Prevalence and Correlates of Posttraumatic Stress Disorder and Common Mental Disorders in Lay Health Workers Working on the Friendship Bench Program in Zimbabwe

Background: Task-shifting using lay health workers (LHWs) to reduce the treatment gap for mental, neurological and substance use disorders is a common feature in health care systems in low and middle-income countries where medical professionals are scarce. The Friendship Bench is a collaborative stepped care intervention for common mental disorders delivered by LHWs in over 70 primary health care facilities in Zimbabwe. In recent years there has been concern about the mental health of over 300 LHWs delivering the intervention due to the stressful nature of the work on the FB and their exposure to vicarious trauma. This study aimed to establish the prevalence and factors associated with common mental disorders such as depression and anxiety (CMD) and post-traumatic stress disorder (PTSD) among the LHWs. Methods: A random sample of LHWs (n=182) working for the FB for more than 2 years had the previously validated Posttraumatic Stress Disorder Checklist (PCL-5) and the Shona Symptom Questionnaire (SSQ-14) administered to them by independent and trained research assistants. Outcomes: 11 LHWs presented with low probable PTSD (6%), CMD was found in 17 cases (11%). Interpretation: The prevalence of PTSD and CMD of LHWs is significantly lower than their clients' despite the stressful nature of their work and the burden of being exposed to the same risk factors. There is need for further studies to understand the protective mechanisms that may be associated with this work. Funding Statement: This study was funded by Grand Challenges Canada, award number 0087-04, awarded to Prof Dr Dixon Chibanda. Declaration of Interests: The authors declare that they have no conflict of interest except for DC who is supported through the DELTAS Africa Initiative [DEL-15-01]. The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)’s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa’s Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust [DEL-15-01] and the UK government. The views expressed in this publication are those of the author(s) and not necessarily those 63 of AAS, NEPAD Agency, Wellcome Trust or the UK government. Ethical Approval Statement: The study was approved by the Medical Research Council of Zimbabwe and by the Health Research Ethics Committee at Stellenbosch University in line with the ethical principles stated by the Helsinki Declaration. Informed consent was obtained from all individual participants included in the study.