Improving mental health outcomes for bipolar disorder in Ethiopia

Mekdes Demissie is an AMARI Fellow based at Addis Ababa University in Ethiopia. The African Mental Health Research Initiative (AMARI) research program is supported by the Developing Excellence, Leadership and Training in Science in Africa (DELTAS Africa), a programme of the African Academy of Sciences. AMARI is one of the 11 programmes funded through the African Academy of Sciences’ Developing Excellence, Leadership and Training in Science in Africa (DELTAS Africa) programme. DELTAS Africa funds collaborative networks/consortia led by Africa-based scientists to amplify Africa-led development of world-class research and scientific leaders on the continent, while strengthening African institutions. DELTAS Africa is implemented through AESA (The Alliance for Accelerating Excellence in Science in Africa), a funding and agenda setting platform created by the AAS in partnership with the African Union Development Agency (AUDA-NEPAD) and with the support of Wellcome and the UK’s Department for International Development (DFID).

Background

Mental disorders are a neglected health concern in Africa. Bipolar disorder affects about 45 million people worldwide, according to the World Health Organization (WHO). It typically consists of both manic and depressive episodes separated by periods of normal mood. Manic episodes involve elevated or irritable mood, over-activity, rapid speech, inflated self-esteem and a decreased need for sleep. People who have manic attacks but do not experience depressive episodes are also classified as having bipolar disorder.

There is a huge treatment gap in bipolar disorder partly because of the stigmatization of mental health in Africa but also because there is limited data reflecting the burden of mental health diseases in low-and middle-income countries (LMICs). In Ethiopia, it is estimated that 15% of people are affected by major mental illness or substance abuse disorders.

Description of study

Dr Mekdes Demissie an AMARI fellow and mental health professional focused her doctoral study on developing and piloting adjunctive psychosocial interventions such as psychoeducation and stigma reduction strategies for bipolar disorder that can be delivered by non-specialist health care workers in primary health care settings in Ethiopia.

She was motivated to carry out this study because studies conducted in other LMICs and in Ethiopia showed that the disorder is linked to health, social, economic and functional problems. In addition, her clinical experience in working with people with severe mental illness revealed that patients would often relapse. 

Social and psychological intervention such as psychoeducation, cognitive and behavioral therapy have proved to be effective in preventing relapse and improving outcomes compared to when pharmacotherapy treatments are used alone.   However, in LMICs, evidence about adaptation, effectiveness, and implementation of contextually appropriate psychosocial intervention is rare. Dr Mekdes study aims to adapt a feasible and acceptable psychosocial intervention for people with bipolar disorder in Ethiopia. 

Results so far

1. A systematic review on psychosocial interventions for bipolar disorder (BD) in LMICs, showed that psychological interventions can be successful in low resource settings: improving emotional control and social support, and reducing relapse rates, symptom severity and hospital admission (Demissie et al., 2018). 
2. A qualitative study conducted to explore the experience of people living with bipolar disorder in Ethiopia, showed that BD is located in a constellation of life problems, primarily rooted in the social, affecting the whole family- as both a cause of the first illness period of BD, a direct/indirect stimulus of a person moving from being well to unwell and as a consequence of illness. In addition, social support, treatment adherence, illness perceptions, and substance use were emphasized as important drivers of the illness experience
3. Psychological intervention for bipolar disorder developed based on the findings of a systematic review, qualitative study and different workshops conducted with different stakeholders like people with BD, caregivers, community leaders, primary health care workers, and mental health professionals. 

Anticipated Impact

1. The study recommends conducting mental health education for people with bipolar disorder, caregivers and the community, which will minimize stigmatization.
2. Results of the study are likely to contribute to the implementation of socio-culturally appropriate and feasible psychosocial intervention for people with bipolar disorder in Ethiopia.
3. Patients with the disorder will receive holistic treatment that include medication, and social and psychological intervention like awareness creation, problem solving and behavioral intervention, which will improve their treatment outcomes, and will decrease the burden among caregivers and communities.