Health Care : Current Reviews

Table 1: Distribution of the severity of depression among study participants.

Table 2 shows the severity of anxiety among study participants according to the sociodemographic characteristics of study participants. There was no significant association between the severity of anxiety with all sociodemographic factors included in this study.

Table 2: distribution of severity of anxiety among study participants.

Although study participants believed that economic constraint, insecurity, political instability, cultural barriers and unemployment were the main causes of mental illnesses, these factors were not significantly associated with the severity of depression and anxiety in this study (Tables 1 and 2) of the 133 cases in this study, 5 (3.8%) suffer from mild depression and mild anxiety, while 46 (34.6%) suffer from mild or moderate depression and anxiety at the same time. Thirty-eight (28.6%) of participants suffered from severe or extremely severe depression and anxiety at the same time, while 11 (8.3%) lived with extremely severe depression and anxiety. Table 3 displays the number and percentage of participants according to their access to mental health and the mode of treatment of significant concern is that a little over one-quarter (27.3%) of cases with extremely severe depression and anxiety had access to mental health, one third (36.3%) were taking medicine, and less than onefifth received counselling. The ratios of access to mental health and counselling have decreased with increasing severity, while the ratio of taking medicine has increased with increasing severity of mental illnesses in this study.

Table 3: Number and percentage of participants according to the severity of both mental illnesses, their access to health services and modes of treatment.

Discussion

The purpose of this study was to determine the treatment gap, the treatment mode and the level of accessibility of depressed and anxious people to mental health services in Herat province of Afghanistan. This study was conducted after the August political changes in the country that have resulted in significant rise in socioeconomic and mental health problems in Afghan population.

The level of awareness about mental health among study participants was 91.0% this is in alignment with the results of a similar study in Bangladesh that reported 96.6% and 93.4% participant’s awareness about depression and anxiety, respectively [25]. The high level of awareness among this study participant is reflected by their high level of education and their employment in university and the NGOs.

Our results revealed a 70.0% treatment gap among study participants. This is in line with the findings of other studies on treatment gap among LMIC, reporting a 70% to 90% treatment gap in these countries [15,19,26]. This minimum treatment gap among LMIC might be attributed to our study samples, that consisted of university and NGO staff, who lived in urban areas of Herat province, this study also shows that 40 (30.0%) cases included in this study used any mental health treatment, including one-fifth who used medication and one-fourth who received counselling and over one-tenth that received both medication and counselling. A study conducted in 2019 among general population of the United States reported that 19.2% of adults had received treatment, including 15.8% who used medication and 9.5% who received counselling [27]. Another study by the US National Alliance on Mental Illnesses (NAMI) reported that 46.2% of adults with mental disorders received treatment of participants with severe/ extremely severe depression/anxiety, 17 (44.7%) received treatment either in form of medication or counseling [28]. NAMI (2021) reported that of adults with serious mental illnesses in the US, 64.5% received treatment (NAMI 2021). The significant difference between the rate of treatment in our study and studies reported herein, might be attributed to several factors including, availability, cost of medicine, stigma, family support, cultural barriers, lack of awareness, access to quality mental health services and supportive community behaviors and attitudes [12,19,29,30].

This study found that 61.7% of participants did not have access to mental health services. Accumulating evidence reveal that the access to mental health care in LMIC fluctuates between 10% to 90% [15,21]. The alarmingly high rate of inaccessibility of our participants to initial mental health services in an urban setting adds to this evidence. Several mental health studies revealed that the need and access to the mental health services varies inversely among different countries, with people at higher need having less access to these services [12,15,26,31].

The findings of this study on the low accessibility of study participants to mental health services, and considerably high treatment gap among educated individuals in Herat province of Afghanistan highlights the need for an urgent intervention to increase the public awareness, enhance accessibility to mental health services and free/inexpensive medication and counselling in this LMIC and traumatized region.

Limitation

The diagnosis of depression and anxiety in this study was based on the Dari version DASS-42 questionnaire. A gold standard confirmed diagnosis of these mental illnesses should be based on structured clinical investigation. Another caveat of this study is the inclusion of a sample not representative of the general population. To understand the magnitude, severity, level of awareness, accessibility and treatment gap in the country, it is recommended to conduct a similar research among general population. Another prominent consideration is the lack of a baseline data on the burden of these mental illnesses, level of awareness, accessibility and treatment gap in Afghanistan in recent years. Therefore, a solid conclusion regarding a significant change in the level of awareness, accessibility and treatment gap could not be envisaged in this study.

Recommendation

Considering the findings of this and studies conducted recently on the burden of mental illnesses in Herat province of Afghanistan the following is recommended:

1. Increasing the level of awareness, accessibility and quality of care for general public about mental illnesses.

2. Encouraging public health authorities, policy makers and mental health professionals to develop and implement policies and strategies in delivering accessible and affordable mental health care.

3. Conducting relevant clinical research involving associated factors and consequences of mental illnesses in the community and individual level.

Conclusion

This study revealed the low level of accessibility, huge treatment gap and a considerable discrepancy in the level of awareness and service use among study participants. Results add to the existing literature on very low level of accessibility and treatment gap in LMIC. The inverse relationship between the need and access to mental health and treatment gap warns international community to allocate funds and resources for the betterment of services in traumatized regions.

Funding Sources

This study was financially supported by the International Assistance Mission, Herat Office.

Role of Funding Sources

The funding source had no role in data acquisition, interpretation, and the decision to publish.

Acknowledgement

Authors express their thanks to Mr. Nawroz Ali Yousofi and Mr. Hosain Adib Kazemi for their contribution in data entry.

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