Knowledge of and attitudes toward mental illness among primary care providers in Saint Vincent and the Grenadines.

Saint Vincent and the Grenadines (SVG) is an Eastern Caribbean country with limited inpatient and outpatient resources to meet the country's mental health needs. In preparation for integrating mental health care into the primary care setting, we assessed knowledge of and attitudes toward mental illness among primary care providers in SVG. From October 24-November 11, 2011, we visited a convenience sample of District Health Centers in SVG. We gave a multiple-choice-answer, self-administered questionnaire to primary care providers and then administered a structured interview. Survey responses were analyzed for frequencies and interview transcripts qualitatively analyzed for major themes. We completed 53 surveys and interviews representing all nine SVG Health Districts. Results demonstrated a provider population with basic, but inadequate, knowledge of mental illness diagnosis and treatment. Results also revealed a curious and interested group of providers who felt mental illness should be a health priority and were willing and eager to receive further mental health training. Providers suggested strengthening resources in existing district clinics, providing additional staff training sessions, establishing positions with a dual health and mental health role, instituting annual mental health screening examinations, and creating weekly mental health clinics. Integrating mental health care into primary care necessitates involvement of primary care staff during the planning stages, and this study initiates an intensive effort to do so in SVG. Results have led to the development of a "mental health check-up" tool, which we hope will improve access to mental health care in this community.

Using a brief 10-item generic measure of quality of life in English and Spanish speaking diabetic patients.

OBJECTIVES: Validation of the Multicultural Quality of Life Index (MQLI), a 10-item self-rated generic multilingual quality of life (QOL) measure in ethnically-diverse diabetic patients. METHODS: Diabetic adult patients (n = 180) in New York City completed the MQLI, English or Spanish version. Its internal consistency, factorial structure, and construct validity were analyzed. Depression screening (PHQ-9) scores were used to divide subjects into two sub-samples with presumed different QOL levels. RESULTS: A Cronbach's alpha of 0.92 demonstrated its internal consistency (English-version = 0.90, Spanish-version = 0.94). A one-single factor structure was documented (all items loadings > or = 0.64), accounting for 59% of the items variance in the total sample; similar results were found for each language version. Correlation of the MQLI and PHQ-9 scores yielded an r = -0.58. Mild negative correlations with self-disclosed diagnosis of depression or other mental disorders, diabetes duration, and abnormal sensation on foot exam were found, but were non-significant with other diabetes aspects (e.g., HbA1c, retinopathy). A significant difference (p < 0.001) between the scores of two subsamples with presumed different levels of QOL (means = 8.02 vs. 5.84) was found. CONCLUSIONS: The MQLI demonstrated coherence around the QOL concept. It correlated significantly with mental health (particularly depression), duration of diabetes, and possible neuropathy, but not with some diabetes-related factors. Its use in diabetic care settings is recommended, possibly supplemented by QOL diabetic-specific instruments.