Patient-level predictors of detection of depressive symptoms, referral, and uptake of depression counseling among chronic care patients in KwaZulu-Natal, South Africa
Open accessAbstract
Background: Integration of depression treatment into primary care could improve patient outcomes in low-resource settings. Losses along the depression care cascade limit integrated service effectiveness. This study identified patient-level factors that predicted detection of depressive symptoms by nurses, referral for depression treatment, and uptake of counseling, as part of integrated care in KwaZulu-Natal, South Africa. Methods: This was an analysis of baseline data from a prospective cohort. Participants were adult patients with at least moderate depressive symptoms at primary care facilities in Amajuba, KwaZulu-Natal, South Africa. Participants were screened for depressive symptoms prior to routine assessment by a nurse. Generalized linear mixed-effects models were used to estimate associations between patient characteristics and service delivery outcomes. Results: Data from 412 participants were analyzed. Nurses successfully detected depressive symptoms in 208 [50.5%, 95% confidence interval (CI) 38.9–62.0] participants; of these, they referred 76 (36.5%, 95% CI 20.3–56.5) for depression treatment; of these, 18 (23.7%, 95% CI 10.7–44.6) attended at least one session of depression counseling. Depressive symptom severity, alcohol use severity, and perceived stress were associated with detection. Similar factors did not drive referral or counseling uptake. Conclusions: Nurses detected patients with depressive symptoms at rates comparable to primary care providers in high-resource settings, though gaps in referral and uptake persist. Nurses were more likely to detect symptoms among patients in more severe mental distress. Implementation strategies for integrated mental health care in low-resource settings should target improved rates of detection, referral, and uptake.
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The provider adoption rate in MeHPriC (69.1%) compares favourably with PRIME sites in South Africa (23-50% adoption) but is lower than Ethiopia (81.7%).
“The provider adoption rate in MeHPriC (69.1%) compares favourably with experiences from similar programs: higher than reported in some PRIME sites in South Africa (23–50% adoption depending on sites) [34] but lower than Ethiopia (81.7%) [35].”
From Co-creating systems change for mental health: a theory of change approach from the MeHPriC initiative in Lagos, Nigeria (2025) · cites this paper as [34]
The Introduction reports that nurses in the South African model detected depression in 16–27% of patients, and the Discussion says detection was higher in this study than in the PRIME evaluation. The source does not report 23–50% provider adoption across PRIME sites: it measures patient-level detection, and its 50.5% result comes from the KwaZulu-Natal cohort, not PRIME. The Ethiopia figure is attached to a different citation and is not assessed here. (LLM, conf=0.86)
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A reflection of the current status of the mental healthcare system in South Africa
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“%) compares favourably with experiences from similar programs: higher than reported in some PRIME sites in South Africa (23–50% adoption depending on sites) [34] but lower than Ethiopia (81.7”
Influential
- Authors
- Kemp, C. G., Mntambo, N., Bachmann, M., Bhana, A., Rao, D., Grant, M., Hughes, J. P., Simoni, J. M., Weiner, B. J., Gigaba, S. G., Luvuno, Z. P. B., & Petersen, I.
- Affiliations
- University of Washington (US)
- University of KwaZulu-Natal (ZA)
- University of East Anglia (GB)
- South African Medical Research Council (ZA)
- Corresponding author
- Kemp, Christopher G.
- ORCID
- Venue
- Global Mental Health
- Publisher
- Cambridge University Press (CUP)
- Published
- 2020
- Volume
- 7
- Pages
- e18-e18
- ISSN
- 2054-4251 (ISSN-L)
- PMC
- PMC7443607
- OpenAlex
- W3044661760
- Cited by
- 12
- References
- 43
- Citations by year
- 2025: 3 · 2024: 3 · 2023: 3 · 2022: 1 · 2021: 2
- FWCI
- 1.64
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Cambridge Prisms Global Mental Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UEA Digital Repository (University of East Anglia) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- National Institute of Mental Health (F31MH112397, U19MH113191)
- National Institute of Allergy and Infectious Diseases (P30AI027757)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Keywords
- depression detection, depressive symptoms, integrated mental health care, primary care, alcohol consumption, perceived stress, depression severity, resource-limited settings, KwaZulu-Natal
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