In sub-Saharan Africa the treatment gap for mental disorders is high. In 2009, 98.0% of people with mental illness in Sierra Leone were not receiving treatment, partly due to the absence of public psychiatric facilities outside the capital. In response, the Ministry of Health and Sanitation rolled out nurse-led mental health units (MHU) to every district. This study aims to retrospectively evaluate the uptake of these services by examining the pathways to care, diagnosis, management, and treatment gap, to provide insight into the functioning of these units and the potential burden of mental health disorders in Sierra Leone. We evaluated the roll out of MHU using summary data from all units between 1 st January 2015 and 1 st January 2017, to establish the burden of diagnoses among service users, pathways to care, treatments provided, and treatment gaps. Negative binomial regressions examine bivariate relationships between diagnoses, treatments, and medication inaccessibility with demographics (age and sex), location (Freetown vs the rest and Ebola endemic regions vs the rest) and year. We collected data from 15 MHU covering 13 districts in 24 months. There were 2401 referrals. The largest age category was 25–34 (23.4%). The prominent diagnoses were epilepsy (43.5%, associated with children) and psychosis (17.5%, associated with males). Reported depression (8.6%) and suicide attempts (33 patients) were low. Ebola endemic regions reported higher rates of grief, trauma, and medically unexplained symptoms. In 24.7% of cases where medication was required, it was not accessible. Nurse-led MHU can have a modest effect on the treatment gap in resource constrained environments such as Sierra Leone, particularly in epilepsy and psychosis.

中文翻译：

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塞拉利昂精神障碍的负担：由分散领导的由护士领导的精神卫生部门推出的计划数据的回顾性观察评估

在撒哈拉以南非洲，精神障碍的治疗差距很大。2009年，塞拉利昂有98.0％的精神疾病患者未得到治疗，部分原因是首都以外没有公共精神病治疗设施。作为回应，卫生和卫生部在每个地区都推出了由护士领导的精神卫生部门。本研究旨在通过检查护理，诊断，管理和治疗差距的途径来回顾性评估这些服务的使用情况，以深入了解这些部门的功能以及塞拉利昂的精神健康障碍的潜在负担。我们使用2015年1月1日至2017年1月1日之间所有部门的汇总数据评估了MHU的推出，以确定服务使用者的诊断负担，护理途径，所提供的治疗，和治疗差距。负二项式回归检验了人口统计学特征（年龄和性别），地理位置（弗里敦与其余地区以及埃博拉流行地区与其余地区）和年份之间的诊断，治疗和无法获得药物之间的二元关系。我们在24个月内收集了来自13个地区的15个MHU的数据。有2401推荐人。最大年龄段是25-34岁（23.4％）。突出诊断为癫痫（43.5％，与儿童有关）和精神病（17.5％，与男性有关）。报告的抑郁症（8.6％）和自杀未遂（33例）的发生率很低。埃博拉流行地区报告有更高的悲伤，创伤和医学上无法解释的症状发生率。在需要药物治疗的病例中，有24.7％无法获得药物治疗。