Primary Care Physicians & the Mental Health Gap Action Programme (mhGAP)

Research Paper Title

Building capacity in mental health care in low- and middle-income countries by training primary care physicians using the mhGAP: a randomized controlled trial.


To address the rise in mental health conditions in Tunisia, a training based on the Mental Health Gap Action Programme (mhGAP) Intervention Guide (IG) was offered to primary care physicians (PCPs) working in the Greater Tunis area.

Non-specialists (such as PCPs)’ training is an internationally supported way to target untreated mental health symptoms.


The researchers aimed to evaluate the programme’s impact on PCPs’ mental health knowledge, attitudes, self-efficacy and self-reported practice, immediately following and 18 months after training.

They conducted an exploratory trial with a combination of designs: a pretest-posttest control group design and a one-group pretest-posttest design were used to assess the training’s short-term impact; and a repeated measures design was used to assess the training’s long-term impact.

The former relied on a delayed-intervention strategy: participants assigned to the control group (Group 2) received the training after the intervention group (Group 1).

The intervention consisted of a weekly mhGAP-based training session (totalling 6 weeks), comprising lectures, discussions, role plays and a support session offered by trainers.

Data were collected at baseline, following Group 1’s training, following Group 2’s training and 18 months after training. Descriptive, bivariate and ANOVA analyses were conducted.

Overall, 112 PCPs were randomised to either Group 1 (n = 52) or Group 2 (n = 60).


The training had a statistically significant short-term impact on mental health knowledge, attitudes and self-efficacy scores but not on self-reported practice.

When comparing pre-training results and results 18 months after training, these changes were maintained.

PCPs reported a decrease in referral rates to specialised services 18 months after training in comparison to pre-training.


The mhGAP-based training might be useful to increase mental health knowledge and self-efficacy, and decrease reported referral rates and negative mental health attitudes among PCPs in Tunisia and other low- and middle-income countries.

Future studies should examine relationships among these outcome variables.


Spagnolo, J., Champagne, F., Leduc, N., Rivard, M., Melki, W., Piat, M., Laporta, M., Guesmi, I., Bram, N. & Charfi, F. (2019) Building capacity in mental health care in low- and middle-income countries by training primary care physicians using the mhGAP: a randomized controlled trial. Health Policy and Planning. pii: czz138. doi: 10.1093/heapol/czz138. [Epub ahead of print].

Is There a Link between News Coverage & Trauma Symptoms?

When something terrible happens in the world, it’s not uncommon to scroll through social media or flip through television channels in search of news coverage. But such media exposure may fuel post-traumatic stress symptoms for years afterwards – and could also drive someone to consume further distressing media.

With high-consequence events where we do not know why they happened, there is a fundamental drive to want to consume information until you get your head around it. Research suggests it may be a function of threat avoidance or wanting to return to some kind of rational understanding of the world around us.

Roxane Silver at the University of California, Irvine, and her colleagues surveyed a representative sample of more than 4400 US residents in the days after the 2013 Boston Marathon bombing. Each person was also asked how many hours of related media coverage they consumed in three follow-up periods:

  • Six months after the bombing;
  • On its second anniversary; and
  • Five days after the 2016 mass shooting in the Pulse nightclub in Florida.

On average, the people surveyed consumed about 6 hours of media a day about the Boston bombing immediately after the event and a little more than 3 hours per day of media about the Pulse shooting.

Those who sought out more media about the bombing – whether or not they had a history of mental health conditions – were more likely to have trauma-related stress symptoms, such as upsetting thoughts, flashbacks and emotional distress, six months later (Thompson et al., 2019).

Two years after the bombing, such people were also more likely to worry about other events of mass violence occurring in the future, and consumed more coverage of the subsequent Pulse shooting.


Thompson, R.R., Jones, N.M., Holman, E.A. & Silver, R.C. (2019) Media Exposure to Mass Violence Events can Fuel a Cycle of Distress. Science Advances. 5(4), eaav3502. DOI: 10.1126/sciadv.aav3502.

Whyte, C. (2019) New Coverage Link to Trauma Symptoms. New Scientist. 27 April 2019, pp.16.