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
Identifieur interne : 003E63 ( Main/Merge ); précédent : 003E62; suivant : 003E64Conceptual models for Mental Distress among HIV-infected and uninfected individuals: A contribution to clinical practice and research in primary-health-care centers in Zambia
Auteurs : Peter J. Chipimo [Zambie, Norvège] ; Mary Tuba [Zambie, Norvège] ; Knut Fylkesnes [Norvège]Source :
- BMC Health Services Research [ 1472-6963 ] ; 2011.
Abstract
Mental 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.
Qualitative 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.
Mental 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.
Patient 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.
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DOI: 10.1186/1472-6963-11-7
PubMed: 21219644
PubMed Central: 3024218
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Chipimo</name><affiliation wicri:level="1"><nlm:aff id="I1">University of Zambia, School of Medicine, Department of Community Medicine, Box 50110, Lusaka, Zambia</nlm:aff><country xml:lang="fr">Zambie</country><wicri:regionArea>University of Zambia, School of Medicine, Department of Community Medicine, Box 50110, Lusaka</wicri:regionArea><wicri:noRegion>Lusaka</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="I2">University of Bergen, Centre for International Health, Faculty of Medicine and Dentistry, 5020, Bergen, Norway</nlm:aff><country xml:lang="fr">Norvège</country><wicri:regionArea>University of Bergen, Centre for International Health, Faculty of Medicine and Dentistry, 5020, Bergen</wicri:regionArea><wicri:noRegion>Bergen</wicri:noRegion></affiliation></author><author><name sortKey="Tuba, Mary" sort="Tuba, Mary" uniqKey="Tuba M" first="Mary" last="Tuba">Mary Tuba</name><affiliation wicri:level="1"><nlm:aff id="I1">University of Zambia, School of Medicine, Department of Community Medicine, Box 50110, Lusaka, Zambia</nlm:aff><country xml:lang="fr">Zambie</country><wicri:regionArea>University of Zambia, School of Medicine, Department of Community Medicine, Box 50110, Lusaka</wicri:regionArea><wicri:noRegion>Lusaka</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="I2">University of Bergen, Centre for International Health, Faculty of Medicine and Dentistry, 5020, Bergen, Norway</nlm:aff><country xml:lang="fr">Norvège</country><wicri:regionArea>University of Bergen, Centre for International Health, Faculty of Medicine and Dentistry, 5020, Bergen</wicri:regionArea><wicri:noRegion>Bergen</wicri:noRegion></affiliation></author><author><name sortKey="Fylkesnes, Knut" sort="Fylkesnes, Knut" uniqKey="Fylkesnes K" first="Knut" last="Fylkesnes">Knut Fylkesnes</name><affiliation wicri:level="1"><nlm:aff id="I2">University of Bergen, Centre for International Health, Faculty of Medicine and Dentistry, 5020, Bergen, Norway</nlm:aff><country xml:lang="fr">Norvège</country><wicri:regionArea>University of Bergen, Centre for International Health, Faculty of Medicine and Dentistry, 5020, Bergen</wicri:regionArea><wicri:noRegion>Bergen</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">21219644</idno><idno type="pmc">3024218</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3024218</idno><idno type="RBID">PMC:3024218</idno><idno type="doi">10.1186/1472-6963-11-7</idno><date when="2011">2011</date><idno type="wicri:Area/Pmc/Corpus">002159</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002159</idno><idno type="wicri:Area/Pmc/Curation">002158</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">002158</idno><idno type="wicri:Area/Pmc/Checkpoint">002329</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">002329</idno><idno type="wicri:Area/Ncbi/Merge">001116</idno><idno type="wicri:Area/Ncbi/Curation">001116</idno><idno type="wicri:Area/Ncbi/Checkpoint">001116</idno><idno type="wicri:Area/Main/Merge">003E63</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">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</title><author><name sortKey="Chipimo, Peter J" sort="Chipimo, Peter J" uniqKey="Chipimo P" first="Peter J" last="Chipimo">Peter J. Chipimo</name><affiliation wicri:level="1"><nlm:aff id="I1">University of Zambia, School of Medicine, Department of Community Medicine, Box 50110, Lusaka, Zambia</nlm:aff><country xml:lang="fr">Zambie</country><wicri:regionArea>University of Zambia, School of Medicine, Department of Community Medicine, Box 50110, Lusaka</wicri:regionArea><wicri:noRegion>Lusaka</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="I2">University of Bergen, Centre for International Health, Faculty of Medicine and Dentistry, 5020, Bergen, Norway</nlm:aff><country xml:lang="fr">Norvège</country><wicri:regionArea>University of Bergen, Centre for International Health, Faculty of Medicine and Dentistry, 5020, Bergen</wicri:regionArea><wicri:noRegion>Bergen</wicri:noRegion></affiliation></author><author><name sortKey="Tuba, Mary" sort="Tuba, Mary" uniqKey="Tuba M" first="Mary" last="Tuba">Mary Tuba</name><affiliation wicri:level="1"><nlm:aff id="I1">University of Zambia, School of Medicine, Department of Community Medicine, Box 50110, Lusaka, Zambia</nlm:aff><country xml:lang="fr">Zambie</country><wicri:regionArea>University of Zambia, School of Medicine, Department of Community Medicine, Box 50110, Lusaka</wicri:regionArea><wicri:noRegion>Lusaka</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="I2">University of Bergen, Centre for International Health, Faculty of Medicine and Dentistry, 5020, Bergen, Norway</nlm:aff><country xml:lang="fr">Norvège</country><wicri:regionArea>University of Bergen, Centre for International Health, Faculty of Medicine and Dentistry, 5020, Bergen</wicri:regionArea><wicri:noRegion>Bergen</wicri:noRegion></affiliation></author><author><name sortKey="Fylkesnes, Knut" sort="Fylkesnes, Knut" uniqKey="Fylkesnes K" first="Knut" last="Fylkesnes">Knut Fylkesnes</name><affiliation wicri:level="1"><nlm:aff id="I2">University of Bergen, Centre for International Health, Faculty of Medicine and Dentistry, 5020, Bergen, Norway</nlm:aff><country xml:lang="fr">Norvège</country><wicri:regionArea>University of Bergen, Centre for International Health, Faculty of Medicine and Dentistry, 5020, Bergen</wicri:regionArea><wicri:noRegion>Bergen</wicri:noRegion></affiliation></author></analytic><series><title level="j">BMC Health Services Research</title><idno type="eISSN">1472-6963</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Mental 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.</p></sec><sec><title>Methods</title><p>Qualitative 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.</p></sec><sec><title>Results</title><p>Mental 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.</p></sec><sec><title>Conclusions</title><p>Patient models concerning mental distress are critical to treatment-seeking decisions and coping mechanisms. 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Wolf</name></author><author><name sortKey="Balson, Pm" uniqKey="Balson P">PM Balson</name></author><author><name sortKey="Morse, Ev" uniqKey="Morse E">EV Morse</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Solano, L" uniqKey="Solano L">L Solano</name></author><author><name sortKey="Costa, M" uniqKey="Costa M">M Costa</name></author><author><name sortKey="Salvati, S" uniqKey="Salvati S">S Salvati</name></author></analytic></biblStruct></listBibl></div1></back></TEI></record>Pour manipuler ce document sous Unix (Dilib)
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