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Kokota D, Stewart RC, Bandawe C, Chorwe-Sungani G, Liwimbi O, Mwale CM, Kulisewa K, Udedi M, Gondwe S, Sefasi A, Banda R, Mkandawire T, Lawrie SM. Pathways to care for psychosis in Malawi. BJPsych Int 2023; 20:84-89. [PMID: 38029442 PMCID: PMC10659844 DOI: 10.1192/bji.2023.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 05/15/2023] [Accepted: 06/15/2023] [Indexed: 12/01/2023] Open
Abstract
People with psychosis in Malawi have very limited access to timely assessment and evidence-based care, leading to a long duration of untreated psychosis and persistent disability. Most people with psychosis in the country consult traditional or religious healers. Stigmatising attitudes are common and services have limited capacity, particularly in rural areas. This paper, focusing on pathways to care for psychosis in Malawi, is based on the Wellcome Trust Psychosis Flagship Report on the Landscape of Mental Health Services for Psychosis in Malawi. Its purpose is to inform Psychosis Recovery Orientation in Malawi by Improving Services and Engagement (PROMISE), a longitudinal study that aims to build on existing services to develop sustainable psychosis detection systems and management pathways to promote recovery.
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Affiliation(s)
- Demoubly Kokota
- Postdoctoral Fellow, Division of Psychiatry, University of Edinburgh, Edinburgh, UK.
| | - Robert C Stewart
- Senior Clinical Research Fellow, Division of Psychiatry, University of Edinburgh, Scotland
| | - Chiwoza Bandawe
- Professor of Clinical Psychology, Department of Psychiatry and Mental Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Genesis Chorwe-Sungani
- Associate Professor, Mental Health Nursing, Department of Psychiatry and Mental Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Olive Liwimbi
- Consultant Psychiatrist, Zomba Mental Hospital, Zomba, Malawi
| | | | - Kazione Kulisewa
- Consultant Psychiatrist, Department of Psychiatry and Mental Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Michael Udedi
- Mental Health Desk Officer, NCDs & Mental Health Unit, Ministry of Health, Lilongwe, Malawi
| | - Saulos Gondwe
- Consultant Psychiatrist, Saint John of God Hospitaller Services, Lilongwe, Malawi
| | - Anthony Sefasi
- Head Mental Health Nursing, Department of Psychiatry and Mental Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Richard Banda
- Mental Health Clinical Officer, Saint John of God Hospitaller Services, Mzuzu, Malawi
| | - Thandiwe Mkandawire
- Clinical Social Worker, Mental Health Users and Carers Association, Blantyre, Malawi
| | - Stephen M Lawrie
- Professor of Psychiatry, Division of Psychiatry, University of Edinburgh, Edinburgh, UK
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Paquin-Goulet M, Krishnadas R, Beattie L. A systematic review of factors prolonging or reducing the duration of untreated psychosis for people with psychosis in low- and middle-income countries. Early Interv Psychiatry 2023; 17:1045-1069. [PMID: 37823582 DOI: 10.1111/eip.13466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/08/2023] [Indexed: 10/13/2023]
Abstract
AIM This review aims to identify factors that may prolong or reduce the duration of untreated psychosis for people with psychosis in low- and middle-income countries. METHODS Electronic searches of six databases were conducted, to find studies from low- and middle-income countries on people with psychotic disorders provided they statistically measured an association between factors that may prolong or reduce the duration of untreated psychosis. Studies were critically appraised and a narrative synthesis exploring differences between and within studies is presented. A socio-ecological model is used to convey the main findings. RESULTS Thirty studies of 16 473 participants in total were included in this review. Taken together participants were 51.5% male and 48.5% female. Various factors potentially associated with longer duration of untreated psychosis for people with psychosis in low- and middle-income countries were found. Examples of these factors are an insidious mode of onset, greater family stigma and low social class. Other factors, such as marital status, educational level, diagnostic type, predominant symptoms and employment status, yielded inconsistent results. CONCLUSIONS The methodological quality of the included studies limits the conclusions of this review. The results indicate an urgent need for further high-quality research in these countries. The socio-ecological model is a helpful framework for clinicians, scholars, and decision-makers to conceptualize factors that may affect the duration of untreated psychosis, highlight gaps in the literature as well as reflect on potential prevention strategies that may ultimately support early intervention services for people with psychosis in developing countries.
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Affiliation(s)
| | | | - Louise Beattie
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Singh SP, Javed A, Thara R, Chadda R, Iyer S, Stefanis N. The WPA Expert International Advisory Panel for Early Intervention in Psychosis in Low- and Middle-Income Countries: an update on recent relevant activities. World Psychiatry 2023; 22:489-490. [PMID: 37713571 PMCID: PMC10503914 DOI: 10.1002/wps.21130] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023] Open
Affiliation(s)
- Swaran P Singh
- Centre for Mental Health and Wellbeing Research, University of Warwick, Warwick, UK
| | - Afzal Javed
- WPA President
- Fountain House, Lahore, Pakistan
| | | | - Rakesh Chadda
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Nikos Stefanis
- National and Kapodistrian University of Athens, Athens, Greece
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Pham TV, Koirala R, Wainberg ML, Kohrt BA. Reassessing the Mental Health Treatment Gap: What Happens if We Include the Impact of Traditional Healing on Mental Illness? Community Ment Health J 2021; 57:777-791. [PMID: 32894398 PMCID: PMC7936992 DOI: 10.1007/s10597-020-00705-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/26/2020] [Indexed: 10/23/2022]
Abstract
In this Fresh Focus, we reassess what the mental health treatment gap may mean if we consider the role of traditional healing. Based on systematic reviews, patients can use traditional healers and qualitatively report improvement from general psychological distress and symptom reduction for common mental disorders. Given these clinical implications, some high-income countries have scaled up research into traditional healing practices, while at the same time in low-and middle-income countries, where the use of traditional healers is nearly ubiquitous, considerably less research funding has studied or capitalized on this phenomena. The World Health Organization 2003-2020 Mental Health Action Plan called for government health programs to include traditional and faith healers as treatment resources to combat the low- and middle-income country treatment gap. Reflection on the work which emerged during the course of this Mental Health Action Plan revealed areas for improvement. As we embark on the next Mental Health Action Plan, we offer lessons-learned for exploring potential relationships and collaborations between traditional healing and biomedicine.
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Affiliation(s)
- Tony V Pham
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2213 Elba Street, Durham, NC, 27705, USA.
- Duke Global Health Institute, 310 Trent Drive, Durham, NC, 27710, USA.
- Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, 44616, Nepal.
| | - Rishav Koirala
- University of Oslo, Problemveien 7, 0315, Oslo, Norway
- Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, 44616, Nepal
- Brain and Neuroscience Center Nepal, Krishna Dhara Marg, Kathmandu, 44600, Nepal
| | - Milton L Wainberg
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, 10032, USA
| | - Brandon A Kohrt
- Duke Global Health Institute, 310 Trent Drive, Durham, NC, 27710, USA
- Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, 44616, Nepal
- George Washington University School of Medicine and Health Sciences, 2120 L Street, NW, Suite 600, Washington, DC, 20037, USA
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Kaminga AC, Myaba J, Dai W, Liu A, Chilale HK, Kubwalo PF, Madula P, Banda R, Pan X, Wen SW. Association between referral source and duration of untreated psychosis in pathways to care among first episode psychosis patients in Northern Malawi. Early Interv Psychiatry 2020; 14:594-605. [PMID: 31657157 PMCID: PMC7496144 DOI: 10.1111/eip.12885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 08/13/2019] [Accepted: 09/26/2019] [Indexed: 12/13/2022]
Abstract
AIMS To examine the association between referral source and duration of untreated psychosis (DUP) and explore determinants of referral source; when adjusting for pathways to care, positive and negative symptoms, diagnosis and socio-demographic characteristics. METHODS A total of 140 subjects with first episode psychosis (FEP) were enrolled from a pilot early intervention service for psychosis in Northern Malawi between June 2009 and September 2012. Logistic regression analyses were used to quantify the associations between variables of interest. RESULTS Age ranged between 18 and 65 at assessment, with median, 33. Median DUP was 12.5 months. First contact did not independently determine DUP. Long DUP (>6 months) was associated with referral from community based volunteer (CBV) or traditional healer (TH), a unit increase in severity of negative symptoms and having schizophrenia, which was also associated with referral from CBV or TH. Additionally, being unemployed was associated with referral from CBV or TH. However, a unit increase in the number of times religious advice (RA) was sought, GP was contacted and severity of positive symptoms was associated with referral by GP. CONCLUSIONS Mental health awareness is justified for this population and collaboration with THs in identifying and treating patients with psychosis may help reduce treatment delays. Access to mental health services ought to improve, particularly for the unemployed group. Future studies should consider adjusting for referral source when ascertaining first contact source as a predictor of DUP.
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Affiliation(s)
- Atipatsa C Kaminga
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.,Department of Mathematics and Statistics, Mzuzu University, Luwinga, Malawi
| | - Japhet Myaba
- Department of Clinical Medicine, Mental Health Research Section, Saint John of God Community Services, Mzuzu, Malawi
| | - Wenjie Dai
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Aizhong Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Harris K Chilale
- Department of Clinical Medicine, Mental Health Research Section, Saint John of God Community Services, Mzuzu, Malawi
| | - Paul F Kubwalo
- Department of Mathematics and Statistics, Mzuzu University, Luwinga, Malawi
| | - Precious Madula
- Department of Communication Studies, Mzuzu University, Mzuzu, Malawi
| | - Richard Banda
- Department of Clinical Medicine, Mental Health Research Section, Saint John of God Community Services, Mzuzu, Malawi
| | - Xiongfeng Pan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Shi W Wen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.,OMNI Research Group, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology, Public Health, and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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