dr. Bradley Wagenaar, who conducted the research as part of his PhD thesis for the department of epidemiology.
The study notes that while outpatient mental health services are rapidly increasing in Mozambique, they remain underfunded and under-resourced. “In Mozambique, a country of 26 million people, there are only 10 to 15 practicing psychiatrists,” Dr. Wagenaar said. He worked with the non-government organization Health Alliance International, which is affiliated with the university’s department of global health.
Dr. Wagenaar and his colleagues examined records of nearly 16,000 outpatient psychiatric consultations in Sofala Province – a poor, northern region of about 2 million people with only one Mozambican psychiatrist. The records covered a 2 1/2-year period.
The number of outpatient consultations nearly doubled over the past two years, mainly from the increased number of psychiatric technicians. But researchers noted there were less than 300 yearly consultations for mood disorders – a prevalence far below what’s typically found in other countries. A large “mental health treatment gap” can be inferred, Dr. Wagenaar said.
In a related study, published in the journal Global Health Action, Dr. Wagenaar and colleagues found that essential anti-depressant and anti-psychotic medications were routinely unavailable at public health facilities across Sofala Province. The study suggests mid-level providers could be retrained and certified to prescribe and monitor some of these drug regimens given the current lack of trained mental health specialists.