Kyle Beuoy, MD

Clinic-Based Assessment Measures High Prevalence of Depression and Anxiety Screens in a Rural Honduran Community and Identifies Potential Areas for Future Intervention

Authors:
Kyle Beuoy, MD; N. Randall Kolb, MD; Mark Meyer, MD; Tara Kedia, MD; Rajwinder Kaur, DO

Introduction:
An interdisciplinary medical brigade and a health committee of a rural Honduran community identified mental health as a priority for its served population of approximately 6,000. A previous brigade project identified prevalence of positive depression screens to be 48% and positive anxiety screens to be 38% among adult clinic patients. The objective of the project was to further assess mental health issues in the served community and identify future directions for interventions.

Methods:
Project team implemented verbal Spanish-language PHQ-9 and GAD-7 screenings to adult patients of the partner local clinic during a two-week brigade in February-March 2023 to remeasure prevalence of positive screens among the served population. They also conducted semi-structured interviews with the local primary care physician and health committee to qualitatively assess mental health issues and community perspectives.

Results:
The PHQ-9 and GAD-7 assessments were conducted with 23 adult patients. They identified 65% (n=15) positive depression screens and 48% (n=11) positive anxiety screens. Ten were comorbid positive and 3 were comorbid severe range. Key points from the semi-structured interviews include somatic presentations of patients with mood disorders, community fear of suicide, importance of patient confidentiality, utilization of religious leaders or traditional healers prior to clinic presentation, and provider self-assessed knowledge gaps in psychiatric care.

Conclusion:
Implemented assessments measured high prevalence of positive depression and anxiety screens but was limited by small sample size and cross-cultural communication challenges. A future direction for this would be increasing sample size of screenings and following up with full diagnostic evaluations. The semi-structured interviews enhanced understanding of the illness history for patients with mood disorders and reiterated the need of enhancing local physician psychiatric skills in future interventions. The key point of high utilization of religious leaders and traditional healers prior to clinic engagement identifies a potential option for future partnership.