Barriers and facilitators for screening for anxiety and depression among children and young people attending Pediatric Epilepsy Clinic at Queen Elizabeth Central Hospital, Malawi
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Date
2022-05-12
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Kamuzu University of Health Sciences
Abstract
Type of Study: A qualitative study
Problem: Despite the high prevalence of depression and anxiety among children and young
people with epilepsy, screening for these mental disorders in CYP with epilepsy is not routinely
done in most health facilities in Malawi.
Objectives:
Broad objective
The broad objective of the study is to assess the barriers and facilitators for implementation of
routine and universal screening for anxiety and depression among children and young people
(CYP) attending Pediatric Epilepsy Clinic at Queen Elizabeth Central Hospital.
Specific objectives
The specific objectives of the study are:
1. To assess the acceptability of screening for depression and anxiety among CYP with epilepsy
and their guardians.
2. To explore the individual and institutional barriers and facilitators for screening for depression
and anxiety among CYP with epilepsy.
3. To explore the views of patients and their carers, and clinical staff (including doctors, nurses
and counsellors working in the epilepsy clinic) regarding the following commonly used and
free-of-cost screening instruments for anxiety and depression in CYP: Revised Child Anxiety
and Depression Scale (RCADS) (8-18 years), Short Mood and Feelings Questionnaire (SMFQ)
(8-18 years), Hospital Anxiety and Depression Scale (HADS) (from 12 years), Beck Depression
Inventory (from 14 year), Beck Anxiety Inventory (from 14 years), and Patient Health
Questionnaire (PHQ-9) (from 13 years). In addition, the Neurological Disorders Depression
Inventory for Epilepsy (NDDI-E) would be discussed with participants. Although the NDDI-E)
has only been validated in adults, we will consider its potential utility because it is specific for
patients with epilepsy, short, and free of charge.
Methodology: This study shall adopt qualitative research design involving Focus Group
Discussions as well as In-depth Interviews with key stakeholders including CYP with epilepsy
and their guardians, epilepsy and psychiatric nurses, a pediatrician, a psychiatrist, a hospital
administrator, and staff of the Ministry of Health (director of non-communicable diseases (NCD)
or his/her representativeā).
Expected Findings: Based on previous studies of barriers and facilitators of screening for
mental health conditions in other Low and Middle Income Countries (LMICs), we hypothesize
that the barriers may include mental health stigma, lack of appropriate culturally adapted
screening instruments, limited training for clinicians about screening, limited time available for
clinicians to conduct the screening in addition to their existing workload, and limited opportunity
for subsequent mental health assessment and treatment for the CYP identified from the screening
12-May-2022
19 | P a g e
Makiyi, Ani, Udedi, and Matanje; Barriers and Facilitators for depression screening among CYP with
epilepsy. Protocol version 3- May, 2022
as requiring further support. We hypothesize that facilitators may include strong institutional
support for screening.
Dissemination of results plan: The findings will be shared with the COMREC, SHARP Program
Coordinator, QECH, Ministry of Health, all participants, presented as relevant academic
conferences, and published in peer reviewed journals.