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Ayinde OO, Fadahunsi O, Kola L, Malla LO, Nyame S, Okoth RA, Cohen A, Appiah-Poku J, Othieno CJ, Seedat S, Gureje O. Explanatory models, illness, and treatment experiences of patients with psychosis using the services of traditional and faith healers in three African countries: Similarities and discontinuities. Transcult Psychiatry 2023; 60:521-536. [PMID: 34913379 DOI: 10.1177/13634615211064370] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
As part of formative studies to design a program of collaborative care for persons with psychosis, we explored personal experience and lay attributions of illness as well as treatment among persons who had recently received care at traditional and faith healers' (TFHs) facilities in three cultural groups in Sub-Saharan Africa. A purposive sample of 85 individuals in Ibadan (Nigeria), Kumasi (Ghana), and Nairobi (Kenya) were interviewed. Data was inductively explored for themes and analysis was informed by the Framework Method. Across the three sites, illness experiences featured suffering and disability in different life domains. Predominant causal attribution was supernatural, even when biological causation was also acknowledged. Prayer and rituals, steeped in traditional spiritual beliefs, were prominent both in traditional faith healing settings as well as those of Christianity and Islam. Concurrent or consecutive use of TFHs and conventional medical services was common. TFHs provided services that appear to meet the therapeutic goals of their patients even when harmful treatment practices were employed. Cultural and linguistic differences did not obscure the commonality of a core set of beliefs and practices across these three groups. This similarity of core worldviews across diverse cultural settings means that a collaborative approach designed in one cultural group would, with adaptations to reflect differences in context, be applicable in another cultural group. Studies of patients' experience of illness and care are useful in designing and implementing collaborations between biomedical and TFH services as a way of scaling up services and improving the outcome of psychosis.
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Affiliation(s)
| | | | | | | | | | | | - Alex Cohen
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine
| | | | | | - Soraya Seedat
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine
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Muswerakuenda FF, Mundagowa PT, Madziwa C, Mukora-Mutseyekwa F. Access to psychosocial support for church-going young people recovering from drug and substance abuse in Zimbabwe: a qualitative study. BMC Public Health 2023; 23:723. [PMID: 37081488 PMCID: PMC10117257 DOI: 10.1186/s12889-023-15633-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 04/08/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND The church and other religious-affiliated organizations have promising yet underexplored potential to provide social support services for young people recovering from substance abuse in communities where drug and substance rehabilitation services are limited. This study aimed to establish the barriers and facilitators of accessing psychosocial support, the role of the church, and strategies to promote access to psychosocial support for youths recovering from drug and substance abuse. METHODS This was a qualitative cross-sectional study, and semi-structured interviews of 18 church-going youths and three youth pastors were conducted in eastern Zimbabwe. Data were collected using recorded telephone interviews. Data were transcribed and analyzed using the thematic network analysis technique of producing basic themes, which build into organizing themes. Organizing themes produces one overarching global theme. The Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines for reporting on qualitative research were used in reporting the study findings. RESULTS The interviews produced the following basic themes under organizing theme barriers: stigma and discrimination, parental/guardian denial, radical religious beliefs, and negative role models. Under the organizing theme facilitators, the basic themes were acceptance, confidentiality, peer and parental support, and an organized support program. The church acted as the bridge between the barriers to access to services and support seeking through innovative, inclusive projects and activities, as well as a pillar of social support. CONCLUSIONS Acceptance of one's addiction problem is critical to initiate seeking psychosocial support. Confidentiality, support from trustworthy relationships, and the availability of a well-coordinated recovery program enable young people to seek support. We recommend formal training church-based counselors in the ethical aspects of psychotherapy to reduce the preconceived social stigma associated with drug and substance abuse.
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Affiliation(s)
| | - Paddington T Mundagowa
- Clinical Research Center, Africa University, Mutare, Zimbabwe.
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, USA.
| | - Clara Madziwa
- College of Social Sciences, Theology and Education, Africa University, Mutare, Zimbabwe
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Impact of traditional healers in the provision of mental health services in Nigeria. Ann Med Surg (Lond) 2022; 82:104755. [PMID: 36212734 PMCID: PMC9539773 DOI: 10.1016/j.amsu.2022.104755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 09/18/2022] [Indexed: 11/24/2022] Open
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Baseline situational analysis in Bangladesh, Jordan, Paraguay, the Philippines, Ukraine, and Zimbabwe for the WHO Special Initiative for Mental Health: Universal Health Coverage for Mental Health. PLoS One 2022; 17:e0265570. [PMID: 35316294 PMCID: PMC8939830 DOI: 10.1371/journal.pone.0265570] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/03/2022] [Indexed: 01/01/2023] Open
Abstract
Introduction Mental, neurological and substance use conditions lead to tremendous suffering, yet globally access to effective care is limited. In line with the 13th General Programme of Work (GPW 13), in 2019 the World Health Organization (WHO) launched the WHO Special Initiative for Mental Health: Universal Health Coverage for Mental Health to advance mental health policies, advocacy, and human rights and to scale up access to quality and affordable care for people living with mental health conditions. Six countries were selected as ‘early-adopter’ countries for the WHO Special Initiative for Mental Health in the initial phase. Our objective was to rapidly and comprehensively assess the strength of mental health systems in each country with the goal of informing national priority-setting at the outset of the Initiative. Methods We used a modified version of the Program for Improving Mental Health Care (PRIME) situational analysis tool. We used a participatory process to document national demographic and population health characteristics; environmental, sociopolitical, and health-related threats; the status of mental health policies and plans; the prevalence of mental disorders and treatment coverage; and the availability of resources for mental health. Results Each country had distinct needs, though several common themes emerged. Most were dealing with crises with serious implications for population mental health. None had sufficient mental health services to meet their needs. All aimed to decentralize and deinstitutionalize mental health services, to integrate mental health care into primary health care, and to devote more financial and human resources to mental health systems. All cited insufficient and inequitably distributed specialist human resources for mental health as a major impediment. Conclusions This rapid assessment facilitated priority-setting for mental health system strengthening by national stakeholders. Next steps include convening design workshops in each country and initiating monitoring and evaluation procedures.
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Wallén A, Eberhard S, Landgren K. The Experiences of Counsellors Offering Problem-Solving Therapy for Common Mental Health Issues at the Youth Friendship Bench in Zimbabwe. Issues Ment Health Nurs 2021; 42:808-817. [PMID: 33555957 DOI: 10.1080/01612840.2021.1879977] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
There is growing evidence that lay health workers providing counselling is a feasible approach of addressing the universally large treatment gap for mental disorders. This study illuminates the experiences of the counsellors in the Youth Friendship Bench in Zimbabwe, a pilot project where students provide problem-solving therapy to adolescents with common mental disorders. Twelve interviews were analysed using content analysis. The first theme "Working in a meaningful project" describes how the counsellors managed to create an alliance with the clients. The project was perceived as helpful, meaningful and urgent, and the counsellors' experienced a professional and individual development through the support of the Friendship Bench organization. The second theme "Encountering obstacles" illuminates how counsellors experienced situations where they failed to reach out to clients, felt unprepared and inadequate, and how they combated preconceptions and taboos. In the third theme, "Carrying an emotional burden," the counsellors described experiences of recognising own problems and empathising with the client.
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Affiliation(s)
| | - Sophia Eberhard
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Lund University, Lund, Sweden
| | - Kajsa Landgren
- Faculty of Medicine, Health Sciences Center, Lund University, Lund, Sweden.,Psychiatric Clinic in Lund, Office of Psychiatry and Habilitation, Region Skåne, Sweden
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Nyame S, Adiibokah E, Mohammed Y, Doku VC, Othieno C, Harris B, Gureje O, Soraya S, Appiah-Poku J. Perceptions of Ghanaian traditional health practitioners, primary health care workers, service users and caregivers regarding collaboration for mental health care. BMC Health Serv Res 2021; 21:375. [PMID: 33892697 PMCID: PMC8063486 DOI: 10.1186/s12913-021-06313-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In low- and middle-income countries, the paucity of conventional health services means that many people with mental health problems rely on traditional health practitioners (THPs). This paper examines the possibility of forging partnerships at the Primary Health Care (PHC) level in two geopolitical regions of Ghana, to maximize the benefits to both health systems. METHODS The study was a qualitative cross-sectional survey. Eight (8) focus group discussions (FGDs) were conducted between February and April 2014. The views of THPs, PHC providers, service users (i.e. patients) and their caregivers, on the perceived benefits, barriers and facilitators of forging partnerships were examined. A thematic framework approach was employed for analysis. RESULTS The study revealed that underlying the widespread approval of forging partnerships, there were mutual undertones of suspicion. While PHC providers were mainly concerned that THPs may incur harms to service users (e.g., through delays in care pathways and human rights abuses), service users and their caregivers highlighted the failure of conventional medical care to meet their healthcare needs. There are practical challenges to these collaborations, including the lack of options to adequately deal with human rights issues such as some patients being chained and exposed to the vagaries of the weather at THPs. There is also the issue of the frequent shortage of psychotropic medication at PHCs. CONCLUSION Addressing these barriers could enhance partnerships. There is also a need to educate all providers, which should include sessions clarifying the potential value of such partnerships.
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Affiliation(s)
- Solomon Nyame
- Kintampo Health Research Centre, Box 200, Kintampo, Bono East Region, Ghana.
| | | | - Yasmin Mohammed
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | | | | | | | - John Appiah-Poku
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Bhad R, Gupta R, Balhara YPS. A study of pathways to care among opioid dependent individuals seeking treatment at a community de-addiction clinic in India. J Ethn Subst Abuse 2019; 19:490-502. [PMID: 30633657 DOI: 10.1080/15332640.2018.1542528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Drug use, including opioid use disorder, is one of the rapidly rising and serious problems affecting populations globally. There is a treatment gap and delay in presentation of drug users to treatment centers. The present study aimed at assessing the pathways to care among opioid-dependent individuals seeking treatment from a community-based treatment center in India. In a cross-sectional observational study conducted at a community clinic of the National Drug Dependence Treatment Centre (NDDTC), New Delhi, India, a total of 100 treatment-seeking drug users (age 18-60 years) fulfilling DSM IV TR criteria for opioid dependence were recruited. The data were collected using a semistructured pro forma based on patient self-report and the encounter form used in the World Health Organization (WHO) Pathway Study. All participants were male, were mostly married, were employed, and belonged to nuclear families. Ninety-eight percent of participants has ever used heroin in a dependent fashion and 20% were using it currently. Mean age of the participants was 40.83 years (SD 12.7). Median age of onset of heroin use was 22 years (IQR 12). Median duration of heroin use was 138 months (IQR 132). Only 21% of participants visited the community deaddiction clinic at the first contact with care. The median time for first treatment-seeking attempt was 9.5 years (IQR 7). The study findings suggest significant delay between onset of drug-related problems and first treatment contact. There is a need to increase the availability and accessibility of treatment services to reduce the delay in treatment seeking.
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Affiliation(s)
- Roshan Bhad
- All India Institute of Medical Sciences, New Delhi, India
| | - Rishab Gupta
- State University of New York Downstate Medical Center, Brooklyn, New York, USA
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Kajawu L, Chiweshe M, Mapara J. Community Perceptions of Indigenous Healers and Mental Disorders in Zimbabwe. ACTA ACUST UNITED AC 2019. [DOI: 10.4236/ojpsych.2019.93015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Anand P, Sachdeva A, Kumar V. Pathway to care and clinical profile of children with attention-deficit hyperactivity disorder in New Delhi, India. J Family Community Med 2018; 25:114-119. [PMID: 29922112 PMCID: PMC5958522 DOI: 10.4103/jfcm.jfcm_142_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Attention-deficit hyperactivity disorder (ADHD) is a common childhood neurobehavioral disorder, which may cause impairment in multiple domains. Understanding the pathway to care helps in planning effective early interventions. The study aims to provide a quantitative description of the factors affecting the help-seeking pathway. MATERIALS AND METHODS The study was conducted at an outpatients department of a tertiary care multispecialty hospital. Fifty consecutive consenting children aged 5-15 years were screened and diagnosed for ADHD using Conners' Parent Rating Scale-Revised: Short Form, Diagnostic and Statistical Manual of Mental Disorders fourth edition text revision criteria, and Kiddie Schedule for affective disorders and schizophrenia. A semi-structured questionnaire was used to study the pathway of care, using the WHO template. The data were analyzed using appropriate parametric and nonparametric tests in SPSS software. RESULTS The average delay from the onset of the illness to first consultation with a qualified health professional was 2.32 ± 1.9 years. Children with an urban background, from a nuclear family, with literate mothers, with a family income of more than Rs. 30,000/month, having hyperactive and combined type of ADHD, and who were referred by school teachers presented significantly earlier. The main source of referrals were school teachers and general medical practitioners. The most common parental beliefs for delay were the views that the "child is naughty" and that "hyperactivity is part of normal growth." CONCLUSION Parents' help-seeking behavior is affected by different sociocultural beliefs. Such factors as the lack of recognition and awareness of ADHD, resulting in the delay in seeking treatment should be addressed through health promotion programs.
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Affiliation(s)
- Puneet Anand
- Department of Pediatrics, ESIC Medical College and Hospital, Faridabad, Haryana, India
| | - Ankur Sachdeva
- Department of Psychiatry, ESIC Medical College and Hospital, Faridabad, Haryana, India
| | - Vipin Kumar
- Department of Psychiatry, ESIC Medical College and Hospital, Faridabad, Haryana, India
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Ovuga E, Boardman J, Oluka EGAO. Traditional healers and mental illness in Uganda. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.23.5.276] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and methodA cross-sectional, interview survey of the beliefs, knowledge, attitudes and practice towards mental illness of 29 traditional healers in the Pallisa district of Uganda was carried out.ResultsMany of the healers had experienced emotional problems that had been treated by other healers. Almost all had a family member who was also a traditional healer. They treated a wide range of conditions and all dealt with mental illness. Most believed that mental disorders were caused by supernatural processes. Many recognised the role of environmental agents. Their diagnosis and management of mental illness was eclectic. The healers were either traditional herbalists or spirit diviners or a mixture of both. Almost all referred patients to the district hospitals and were willing to work with government health services.Clinical implicationsThe results of the survey suggest the presence of fertile ground on which to build cooperation between traditional healers and medical services. Such cooperation may harness primary care resources more effectively. Sequential or simultaneous models of collaboration (or combinations of both) may be considered. Further work on specific treatments, their outcomes and the evaluation of collaborative models is needed.
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Hossien SA, Loganathan S, Kolar Sridara Murthy M, Palanimuthu Thangaraju S, Bharath S, Varghese M. Pathways to care among persons with dementia: Study from a tertiary care center. Asian J Psychiatr 2017; 30:59-64. [PMID: 28756165 DOI: 10.1016/j.ajp.2017.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 06/15/2017] [Accepted: 07/02/2017] [Indexed: 11/17/2022]
Abstract
The prevalence of dementia is increasing rapidly, specifically in low and middle income countries (LAMIC) due to demographic aging. Help seeking is delayed and usually sought at an advanced stage of illness and many are yet to receive a formal diagnosis. We interviewed 35 caregivers of persons with Dementia (as per ICD-10) using a semi-structured questionnaire, the Short Explanatory Model Interview (SEMI). We explored the pathways taken by caregivers of people with dementia en route to a tertiary care centre and the interactions they had with different health care providers. Qualitative data analysis was done using ATLAS.ti. We identified three major pathways: I) The Neuropsychiatric pathway II) The General Practitioner pathway and III) The Non-cohesive pathway. In general, the caregivers were poorly informed about the illness details such as diagnosis, course and outcome. Neurologists communicated the diagnosis of 'Dementia' more frequently. When information was made available, the caregivers were satisfied with proper information about illness and with at least, partial improvement of symptoms. There is a need for increasing the awareness of dementia in community at large. Health services and systems that address this important public health problem need strengthening. Sensitization and training of primary care physician and staff to identify dementia at an early stage are the need of the hour.
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Affiliation(s)
- Sk Altaf Hossien
- Senior Resident, Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India.
| | - Santosh Loganathan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Meena Kolar Sridara Murthy
- Department of Mental Health Education, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | | | - Srikala Bharath
- Consultant Psychiatrist, Mildura Base Hospital, Ramsay Healthcare Mildura Vic 3500
| | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
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Labys CA, Susser E, Burns JK. Psychosis and help-seeking behavior in rural KwaZulu Natal: unearthing local insights. Int J Ment Health Syst 2016; 10:57. [PMID: 27660651 PMCID: PMC5029022 DOI: 10.1186/s13033-016-0089-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 08/26/2016] [Indexed: 12/16/2022] Open
Abstract
Background Growing interest in strategies regarding early intervention for psychosis has led to a parallel interest in understanding help-seeking behavior, especially in low- and middle-income countries (LMICs). Nevertheless, few LMIC studies have examined individuals with psychosis in non-urban, non-hospital settings. Using the perspective of formal and informal community service providers, we aimed to uncover descriptions of people with psychosis in a rural South African community and illuminate the potential complexities of their help-seeking journeys. Methods We conducted a qualitative study of 40 key informant interviews and seven focus groups with stakeholders (traditional leaders, traditional healers, religious leaders, health care nurses, heads of non-governmental organizations, schoolteachers, community caregivers) in a rural Zulu community (Vulindlela). Thematic analysis of the data was performed using the inductive analysis approach. Results Interviewees discussed 32 individuals with probable psychosis in their community and provided rich descriptions of their symptoms. A complex picture of help-seeking behavior, primarily involving informal mental health service providers, emerged. Over half of the reported cases had no contact with formal health services in the course of their help-seeking journey; while more than two-thirds never attended a hospital and only 1 in 8 accessed a psychiatric hospital. Conclusions Our results highlight the important role of informal care providers in LMICs as well as the need for more research on mental illness and local providers in non-hospital contexts. Community stakeholders can contribute to a fuller understanding of these issues, thereby assisting in the creation of appropriate and effective mental health interventions for rural South African communities like Vulindlela.
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Affiliation(s)
- Charlotte A Labys
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Ezra Susser
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA ; New York State Psychiatric Institute, New York, USA
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Hickey JE, Pryjmachuk S, Waterman H. Mental illness research in the Gulf Cooperation Council: a scoping review. Health Res Policy Syst 2016; 14:59. [PMID: 27492156 PMCID: PMC4972953 DOI: 10.1186/s12961-016-0123-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 06/24/2016] [Indexed: 11/26/2022] Open
Abstract
Rapid growth and development in recent decades has seen mental health and mental illness emerge as priority health concerns for the Gulf Cooperation Council (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates). As a result, mental health services in the region are being redefined and expanded. However, there is a paucity of local research to guide ongoing service development. Local research is important because service users’ experience of mental illness and mental health services are linked to their sociocultural context. In order for service development to be most effective, there is a need for increased understanding of the people who use these services. This article aims to review and synthesize mental health research from the Gulf Cooperation Council. It also seeks to identify gaps in the literature and suggest directions for future research. A scoping framework was used to conduct this review. To identify studies, database searches were undertaken, regional journals were hand-searched, and reference lists of included articles were examined. Empirical studies undertaken in the Gulf Cooperation Council that reported mental health service users’ experience of mental illness were included. Framework analysis was used to synthesize results. Fifty-five studies met inclusion criteria and the following themes were identified: service preferences, illness (symptomology, perceived cause, impact), and recovery (traditional healing, family support, religion). Gaps included contradictory findings related to the supportive role of the Arabic extended family and religion, under-representation of women in study samples, and limited attention on illness management outside of the hospital setting. From this review, it is clear that the sociocultural context in the region is linked to service users’ experience of mental illness. Future research that aims to fill the identified gaps and develop and test culturally appropriate interventions will aid practice and policy development in the region.
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Affiliation(s)
- Jason E Hickey
- University of Calgary Qatar, P.O. Box 23133, Doha, Qatar. .,University of Manchester, Oxford Rd, Manchester, M13 9PL, United Kingdom.
| | - Steven Pryjmachuk
- University of Manchester, Oxford Rd, Manchester, M13 9PL, United Kingdom
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Nortje G, Oladeji B, Gureje O, Seedat S. Effectiveness of traditional healers in treating mental disorders: a systematic review. Lancet Psychiatry 2016; 3:154-70. [PMID: 26851329 DOI: 10.1016/s2215-0366(15)00515-5] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 11/10/2015] [Accepted: 11/11/2015] [Indexed: 10/22/2022]
Abstract
Traditional healers form a major part of the mental health workforce worldwide. Despite this, little systematic examination has been done of their effectiveness in treating mental illness or alleviating psychological distress. In this Review, we aim to fill this gap, with a focus on quantitative outcomes. We searched four databases and reference lists for papers that explicitly measured the effectiveness of traditional healers on mental illness and psychological distress. Eligible papers were assessed for quality, and outcomes and other details were extracted with the use of a standardised template. 32 eligible papers from 20 countries were included. The published literature on this topic is heterogeneous and studies are generally of poor quality, although some findings emerge more consistently. Some evidence suggests that traditional healers can provide an effective psychosocial intervention. Their interventions might help to relieve distress and improve mild symptoms in common mental disorders such as depression and anxiety. However, little evidence exists to suggest that they change the course of severe mental illnesses such as bipolar and psychotic disorders. Nevertheless, qualitative changes that are captured poorly by conventional rating scales might be as important as the quantitative changes reviewed here. We conclude by outlining the challenges involved in assessing the effectiveness of traditional healers.
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Affiliation(s)
- Gareth Nortje
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa.
| | | | - Oye Gureje
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
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Arya A, Agarwal V, Yadav S, Gupta PK, Agarwal M. A study of pathway of care in children and adolescents with attention deficit hyperactivity disorder. Asian J Psychiatr 2015; 17:10-5. [PMID: 26303842 DOI: 10.1016/j.ajp.2015.07.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 07/16/2015] [Accepted: 07/25/2015] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Attention deficit hyperactivity disorder (ADHD) is associated with impairment in all aspects of the patient's life. Despite availability of effective treatments for ADHD, a majority of the patient lack access to or have a significant delay in seeking help. This study aimed to assess the pathway of care in ADHD among patients attending the outpatient psychiatric services of a tertiary care centre in India. METHODS 57 newly registered cases of the age group 6-16 years with the diagnosis of ADHD as per DSM-IV-TR criteria were included in the study. Pathway of care was assessed on the semi structured proforma. RESULTS The mean duration of delay in seeking help for ADHD symptoms was 3.96 Years (SD=1.96). Only 50% of the subjects consulted psychiatrists as first contact. Majority of the patients (45.61%) were referred by school teachers. Major reason given by the family members was that the patient was naughty rather than having any disorder for not seeking treatment in (89.47%). CONCLUSION Our study showed that there was lack of recognition of ADHD at the level of other qualified practitioners and subsequent delay in referral to CAMHS. Sociocultural beliefs affected the help seeking by the parents.
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Affiliation(s)
- Amit Arya
- Department of Psychiatry, King George's Medical University, Lucknow 226003, Uttar Pradesh, India.
| | - Vivek Agarwal
- Department of Psychiatry, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Suresh Yadav
- Department of Psychiatry, National Institute of Mental Health and Neuro-Sciences, Bengaluru 560029, Karnataka, India
| | - Pawan Kumar Gupta
- Department of Psychiatry, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Manu Agarwal
- Department of Psychiatry, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
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Abera M, Robbins JM, Tesfaye M. Parents' perception of child and adolescent mental health problems and their choice of treatment option in southwest Ethiopia. Child Adolesc Psychiatry Ment Health 2015; 9:40. [PMID: 26300967 PMCID: PMC4546139 DOI: 10.1186/s13034-015-0072-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 08/05/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Parents' perception and awareness about psychiatric illness in children and adolescents is an important determinant of early detection and treatment seeking for the condition. However, there has been limited information about the perception and awareness of parents about these issues as well as their preferred treatment options in Ethiopia. This study is, therefore, aimed at assessing the perception of parents about psychiatric illness in children and adolescents and their preferred treatment options in Jimma, Ethiopia. METHOD A cross-sectional study was conducted among 532 parents in Jimma City, Ethiopia from April to May 2013. Parents from the city were invited to participate in this study to assess their knowledge on causes, and manifestations of psychiatric illness in children and adolescents as well as their preferred treatment options if their children exhibited signs and symptoms of mental illness. RESULTS Nearly three quarters of the parents identified genetic factors while approximately 20 % of them mentioned neuro-chemical disturbance as possible causes of their children's mental health problems. On the other hand, magic, curse, and sin were mentioned as causes of mental health problems by 93.2, 81.8 and 73.9 % of the parents, respectively. Externalizing behavioral symptoms like "stealing from home, school or elsewhere" and internalizing symptoms like "being nervous in new situations and easily loses confidence" were perceived by 60.9 and 38.2 % of the parents, respectively. The majority (92.7 %) of parents agreed that they would seek treatment either from religious or spiritual healers if their children developed mental illness. CONCLUSIONS The low level of awareness about internalizing symptoms, the widespread traditional explanatory models as well as preference for traditional treatment options might present significant challenges to utilization of child and adolescent mental health services in this population. Public health intervention programs targeting parental attitude regarding the causes and treatment for child and adolescent mental health problems need to be designed and evaluated for their effectiveness in low-income settings. Additionally, including religious and spiritual leaders in the process of educating members of their respective churches and mosques should also be explored.
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Affiliation(s)
- Mubarek Abera
- Department of Psychiatry, College of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Jeffrey M. Robbins
- Division of Cognitive and Behavioral Neurology, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
| | - Markos Tesfaye
- Department of Psychiatry, College of Health Sciences, Jimma University, Jimma, Ethiopia
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Poreddi V, BIrudu R, Thimmaiah R, Math SB. Mental health literacy among caregivers of persons with mental illness: A descriptive survey. J Neurosci Rural Pract 2015; 6:355-60. [PMID: 26167019 PMCID: PMC4481790 DOI: 10.4103/0976-3147.154571] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Despite of growing evidence of mental disorders in developing countries, research on mental health literacy is limited from India. AIM To examine mental health literacy among caregivers of persons with mental illness. MATERIALS AND METHODS A cross-sectional descriptive survey was carried out among 161 randomly selected caregivers of persons with mental illness at outpatient department of a tertiary care centre. Data was collected through face to face interview using a structured questionnaire. RESULTS Regarding the causes of mental illness, a majority agreed that genetic inheritance (69%), substance abuse (64%) and brain disease (59.6%) are main factors for developing mental illness. Although more than two-thirds agreed that anyone could suffer from mental illness, 61.5% also agreed that people with mental health problems are largely to blame for their condition. The majority of the participants also agreed that mentally ill are not able to maintain friendships (45.9%), are dangerous (54%), and not capable to work (59.1%). Just over half (55.9%) of the participants would not want people to know if they had a mental illness and nearly half of them also expressed that they would feel ashamed if a family member had a mental illness. CONCLUSION Based on the findings of the present study researchers suggest that there is an urgent need to educate and change the attitudes of caregivers through mental health literacy programs specifically designed for them.
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Affiliation(s)
- Vijayalakshmi Poreddi
- Department of Nursing, College of Nursing, National Institute of Mental Health and Neuro Sciences, Institute of National Importance, Bangalore, Karnataka, India
| | - Raju BIrudu
- Department Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Institute of National Importance, Bangalore, Karnataka, India
| | - Rohini Thimmaiah
- Department of Psychiatry, Videhi Medical College, Bangalore, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Institute of National Importance, Bangalore, Karnataka, India
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Traditional and religious healers in the pathway to care for people with mental disorders in Africa: a systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol 2015; 50:867-77. [PMID: 25515608 PMCID: PMC4442066 DOI: 10.1007/s00127-014-0989-7] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 11/26/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE In resource-limited contexts in low- and middle-income countries (LMICs), a considerable proportion of individuals seeking care for mental disorders consult traditional and religious healers in their pathway to mental health care. Reports from Africa suggest that early involvement of healers may result in delays in the care pathway; a potential barrier to early identification and intervention. METHODS A systematic review was conducted to evaluate the proportion of patients attending formal health services after making first contact for treatment of mental disorders with traditional or religious healers or other informal and formal care providers within published research in Africa. Electronic databases were searched for the period from January 1990 to February 2014. Quality assessment of included studies was conducted the SAQOR tool. RESULTS Fourteen papers were identified with data on category of first care provider. Utilizing random effects modelling with inverse variance method, the pooled proportion of participants making first contact for treatment of mental disorders with two broadly categorised providers (informal and formal) was 48.1 % (95 % CI 36.4-60.0 %) and 49.2 % (95 % CI 38.0-60.4 %), respectively. The pooled proportion of participants making first contact with specific providers was: traditional healers (17.0 %, 95 % CI 10.9-24.1 %); religious healers (26.2 %, 95 % CI 18.1-35.1 %); general health services (24.3 %, 95 % CI 16.9-32.5 %); and mental health services (13.0 %, 95 % CI 5.1-23.5 %). Substantial regional variation in patterns of first provider choice was evident. CONCLUSIONS Conclusions of this review must be qualified in the light of several limitations. Approximately half of individuals seeking formal health care for mental disorders in Africa, choose traditional and religious healers as their first care provider. Previous reports suggest that this choice is associated with delays in accessing formal mental health services. Strategies to improve pathways to mental health care in Africa must include innovative programmes aimed at fostering collaboration between biomedical mental health services and these key community-based providers.
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Flisher AJ, Dawes A, Kafaar Z, Lund C, Sorsdahl K, Myers B, Thom R, Seedat S. Child and adolescent mental health in South Africa. J Child Adolesc Ment Health 2015; 24:149-61. [PMID: 25860182 DOI: 10.2989/17280583.2012.735505] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Mental health problems in childhood and adolescence pose a major threat to public health. Epidemiological studies in high, middle and low income countries indicate that approximately one in five children and adolescents suffer from a mental disorder. In many instances these persist into adulthood. In South Africa, HIV infection, substance use, and exposure to violence increase vulnerability to mental disorders. Child and adolescent mental health services play a key role in reducing the burden of mental disorders in childhood and later in adulthood. This paper focuses on service needs for children and adolescents in South Africa. It commences with a discussion of the prevalence of child and adolescent psychiatric disorders after which the legal and policy context of child and adolescent psychiatric services is described. A framework for child and adolescent mental health service provision is presented, following which steps for reducing the extent of unmet service need are considered. The paper concludes with a call to scale up child and adolescent mental health services in South Africa, based on the stark realities of unmet need and the constitutional rights of children and adolescents to appropriate mental health care.
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Affiliation(s)
- Alan J Flisher
- a Division of Child and Adolescent Psychiatry and Adolescent Health Research Institute , University of Cape Town , South Africa
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Abstract
Considerable controversy surrounds the role of traditional health practitioners (THPs) as first-contact service providers and their influence on the duration of untreated psychosis (DUP) in sub-Saharan Africa. This study examined first-contact patterns and pathways to psychiatric care among individuals with severe mental illness in South Africa. A cross-sectional study was conducted at a referral-based tertiary psychiatric government hospital in KwaZulu-Natal Province. Information on pathways to care was collected using the World Health Organization's Encounter Form. General hospital was the most common first point of contact after mental disorder symptom onset and the strongest link to subsequent psychiatric treatment. Family members were the most common initiators in seeking care. First contact with THPs was associated with longer DUP and higher number of provider contacts in the pathway based on adjusted regression analyses. Strengthening connections between psychiatric and general hospitals and provision of culturally competent family-based psychoeducation to reduce DUP are warranted.
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Abstract
BACKGROUND Paramedics dominate primary health care in Malawi where native healers also play a major role in the provision of health care and psychiatric nurses are the backbone of district mental health services. AIM The aim is to improve understanding of prior care-seeking and treatment of new patients seen at mental health services in a developing country like Malawi. METHOD For one calendar month, 128 newly referred patients to the mental health services in the three psychiatric units in Malawi were interviewed using an encounter form. RESULTS Most of the patients went through a first carer before attending a psychiatric unit with only 11.7% going straight to a psychiatric unit. All patients who went straight to a psychiatric unit involved the private/Christian Health Association of Malawi (CHAM) unit in the northern region of Malawi. About 22.7% of the patients had a native healer as a first carer. Only 23% of all patients seen went through a second carer, with none going through a third carer. Over 8% of those who had a paramedic as their first carer had a native healer as their second carer. Duration of stay at different carers varied a lot with about half (48.2%) of all patients who saw a native healer as the first carer spending more than 2 weeks before referral while about 67.0% of those who saw convectional health workers spent 3 days or less before referral. CONCLUSION The pathway to care for patients with psychological problems in Malawi is not very much different to pathways to care in other developing countries whereby native healers and paramedics play a significant role. With the high proportion of patients being seen by native healers and the fact that most patients stay longer at native healers before referral, there is need for official collaboration and training of native healers on mental health.
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Affiliation(s)
- Felix Kauye
- Clinical Psychiatry Department, Zomba Mental Hospital, Zomba, Malawi Department of Mental Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Michael Udedi
- NCDs and Mental Health Unit, Clinical Services Department, Ministry of Health, Lilongwe, Malawi
| | - Chitsanzo Mafuta
- Clinical Psychiatry Department, Zomba Mental Hospital, Zomba, Malawi
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Gureje O, Nortje G, Makanjuola V, Oladeji B, Seedat S, Jenkins R. The role of global traditional and complementary systems of medicine in treating mental health problems. Lancet Psychiatry 2015; 2:168-177. [PMID: 26052502 PMCID: PMC4456435 DOI: 10.1016/s2215-0366(15)00013-9] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 09/26/2014] [Indexed: 11/26/2022]
Abstract
Traditional and complementary systems of medicine (TCM) encompass a broad range of practices which are commonly embedded within contextual cultural milieu, reflecting community beliefs, experiences, religion and spirituality. Evidence from across the world, especially from low- and middle-income countries (LMIC), suggests that TCM is commonly used by a large number of persons with mental illness. Even though some overlap exists between the diagnostic approaches of TCM and conventional biomedicine (CB), there are major differences, largely reflecting differences in the understanding of the nature and etiology of mental disorders. However, treatment modalities employed by providers of TCM may sometimes fail to meet common understandings of human rights and humane care. Still, there are possibilities for collaboration between TCM and CB in the care of persons with mental illness. Research is required to clearly delineate the boundaries of such collaboration and to test its effectiveness in bringing about improved patient outcomes.
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Affiliation(s)
- Oye Gureje
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Gareth Nortje
- Department of Psychiatry, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | | | - Soraya Seedat
- Department of Psychiatry, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rachel Jenkins
- Health Service and Population Research Department, Institute of Psychiatry, King's College, London
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Atilola O. Level of community mental health literacy in sub-Saharan Africa: current studies are limited in number, scope, spread, and cognizance of cultural nuances. Nord J Psychiatry 2015; 69:93-101. [PMID: 25151995 DOI: 10.3109/08039488.2014.947319] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The combination of high prevalence of mental disorders and the scarcity of resources to care for them in sub-Saharan Africa underscores the need for good mental health literacy as a potential mental health resource. AIM To conduct a systematic review of the findings of studies that have examined aspects of mental health literacy among community dwellers in sub-Saharan Africa. METHODS A search was conducted using local and international indexes like MEDLINE, EMBASE and PsychInfo. RESULTS Only 19 studies from eight different countries met inclusion criteria. Key aspects of the functional mental health literacy that has been examined include recognition of mental disorders, knowledge about causation, and treatment preferences. The modes of seeking mental health information are yet to be examined. Some studies utilized a methodology that allowed for respondents to use local labels to describe their understanding of various mental disorders. Otherwise, respondents were largely unable to label orthodox psychiatry syndromes correctly. Supernatural and ultra-human views were rampant, and alternative mental health services were mostly preferred. Quantitative modes of assessment were the most common, and authors-especially those that adopted this mode of assessment-did not take full cognizance of socio-cultural underpinnings of the concept of mental health literacy in their conclusion and recommendations. CONCLUSION There is need for more studies to adopt more comprehensive approaches to the assessment of mental health literacy. The outcomes of such studies will provide the right context for making profound statements on the level of knowledge and skills for mental health promotion in sub-Saharan Africa.
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Affiliation(s)
- Olayinka Atilola
- Olayinka Atilola, Department of Behavioral Medicine, Lagos State University College of Medicine Ikeja , Lagos Nigeria
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Potchen MJ, Siddiqi OK, Elafros MA, Koralnik IJ, Theodore WH, Sikazwe I, Kalungwana L, Bositis CM, Birbeck GL. Neuroimaging abnormalities and seizure recurrence in a prospective cohort study of zambians with human immunodeficiency virus and first seizure. Neurol Int 2014; 6:5547. [PMID: 25568738 PMCID: PMC4274408 DOI: 10.4081/ni.2014.5547] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 08/11/2014] [Indexed: 02/06/2023] Open
Abstract
In HIV-positive individuals with first seizure, we describe neuroimaging findings, detail clinical and demographic risk factors for imaging abnormalities, and evaluate the relationship between imaging abnormalities and seizure recurrence to determine if imaging abnormalities predict recurrent seizures. Among 43 participants (mean 37.4 years, 56% were male), 16 (37%) were on antiretroviral drugs, 32 (79%) had advanced HIV disease, and (28) 66% had multiple seizures and/or status epilepticus at enrollment. Among those with cerebrospinal fluid studies, 14/31 (44%) had opportunistic infections (OIs). During follow-up, 9 (21%) died and 15 (35%) experienced recurrent seizures. Edema was associated with OIs (odds ratio: 8.79; confidence interval: 1.03-236) and subcortical atrophy with poorer scores on the International HIV Dementia Scale) (5.2 vs. 9.3; P=0.002). Imaging abnormalities were not associated with seizure recurrence or death (P>0.05). Seizure recurrence occurred in at least a third and over 20% died during follow-up. Imaging was not predictive of recurrent seizure or death, but imaging abnormalities may offer additional diagnostic insights in terms of OI risk and cognitive impairment.
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Affiliation(s)
- Michael J. Potchen
- Neuroradiology Division Department of Imaging Sciences, University of Rochester, NY, USA
| | - Omar K. Siddiqi
- Department of Internal Medicine, University of Zambia, Lusaka, Zambia,Division of NeuroVirology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Melissa A. Elafros
- College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Igor J. Koralnik
- Division of NeuroVirology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - William H. Theodore
- Clinical Epilepsy Section, United States National Institutes of Health, Bethesda, MD, USA
| | - Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Lisa Kalungwana
- Department of Psychology, University of Zambia, Lusaka, Zambia
| | | | - Gretchen L. Birbeck
- Epilepsy Division, Department of Neurology, University of Rochester, NY, USA,Chikankata Epilepsy Care Team, Mazabuka, Zambia,Epilepsy Division, Department of Neurology, University of Rochester, 265 Crittenden Blvd, Rochester, NY 14624, USA. +1.585.273.4265 - +1.517.507.5440.
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January J, Sodi T. The Practices of Apostolic Faith Healers in Mental Health Care in Zimbabwe. JOURNAL OF PSYCHOLOGY IN AFRICA 2014. [DOI: 10.1080/14330237.2006.10820135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Li X, Zhang W, Lin Y, Zhang X, Qu Z, Wang X, Zhang Y, Xu H, Zhao S, Li Y, Tian D. Pathways to psychiatric care of patients from rural regions: a general-hospital-based study. Int J Soc Psychiatry 2014; 60:280-9. [PMID: 23704113 DOI: 10.1177/0020764013485364] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pathway studies highlight the help-seeking behaviours of patients with physical and mental illness. A number of these studies have been completed in other countries, but there have been few reports from China. Therefore, this study was planned to explore the characteristics of the help-seeking pathways of patients with mental illness from rural regions of China through the mental health professionals and treatment at the General Hospital of the People's Liberation Army (PLAGH). METHODS The pathway diagrams were documented for 203 subjects with various mental disorders using the translated version of the World Health Organization (WHO) pathway encounter form. The patterns of help-seeking and durations were analysed, and the χ(2) test and Mann-Whitney U test were employed as needed. RESULTS On average, each patient consulted 3.6 caregivers. The vast majority of patients first visited local secondary general hospitals (SGHs) (35.5%, χ(2) = 41.93, p < .0001) or local tertiary general hospitals (TGHs) (32%, χ(2) = 36.21, p < .0001); however, 75.4% of them had not received professional diagnosis and treatment. The patients who first contacted the psychiatric service, finally reached the PLAGH, because of poor treatment or the high cost of medical care. CONCLUSION The subjects first seek the help of various sources before attending PLAGH due to a lack of awareness of the treatment services and the fear of the stigma associated with mental disorders. The primary care, even the local general hospital, did not act as a gatekeeper to psychiatric services.
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Affiliation(s)
- Xuemei Li
- 1Clinics of Cadre, Department of Outpatient, General Hospital of the People's Liberation Army, China
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Vijayalakshmi P, Ramachandra, Reddemma K, Math SB. Impact of socio-economic status in meeting the needs of people with mental illness; human rights perspective. Community Ment Health J 2014; 50:245-50. [PMID: 23288490 DOI: 10.1007/s10597-012-9577-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 12/21/2012] [Indexed: 11/27/2022]
Abstract
The present descriptive study investigated the impact of socio-economic status in meeting the human rights needs among randomly selected recovered psychiatric patients (n = 100) at a tertiary care center. Data was collected through face to face interview, using structured Needs Assessment Questionnaire. The findings revealed that the participants from below poverty line were deprived of physical needs such as 'electricity facilities' (χ (2) = 6.821, p < .009) 'safe drinking water' (χ (2) = 13.506, p < .004) and purchasing medications (χ (2) = 9.958, p < .019). Conversely, participants from above poverty line were dissatisfied in emotional needs dimension i.e. 'commenting on physical appearance (χ (2) = 8.337, p < .040), afraid of family members (χ (2) = 17.809, p < .000). Thus, there is an urgent need to implement mental illness awareness campaigns and government should take active steps for providing employment, disability pension, free housing, free treatment and free transportation service for people with mental illness to attend hospital or rehabilitation centres.
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Affiliation(s)
- Poreddi Vijayalakshmi
- Department of Nursing, College of Nursing, National Institute of Mental Health and Neuro Sciences, Deemed University, Bangalore, 560 029, India,
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Zhang W, Li X, Lin Y, Zhang X, Qu Z, Wang X, Xu H, Jiao A, Guo M, Zhang Y, Li Y, Tian D. Pathways to psychiatric care in urban north China: a general hospital based study. Int J Ment Health Syst 2013; 7:22. [PMID: 24020825 PMCID: PMC3852166 DOI: 10.1186/1752-4458-7-22] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 09/02/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pathway studies highlight the help-seeking behaviors of patients with physical and mental illnesses. A number of studies in this field have been completed in various parts of the world. The purpose of this study is to explore the characteristics of the help-seeking pathways of patients with mental illness from urban north China at Mental Health Professional (MHP). METHODS The pathway diagrams, which accounted for more than five percent of patients, were documented for 441 subjects using the translated version of the World Health Organization (WHO) pathway encounter form. The patterns and durations of care-seeking were analyzed in different diagnostic groups. The χ2-test and the Mann-Whitney U test were employed, as needed. RESULTS Respondents visited the MHP through a variety of pathways. Approximately three-quarters of the patients took an indirect pathway (74.8% vs 25.2%, χ2 = 108.8, p < 0.0001), and on average, each patient consulted 3.4 caregivers. The vast majority of patients first visited local tertiary general hospitals (56.4% vs 4.1%, χ2 = 138.3, p < 0.0001) or local secondary general hospitals (24.8% vs 4.1%, χ2 = 40.96, p < 0.0001). However, only 9.6% of patients were diagnosed with mental disorders for the patients who first visited non-psychiatric hospitals. Of the patients who first contacted with psychiatry hospital, 55.6% received a professional diagnosis and finally reached the MHP because of the poor treatment or high-cost medical care. CONCLUSIONS The majority of patients seek other pathways than to go to MHP directly and this may be due to stigma, and/or lack of knowledge. The study gives emphasis on the importance of improving skills and knowledge that will facilitate the recognition of psychiatric disorders in the community health centers, the general hospitals system and by private practitioners. The pathway described by this study may be helpful while preparing mental health programs in the future.
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Affiliation(s)
- Weijun Zhang
- School of Social Development and Public policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing 100875, China
| | - Xuemei Li
- Clinics of Cadre, Department of Outpatient, General Hospital of the People's Liberation Army, Beijing 100853, China
| | - Yan Lin
- School of Social Development and Public policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing 100875, China
| | - Xiulan Zhang
- School of Social Development and Public policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing 100875, China
| | - Zhiyong Qu
- School of Social Development and Public policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing 100875, China
| | - Xiaohua Wang
- School of Social Development and Public policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing 100875, China
| | - Huiwen Xu
- School of Social Development and Public policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing 100875, China
| | - Alvina Jiao
- Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, NJ 08544-1013, USA
| | - Mengqi Guo
- School of Social Development and Public policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing 100875, China
| | - Yurong Zhang
- School of Social Development and Public policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing 100875, China
| | - Yafang Li
- School of Social Development and Public policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing 100875, China
| | - Donghua Tian
- School of Social Development and Public policy, China Institute of Health, Beijing Normal University, 19, Xinjiekou Wai Street, Beijing 100875, China
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Sorketti EA, Zainal NZ, Habil MH. The treatment outcome of psychotic disorders by traditional healers in central Sudan. Int J Soc Psychiatry 2013; 59:365-76. [PMID: 22433242 DOI: 10.1177/0020764012437651] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Alternative and traditional healing methods are common and popular in Sudan, particularly for treating people with mental disorders, but little information is available about the outcome of theses traditional healing approaches. OBJECTIVES To study the outcome of treating patients with psychotic disorders by traditional healers, and to understand the type of services, interventions procedures and treatments methods used by traditional healers to manage patients with psychotic disorders. METHOD A prospective follow-up quantitative study of a cohort of inpatients with psychotic disorders was carried out from admission until discharge. Subjects were people with psychotic disorders undergoing treatment in traditional healer centres in central Sudan. The Mini International Neuropsychiatric Interview (MINI) was used to diagnose the psychotic disorders and the Positive and Negative Syndrome Scale (PANSS) was used to assess the severity of psychotic symptoms on admission and discharge from the traditional healer centre. RESULTS We interviewed 129 inpatients with psychotic disorders on admission and discharge from the traditional healers centres. There was a significant reduction in the PANSS score (p = .0001) after a mean period of stay of 4.5 months. The mean for the overall PANSS score was 118.36 on admission and 69.36 on discharge. CONCLUSION Although traditional-healing approaches produce a significant improvement in the signs and symptoms of psychotic disorders measured on the PANSS, they need to be further investigated, assessed and studied.
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Affiliation(s)
- Ehab Ali Sorketti
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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Vijayalakshmi P, Math SB. Gender differences in mental health literacy of family caregivers of persons with mental illness: an Indian perspective. INTERNATIONAL JOURNAL OF MENTAL HEALTH PROMOTION 2013. [DOI: 10.1080/14623730.2013.792514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bhikha AG, Farooq S, Chaudhry N, Husain N. A systematic review of explanatory models of illness for psychosis in developing countries. Int Rev Psychiatry 2012; 24:450-62. [PMID: 23057981 DOI: 10.3109/09540261.2012.711746] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Explanatory models of illness, held by patients and treating clinicians, offer justifications and propose explanations for sickness, treatment evaluations and choice. These have been studied in relation to common mental disorders but research on explanatory models of psychosis (EMOP) has received scant attention. Adequately understanding patients' explanatory models for psychosis has important clinical implications. METHOD We systematically examined studies on EMOP in the developing world to report on the nature of explanatory models, their relationship with help-seeking, duration of untreated psychosis (DUP), perceived stigma and any differences in the explanatory models between first and subsequent episodes. RESULTS 14 studies examining EMOP in developing countries were identified. The majority of studies reported predominantly supernatural and psychosocial EMOP. Holding supernatural and psychosocial explanatory models affected help-seeking behaviour, treatment modalities used and DUP. DISCUSSION EMOP in developing countries are rich and varied. The literature reports on a variety of populations using different methods and suffers from methodological limitations. Some recent studies have also attempted to modify explanatory models by using educational interventions; however, this was not examined in patient populations. Further research is needed to examine the impact of different explanatory models on DUP and help-seeking behaviours.
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Affiliation(s)
- Aqeela G Bhikha
- Psychiatry Research Group, School of Community Based Medicine, University of Manchester, UK.
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Nsereko JR, Kizza D, Kigozi F, Ssebunnya J, Ndyanabangi S, Flisher AJ, Cooper S. Stakeholder's perceptions of help-seeking behaviour among people with mental health problems in Uganda. Int J Ment Health Syst 2011; 5:5. [PMID: 21314989 PMCID: PMC3050843 DOI: 10.1186/1752-4458-5-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Accepted: 02/13/2011] [Indexed: 12/04/2022] Open
Abstract
Introduction Mental health facilities in Uganda remain underutilized, despite efforts to decentralize the services. One of the possible explanations for this is the help-seeking behaviours of people with mental health problems. Unfortunately little is known about the factors that influence the help-seeking behaviours. Delays in seeking proper treatment are known to compromise the outcome of the care. Aim To examine the help-seeking behaviours of individuals with mental health problems, and the factors that may influence such behaviours in Uganda. Method Sixty-two interviews and six focus groups were conducted with stakeholders drawn from national and district levels. Thematic analysis of the data was conducted using a framework analysis approach. Results The findings revealed that in some Ugandan communities, help is mostly sought from traditional healers initially, whereas western form of care is usually considered as a last resort. The factors found to influence help-seeking behaviour within the community include: beliefs about the causes of mental illness, the nature of service delivery, accessibility and cost, stigma. Conclusion Increasing the uptake of mental health services requires dedicating more human and financial resources to conventional mental health services. Better understanding of socio-cultural factors that may influence accessibility, engagement and collaboration with traditional healers and conventional practitioners is also urgently required.
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Affiliation(s)
- James R Nsereko
- Butabika National Referral and Teaching Mental Hospital, Kampala, Uganda.
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Abstract
There are few population-level insights into the use of traditional healers and other forms of alternative care for the treatment of common mental disorders in sub-Saharan Africa. We examined the extent to which alternative practitioners are consulted, and predictors of traditional healer visits. A national survey was conducted with 3651 adult South Africans between 2002 and 2004, using the World Health Organization Composite International Diagnostic Interview (CIDI) to generate DSM-IV diagnoses for common mood, anxiety, and substance use disorders. A minority of participants with a lifetime DSM-IV diagnosis obtained treatment from Western (29%) or alternative (20%) practitioners. Traditional healers were consulted by 9% of the respondents and 11% consulted a religious or spiritual advisor. Use of traditional healers in the full sample was predicted by older age, black race, unemployment, lower education, and having an anxiety or a substance use disorder. Alternative practitioners, including traditional healers and religious advisors, appear to play a notable role in the delivery of mental health care in South Africa.
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Salem MO, Saleh B, Yousef S, Sabri S. Help-seeking behaviour of patients attending the psychiatric service in a sample of United Arab Emirates population. Int J Soc Psychiatry 2009; 55:141-8. [PMID: 19240203 DOI: 10.1177/0020764008093373] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Many patients suffering from psychiatric disorders seek non-professional care before attending specialized services. AIMS To study the help-seeking behaviour of patients referred to the psychiatric department of Al-Ain Hospital, which is the main university teaching hospital in UAE. METHODS This study was a descriptive cross-sectional epidemiological survey. All new patients attending the psychiatry out-patient clinic at Al-Ain Hospital were screened for nine consecutive months from March to November 2003 inclusive. RESULTS The sample consisted of 106 patients (52 male; 54 female). Prior to presenting to the psychiatric service, 44.8% consulted faith healers, 31% of whom had had a previous experience with them; 45% reported some improvement but their symptoms recurred later, while 47% reported no improvement. In 8% their symptoms worsened for the current episode. Treatments received were herbal (29.8%) and prayer (70.2%). Of the sample, 43.4% consulted a primary care physician before presenting to the secondary psychiatric care. CONCLUSION In this sample a sizable number of patients sought alternative methods of treatment before attending the specialized psychiatric services.
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Temmingh HS, Oosthuizen PP. Pathways to care and treatment delays in first and multi episode psychosis. Findings from a developing country. Soc Psychiatry Psychiatr Epidemiol 2008; 43:727-35. [PMID: 18449465 DOI: 10.1007/s00127-008-0358-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Accepted: 04/05/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND In contrast to findings from the developed world where general practitioners and mental health professionals are central in first episode psychosis pathways, studies from Africa have found GPs to play a less prominent role with other help providers such as traditional healers being more important. METHODS We compared pathways to care, treatment delays and gender differences in patients with first versus multi episode psychosis. RESULTS Private sector GPs were first contacts in first episode patients in as many as 38% of patients and were significantly more likely to be the first contact (odds ratio = 4.5, 95% CI = 1.38-14.67) and final referring agent (odds ratio = 6.8, 95% CI = 1.56-25.12) in first episode patients. Female multi episode patients were significantly more likely to make first contact with primary care practitioners whereas male multi episode patients were more likely to first come into contact with the police (P = 0.003) and be admitted compulsorily (P = 0.009). Only 5.6% (n = 4) of patients contacted traditional healers at some point in their pathway to care. Treatment delays and DUP in first episode patients were longer and reached a median of 4.5 versus 2.5 months in multi episode patients. Treatment discontinuation of antipsychotics occurred in 82% of multi episode patients. Despite significantly longer overall treatment delays in first episode patients the distribution of treatment delays in multi episode patients followed a similar pattern to DUP in first episode patients with a subgroup having very long delays. CONCLUSIONS Pathways to care in this treatment setting correspond more to findings from first world and newly industrialized countries. A subgroup of multi episode patients had very long periods of untreated illness. Limitations include small sample size and the retrospective nature of data collection.
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Affiliation(s)
- Hendrik S Temmingh
- Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa
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Razali SM, Mohd Yasin MA. The pathway followed by psychotic patients to a tertiary health center in a developing country: a comparison with patients with epilepsy. Epilepsy Behav 2008; 13:343-9. [PMID: 18514034 DOI: 10.1016/j.yebeh.2008.04.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Revised: 03/13/2008] [Accepted: 04/15/2008] [Indexed: 11/16/2022]
Abstract
The objective of this study was to describe and compare the pathways followed by Malay patients with psychoses (schizophrenia and schizophreniform disorder) and Malay patients with epilepsy to a tertiary health center in the northeastern area of peninsular Malaysia. There were 60 patients in each group. The most popular pathway for both groups was first contact with traditional or alternative healers. Consultation with Malay traditional healers (bomohs) and/or homeopathic practitioners (44.2%) was significantly higher for psychotic patients (61.7%) than for patients with epilepsy (26.7%) (chi(2)(2)=15.609, P<0.001). Direct access (24.2%) was the second most popular pathway and almost equally followed by both groups of patients. The third and last pathway was initial contact with private general practitioners and government doctors, respectively. Patients with epilepsy dominated the last two pathways. The treatment delay (TD) was significantly longer in epileptic than psychotic patients regardless of their visit to a bomoh and/or homeopathic practitioner (P<0001) or not (p<0.01). The socioeconomic status of psychotic patients also was significantly better than people with epilepsy (chi(2)=9.957, chi(2)(4), p=0.041).
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Affiliation(s)
- S M Razali
- Department of Psychiatry, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kota Baru, Kelantan, Malaysia.
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Developing mental health services in Nigeria : the impact of a community-based mental health awareness programme. Soc Psychiatry Psychiatr Epidemiol 2008; 43:552-8. [PMID: 18288432 DOI: 10.1007/s00127-008-0321-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2007] [Accepted: 01/25/2008] [Indexed: 10/22/2022]
Abstract
This grass-roots level mental health awareness programme considerably increased use of community-based mental health services in a part of Nigeria where knowledge about treatability of mental illness was limited. The benefits of the programme were sustained for a significant period after the initial awareness programme. In order for attitude changes to be reinforced, similar awareness programmes must be repeated at regular intervals.
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Gater R, Jordanova V, Maric N, Alikaj V, Bajs M, Cavic T, Dimitrov H, Iosub D, Mihai A, Szalontay AS, Helmchen H, Sartorius N. Pathways to psychiatric care in Eastern Europe. Br J Psychiatry 2005; 186:529-35. [PMID: 15928365 DOI: 10.1192/bjp.186.6.529] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND There has been almost no research into mental health services in Eastern Europe. A pathways study is a quick and useful starting point, requiring few resources. AIMS To improve understanding of prior care-seeking and treatment of new patients seen at mental health services. METHOD Pathways diagrams were drawn showing the routes of care-seeking for 50 new patients in eight centres. Patterns of care-seeking, durations and previous treatments were compared for ICD-10 diagnostic groups. RESULTS The diagnoses varied according to the organisation of services. Major pathways included general practitioners, direct access and hospital doctors. General practitioners have a limited role as 'gatekeeper' in centres in Albania, Croatia, Macedonia, Romania and Serbia-Montenegro, and rarely prescribed treatment, except sedatives, for mental disorders. CONCLUSIONS Findings highlight areas that require attention if aspirations for community-oriented mental health care are to be realised, particularly integration of mental health into primary care.
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Affiliation(s)
- Richard Gater
- University of Manchester and Lancashire Care NHS Trust, Preston, UK.
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Abstract
India is a country with a population of over 1 billion, and immense diversity in the languages spoken, levels of literacy, and social and cultural practices. Organising mental health services for this predominantly rural population is indeed a daunting task. Compounding this problem are low budgetary resources, the presence of competing and conflicting healing systems, scarcity of mental health personnel, ‘brain drain’, and the stigma of seeking help for problems related to the mind. This paper looks at the mental health scene in India with respect to services and research. It deals with conditions such as schizophrenia, acute psychoses, minor mental morbidity and drug misuse, highlighting aspects unique to the Indian scene. Indian families exhibit great tenacity in caring for relatives who are ill, and are a great resource in treatment and rehabilitation.
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Affiliation(s)
- R Thara
- Schizophrenia Research Foundation, Anna Nagar (West Extension), Chennai, India.
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Morgan C, Mallett R, Hutchinson G, Leff J. Negative pathways to psychiatric care and ethnicity: the bridge between social science and psychiatry. Soc Sci Med 2004; 58:739-52. [PMID: 14672590 DOI: 10.1016/s0277-9536(03)00233-8] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It has been consistently reported that the African-Caribbean population in the UK are more likely than their White counterparts to access psychiatric services via the police and under compulsion. The reasons for these differences are poorly understood. This paper comprises two main parts. The first provides a comprehensive review of research in this area, arguing the current lack of understanding stems from a number of methodological limitations that characterise the research to date. The issue of ethnic variations in pathways to psychiatric care has been studied almost exclusively within a medical epidemiological framework, and the potential insights offered by sociological and anthropological research in the fields of illness behaviour and health service use have been ignored. This has important implications as the failure of research to move beyond enumerating differences in sources of referral to psychiatric services and rates of compulsory admission means no recommendations for policy or service reform have been developed from the research. The second part of the paper sets out the foundations for future research, arguing that the pathway to care has to be studied as a social process subject to a wide range of influences, including the cultural context within which illness is experienced. It is further argued that Kleinman's (Patients and healers in the context of culture: an exploration of the borderland between anthropology, medicine and psychiatry, University of California Press, Los Angeles, 1980) Health Care System model offers a particularly valuable preliminary framework for organising and interpreting future research. It is only through gaining a more qualitative understanding of the processes at work in shaping different responses to mental illness and interactions with mental health services that the patterns observed in quantitative studies can be fully understood. This further reflects the need for a bridge between the social sciences and psychiatry if services are to be developed to respond to the increasing diversity of modern societies.
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Affiliation(s)
- Craig Morgan
- Department of Social Policy and Social Work, University of Oxford, Barnett House, 32 Wellington Square, Oxford OX1 2ER, UK.
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Patel V, Abas M, Broadhead J, Todd C, Reeler A. Depression in developing countries: lessons from Zimbabwe. BMJ (CLINICAL RESEARCH ED.) 2001; 322:482-4. [PMID: 11222428 PMCID: PMC1119689 DOI: 10.1136/bmj.322.7284.482] [Citation(s) in RCA: 140] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- V Patel
- University of Zimbabwe Medical School, Harare, Zimbabwe.
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Abstract
The debate on the role of culture on psychiatric epidemiology has evolved considerably in the past two decades. There is now a general consensus that the integration of the universalist and culturally relativist approaches, and their methodologies, is required to generate a truly international psychiatric epidemiology. The large body of research investigating the influence of culture on the epidemiology of depression has produced a number of key findings: the clinical presentation of depression in all cultures is associated with multiple somatic symptoms of chronic duration; psychological symptoms, however, are important for diagnosis and can be easily elicited. The diagnostic differentiation between depression and anxiety in general health care settings is not clinically valid. Culturally appropriate terminology for depression can be identified and their use may improve levels of recognition and treatment compliance. It is also evident that culture is only one factor in the difference between, and within, human societies which has a bearing on the epidemiology of depression. Other factors, which may interact with culture, such as gender and income inequality, are major risk factors for depression. Future international research must focus on two themes: (i) intervention studies including cost-effectiveness outcomes; and (ii) research aiming to bridge the gap between regional public health priorities and the concern that psychiatrists have about depression.
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Affiliation(s)
- V Patel
- London School of Hygiene and Tropical Medicine, UK
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