Abstract summary 

To estimate the proportion of adult primary care outpatients who are clinically detected and initiate treatment for depression and alcohol use disorder (AUD) in low-income and middle-income country (LMIC) settings.Five cross-sectional studies.Adult outpatient services in 36 primary healthcare facilities in Sodo District, Ethiopia (9 facilities); Sehore District, India (3); Chitwan District, Nepal (8); Dr Kenneth Kaunda District, South Africa (3); and Kamuli District, Uganda (13).Between 760 and 1893 adults were screened in each district. Across five districts, between 4.2% and 20.1% screened positive for depression and between 1.2% and 16.4% screened positive for AUD. 96% of screen-positive participants provided details about their clinical consultations that day.Detection of depression, treatment initiation for depression, detection of AUD and treatment initiation for AUD.Among depression screen-positive participants, clinical detection of depression ranged from 0% in India to 11.7% in Nepal. Small proportions of screen-positive participants received treatment (0% in Ethiopia, India and South Africa to 4.2% in Uganda). Among AUD screen-positive participants, clinical detection of AUD ranged from 0% in Ethiopia and India to 7.8% in Nepal. Treatment was 0% in all countries aside Nepal, where it was 2.2%.The findings of this study suggest large detection and treatment gaps for adult primary care patients, which are likely contributors to the population-level mental health treatment gap in LMIC. Primary care facilities remain unfulfilled intervention points for reducing the population-level burden of disease in LMIC.

Authors & Co-authors:  Rathod Sujit D SD Roberts Tessa T Medhin Girmay G Murhar Vaibhav V Samudre Sandesh S Luitel Nagendra P NP Selohilwe One O Ssebunnya Joshua J Jordans Mark J D MJD Bhana Arvin A Petersen Inge I Kigozi Fred F Nakku Juliet J Lund Crick C Fekadu Abebaw A Shidhaye Rahul R

Study Outcome 

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