Advancing Caring Science in Global Health: Assessment of Mental Health Needs in Bondeau, Haiti

Saturday, 29 July 2017

Beth M. King, PhD
Charlotte D. Barry, PhD
Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA

Purpose:  The purpose of this exploratory study was to investigate the mental health needs of adults living in Bondeau, Haiti, a rural community located in the southwest region of the country. The aims of the study were to: (1) develop collaborative partnerships and relationships to facilitate the study, (2) determine the severity of depressive symptomatology (measured by the PHQ-9 & Zanmi Lasante Depression Inventory Scale), (3) assess the degree of anxiety (measured by the PROMIS Anxiety scale), and (4) appraise resiliency (measured by Connor-Davidson Resilience scale) for participants in the study compared to the global community.

Significance: In 2011, the World Health Organization (WHO) called for a comprehensive, coordinated response to the global burden of mental disorders. The World Bank reports that 350 million persons are impacted by depression and is “the leading cause of disability world wide” (2016, para 1). Yet, assessment and treatment of mental health disorders remains limited, with estimates of 76% to 85% of persons living in low and middle-income countries receiving no treatment for mental health disorders (WHO, 2015).

Haiti, declared a priority nation by the Pan American Health Organization & World Health Organization (PAHO/WHO) in 2002 is the poorest and most vulnerable country in the Americas (PAHO, 2006, World Bank, 2016). With an estimated population of 10.4 million, only 40% of the population has access to health care (WHO, 2014). The country has no specific mental health policies or legislation and has only 2 mental health hospitals and .07 psychiatrists, .07 psychologists, .29 nurses, and .06 social workers per 100,000 populations to care for persons with mental health disorders (WHO, 2014).

Theoretical Framework: The Community Nurse Practice Model (CNPM) served as the framework for this study. Based in the values of respect, wholeness, and caring, the CNPM promotes community participation and intersectoral collaboration. The CNPM is grounded in the beliefs: respect for person, persons are caring, and persons are whole and connected to the community and environment (Parker, Barry, & King, 2015). In addition, services and activities are intentionally guided by the concepts of community participation/partnership, empowerment, access, essentiality, and intersectoral collaboration (World Health Organization, 1978).

Literature Review: Rasmussen et al. (2015) described the development of a 13 item, culturally sensitive, depression screening tool, the Zanmi Lasante Depression Symptom Inventory (ZLDSI) for use in Haiti. Using an emic-etic approach, the investigators developed a screening tool with construct and concurrent validity for depression. Wagenaar et al. (2013) asserts that mental health resources should be community based, as supported by the report that there were ten psychiatrists practicing in the public sector at the time of the earthquake mostly located in Port au Prince and mental health services were nonexistent in rural communities. The findings of their study revealed a lack of faith in biomedical providers and the high likelihood of seeking help from a local healer or religious leader for mental health problems. The authors supported the WHO’s initiative to scale up mental health interventions in low income countries by using trained community based health care providers who are not psychiatrists.

Barry, King, Goodman, Gullett, and Grumme (2016) identified overall health needs of the community in Bondeau, Haiti and the need to investigate the mental health needs of the community. Health disparities and limited access to health care in Haiti impact the mental health and well-being of persons. The authors asserted that competence, compassion and humility are needed to develop collaborative partnerships and relationships to explore the mental health needs and resources of the community.

Methods: The study design was a sequential (quantitative-qualitative) mixed methods design. Only the quantitative phase of the study has been conducted which assessed the severity of depressive symptomatology, anxiety and resilience of a convenience sample comprised of adults’ age 18-84 living in Bondeau, Haiti. Data analysis consists of descriptive statistics and correlational statistics (Pearson r, Spearman rho) which compare the participants’ scores on the Promise Anxiety tool, PHQ-9, Zamni Lasante Depression Symptom Inventory and Connors-Resilience scores to the participants’ demographics. IRB approval was obtained by the University IRB and written and/or oral consents were obtained by all participants.

Results: The study is in process and findings will be completed in 2017.

Conclusion: This study advances caring science in the discipline of nursing, arrived through intentional research focused on the relationship of caring to mental health and well-being of the whole person within the family and community. The critical role nursing plays in global collaborations and in attaining the United Nation’s Sustainable Health Goals of “people-centeredness” healthcare programs (United Nations, 2015) was demonstrated in the study.