Common mental disorders among patients attending monk healers and primary health care centres in Thailand: a cross-sectional study

(2020) 14:78 Pengpid and Peltzer Int J Ment Health Syst https://doi.org/10.1186/s13033-020-00414-2 International Journal of Mental Health Systems Open Access RESEARCH Common mental disorders among patients attending monk healers and primary health care centres in Thailand: a cross‑sectional study Supa Pengpid1,2 and Karl Peltzer3* Abstract Background: This study aimed to assess the rate of common mental disorders in patients consulting monk healers or health centres in Thailand. Methods: Patients consecutively consulting monk healers or health centres were assessed with screening measures of three common mental disorders (major depressive, general anxiety and somatization disorder). Results: The prevalence of any common mental disorder was significantly higher in patients attending monk healers (31.1%) than those attending primary care health centres (22.3%) (P < 0.001). Likewise, the prevalence of each common mental disorder was significantly higher in clients attending monk healers (major depressive disorder 21.0%, generalized anxiety disorder 8.1%, and somatization disorder 19.0%) than in patients attending health centres (major depressive disorder 15.8%, generalized anxiety disorder 3.5%, and somatization disorder 12.5%). In adjusted logistic regression analysis among patients of monk healers, female sex, being single, divorced, separated or widowed, and low social support were associated with any common mental disorder. Among patients of a health centre, lower education, not employed, high debt status and low social support were associated with any common mental disorder. Conclusion: The study found a higher prevalence of common mental disorders in patients consulting monk healers than primary care centre attendees, calling for integrated management of common mental disorders. Keywords: Common mental disorders, Monk healer, Primary care, Thailand Background Traditional and faith healers have been identified as a workforce contributing to mental health care worldwide [1]. In a systematic review, traditional healers have shown to be beneficial in psychosocial interventions by reducing psychological distress and mild symptoms in common mental disorders (= CMD) [1]. Among non-communicable disease and mental disorder patients in Thailand, 26.3% had been utilizing traditional and/or faith healing practitioners in the past 12 months [2]. Traditional health *Correspondence: 3 Department of Psychology, University of the Free State, Bloemfontein, South Africa Full list of author information is available at the end of the article practitioners that may include spiritual, monk, and herbal healers, are located in all different parts of Thailand [3]. Monk healers (maw pra) that reside at Buddhist temples provide various types of treatments to patients, including prayers and Thai traditional medicine [4, 5]. Several studies [6, 7] have described the management of CMD by monk healers in Thailand [6, 7]. Studies investigating the prevalence of CMD in the traditional health practitioner setting and comparative studies in the primary health care system are scarce, in particular in Southeast Asia. Several studies on the prevalence of CMD in the traditional health practitioner setting have been conducted in Africa, e.g. in Kenya the prevalence of depression was 22.9% [8], in Tanzania, the prevalence of CMD was 48% (double that of primary © The Author(s) 2020. 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The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/ zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Pengpid and Peltzer Int J Ment Health Syst (2020) 14:78 care patients 24%) [9], and in Uganda the prevalence of psychological distress was 65.1% [10]. A number of studies investigated the prevalence of CMD in a primary care setting in Asia, e.g., in Thailand, the prevalence of depression (mild to severe) was 11.5% [11], in Nepal, the prevalence of depression was 16.8% [12], in Kuwait the prevalence of CMD was 42.7% [13], in Singapore, the prevalence of major/minor depressive disorders was 9% [14], and in China, the prevalence of moderate or high somatic symptoms (PHQ-15: scores ≥ 10) was 19.0%, depression 15.2%, anxiety 6.9%, both depression and anxiety 5.2% [13]. Determinants of CMD of persons attending traditional health practitioners, include being older [8, 9], being female [8], single, divorced or separated [8, 9], Christian [9], lack of education [8], better educated [9], unemployed [8], lack of food and being in debt [10]. Determinants of CMD of persons attending primary health facilities include lack of social support and life stress [11]. This study aimed to assess the rate of CMD in patients presenting to monk healers or primary care health facilities in Thailand. Methods Participants and procedures In a cross-sectional study design, adult patients attending primary care health centres or monk healers were systematically recruited (consecutive sampling) after written informed consent was obtained. Purposeful sampling was used to select three monk healers or temples and three primary health care centres located in four districts of the eastern and central region of Thailand. Inclusion criteria for the selection of the study sites were to have at least five patients a day, and the inclusion criteria for the selection of clients or patients was aged 18 years and above. The study was conducted from November 2018 to February 2019. A professional nurse conducted face-to-face interviews in Thai language with patients on background data and CMD. Questionnaires were pretested for validity on a sample of 30 patients, not included in the final sample. Research nurses were systematically trained in the administration of the questionnaires. Moreover, the assessment procedures and implementation were routinely monitored by senior research staff. Study approval was obtained from each of the study sites, and the study protocol was approved by the “Office of The Committee for Research Ethics (Social Sciences), Mahidol University (No.: 2017/055.1403).” Measures Sociodemographic data included (...truncated)