title: Common mental disorder symptoms among patients with malaria attending primary care in Ethiopia: a cross-sectional survey.
abstract: BACKGROUND
  Common Mental Disorders (CMDs) are frequent among patients attending primary care. In Africa, CMDs are often misdiagnosed as physical illnesses because many of the patients complain of somatic symptoms of mental distress. We explored whether there was difference in the levels of CMD symptoms between patients with thick film confirmed and clinical cases of malaria with negative thick film in primary care.
  
  
  METHODS
  A cross-sectional comparative study was conducted on 300 adults with a clinical diagnosis of malaria in primary care centres in Jimma, Ethiopia. Patients were recruited consecutively until 100 cases of 'malaria' with a negative thick film and 200 cases of malaria with a positive thick film consented to participate. The 20-item Self-Reporting Questionnaire (SRQ-20) was used to measure CMD. The non-parametric Wilcoxon rank-sum test was used to explore the association between thick film result and CMD.
  
  
  RESULTS
  Participants had a mean age of 28.2 (S.D = 10.9) years and the majority (57.3%) were women. The prevalence of high CMD symptoms (six or more symptoms on the SRQ-20) was 24.5%. Suicidal ideation was reported by 13.8% of the participants. CMD symptoms were significantly higher in patients who had taken medication prior to visiting the primary care (p = 0.012) and in those whose symptoms had been present for seven days or more (p = 0.041). There was no statistically significant association between level of CMD symptoms and having a negative thick film result (OR 0.98; 95%CI 0.92, 1.04) or objective presence of fever (OR 1.04; 95%CI 0.93, 1.15).
  
  
  CONCLUSIONS
  CMD symptoms among cases of malaria did not appear to be associated with a negative thick film result. The high levels of CMD symptoms, including suicidal ideation, calls for further studies to investigate the persistence and progression of these symptoms following resolution of the acute malarial episode.
authors.affiliation: Department of Psychiatry, College of Public Health & Medical Sciences, Jimma University, Jimma, Ethiopia.
authors.forename: Markos
authors.initials: M
authors.lastname: Tesfaye
authors.affiliation: Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, King's College London, London, United Kingdom.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Hanlon
authors.affiliation: Department of Epidemiology and Biostatistics, College of Public Health & Medical Sciences, Jimma University, Jimma, Ethiopia.
authors.forename: Fasil
authors.initials: F
authors.lastname: Tessema
authors.affiliation: Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, King's College London, London, United Kingdom.
authors.forename: Martin
authors.initials: M
authors.lastname: Prince
authors.affiliation: Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Atalay
authors.initials: A
authors.lastname: Alem
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D006801:Humans; D008288:Malaria / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D008297:Male; D015995:Prevalence; D011320:Primary Health Care; D011618:Psychotic Disorders / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D059020:Suicidal Ideation; D011795:Surveys and Questionnaires