- Research article
- Open Access
Correlates of self-reported history of mental health help-seeking: a cross-sectional study among individuals with symptoms of a mental or substance use disorder initiating care for HIV in Cameroon
BMC Psychiatry volume 21, Article number: 293 (2021)
Mental health and substance use disorders (MSDs) increase the risk of poor human immunodeficiency virus (HIV) care outcomes among people living with HIV (PLWH). Receipt of mental health care may improve these adverse outcomes. We aimed to identify correlates of prior mental health help-seeking among PLWH with symptoms of an MSD in Cameroon.
We characterize prior mental health help-seeking from formal (mental health specialist/general medical provider) and informal (traditional healer/religious leader) sources among 161 people with symptoms of depression (Patient Health Questionnaire-9 scores> 9), anxiety (General Anxiety Disorder-7 scores> 9), probable post-traumatic stress disorder (PTSD Checklist for DSM-5 scores> 30), or possible alcohol use disorder (Alcohol Use Disorders Identification Test scores≥16) who were newly entering HIV care at three healthcare facilities in Cameroon between June 2019 and March 2020. Help-seeking was defined as ever speaking to a formal or informal source about emotional problems, sadness, or the way they were feeling or behaving. We estimated the association between sociodemographic and psychosocial measures and lifetime mental health help-seeking from each type of source using log-binomial regression.
Overall, 55.3% of 161 PLWH with MSD symptoms reported prior mental health help-seeking, with 24.2% and 46.0% seeking help from formal and informal sources, respectively. Religious leaders were the most common source of help (40.4%), followed by general medical professionals (22.4%), traditional healers (16.8%), and mental health specialists (7.4%). Individuals with higher depressive, anxiety, and trauma symptom severity scores were more likely to have sought help than those with lower scores. Individuals with possible alcohol use disorder were the least likely to have sought help. Prior help-seeking was more common among those reporting a higher number of lifetime traumatic events (prevalence ratio [PR]: 1.06; 95% confidence interval [CI]: 1.01, 1.11) and those with a history of emotional intimate partner violence (PR: 1.34; 95% CI: 1.01, 1.80).
Prior mental health help-seeking was associated with psychosocial stressors. Help-seeking from informal networks was more common than formal help-seeking. Training in the provision of evidence-based mental health support for informal networks could improve access to mental health care for PLWH with MSDs in Cameroon.
Mental health and substance use disorders (MSDs) constitute the largest cause of disability worldwide [1, 2] and increase the risk of early mortality [3,4,5,6]. People living with human immunodeficiency virus (HIV) are particularly vulnerable to MSDs, which are among the most common comorbidities among people living with HIV (PLWH) globally [7,8,9]. MSDs contribute to poor HIV care outcomes (e.g., delayed linkage to care and anti-retroviral therapy [ART] initiation, poor retention in care, and sub-optimal ART adherence) throughout the HIV care continuum [10,11,12], further increasing risk of early mortality among PLWH with MSDs [13, 14].
Receipt of mental health care not only improves MSD outcomes [15, 16] but has been shown to improve chronic health outcomes in individuals with comorbidities such as HIV in high-income countries [17,18,19]. In sub-Saharan Africa, where a disproportionate burden of the HIV epidemic is concentrated , access to evidence-based mental health care remains limited . To narrow the mental health treatment gap, mental health care task-sharing, or shifting service delivery tasks from health professionals with specialized training to individuals with less specialized, but task-specific training is being scaled-up in numerous settings [22, 23]. This approach has improved access to care and, in many cases, MSD outcomes overall [16, 23,24,25]. Despite this overall increase in access to mental health care, a substantial proportion of individuals with MSDs still do not have access to evidence-based mental health care in resource-constrained settings .
Research suggests that individuals with symptoms of an MSD often seek help from informal support networks such as friends, family members, traditional healers, or religious leaders, instead of, or in addition to, formal care from trained medical providers or mental health specialists [26,27,28]. In settings where access to formal mental health care remains limited, help-seeking from informal sources is particularly common and could provide a bridge to more formalized, evidence-based care where necessary [29, 30]. While barriers and facilitators of formal and informal mental health help and care-seeking have been identified in high-resource settings [26, 27, 31,32,33,34], research from resource-constrained settings is scarce, particularly in populations substantially affected by MSDs such as PLWH . Greater understanding of prior mental health help-seeking behaviors among PLWH with MSD symptoms can clarify which individuals with MSD symptoms have or have not sought help, where they typically turned for help, and who sought informal help but may have benefited from more formal care. Further, this work can identify members of informal support networks who, with additional evidence-based psychoeducation, could serve as key community partners in improving access to and uptake of mental health care broadly. In some settings, these individuals may even aid in screening and referring individuals with symptoms of an MSD to formal care networks.
Given the negative effects of MSDs on quality of life, HIV treatment outcomes, and life expectancy in PLWH in sub-Saharan Africa specifically , it is important to understand the mental health help-seeking behaviors of PLWH with symptoms of an MSD . In this study, we characterize prior mental health help-seeking from formal and informal sources in individuals with current symptoms of depression, anxiety, post-traumatic stress disorder (PTSD), or possible alcohol use disorder (AUD). Further, we explore socio-demographic and psychosocial correlates of lifetime mental health help-seeking from formal and informal sources separately, and overall, among individuals with symptoms of depression, anxiety, PTSD, or possible AUD.
This study was conducted in three public sector health facilities located in the North-West, South-West, and Central (Yaounde) regions of Cameroon. These areas have an estimated HIV prevalence of 5.1%, 3.6%, and 4.4%, respectively . Each site also serves as an International epidemiology Databases to Evaluate AIDS (IeDEA) study site.
Study design and population
We conducted this structured quantitative interview in a cohort of adults entering care for HIV between June 2019 and March 2020. To be eligible, individuals had to be at least 21 years of age, initiating HIV care at one of the three study sites, and provide written informed consent for participation. Eligible individuals were invited to participate in this study at their first HIV care visit. Individuals transferring HIV care from another clinic were ineligible.
Eligible and consenting individuals were interviewed by a research assistant fluent in French and English. Interviews, which captured data on participants’ socio-demographic and economic backgrounds, mental health, social support, experiences with intimate partner violence (IPV), history of trauma, and substance use were conducted in the participant’s language of choice in a private setting within the health facility. Ethical approval for this study was obtained from the University of North Carolina’s Institutional Review Board and from the national Ethical Committee of Research for Human Health at Yaoundé, Cameroon. This analysis includes data from individuals who screened positive for symptoms of at least one MSD assessed.
The Patient Health Questionnaire-9 (PHQ-9) , which has been validated and used among PLWH in sub-Saharan Africa, including in Cameroon [39,40,41,42], was used to assess depressive symptoms. Scores range from 0 to 27 with scores greater than 9 considered indicative of moderate or severe depressive symptoms . Cronbach’s alpha from the current study was 0.81.
Anxiety symptoms were assessed using the 7-item General Anxiety Disorder-7 (GAD-7) scale , which has been validated in a high HIV prevalence population in sub-Saharan Africa , and used among PLWH in Cameroon . Scores range from 0 to 21 with scores greater than 9 considered indicative of moderate to severe anxiety symptoms [42, 44]. Cronbach’s alpha from the current study was 0.82.
Post-traumatic stress disorder
PTSD symptoms were assessed using the PTSD Checklist for DSM-5 (PCL-5) [46, 47] which has been validated and used in high HIV prevalence populations in sub-Saharan Africa [48, 49]. Scores range from 0 to 80 with scores greater than 30 considered indicative of probable PTSD . Cronbach’s alpha from the current study was 0.92.
Alcohol use disorder
Alcohol use was measured using the Alcohol Use Disorders Identification Test (AUDIT) [50,51,52], which has been validated and used in high HIV prevalence populations in sub-Saharan Africa [53,54,55]. Scores range from 0 to 40 with scores equal to or greater than 16 considered indicative of possible AUD . Cronbach’s alpha from the current study was 0.85.
Comorbid MSD outcomes
We created a dichotomous variable, “MSD comorbidities”, to represent individuals with and without symptoms of two or more of the MSDs assessed (i.e., depression, anxiety, PTSD, AUD).
Mental health help-seeking
Help-seeking is inconsistently measured throughout the scientific literature, yielding no standard definitions of, or tools for measuring, the outcome of interest . In this study, history of mental health help-seeking was ascertained by asking study participants if they had ever spoken with any of the following individuals about emotional problems, sadness, or the way they were feeling or behaving: 1) traditional healer, 2) religious leader, 3) general medical professional (e.g., general practitioner, nurse), or 4) a mental health specialist (e.g., psychiatrist, psychologist, or social worker). Separate dichotomous variables were created to represent help-seeking from each source (ever/never). Summary variables were created to represent ever help-seeking from 1) any “formal” source (i.e., mental health specialist or general medical provider), 2) any “informal” source (i.e., traditional healer or religious leader), and 3) any formal or informal source.
Sociodemographic factors of interest were captured through self-report and included age (continuous), sex, relationship status (single/partnered), education (none/primary/secondary or above), and religion (Protestant/Christian/Born Again/other).
Potential psychosocial stressors
Potential psychosocial stressors (i.e., trauma and IPV) were also hypothesized as possible correlates of ever seeking mental health help. We assessed exposure to twelve specific potentially traumatic events (PTEs), including lifetime experiences of physical and sexual violence, natural disaster, and loss of a child, among others. One additional question asked individuals to identify any other traumatizing event experienced during childhood or adulthood. These questions were drawn from existing traumatic event screening tools that have been widely used [57,58,59,60] and were selected based on their relevance in the given context. The Demographic and Health Survey violence module was used to assess four domains of IPV: controlling behavior, and emotional, sexual, and physical IPV (dichotomous; any/no violence for each domain) [61,62,63]. We also considered “any IPV” (any controlling behavior, or emotional, sexual, or physical IPV) versus no IPV.
Descriptive statistics (counts/proportions or medians/interquartile ranges [IQRs]) were used to characterize the study population overall and by ever help-seeking. Pearson’s chi-squared tests and Wilcoxon-rank sum tests were used to identify potential correlates of ever help-seeking overall, and from formal and informal sources specifically. Unadjusted log-binomial regression was used to estimate the association between each correlate of interest and ever help-seeking outcome. Multivariable regression was not utilized as the aim of this analysis was to characterize marginal associations as opposed to causal relationships.
A total of 426 individuals were enrolled in the parent study, with 161 participants (37.8%) reporting symptoms of depression, anxiety, PTSD, or possible AUD and included in this analysis. Of the 161 individuals included, median age was 36 (IQR: 30–43) (Table 1). A majority of participants were female (n = 92; 57.1%), had completed some primary school (n = 87; 54.0%), and were in a relationship (n = 90; 55.9%). Overall, 87 participants (54.0%) reported moderate or severe depressive symptoms, 52 (32.3%) reported moderate or severe anxiety symptoms, 67 (41.6%) screened positive for probable PTSD, and 57 (35.4%) screened positive for possible AUD. Over 40% of included individuals (n = 68) screened positive for comorbid MSDs.
Among the included participants, 89 (55.3%) reported ever seeking help from a formal or informal source. Nearly 25% of participants (n = 39; 24.2%) reported ever seeking help from a formal source specifically and 50% (n = 74; 46.0%) from an informal source specifically. Twenty-four individuals (14.9%) reported ever seeking help from both a formal and informal source. More specifically, 27 (16.8%) individuals reported ever seeking help from a traditional healer, 65 (40.4%) from a religious leader, 36 (22.4%) from a general medical provider, and 12 (7.4%) from a mental health specialist.
The proportions of individuals who reported ever seeking help from a formal or informal source were as follows: 59.8% among those who screened positive for moderate to severe depressive symptoms, 66.7% among those with moderate to severe anxiety symptoms, 61.2% among those with probable PTSD, 49.1% among those with possible AUD, and 64.7% among those with comorbid MSD symptoms. The prevalence of ever seeking help from a mental health specialist, general medical provider, traditional healer, and religious leader specifically, among individuals screening positive for symptoms of each MSD, is presented in Fig. 1.
The prevalence of ever seeking help from a formal or informal source was more common among individuals with higher symptom severity scores on the GAD-7, PCL-5, and PHQ-9 (Tables 2 and 4). The prevalence of ever seeking help from an informal source was more common among individuals with higher symptom severity scores on the GAD-7 and PCL-5 (Table 4). The prevalence of ever seeking mental health help from a formal source was higher among individuals with higher symptom severity scores on the PHQ-9 (Table 4). There was no difference in the prevalence of any type of help-seeking by AUDIT score (Tables 2 and 4).
Ever seeking help from a formal or informal source was also associated with reporting a history of emotional IPV and reporting a higher number of PTEs (Tables 3 and 4). Ever seeking help from a formal source specifically, and from an informal source specifically, was only associated with reporting a higher number of PTEs (Table 4). Prevalence of ever seeking help from a formal or informal source among those with a history of emotional IPV was 1.34 (95% confidence interval [CI]: 1.01, 1.80) times the prevalence in those with no history of emotional IPV (Table 4). For each additional PTE reported, the prevalence of ever seeking help from a formal or informal source, informal source specifically, and formal source specifically was 1.06 (95% CI: 1.01, 1.11), 1.07 (95% CI: 1.01, 1.14), and 1.15 (95% CI: 1.04, 1.28) times higher, respectively (Table 4).
The prevalence of ever seeking help from a formal or informal source among those with comorbid MSD symptoms was 1.34 (95% CI: 1.02, 1.76) times the prevalence among those without comorbid MSD symptoms (Table 4). The prevalence of ever seeking help from an informal source among those with comorbid MSD symptoms was 1.44 (95% CI: 1.04, 2.01) times the prevalence in those without comorbid MSD symptoms (Table 4). No significant difference was observed in the prevalence of ever seeking help from a formal source among those with and without comorbid MSD symptoms (Table 4).
This study is among the first to characterize self-reported history of mental health help-seeking from formal and informal sources in a population of PLWH with an MSD entering HIV care in a low-resource setting. To our knowledge, it is the first study of this type in Cameroon.
Overall, 55.3% of individuals with an MSD reported ever talking to a formal or informal source about their emotional problems, sadness, or the way they were feeling or behaving. Ever seeking help from an informal source was nearly twice as common as ever seeking help from a formal source, at 46.0% and 24.2%, respectively. Religious leaders were the most common source of help (40.4%), followed by general medical professionals (22.4%), traditional healers (16.8%), and mental health specialists (7.4%). This is likely due in part to the severely limited number of specialized mental health providers across Cameroon, and the low- or no-cost nature of seeking informal help as compared to formal help-seeking. These results are similar to findings from other resource-constrained settings, which suggest help-seeking from informal sources is substantially more common than help- or care-seeking from formal sources [29, 30, 64, 65], and that help-seeking from mental health specialists may be particularly uncommon [64, 66,67,68]. In a hospital-based study conducted among 384 individuals with mental illness in Ethiopia, more than half of the participants (n = 193; 50.2%) had ever sought care from an herbalist or religious healer before seeking formal care services from a psychiatric hospital . Contrary to our findings, help-seeking from general healthcare providers (12.7%) was slightly more common than help-seeking from religious leaders (11.7%) after the onset of post-partum depression among 385 women in Ethiopia . The prevalence of help-seeking from a mental health professional in this population was similar to that found in our study, at 4.2% .
Given the high prevalence of help-seeking from informal networks, religious leaders and traditional healers could serve as important partners in improving the overall mental health of PLWH in Cameroon. While some mission hospitals throughout Cameroon already have religious leaders who serve as counselors within the facility, this is not widely implemented. With appropriate psychoeducation and stigma reduction training, members of informal networks could broadly serve as advocates for formal mental health care-seeking, normalizing and promoting this type of care-seeking within their communities, where such care is available. If adequately trained in task-specific care, these individuals could also directly participate in the provision of mental health support, screening individuals for MSDs, and making referrals to formal care as necessary. It is notable that in a cross-sectional study of primary healthcare providers in Cameroon, just 1.8% of surveyed providers knew of a standardized depression screening tool, less than half (49.1%) had received formal mental health training, and just 26.6% reported feeling comfortable working with depressed patients . This suggests that comprehensive evidence-based mental health support and care training is critical not only for informal support networks in Cameroon but could similarly benefit formal care providers.
Higher symptom severity scores on the PHQ-9, GAD-7, and PCL-5, and having symptoms of MSD comorbidities, were significantly associated with ever seeking mental health help from a formal or informal source. This is congruent with help- or treatment-seeking patterns observed in similarly resource-constrained settings [29, 66, 70], and suggests that participants with more severe symptoms, and those with psychiatric comorbidities, are more likely to have sought out mental health help than those with less severe symptoms or symptoms of just one MSD. More severe depressive symptoms were associated with ever seeking help from a formal provider specifically, while more severe anxiety and PTSD symptoms were associated with ever seeking help from an informal provider specifically. This suggests depressive symptoms may be more readily identified by those affected as a medical concern needing attention from a formal provider, while symptoms of PTSD and anxiety may be conceptualized by those affected as less severe or less appropriate to discuss with medical providers in this context. Ensuring informal networks have the skills and training necessary to identify mental illness, particularly severe anxiety and PTSD, as well as psychiatric comorbidities, will be important to bridging the most vulnerable individuals to formal mental health care.
Notably, ever seeking help from a formal or informal source was less commonly reported among individuals screening positive for possible AUD when compared to individuals with current symptoms of depression, anxiety, or PTSD. No significant association was observed between AUDIT scores and any of the help-seeking behaviors explored, suggesting AUD may function differently than mood or anxiety disorders within this context. For example, unhealthy drinking may be viewed as a more normalized behavior within society, less concerning by those affected, or less appropriate for discussion with formal or informal networks among PLWH with possible AUD in Cameroon. Alternatively, it is possible that unhealthy drinking is more stigmatized than mood or anxiety disorder symptoms, creating greater hesitancy to disclose concerns around alcohol use to formal or informal networks. Help-seeking for AUD may be further hindered by limited availability or perceived ineffectiveness of substance use-related services. This is consistent with findings from studies in similar contexts [68, 71]. For example, just 6 of 57 (10.5%) individuals screening positive for harmful alcohol use in a study of 1500 adults in Ethiopia had sought help from a health center for their alcohol use . The primary barriers to help-seeking were wanting to handle the problem on their own (63.3%), believing the problem would get better by itself (60.2%), being unsure of where to go for help (57.0%), and being unbothered by the problem (49.2%) . Additional research into alcohol use and treatment norms could shed light on the drivers of low help-seeking among PLWH with symptoms of possible AUD in this context.
Current socio-demographic factors were not significantly associated with any type of ever help-seeking, with the exception of increased help-seeking from informal sources in individuals who identified as Born Again. We hypothesized socio-demographic factors would be associated with help-seeking due to their relationship with poor mental health and HIV care outcomes , and existing literature suggesting that age, sex, education, or income may influence help-seeking [35, 72,73,74,75]. However, our results are consistent with studies from similarly low-resourced settings [67, 70]. For example, in a study conducted in rural India, no association was observed between gender, religion, education, age, caste, or employment status and treatment-seeking .
Psychosocial stressors, specifically higher numbers of reported PTEs and history of emotional IPV were associated with mental health help-seeking. In a study from Nigeria, emotional IPV was also associated with an increased likelihood of help-seeking while sexual IPV was not . In this setting, physical IPV was associated with increased help-seeking as well, contrary to our findings . It is possible that emotional IPV functions differently from physical and sexual IPV in Cameroon due to cultural or gender norms within relationships. For example, if physical and sexual violence are normalized behaviors within partnerships, or are viewed as problems that should be kept private, individuals may be less inclined to seek help for distress resulting from this type of IPV [76, 77]. Alternatively, individuals may fear seeking help if they have experienced physical or sexual IPV and are concerned about re-victimization , or may find it more appropriate to seek general medical care for physical problems as opposed to emotional distress resulting from physical or sexual violence. Our results suggesting greater trauma is associated with a greater likelihood of help-seeking are consistent with existing literature [75, 79]. Overall, findings highlight the significance of co-occurring psychosocial stressors in understanding patterns of mental health help-seeking.
Results from this study should be interpreted within the context of study limitations. Given the cross-sectional nature of these data, we were unable to investigate the longitudinal effects of socio-demographic and psychosocial factors on mental health help-seeking behaviors. Further, data were not available on the timing, frequency of, or reasoning for prior help-seeking behaviors. Importantly, this study captured information on lifetime help-seeking and current MSD symptoms. Thus, we are unable to assess to what extent participants’ MSD symptoms at the time of help-seeking were similar or dissimilar to their current MSD symptoms. However, evidence suggests symptoms of depression, anxiety, PTSD, and AUD are often chronic or reoccurring throughout one’s lifetime [80, 81]. Because we defined help-seeking as ever speaking to a source about their emotional problems, we cannot draw conclusions about efforts to seek help that may have been unsuccessful. This is particularly relevant to formal help-seeking as it is possible participants tried to seek formal help but were ultimately unable to speak with someone due to highly limited provider availability. Further, these results are subject to social desirability bias and recall bias as reported in other studies on the agreement between self-report and medical record care-seeking [82, 83]. Finally, participants were recruited from three clinics specifically selected because of existing data collection capacity, limiting the generalizability of findings to other settings or populations. Future studies should investigate MSD symptoms, help-seeking behaviors, and predictors of help-seeking over time in order to ascertain causal relationships between key factors of interest and mental health help-seeking among PLWH as they move through the HIV care continuum.
Increased access to formal and informal mental health help is needed in Cameroon given just over half of PLWH with symptoms of an MSD in this sample have previously sought help. History of mental health help-seeking from informal networks was more common than formal help-seeking. Seeking help from formal or informal sources, and from formal and informal sources separately, was significantly associated with psychosocial stressors. Psychoeducation and training in the provision of evidence-based mental health support for informal networks have the potential to improve access to mental health care for PLWH with less severe symptoms and improve referral to formal services for those with more severe symptoms and substantial care needs.
Availability of data and materials
Data used in this analysis are not publicly available at the present time. Data may be made available by author AP on reasonable request.
Alcohol use disorder
Alcohol Use Disorders Identification Test
General Anxiety Disorder-7
Human immunodeficiency virus
International epidemiology Databases to Evaluate AIDS
Intimate partner violence
Mental or substance use disorder
PTSD Checklist for DSM-5
Patient Health Questionnaire-9
People living with HIV
Potentially traumatic event
Post-traumatic stress disorder
Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, et al. Global burden of disease attributable to mental and substance use disorders: findings from the global burden of disease study 2010. Lancet. 2013;382:1575–86. https://doi.org/10.1016/S0140-6736(13)61611-6.
World Health Organization. Depression and other common mental disorders: Global health estimates. Geneva: World Health Organization; 2017.https://apps.who.int/iris/handle/10665/254610.
Krupchanka D, Mladá K, Winkler P, Khazaal Y, Albanese E. Mortality in people with mental disorders in the Czech Republic: a nationwide, register-based cohort study. Lancet Public Health. 2018;3(6):e289–95. https://doi.org/10.1016/S2468-2667(18)30077-X.
Druss BG, Zhao L, Von Esenwein S, et al. Understanding excess mortality in persons with mental illness: 17-year follow up of a nationally representative US survey. Med Care. 2011;49(6):599–604. https://doi.org/10.1097/MLR.0b013e31820bf86e.
Roberts LW, Louie AK, Guerrero APS, Balon R, Beresin EV, Brenner A, et al. Premature mortality among people with mental illness: advocacy in academic psychiatry. Acad Psychiatry. 2017;41(4):441–6. https://doi.org/10.1007/s40596-017-0738-9.
Kendler KS, Ohlsson H, Sundquist J, Sundquist K. Alcohol use disorder and mortality across the lifespan a longitudinal cohort and co-relative analysis. JAMA Psychiatry. 2016;73(6):575–81. https://doi.org/10.1001/jamapsychiatry.2016.0360.
Remien RH, Stirratt MJ, Nguyen N, Robbins RN, Pala AN, Mellins CA. Mental health and HIV/AIDS: the need for an integrated response. AIDS. 2019;33(9):1411–20. https://doi.org/10.1097/QAD.0000000000002227.
Belayneh Z, Mekuriaw B, Mehare T, Shumye S, Tsehay M. Magnitude and predictors of common mental disorder among people with HIV/AIDS in Ethiopia: a systematic review and meta-analysis. BMC Public Health. 2020;20(1):689. https://doi.org/10.1186/s12889-020-08800-8.
Tesfaw G, Ayano G, Awoke T, Assefa D, Birhanu Z, Miheretie G, et al. Prevalence and correlates of depression and anxiety among patients with HIV on-follow up at alert hospital, Addis Ababa, Ethiopia. BMC Psychiatry. 2016;16(1):1–7. https://doi.org/10.1186/s12888-016-1037-9.
Pence BW. The impact of mental health and traumatic life experiences on antiretroviral treatment outcomes for people living with HIV/AIDS. J Antimicrob Chemother. 2009;63(4):636–40. https://doi.org/10.1093/jac/dkp006.
Uthman O, Magidson J, Safren S, Nachega J. Depression and Adherence to Antiretroviral Therapy in Low-, Middle- and High-Income Countries: A Systematic Review and Meta-Analysis. Current HIV/AIDS Reports 2014;11(3):291–307.
Antelman G, Kaaya S, Wei R, Mbwambo J, Msamanga GI, Fawzi WW, et al. Depressive symptoms increase risk of HIV disease progression and mortality among women in Tanzania. J Acquir Immune Defic Syndr. 2007;44(4):470–7. https://doi.org/10.1097/QAI.0b013e31802f1318.
Saavedra A, Campinha-Bacote N, Hajjar M, Kenu E, Syeda Gillani F, Obo-Akwa A, et al. Causes of death and factors associated with early mortality of HIV-infected adults admitted to Korle-Bu teaching hospital. Pan Afr Med J. 2017;27. https://doi.org/10.11604/pamj.2017.27.48.8917.
Bisson GP, Ramchandani R, Miyahara S, Mngqibisa R, Matoga M, Ngongondo M, et al. Risk factors for early mortality on antiretroviral therapy in advanced HIV-infected adults. AIDS. 2017;31(16):2217–25. https://doi.org/10.1097/QAD.0000000000001606.
Petersen I, Hanass Hancock J, Bhana A, Govender K. A group-based counselling intervention for depression comorbid with HIV/AIDS using a task shifting approach in South Africa: a randomized controlled pilot study. J Affect Disord. 2014;158:78–84. https://doi.org/10.1016/j.jad.2014.02.013.
Chibanda D, Mesu P, Kajawu L, Cowan F, Araya R, Abas MA. Problem-solving therapy for depression and common mental disorders in Zimbabwe: piloting a task-shifting primary mental health care intervention in a population with a high prevalence of people living with HIV. BMC Public Health. 2011;11(1). https://doi.org/10.1186/1471-2458-11-828.
Saag LA, Tamhane AR, Batey DS, Mugavero MJ, Eaton EF. Mental health service utilization is associated with retention in care among persons living with HIV at a university-affiliated HIV clinic. AIDS Res Ther. 2018;15(1):1. https://doi.org/10.1186/s12981-018-0188-9.
Coyle RP, Schneck CD, Morrow M, Coleman SS, Gardner EM, Zheng JH, et al. Engagement in mental health care is associated with higher cumulative drug exposure and adherence to antiretroviral therapy. AIDS Behav. 2019;23(12):3493–502. https://doi.org/10.1007/s10461-019-02441-8.
Aggarwal R, Pham M, Dillingham R, McManus K. Expanded HIV Clinic-Based Mental Health Care Services: Association with Viral Suppression. Open Forum Infect Dis. 2019:6. https://doi.org/10.1093/ofid/ofz146.
Dwyer-Lindgren L, Cork MA, Sligar A, Steuben KM, Wilson KF, Provost NR, et al. Mapping HIV prevalence in sub-Saharan Africa between 2000 and 2017. Nature. 2019;570(7760):189–93. https://doi.org/10.1038/s41586-019-1200-9.
Lovero KL, Giusto AM, Wainberg ML. Evidence for efficacy of psychosocial interventions in LMICs. Lancet Psychiatry. 2020;7(2):113–4. https://doi.org/10.1016/S2215-0366(19)30531-0.
Javadi D, Feldhaus I, Mancuso A, Ghaffar A. Applying systems thinking to task shifting for mental health using lay providers: a review of the evidence. Glob Ment Heal. 2017;4:1–32. https://doi.org/10.1017/gmh.2017.15.
Barbui C, Purgato M, Abdulmalik J, Acarturk C, Eaton J, Gastaldon C, et al. Efficacy of psychosocial interventions for mental health outcomes in low-income and middle-income countries: an umbrella review. Lancet Psychiatry. 2020;7(2):162–72. https://doi.org/10.1016/S2215-0366(19)30511-5.
Ali BS, Rahbar MH, Naeem S, Gul A, Mubeen S, Iqbal A. The effectiveness of counseling on anxiety and depression by minimally trained counselors: a randomized controlled trial. Am J Psychother. 2003;57(3):324–6. https://doi.org/10.1176/appi.psychotherapy.2003.57.3.324.
Chatterjee S, Naik S, John S, Dabholkar H, Balaji M, Koschorke M, et al. Effectiveness of a community-based intervention for people with schizophrenia and their caregivers in India (COPSI): a randomised controlled trial. Lancet. 2014;383(9926):1385–94. https://doi.org/10.1016/S0140-6736(13)62629-X.
Brown JS, Evans-Lacko S, Aschan L, et al. Seeking informal and formal help for mental health problems in the community: a secondary analysis from a psychiatric morbidity survey in South London. BMC Psychiatry. 2014;14(1):1–15. https://doi.org/10.1186/s12888-014-0275-y.
Nguyen MH, Serik M, Vuong TT, Ho MT. Internationalization and its discontents: help-seeking behaviors of students in a multicultural environment regarding acculturative stress and depression. Sustain. 2019;11(7):1865. https://doi.org/10.3390/su11071865.
Rodgers S, Vandeleur CL, Strippoli MPF, Castelao E, Tesic A, Glaus J, et al. Low emotion-oriented coping and informal help-seeking behaviour as major predictive factors for improvement in major depression at 5-year follow-up in the adult community. Soc Psychiatry Psychiatr Epidemiol. 2017;52(9):1169–82. https://doi.org/10.1007/s00127-017-1421-x.
Menberu M, Mekonen T, Azale T, Ayano G, Yimer S, Getnet A, et al. Health care seeking behavior for depression in Northeast Ethiopia: depression is not considered as illness by more than half of the participants. Ann General Psychiatry. 2018;17(1):34. https://doi.org/10.1186/s12991-018-0205-3.
Girma E, Tesfaye M. Patterns of treatment seeking behavior for mental illnesses in Southwest Ethiopia: A hospital based study. BMC Psychiatry. 2011:11. https://doi.org/10.1186/1471-244X-11-138.
Satre DD, DeLorenze GN, Quesenberry CP, et al. Factors associated with treatment initiation for psychiatric and substance use disorders among persons with HIV. Psychiatr Serv. 2013;64(8):745–53. https://doi.org/10.1176/appi.ps.201200064.
Lindamer LA, Liu L, Sommerfeld DH, Folsom DP, Hawthorne W, Garcia P, et al. Predisposing, enabling, and need factors associated with high service use in a public mental health system. Adm Policy Ment Health Ment Health Serv Res. 2012;39(3):200–9. https://doi.org/10.1007/s10488-011-0350-3.
Brown MC, Creel AH, Engel CC, Herrell RK, Hoge CW. Factors associated with interest in receiving help for mental health problems in combat veterans returning from deployment to Iraq. J Nerv Ment Dis. 2011;199(10):797–801. https://doi.org/10.1097/NMD.0b013e31822fc9bf.
Wu P, Hoven CW, Cohen P, Liu X, Moore RE, Tiet Q, et al. Factors associated with use of mental health services for depression by children and adolescents. Psychiatr Serv. 2001;52(2):189–95. https://doi.org/10.1176/appi.ps.52.2.189.
Roberts T, Miguel Esponda G, Krupchanka D, Shidhaye R, Patel V, Rathod S. Factors associated with health service utilisation for common mental disorders: a systematic review. BMC Psychiatry. 2018;18(1):1–19. https://doi.org/10.1186/s12888-018-1837-1.
Parcesepe AM, Bernard C, Agler R, Ross J, Yotebieng M, Bass J, et al. Mental health and HIV: research priorities related to the implementation and scale up of “treat all” in sub-Saharan Africa. J Virus Erad. 2018;4(Suppl 2):16–25. https://doi.org/10.1016/S2055-6640(20)30341-1.
Ministry of Health (MOH), Division of Health Operations Research (DROS). Cameroon Population-based HIV Impact Assessment (CAMPHIA) 2017-2018: Final Report. Yaounde: MOH, DROS; December 2020.
Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13. https://doi.org/10.1046/j.1525-1497.2001.016009606.x.
Cholera R, Gaynes BN, Pence BW, Bassett J, Qangule N, Macphail C, et al. Validity of the patient health questionnaire-9 to screen for depression in a high-HIV burden primary healthcare clinic in Johannesburg, South Africa. J Affect Disord. 2014;167:160–6. https://doi.org/10.1016/j.jad.2014.06.003.
Pence BW, Gaynes BN, Atashili J, O'Donnell JK, Tayong G, Kats D, et al. Validity of an interviewer-administered patient health questionnaire-9 to screen for depression in HIV-infected patients in Cameroon. J Affect Disord. 2012;143(1-3):208–13. https://doi.org/10.1016/j.jad.2012.05.056.
Monahan PO, Shacham E, Reece M, Kroenke K, Ong’or WO, Omollo O, et al. Validity/reliability of PHQ-9 and PHQ-2 depression scales among adults living with HIV/AIDS in Western Kenya. J Gen Intern Med. 2009;24(2):189–97. https://doi.org/10.1007/s11606-008-0846-z.
Chibanda D, Verhey R, Gibson LJ, Munetsi E, Machando D, Rusakaniko S, et al. Validation of screening tools for depression and anxiety disorders in a primary care population with high HIV prevalence in Zimbabwe. J Affect Disord. 2016;198:50–5. https://doi.org/10.1016/j.jad.2016.03.006.
Manea L, Gilbody S, McMillan D. Optimal cut-off score for diagnosing depression with the patient health questionnaire (PHQ-9): a meta-analysis. CMAJ. 2012;184(3):E191–6. https://doi.org/10.1503/cmaj.110829.
Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–7. https://doi.org/10.1001/archinte.166.10.1092.
Pefura-Yone EW, Soh E, Kengne AP, Balkissou AD, Kuaban C. Non-adherence to antiretroviral therapy in Yaounde: prevalence, determinants and the concordance of two screening criteria. J Infect Public Health. 2013;6(4):307–15. https://doi.org/10.1016/j.jiph.2013.02.003.
Weathers FW, Litz BT, Keane TM, Palmieri PA, Marx BP, Schnurr PP. The PTSD Checklist for DSM-5 (PCL-5). National Center for PTSD. 2013; Scaleavailable from the National Center for PTSD at www.ptsd.va.gov.
Blevins CA, Weathers FW, Davis MT, Witte TK, Domino JL. The posttraumatic stress disorder checklist for DSM-5 (PCL-5): development and initial psychometric evaluation. J Trauma Stress. 2015;28(6):489–98. https://doi.org/10.1002/jts.22059.
Verhey R, Chibanda D, Gibson L, Brakarsh J, Seedat S. Validation of the posttraumatic stress disorder checklist - 5 (PCL-5) in a primary care population with high HIV prevalence in Zimbabwe. BMC Psychiatry. 2018;18(1):109. https://doi.org/10.1186/s12888-018-1688-9.
Duko B, Toma A, Abraham Y, Kebble P. Post-traumatic stress disorder and its correlates among people living with HIV in southern Ethiopia, an institutionally based cross-sectional study. Psychiatr Q. 2020;91(3):783–91. https://doi.org/10.1007/s11126-020-09735-4.
Saunders JB, Aasland OG, Babor TF, et al. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction. 1993;88(6):791–804. https://doi.org/10.1111/j.1360-0443.1993.tb02093.x.
Babor TF, Robaina K. The alcohol use disorders identification test (AUDIT): a review of graded severity algorithms and national adaptations. Int J Alcohol Drug Res. 2016;5(2):17–24. https://doi.org/10.7895/ijadr.v5i2.222.
Babor T, Higgins-Biddle JC, Saunders JB, Monteiro MG. The alcohol use disorders identification test: guidelines for use in primary care. 2nd ed. Geneva: World Health Organization; 2001.
Blair AH, Pearce ME, Katamba A, Malamba SS, Muyinda H, Schechter MT, et al. The alcohol use disorders identification test (AUDIT): exploring the factor structure and cutoff thresholds in a representative post-conflict population in northern Uganda. Alcohol Alcohol. 2017;52:318–27. https://doi.org/10.1093/alcalc/agw090.
Lancaster KE, MacLean SA, Lungu T, et al. Socioecological factors related to hazardous alcohol use among female sex Workers in Lilongwe, Malawi: a mixed methods study. Subst Use Misuse. 2018;53(5):782–91. https://doi.org/10.1080/10826084.2017.1365088.
Adewuya AO. Validation of the alcohol use disorders identification test (AUDIT) as a screening tool for alcohol-related problems among Nigerian University students. Alcohol Alcohol. 2005;40(6):575–7. https://doi.org/10.1093/alcalc/agh197.
Rickwood D, Thomas K. Conceptual measurement framework for help-seeking for mental health problems. Psychol Res Behav Manag. 2012;5:173–83. https://doi.org/10.2147/PRBM.S38707.
Kubany ES, Leisen MB, Kaplan AS, Watson SB, Haynes SN, Owens JA, et al. Development and preliminary validation of a brief broad-spectrum measure of trauma exposure: the traumatic life events questionnaire. Psychol Assess. 2000;12(2):210–24. https://doi.org/10.1037//1040-35126.96.36.199.
Weathers FW, Blake DD, Schnurr PP, Kaloupek DG, Marx BP, Keane T. The Life Events Checklist for DSM-5 (LEC-5). National Center for PTSD. 2013;Scale available from the National Center for PTSD at www.ptsd.va.gov
Wolfe J, Kimerling R. Gender issues in the assessment of posttraumatic stress disorder. In: Wilson J, Keane T, editors. Assessing psychological trauma and PTSD. New York: The Guilford Press; 1997. p. 192–238.
Pierucci-Lagha A, Gelernter J, Feinn R, Cubells JF, Pearson D, Pollastri A, et al. Diagnostic reliability of the semi-structured assessment for drug dependence and alcoholism (SSADDA). Drug Alcohol Depend. 2005;80(3):303–12. https://doi.org/10.1016/j.drugalcdep.2005.04.005.
Kishor S, Johnson K. Profiling domestic violence: a multi-country study. Studies in Family Planning. 2005;36(3):259–61.
World Health Organization. Putting women's safety first: Ethical and safety recommendations for research on domestic violence against women. Geneva: World Health Organization; 2001. http://www.who.int/gender/violence/womenfirtseng.pdf.
Ellsberg M, Heise L, Peña R, et al. Researching domestic violence against women: Methological and ethical considerations. Stud Fam Plan. 2001;32(1):1–16. https://doi.org/10.1111/j.1728-4465.2001.00001.x.
Umubyeyi A, Mogren I, Ntaganira J, Krantz G. Help-seeking behaviours, barriers to care and self-efficacy for seeking mental health care: a population-based study in Rwanda. Soc Psychiatry Psychiatr Epidemiol. 2016;51(1):81–92. https://doi.org/10.1007/s00127-015-1130-2.
Tenkorang EY, Asamoah-Boaheng M, Owusu AY. Intimate partner violence (IPV) against HIV-positive women in sub-Saharan Africa: a mixed-method systematic review and meta-analysis. Trauma Violence Abuse. 2020;152483802090656. https://doi.org/10.1177/1524838020906560.
Azale T, Fekadu A, Hanlon C. Treatment gap and help-seeking for postpartum depression in a rural African setting. BMC Psychiatry. 2016;16(1):1–10. https://doi.org/10.1186/s12888-016-0892-8.
Seedat S, Williams DR, Herman AA, et al. Mental health service use among south Africans for mood, anxiety and substance use disorders. S Afr Med J. 2009;99:346–52. https://doi.org/10.7196/SAMJ.3061.
Rathod SD, De Silva MJ, Ssebunnya J, et al. Treatment contact coverage for probable depressive and probable alcohol use disorders in four low- and middle-income country districts: the prime cross-sectional community surveys. PLoS One. 2016;11(9):e0162038. https://doi.org/10.1371/journal.pone.0162038.
Mulango ID, Atashili J, Gaynes BN, Njim T. Knowledge, attitudes and practices regarding depression among primary health care providers in Fako division, Cameroon. BMC Psychiatry. 2018;18(1):66. https://doi.org/10.1186/s12888-018-1653-7.
Roberts T, Shidhaye R, Patel V, Rathod SD. Health care use and treatment-seeking for depression symptoms in rural India: an exploratory cross-sectional analysis. BMC Health Serv Res. 2020;20(1):287. https://doi.org/10.1186/s12913-020-05162-0.
Zewdu S, Hanlon C, Fekadu A, Medhin G, Teferra S. Treatment gap, help-seeking, stigma and magnitude of alcohol use disorder in rural Ethiopia. Subst Abus Treat Prev Policy. 2019;14(1):1–10. https://doi.org/10.1186/s13011-019-0192-7.
Andersson LMC, Schierenbeck I, Strumpher J, Krantz G, Topper K, Backman G, et al. Help-seeking behaviour, barriers to care and experiences of care among persons with depression in eastern cape, South Africa. J Affect Disord. 2013;151(2):439–48. https://doi.org/10.1016/j.jad.2013.06.022.
Topper K, van Rooyen K, Grobler C, van Rooyen D, Andersson LMC. Posttraumatic stress disorder and barriers to Care in Eastern Cape Province, South Africa. J Trauma Stress. 2015;28(4):375–9. https://doi.org/10.1002/jts.22032.
Fang X, Zheng X, Deborah AF, et al. The economic burden of violence against children in South Africa. Int J Environ Res Public Health. 2017;14(11). https://doi.org/10.3390/ijerph14111431.
Ssebunnya J, Medhin G, Kangere S, Kigozi F, Nakku J, Lund C. Prevalence, correlates and help-seeking behaviour for depressive symptoms in rural Uganda: a population-based survey. Glob Ment Health. 2019;6:1–10. https://doi.org/10.1017/gmh.2019.25.
Leonardsson M, San Sebastian M. Prevalence and predictors of help-seeking for women exposed to spousal violence in India - a cross-sectional study. BMC Womens Health. 2017;17(1):99. https://doi.org/10.1186/s12905-017-0453-4.
Tenkorang EY, Owusu AY, Kundhi G. Help-seeking behavior of female victims of intimate partner violence in Ghana: the role of trust and perceived risk of injury. J Fam Violence. 2018;33(5):341–53. https://doi.org/10.1007/s10896-018-9959-2.
Cho H, Kim WJ. Intimate partner violence among Asian Americans and their use of mental health services: comparisons with white, black, and Latino victims. J Immigr Minor Health. 2012;14(5):809–15. https://doi.org/10.1007/s10903-012-9625-3.
Gavrilovic JJ, Schützwohl M, Fazel M, Priebe S. Who seeks treatment after a traumatic event and who does not? A review of findings on mental health service utilization. J Trauma Stress. 2005;18(6):595–605. https://doi.org/10.1002/jts.20068.
Eaton WW, Shao H, Nestadt G, Lee BH, Bienvenu OJ, Zandi P. Population-based study of first onset and chronicity in major depressive disorder. Arch Gen Psychiatry. 2008;65(5):513–20. https://doi.org/10.1001/archpsyc.65.5.513.
Patel V. Mental health in low- and middle-income countries. Br Med Bull. 2007;81–82(1):81–96. https://doi.org/10.1093/bmb/ldm010.
Rhodes AE, Fung K. Self-reported use of mental health services versus administrative records: care to recall? Int J Methods Psychiatr Res. 2004;13(3):165–75. https://doi.org/10.1002/mpr.172.
Drapeau A, Boyer R, Diallo F. Discrepancies between survey and administrative data on the use of mental health services in the general population: findings from a study conducted in Québec. BMC Public Health. 2011;11(1):1–10. https://doi.org/10.1186/1471-2458-11-837.
The authors would like to thank all the individuals who participated in this study.
This research was supported by NIMH grant K01 MH114721, NICHD grant P2C HD050924 (Carolina Population Center), NIAID grant P30 AI050410 (UNC Center for AIDS Research), NIAID grant U01AI096299, and ViiV Healthcare. This work is solely the responsibility of the authors and does not necessarily represent the official views of any of the institutions mentioned above.
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Ethical approval for this study was obtained from the University of North Carolina’s Institutional Review Board and from the national Ethical Committee of Research for Human Health at Yaoundé, Cameroon. To be eligible, individuals had to provide written informed consent for participation.
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The authors have no conflicts of interest to report.
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Filiatreau, L.M., Ebasone, P.V., Dzudie, A. et al. Correlates of self-reported history of mental health help-seeking: a cross-sectional study among individuals with symptoms of a mental or substance use disorder initiating care for HIV in Cameroon. BMC Psychiatry 21, 293 (2021). https://doi.org/10.1186/s12888-021-03306-y
- Mental health
- Alcohol use
- Sub-Saharan Africa