{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T17:10:03Z","timestamp":1756660203322,"version":"3.44.0"},"reference-count":44,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,3,13]],"date-time":"2025-03-13T00:00:00Z","timestamp":1741824000000},"content-version":"unspecified","delay-in-days":12,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["R01MH123682"],"award-info":[{"award-number":["R01MH123682"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2025,2,24]]},"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Mental, neurological and substance use (MNS) disorders are leading causes of disability worldwide. Nevertheless, limited research exists regarding MNS health system performance across the care cascade and associated patient characteristics in low-income and middle-income countries (LMICs) such as Mozambique.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We used baseline data from an ongoing randomised controlled trial, collected across 16 outpatient clinics on variables of sex, age, marital status, tuberculosis and HIV status, alcohol and drug use, suicidal ideation, pregnancy and MNS diagnosis. Mixed-effects multivariable regression was used to examine factors associated with patient functional improvement or low functional impairment measured by a standardised disability questionnaire.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>From February to September 2022, there were 4323 patient visits, of which 65.9% (n=2851) were attended on time (\u00b15\u2009days), 41.4% (n=1793) had medication adherence and 30.5% (n=1321) achieved a functional impairment score &lt;10\u2009or 50% improvement from baseline. Patients 15\u201318 years old had 60% lower odds of demonstrating functional improvement or low functional impairment during a follow-up visit compared with those 26\u201335 years old (95%\u2009CI: 0.19, 0.85). Compared with single persons, those in a domestic union had 3.3 times higher odds of demonstrating functional improvement or low functional impairment (95%\u2009CI: 1.8, 6.1). Individuals expressing suicidal ideation had 85% lower odds of demonstrating functional improvement than those without suicidal ideation (95%\u2009CI: 0.02, 0.91). For patients new to treatment, each additional visit was associated with a mean reduction in functional impairment of 0.62 points (95%\u2009CI: \u22120.76, \u20130.47).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This analysis revealed gaps in patients reaching functional improvement or low functional impairment in outpatient MNS care in Mozambique. Gaps were more pronounced for patients who are \u226418 years of age, single or expressing suicidal ideation. Implementation strategies to optimise patient outcomes are needed as nascent mental health systems are scaled-up in Mozambique and other similar LMICs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration number<\/jats:title>\n                  <jats:p>\n                     <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT05103033\">NCT05103033<\/jats:ext-link>.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjph-2024-001024","type":"journal-article","created":{"date-parts":[[2025,3,13]],"date-time":"2025-03-13T23:15:37Z","timestamp":1741907737000},"page":"e001024","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Mental health care cascade performance and associated factors: longitudinal analyses of routine Ministry of Health services in Mozambique"],"prefix":"10.1136","volume":"3","clinical-trial-number":[{"clinical-trial-number":"nct05103033","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-9776-8651","authenticated-orcid":false,"given":"Morgan","family":"Turner","sequence":"first","affiliation":[{"name":"Global Health, University of Washington, Seattle, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto","family":"Muanido","sequence":"additional","affiliation":[{"name":"Mozambique Health Committee, Beira, Mozambique"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vasco","family":"Cumbe","sequence":"additional","affiliation":[{"name":"Mental Health Department, Provincial Health Directorate, Ministry of Health, Beira, Mozambique"},{"name":"Centro de Forma\u00e7\u00e3o e Pesquisa em Sa\u00fade, Hospital Central da Beira, MISAU, Beira, Mozambique"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"Jr","given":"Jo\u00e3o Nhalimue","family":"Jala","sequence":"additional","affiliation":[{"name":"Mozambique Health Committee, Beira, Mozambique"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ernesto Eus\u00e9bio","family":"Armando","sequence":"additional","affiliation":[{"name":"Mozambique Health Committee, Chimoio, Mozambique"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"Jr","given":"Eduarte","family":"Mambuque","sequence":"additional","affiliation":[{"name":"Mozambique Health Committee, Chimoio, Mozambique"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fl\u00e1via","family":"Faduque","sequence":"additional","affiliation":[{"name":"Mental Health Department, Provincial Health Directorate, Ministry of Health, Chimoio, Mozambique"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ernesto Rodrigo","family":"Xerinda","sequence":"additional","affiliation":[{"name":"Mental Health Department, Provincial Health Directorate, Ministry of Health, Beira, Mozambique"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2963-0829","authenticated-orcid":false,"given":"Kenneth","family":"Sherr","sequence":"additional","affiliation":[{"name":"Global Health, University of Washington, Seattle, Washington, USA"},{"name":"Epidemiology, University of Washington, Seattle, Washington, USA"},{"name":"Industrial & Systems Engineering, University of Washington, Seattle, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bryan J","family":"Weiner","sequence":"additional","affiliation":[{"name":"Global Health, University of Washington, Seattle, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian P","family":"Flaherty","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of Washington, Seattle, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monisha","family":"Sharma","sequence":"additional","affiliation":[{"name":"Global Health, University of Washington, Seattle, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bradley H","family":"Wagenaar","sequence":"additional","affiliation":[{"name":"Global Health, University of Washington, Seattle, Washington, USA"},{"name":"Epidemiology, University of Washington, Seattle, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,3,13]]},"reference":[{"key":"2025083109325628000_3.1.e001024.1","doi-asserted-by":"crossref","DOI":"10.1016\/j.eclinm.2022.101675","article-title":"Quantifying the global burden of mental disorders and their economic value","volume":"54","author":"Arias","year":"2022","journal-title":"EClinicalMedicine"},{"key":"2025083109325628000_3.1.e001024.2","doi-asserted-by":"crossref","unstructured":"Patel V , Chisholm D , Dua T , et al . 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