Psychol Med. 1999 Jan; 29(1): 97-104.

The onset of common mental disorders in primary care attenders in Harare, Zimbabwe.

Todd C, Patel V, Simunyu E, Gwanzura F, Acuda W, Winston M, Mann A.

Department of Psychiatry, University of Zimbabwe Medical School, Harare.

BACKGROUND: This study aimed to investigate the onset and predictors of common mental disorders (CMD) in primary-care attenders in Harare, Zimbabwe. METHOD: Two (T1) and 12-month (T2) follow-up of a cohort of primary-care attenders without a common mental disorder (N = 197) as defined by the Shona Symposium Questionnaire (SSQ), recruited from primary health care clinics, traditional medical practitioner clinics and general practitioner surgeries. Outcome measure was caseness as determined by scores on the SSQ at follow-up. RESULTS: Follow-up rate was 86% at 2 months and 75% at 12 months. Onset of CMD was recorded in 16% at T1 and T2. Higher psychological morbidity scores at recruitment, death of a first-degree relative and disability predicted the presence of a CMD at both follow-up points. While female gender and economic difficulties predicted onset only in the short-term, belief in supernatural causation was strongly predictive of CMD at T2. Caseness at both follow-up points was associated with economic problems and disability at those follow-up points. CONCLUSIONS: Policy initiatives to reduce economic deprivation and targeting interventions to primary-care attenders who are subclinical cases and those who have been bereaved or who are disabled may reduce the onset of new cases of CMD. Closer collaboration between biomedical and traditional medical practitioners may provide avenues for developing methods of intervention for persons with supernatural illness models.