Impact of integrated mental healthcare on food insecurity of households of people with severe mental illness in a rural African district: a community-based, controlled before-after study

Kebede Tirfessa, Crick Lund, Girmay Medhin, Medhin Selamu, Rahel Birhane, Yohannes Hailemichael, Abebaw Fekadu, Charlotte Hanlon

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5 Citations (Scopus)
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Abstract

Objectives: To evaluate the impact of integrated mental health care upon food insecurity (FI) in households of people with severe mental illness (SMI) in a rural Ethiopian district, and to investigate mediation by improved work impairment and discrimination. Methods: A community-based, controlled before–after study was conducted. People with probable SMI were identified in the community, diagnosed by primary healthcare workers, with diagnostic confirmation from a psychiatric nurse. Households of a person with SMI were matched to control households. District-wide integration of mental health care was implemented. Change in FI status over 12 months of follow-up was measured using the Household Food Insecurity Access Scale. Multivariable models were used to assess improvement in FI. Direct and indirect mediators of change in FI status were modelled using path analysis. Results: A total of 239 (81.8%) people with SMI and 273 (96.5%) control households were assessed after 12 months. Maintenance of food security or improvement in food insecurity status was observed in 51.5% of households of a person with SMI vs. 39.7% of control households (adjusted risk ratio 1.41: 95% CI 1.11, 1.80). Reduction in symptom severity was indirectly associated with improved FI status via an impact on reducing work impairment and discrimination (P < 0.001). Conclusions: Improving access to mental health care may reduce food insecurity in households of people with SMI. Optimising engagement in care and adding interventions to improve work functioning and tackle discrimination may further reduce food insecurity.

Original languageEnglish
Pages (from-to)414-423
Number of pages10
JournalTropical Medicine & International Health
Volume25
Issue number4
Early online date10 Jan 2020
DOIs
Publication statusPublished - 1 Apr 2020

Keywords

  • bipolar disorder
  • mental illness
  • poverty
  • schizophrenia
  • sub-Saharan Africa
  • task-sharing

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