Perceived burden of care and reported coping strategies and needs for family caregivers of people with mental disorders in Zimbabwe.

BACKGROUND: Mental health service resources are inadequate in low-income countries, and families are frequently expected to provide care for their relative with a mental disorder. However, research on the consequences of caregiving has been limited in low-income countries, including Zimbabwe. OBJECTIVE: The study explored the perceived impact of mental illness, reported coping strategies and reported needs of the family members of persons diagnosed with bipolar affective disorder or schizophrenia attending a psychiatric hospital in Harare, Zimbabwe. METHODS: A purposive sample of 31 family members participated in in-depth interviews and focus group discussions using standardised study guides. Participants were also screened for common mental disorders (CMDs) using the 14-item Shona Symptom Questionnaire. Qualitative data were analysed thematically using NVivo 8 qualitative data analysis software. Statistical Package for Social Sciences (SPSS version 16) was used for descriptive quantitative data analysis. RESULTS: Caregivers experienced physical, psychological, emotional, social and financial burdens associated with caregiving. They used both emotion-focused and problem-focused coping strategies, depending on the ill family members' behaviours. Seeking spiritual assistance emerged as their most common way of coping. Twenty-one (68%) of the caregivers were at risk of CMDs (including three participants who were suicidal) and were referred to a psychiatrist for further management. Caregivers required support from healthcare professionals to help them cope better. CONCLUSION: Caregivers of patients attending psychiatry hospitals in Zimbabwe carry a substantial and frequently unrecognised burden of caring for a family member with a mental disorder. Better support is needed from health professionals and social services to help them cope better. Further research is required to quantitatively measure caregiver burden and evaluate potential interventions in Zimbabwe.

'Simulation-based learning in psychiatry for undergraduates at the University of Zimbabwe medical school'.

BACKGROUND: The use of simulated patients to teach in psychiatry has not been reported from low-income countries. This is the first study using simulation teaching in psychiatry in Africa. The aim of this study was to introduce a novel method of psychiatric teaching to medical students at the University of Zimbabwe and assess its feasibility and preliminary effectiveness. We selected depression to simulate because students in Zimbabwe are most likely to see cases of psychoses during their ward-based clinical exposure. METHODS: Zimbabwean psychiatrists adapted scenarios on depression and suicide based on ones used in London. Zimbabwean post-graduate trainee psychiatrists were invited to carry out the teaching and psychiatric nursing staff were recruited and trained in one hour to play the simulated patients (SPs). All students undertaking their psychiatry placement (n = 30) were allocated into groups for a short didactic lecture on assessing for clinical depression and then rotated around 3 scenarios in groups of 4-5 and asked to interview a simulated patient with signs of depression. Students received feedback from peers, SPs and facilitators. Students completed the Confidence in Assessing and Managing Depression (CAM-D) questionnaire before and after the simulation session and provided written free-text feedback. RESULTS: Post-graduate trainers, together with one consultant, facilitated the simulated teaching after three hours training. Student confidence scores increased from mean 15.90 to 20.05 (95% CI = 2.58- 5.71) t (20) = 5.52, (p > 0.0001) following the simulation teaching session. Free-text feedback was positive overall with students commenting that it was "helpful", "enjoyable" and "boosted confidence". CONCLUSIONS: In Zimbabwe, simulation teaching was acceptable and could be adapted with minimal effort by local psychiatrists and implemented by post-graduate trainees and one consultant, Students found it helpful and enjoyable and their confidence increased after the teaching. It offers students a broader exposure to psychiatric conditions than they receive during clinical attachment to the inpatient wards. Involving psychiatry trainees and nursing staff may be a sustainable approach in a setting with small number of consultants and limited funds to pay for professional actors.