Managing depression in primary health care centers: The highlights of the program and further improvements

Herlina Siwi Widiana, Lenore Manderson, Katrina Simpson


Many people with probable depression present at primary health care centers (PHC) with physical complaints. Clinical psychologists (CPs) in Sleman district and Yogyakarta city, Special Province of Yogyakarta, Indonesia, have been integrated into PHC to provide psychological services. The study on which we draw aimed to explore how depression is managed in PHC. Thirty four CPs and twenty people diagnosed with mild to moderate depression participated in semi-structured interviews. Based on the thematic analysis of their transcribed interviews, seven themes emerged: community education and support, referral pathways, assessing depression, diagnosis, communicating a diagnosis, accepting diagnosis, and treatment of depression. The co-location of CPs with other medical services at the PHC level supports community understandings of mental health problems. It also encourages community members to use PHC services and to have access to various behavioral interventions for people with depression. Recommendations and directions for further research are discussed.


clinical psychologist; depression; management; primary health care

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AbdAleati, N. S., Zaharim, N. M., & Mydin, Y. O. (2016). Religiousness and mental health: Systematic review study. Journal of Religion & Health, 55(6), 1929-1937.

Aggarwal, N. K. (2013). Cultural psychiatry, medical anthropology and the DSM-5 field trials. Medical Anthropology, 32, 393-398.

Alang, S. M. (2016). "Black folk don't get no severe depression": Meanings and expressions of depression in a predominantly black urban neighborhood in Midwestern United States. Social Science & Medicine, 157, 1-8.

Ananta, A., Arifin, E. N., Hasbullah, M. S., Handayani, N. B., & Pramono, A. (2015). Demography of Indonesia's ethnicity. Singapore: Institute of Southeast Asian Studies.

APA. (2013). American Psychiatric Association: Diagnostic and Statistical Manual on Mental Disorder (5th ed.). Arlington, VA: American Psychiatric Association.

Azhar, M. Z., & Varma, S. L. (1995). Religious psychotherapy in depressive patients. Psychotherapy and Psychosomatics, 63(3-4), 165-168.

Bajaj, P., Borreani, E., Ghosh, P., Methuen, C., Patel, M., & Crawford, M. J. (2008). Screening for suicidal thoughts in primary care: The views of the patients and the general practitioners. Mental Health in Family Medicine, 5, 229-235.

Boothby, N., Veatch, M., & Pentes, M. (2011). Evaluating of treatment of Axis I mental health disorders in Aceh, Indonesia. The Psychiatric Online, 35, 248-255.

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101.

Brintnell, E. S., Sommer, R. W., Kuncoro, B., Setiawan, G. P., & Bailey, P. (2013). The expression of depression among Javanese patients with major depressive disorder: A concept mapping study. Transcultural Psychiatry, 50(4), 579-598.

Bryman, A. (2004). Social research methods (2nd ed.). New York: Oxford University Press.

Dazzi, T., Gribble, R., Wessely, S., & Fear, N. T. (2014). Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychological Medicine, 44(16), 331-336.

Departemen Kesehatan. (1993). Pedoman Penggolongan dan Diagnosis Gangguan Jiwa di Indonesia III (Manual for the Classification and Diagnosis of Mental Disorders in Indonesia III). Jakarta: Direktorat Jenderal Pelayanan Medik Departemen Kesehatan Republik Indonesia.

Dos Santos, E. R., Huang, H., Menezes, P. R., & Scazufca, M. (2016). Prevalence of depression and depression care for populations registered in primary care in two remote cities in the Brazilian Amazon. Plos One, 11(3), 1-13.

Ferrari, A. J., Charlson, F. J., Norman, R. E., Patten, S. B., Freedman, G., Murray, C. J. L., & Whiteford, H. A. (2013). Burden of Depressive Disorders by Country, Sex, Age, and Year: Findings from the Global Burden of Disease Study 2010. Plos Medicine, 10(11).

Gilbody, S., Bower, P., Fletcher, J., Richards, D., & Sutton, A. J. (2006). Collaborative care for depression - A cumulative meta-analysis and review of longer-term outcomes. Archives of Internal Medicine, 166(21), 2314-2321.

Henderson, C., Noblett, J., Parke, H., Clement, S., Caffrey, A., Gale-Grant, O., . . ., & Thornicroft, G. (2014). Mental health-related stigma in health care and mental health-care settings. Lancet Psychiatry, 1(6), 467-482.

Hepworth, J., Askew, D., Foley, W., Duthie, D., Shuter, P., Combo, M., & Clements, L. A. (2015). How an urban Aboriginal and Torres Strait Islander primary health care service improved access to mental health care. International Journal for Equity in Health, 14, 51-58.

Hitchcock, C., Mueller, V., Hammond, E., Rees, C., Werner-Seidler, A., & Dalgleish, T. (2016). The effects of autobiographical memory flexibility (memflex) training: An uncontrolled trial in individuals in remission from depression. Journal of Behavior Therapy and Experimental Psychiatry, 52, 92-98.

Illes, R. A. C., Grace, A. J., Nino, J. R., & Ring, J. M. (2015). Culturally responsive integrated health care: Key issues for medical education. International Journal of Psychiatry in Medicine, 50(1), 92-103.

Isfandari, S., Rahmawati, T., Siahaan, S., Roosihermiatie, B., Abbas, I., Afiatin, T., & Maslim, R. (2012). Evaluasi penempatan psikolog dalam pelayanan kesehatan jiwa di Puskesmas Kabupaten Sleman, Yogyakarta, Indonesia, 2011 (Evaluation of the presence of psychologist for mental health service at Primary Health Cares in Sleman District, Yogyakarta, Indonesia,. Buletin Penelitian Sistem Kesehatan, 15(4), 354-359.

Johnson, L. R., Chin, E. G., Kajumba, M., Kizito, S., & Bangirana, P. (2017). Views on depression from traditional healing and psychiatry clinics in Uganda: Perspectives from patients and their providers. Journal of Cross-Cultural Psychology, 48(2), 243-261.

Katon, W., & Unutzer, J. (2006). Collaborative care models for depression - Time to move from evidence to practice. Archives of Internal Medicine, 166(21), 2304-2306.

Kementerian Kesehatan. (2013). Riset Dasar Kesehatan 2013 (Basic Health Research 2013). Jakarta: Badan Penelitian dan Pengembangan Kementerian Kesehatan Republik Indonesia.

Kleinman, A. (1980). Patients and healers in the context of culture: An exploration on the borderland between Anthropology, Medicine and Psychiatry. Berkeley: University of California Press.

Kleinman, A. (2004). Culture and depression. The New England Journal of Medicine, 351(10), 951-952.

Knowles, S. E., Chew-Graham, C., Adeyemi, I., Coupe, N., & Coventry, P. A. (2015). Managing depression in people with multimorbidity: a qualitative evaluation of an integrated collaborative care model. BMC Family Practice, 16, 32-41.

Lopez, A. D., & Mathers, C. D. (2006). Measuring the global burden of disease and epidemiological transitions: 2002-2030. Annals of Tropical Medicine and Parasitology, 100(5-6), 481-499.

Marchira, C. R. (2011). Integrasi kesehatan jiwa pada pelayanan primer di Indonesia: Sebuah tantangan masa sekarang. (Integration mental health into community health care in Indonesia: A review of current challenges). Manajemen Pelayanan Kesehatan, 14(3), 120-126.

Meer, S., & Mir, G. (2014). Muslim and depression: The role of religious belief in therapy. Journal of Integrative Psychology and Therapeutics, 2(2), 1-8.

Mehta, N., Clement, S., Marcus, E., Stona, A. C., Bezborodovs, N., Evans-Lacko, S., & Thornicroft, G. (2015). Evidence for effective interventions to reduce mental health-related stigma and discrimination in the medium and long term: systematic review. British Journal of Psychiatry, 207(5), 377-384.

Milanovic, S. M., Erjavec, K., Poljicanin, T., Vrabec, B., & Brecic, P. (2015). Prevalence of depression symptoms and associated socio-demographic factors in primary health care patients. Psychiatria Danubina, 27(1), 31-37.

Molina, M. A. L., Jansen, K., Drews, C., Pinheiro, R., Silva, R., & Souza, L. (2014). Major depressive disorder symptoms in male and female young adults. Psychology Health & Medicine, 19(2), 136-145.

Mutiso, V. N., Musyimi, C. W., Nayak, S. S., Musau, A. M., Rebello, T., Nandoya, E., & Ndetei, D. M. (2017). Stigma-related mental health knowledge and attitudes among primary health workers and community health volunteers in rural Kenya. Journal of Social Psychiatry, 63(6), 508-517.

Pargament, K. I., Tarakeshwar, N., Ellison, C. G., & Wulff, K. M. (2001). Religious coping among the religious: The relationships between religious coping and well-being in a national sample of Presbyterian clergy, elders, and members. Journal for the Scientific Study of Religion, 40(3), 497-513.

Sadock, E., Auerbach, S. M., Rybarczyk, B., & Aggarwal, A. (2014). Evaluation of integrated psychological services in a university-based primary care clinic. Journal of Clinical Psychology in Medical Settings, 21(1), 19-32.

Sari, E. P. (2016). Upaya pemberdayaan komunitas melalui sinergi kader posyandu dan psikolog puskesmas (Community empowerment through synergy between posyandu cadres and psychologists in the PHC). Jurnal Ilmiah Psikologi Terapan, 4(1), 53-61.

Sarwono, S. (1996). Personalistic belief in health: A case in West Java. In P. Boomgaard, R. Sciortino, & I. Smith (Eds.), Health care in Java: Past and Present (pp. 81-91). Leiden: KITLV Press.

Seifsafari, S., Firoozabadi, A., Ghanizadeh, A., & Salehi, A. (2013). A symptom profile analysis of depression in a sample of Iranian patients. Iranian Journal of Medical Sciences, 38(1), 22-29.

Selim, N. (2010). Cultural dimensions of depression in Bangladesh: A qualitative study in two villages of Matlab. Journal of Health Population and Nutrition, 28(1), 95-106.

Setiyawati, D., Blashki, G., Wraith, R., Colucci, E., & Minas, H. (2014). Indonesian experts' perspectives on a curriculum for psychologists working in primary health care in Indonesia. Health Psychology & Behavioural Medicine, 2(1), 623-639.

Thornicroft, G., Mehta, N., Clement, S., Evans-Lacko, S., Doherty, M., Rose, D., & Henderson, C. (2016). Evidence for effective interventions to reduce mental-health-related stigma and discrimination. Lancet, 387(10023), 1123-1132.

Townsend, M., Kladder, V., Ayele, H., & Mulligan, T. (2002). Systematic review of clinical trials examining the effects of religion on health. Southern Medical Journal, 95(12), 1429-1434.

Udedi, M. (2014). The prevalence of depression among patients and its detection by primary health care workers at Matawale Health Centre (Zomba). Malawi Medical Journal, 26(2), 34-37.

WHO. (2011). Mental Health ATLAS (Indonesia). Geneva: WHO.

Widiana, H. S., Manderson, L., & Simpson, K. (2018). Experiences of depression in Yogyakarta, Indonesia. Mental Health, Religion & Culture, 21(5), 470-483.

Widiana, H. S., Simpson, K., & Manderson, L. (2018). Cultural expression of depression and the development of the Indonesian Depression Checklist. Transcultural Psychiatry, 55(3), 339-360.

Woodward, M. R. (1985). Healing and morality: A Javanese example. Social Science & Medicine, 21(9), 1007-1021.

Worcester, S. (2013). New interview enhances DSM-5 cultural formulation. Family Practice News, 43(9), 16.



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