Evaluation of public knowledge and clinical management of depression in the state of Penang, Malaysia
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Date
2009
Authors
Khan, Tahir Mehmood
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Abstract
Depression is one of the most important public health issues in Malaysian and global
context. World Health Organisation declared depression as the leading cause of disability
because of its physical, psychological and social affects. These affects can be reduced by
evaluating the management of depression and through public knowledge, attitude and perception
towards the symptoms, causes, treatment, and help seeking behaviour. According to Ministry of
Health Malaysia (MOH), no current data is available that evaluate these issues. Based on this
need to evaluate the pharmacotherapy and social aspects of depression a cross sectional,
retrospective and prospective study was conducted in Penang from Jun 2007 until Feb 2008.
This study has three main objectives, firstly to explore the public knowledge, attitudes
and perceptions about symptoms, causes and help seeking behaviours toward depression,
secondly to document the modality used for depression treatment at the outpatient psychiatry unit
of Penang general hospital and thirdly to evaluate the cost spent for purchasing antidepressants
agents in Penang general hospital. A total of N(1149) respondents participated in the survey from
two main groups’ i.e general public (n=1037), and patients visiting psychiatry out patient
department Penang general hospital (n=112). The overall average knowledge level was observed
among the general public regarding the recognition of depression; however an excellent
knowledge was observed among those with personal experiences. Majority has recognised not
more than three symptoms of depression. Concepts about the professional help seeking were
clear among all groups but the knowledge about medication was poor. Whilst exploring the
public beliefs about the aetiology of depression, it was revealed that majority had highlighted
social factors like martial and relationship problems followed by educational issues. In terms of
gender female were found to have a better knowledge and ethnically Malay were on the top.
Retrospective and prospective record has demonstrated a prevalence of depression is high among
young Chinese women (age < 50 years). Most frequently reported symptoms by patients were
depressed mood followed by disturbed sleep, loss of interest in enjoyment, diminished appetite,
reduced energy /fatigue and suicidal/suicidal thoughts. Suicide rate was highest among Chinese
female especially the age group 18-30 years. The social issues like marital and relationship
problems were the main etiological factors reported in retrospective and prospective medical
records. For diagnosis the use of Beck depression inventory was found frequent instead of;
Diagnostic statistical manual IV (DSM IV) and International Classification of Disease (ICD-10),
which are recommended by the Malaysians guideline for the management of depression. In
addition to this the diagnosis was not supported by any laboratory test. This negligence not only
hinders the accuracy of diagnosis but also shows non-compliance with Malaysian guideline for
management which emphasise on the laboratory test especially among those with comorbidities
like; Diabetes mellitus, renal and cardiovascular disorders.
Prescription trend from the prospective cases has demonstrated the frequent use of
selective serotonin reuptake inhibitors but the use of tri-cyclic antidepressants, mono amine
oxidase inhibitors and serotonin and norepinephrine inhibitors were negligible. Evaluation of cost
of antidepressant revealed Penang GH has spent RM 1,070,000 for the purchase of
antidepressants in 2006 and this amount has increased up to RM 1,310,000 in 2007. Overall an
increase of 22.4% was observed in year 2007 in comparison to year 2006. Main burden was due
to the purchase of selective serotonin reuptake inhibitors i.e the cost of fluoxetine RM 80
thousand 2006 increased to RM 140 thousand in 2007 and sertraline RM 79 thousand 2006
increased to RM113 thousand in 2007. These findings recommend an immediate need of a
mental health literacy program to modify the public knowledge and beliefs about depression and
its treatment. In terms of management of depression at Penang general hospital an improved and
strictly monitor management policy can enhance the outcome of treatment and compliance to
Ministry of Health guideline as well.
Description
Master
Keywords
Pharmaceutical science , Clinical management , Depression