Barriers and facilitators to the integration of services for depression in primary care in Vietnam: the perspective of primary care providers

Although evidence suggests that depression is one of the leading causes of morbidity and disability in the world, treatment for depression is often unavailable, especially in low and middle-income countries. This gap in treatment has led to momentum to improve and scale-up services through approaches such as task-shifting. These steps, however, must be carefully considered to ensure that such efforts are appropriate, effective and acceptable for populations being served. This dissertation assesses barriers and facilitators to the integration of services for depression in primary care in Vietnam from the perspective of primary care providers (PHPs) by examining sociocultural considerations and individual, organizational and structural factors that might influence the process of service integration. The study has three components. The first, a narrative review, explores considerations for studying depression cross-culturally and the implications for global depression research. The results suggest that although depression is universally experienced, it varies by cultural context, and improved epidemiological methods that account for these cross-cultural variations are needed. The relationship of social determinants of health to depression must also be further explored. The second component, a qualitative study, examined how depression is conceptualized in Vietnam from the perspective of PHPs. Findings indicate that although depression is not widely recognized or seen in primary care, depression in Vietnam is largely understood in psychosocial terms. Along with efforts to improve screening and help-seeking, the introduction of psychosocial depression interventions in primary care is both appropriate and important. The third component used mixed methods to assess barriers and facilitators to the integration of services for depression in primary care. The findings suggest that although PHPs are motivated to build capacity and deliver services for depression for their patients, systemic factors must be addressed to ensure that PHPs are adequately trained and supported to deliver psychosocial interventions. By integrating an approach that examines sociocultural considerations of depression with individual, organizational and structural factors influencing service integration, this study suggests that a balance is both necessary and possible between approaches prioritizing efficient treatment delivery and those emphasizing the need for contextualization and careful sociocultural consideration. A balance of these approaches should be applied when introducing enhanced depression services cross-culturally.