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Galvin M, Byansi W, Chiwaye L, Luvuno Z, Moolla A. Pathways to care among patients with mental illness at two psychiatric facilities in Johannesburg, South Africa. Int J Soc Psychiatry 2023; 69:2059-2067. [PMID: 37477344 DOI: 10.1177/00207640231188037] [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] [Indexed: 07/22/2023]
Abstract
BACKGROUND A patient's pathway to care is often characterized by a sequence of actions taken to remedy ill-health. Research exploring the help-seeking behavior of individuals with mental health problems in sub-Saharan Africa is relatively limited. This study assessed the perceptions and experiences of mental illness and treatment among patients with mental illness at two psychiatric facilities in Johannesburg, South Africa. METHODS 309 interviewer administered surveys were conducted between January and July 2022. We used a logistic regression model to examine factors associated with receiving treatment for mental illnesses from traditional healers. Semi-structured interviews were conducted with 18 participants during the same period. Interviews were transcribed and translated into English. Data were managed using NVivo 11 software and thematically analyzed. FINDINGS Results showed that 144 (47%) patients sought mental health care from traditional healers. Higher anxiety symptoms, number of people in the household, believing that traditional medicine can cure mental illnesses, and township living were associated with seeking mental healthcare from traditional healers. Qualitative analysis indicated that participants often believed that mental illness was due to bewitchment and consulted with multiple traditional healers, thus spending large amounts of money for treatment and ultimately delaying access to biomedical care. CONCLUSION Collaborative approaches between traditional healers and biomedical professionals show promise in terms of allowing for improved identification and treatment of individuals with mental disorders.
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Affiliation(s)
- Michael Galvin
- Department of Psychiatry, Boston Medical Center (BMC), Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Cambridge, MA, USA
- Faculty of Health Sciences, Health Economics and Epidemiology Research Office (HE2 RO), University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - William Byansi
- School of Social Work, Boston College, Chestnut Hill, MA, USA
| | - Lesley Chiwaye
- Faculty of Health Sciences, Health Economics and Epidemiology Research Office (HE RO), University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Zoleka Luvuno
- Faculty of Health Sciences, Health Economics and Epidemiology Research Office (HE RO), University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Aneesa Moolla
- Faculty of Health Sciences, Health Economics and Epidemiology Research Office (HE RO), University of the Witwatersrand, Johannesburg, Gauteng, South Africa
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Christian BIN, Christian NG, Keshinro MI, Olutade-Babatunde O. How to build bridges for Universal Health Coverage in Nigeria by linking formal and informal health providers. BMJ Glob Health 2023; 8:e014165. [PMID: 38007226 PMCID: PMC10680001 DOI: 10.1136/bmjgh-2023-014165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/12/2023] [Indexed: 11/27/2023] Open
Affiliation(s)
| | | | - Maryam I Keshinro
- Department of Paediatrics, State House Medical Centre, Hospital Authority Head Office, Aso Rock, Abuja, Nigeria
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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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Tyagi S, Deopa N, Pardal PK, Charan D, Prakash J. Pathways to the first contact with mental health services among patients with schizophrenia: A cross-sectional observational study. Ind Psychiatry J 2023; 32:348-353. [PMID: 38161450 PMCID: PMC10756626 DOI: 10.4103/ipj.ipj_165_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 03/09/2023] [Accepted: 03/20/2023] [Indexed: 01/03/2024] Open
Abstract
Background Schizophrenia is a mental illness with a profound impact on patient and their caregivers. There is increasing evidence that delay in the commencement of treatment following the onset of illness may be related to the pathways; patients navigate before accessing mental health services. Aim The aim of this study is to assess the pathways of care to the first contact with mental health services among patients with schizophrenia. Methods A total of 150 diagnosed schizophrenia patients aged 12-60 years were recruited as per inclusion and exclusion criteria. The sociodemographic details were gathered using semistructured sociodemographic data sheets; semistructured pathways to care questionnaire and positive and negative syndrome scale for schizophrenia were administered. Results The most common first pathway to care was faith healers. The education of the head of family, socioeconomic status, rural background, and occupational status of patients have a significant impact on the first pathway of psychiatric care. The findings suggest that while planning mental health services, emphasis should be made on collaboration between psychiatric and nonpsychiatric services. Conclusion The pathways patient choose depend on a number of factors like their socio-cultural background, belief about the supernatural causation of psychiatric illness, stigma associated with psychiatric illness, lack of knowledge about the mental illness, and influence of close family relatives on the choice of treatment.
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Affiliation(s)
- Swati Tyagi
- Department of Psychiatry, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
| | - Nikita Deopa
- Department of Psychiatry, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
| | - Pavan K. Pardal
- Department of Psychiatry, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
| | - Deepak Charan
- Department of Psychiatry, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
| | - Jyoti Prakash
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
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Raj S, Das SK, Pattnaik JI, Das R, Das N, Ravan JR. Change in attitude and help-seeking pattern of caregivers and patients with mental disorders in the community - Recent findings from India. J Family Med Prim Care 2022; 11:5194-5198. [PMID: 36505518 PMCID: PMC9730986 DOI: 10.4103/jfmpc.jfmpc_2261_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/10/2022] [Accepted: 02/15/2022] [Indexed: 12/15/2022] Open
Abstract
Knowledge of factors related to patients' and primary caregivers' health-seeking behaviour is required for a complete early intervention for the management of mental illness. Previous research has found that men are more likely to seek care and that a considerable proportion of patients seek help from native healers before obtaining psychiatric help. The goal of this study was to see if there had been any changes in the paths to psychiatric care, as well as the socio-demographic characteristics that were linked to early help-seeking behaviour among patients with mental illnesses in metropolitan eastern India. Method The researchers utilised a cross-sectional study design. A face-to-face interview was used to collect data using the WHO Encounter Form. Using a successive sample technique, patients with various diagnoses of mental illness undergoing Psychiatry outpatient therapy at a tertiary care medical college were included in the study. Results In terms of gender, ladies (53.3%) were seen to use psychiatric services more than males (46.7%) from an urban or semi-urban background. For dissociative disorders, the median time from onset to first contact with a care provider was 0.1 years; 0.3 years for mood episodes; 0.6 years for anxiety disorders; one year for psychotic disorders; and seven years for Substance Use Disorders (SUD). However, interaction with current psychiatric services took an average of six months for dissociation; 3.5 years for mood disorders; three years for anxiety disorders; six years for psychotic disorders; and a maximum of seventeen years for SUD. Participants in the study who had a family history of mental illness sought care more quickly (OR = 4.3, 95 percent CI 1.19 to 7.11, P = 0.03). The fact that 73 percent of patients have a GP or mental health professional as their first point of contact for various mental diseases is good. Higher education status, urban background, dwelling closer to the mental health centre, and having a biological attribution model for psychological illness were the other clinical and demographic characteristics important for quicker paths to mental health treatment. Conclusions In most cases of psychosis and SUD (substance use disorders), there is still a significant delay in receiving modern psychiatric therapy. The number of initial contacts with Native Healers ha s decreased. The majority of people said mental illness was caused by environmental or biological factors. Education and scientific information regarding mental health have aided the process of seeking treatment, and there should be a provision of training programmes for family physicians and community health professionals to facilitate the process of help-seeking behavior of psychiatric patients in the Indian subcontinent.
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Affiliation(s)
- Shirley Raj
- Department of Psychiatry, KIMS, KIIT, Bhubaneswar, Odisha, India
| | | | | | - Ramachandra Das
- Department of Psychiatry, KIMS, KIIT, Bhubaneswar, Odisha, India
| | - Namita Das
- Department of Psychology, Utkal University, Bhubaneswar, Odisha, India
| | - Jayaprakash Russell Ravan
- Department of Psychiatry, KIMS, KIIT, Bhubaneswar, Odisha, India,Address for correspondence: Dr. Jayaprakash Russell Ravan, Department of Psychiatry and Behavioral Sciences, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India. E-mail:
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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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7
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Iheanacho T, Nduanya UC, Slinkard S, Ogidi AG, Patel D, Itanyi IU, Naeem F, Spiegelman D, Ezeanolue EE. Utilizing a church-based platform for mental health interventions: exploring the role of the clergy and the treatment preference of women with depression. Glob Ment Health (Camb) 2021; 8:e5. [PMID: 34026236 PMCID: PMC8127631 DOI: 10.1017/gmh.2021.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/28/2020] [Accepted: 01/17/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Training lay people to deliver mental health interventions in the community can be an effective strategy to mitigate mental health manpower shortages in low- and middle-income countries. The healthy beginning initiative (HBI) is a congregation-based platform that uses this approach to train church-based lay health advisors to conduct mental health screening in community churches and link people to care. This paper explores the potential for a clergy-delivered therapy for mental disorders on the HBI platform and identifies the treatment preferences of women diagnosed with depression. METHODS We conducted focus group discussion and free-listing exercise with 13 catholic clergy in churches that participated in HBI in Enugu, Nigeria. These exercises, guided by the positive, existential, or negative (PEN-3) cultural model, explored their role in HBI, their beliefs about mental disorders, and their willingness to be trained to deliver therapy for mental disorders. We surveyed women diagnosed with depression in the same environment to understand their health-seeking behavior and treatment preferences. The development of the survey was guided by the health belief model. RESULTS The clergy valued their role in HBI, expressed understanding of the bio-psycho-socio-spiritual model of mental disorders, and were willing to be trained to provide therapy for depression. Majority of the women surveyed preferred to receive therapy from trained clergy (92.9%), followed by a psychiatrist (89.3%), and psychologist (85.7%). CONCLUSION These findings support a potential clergy-focused, faith-informed adaptation of therapy for common mental disorders anchored in community churches to increase access to treatment in a resource-limited setting.
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Affiliation(s)
| | - Ujunwa Callista Nduanya
- Center for Translation and Implementation Research, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Department of Psychiatry, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | | | - Amaka Grace Ogidi
- Center for Translation and Implementation Research, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Dina Patel
- Healthy Sunrise Foundation, Las Vegas, NV, USA
| | - Ijeoma Uchenna Itanyi
- Center for Translation and Implementation Research, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Department of Community Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | | | | | - Echezona E. Ezeanolue
- Center for Translation and Implementation Research, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Healthy Sunrise Foundation, Las Vegas, NV, USA
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Lilford P, Wickramaseckara Rajapakshe OB, Singh SP. A systematic review of care pathways for psychosis in low-and middle-income countries. Asian J Psychiatr 2020; 54:102237. [PMID: 33271678 DOI: 10.1016/j.ajp.2020.102237] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/14/2020] [Indexed: 11/29/2022]
Abstract
Pathways to care for psychosis in high-income countries have been well studied, with the finding of an association between longer duration of untreated psychosis (DUP) and poorer outcomes focusing interest on care pathways to minimise treatment delay. Little is known about how people with psychosis in low-to middle-income countries (LMIC) present for help and specific care pathways that might be associated with treatment delays in those contexts. We conducted a systematic review using electronic databases (MEDLINE, PsychINFO, Embase, Ovid) to explore what proportion of patients with psychosis in LMIC are accessing care through traditional healers and whether this is associated with treatment delay. Studies were included if they assessed the pathway to care for participants with a psychotic illness in a LMIC. From 3929 results, 15 studies met our inclusion criteria. In 7 out of 15 studies first contact for the majority of patients were traditional health practitioners (THPs). In 5 out of 15 studies, mental health practitioners (MHPs) were most often the initial care pathway and in 3 studies first contact was with primary care. DUP ranged from a mean of 30 weeks to 225 weeks. Accessing THPs as initial contact was associated with a longer DUP. In LMICs, a large proportion of patients use THP as their first point of contact for accessing care. This is associated with longer DUP. Services in these countries need to focus both on raising public awareness and collaborative working with THPs to facilitate access to biomedical care.
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Affiliation(s)
- Philippa Lilford
- Severn Postgraduate Medical Education School of Psychiatry, United Kingdom.
| | | | - Swaran Preet Singh
- Mental Health & Wellbeing, Warwick Medical School, United Kingdom; National Institute for Health Research (NIHR), United Kingdom
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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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10
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Khiari H, Ouali U, Zgueb Y, Mrabet A, Nacef F. Pathways to mental health care for patients with severe mental illness in Tunisia. Pan Afr Med J 2019; 34:118. [PMID: 31934259 PMCID: PMC6945374 DOI: 10.11604/pamj.2019.34.118.19661] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/05/2019] [Indexed: 11/11/2022] Open
Abstract
Introduction Schizophrenia, bipolar disorder and schizoaffective disorders are severe mental illnesses (SMI) associated with high levels of co-morbid psychopathology and premature mortality. Reducing delays in accessing services and providing early intervention are key strategies in preventing morbidity and mortality associated with these diseases. The pathways to psychiatric care have been studied in many countries worldwide. To the best of our knowledge, no study on this subject has so far been conducted in Tunisia. The purpose of the present study was to understand the pathways of care adopted by patients, to determine the care delay and to explore the relationship between delayed consultation and socio-demographic and clinical variables. Methods This is a cross-sectional descriptive study conducted at the Department Psychiatry A of Razi Hospital including patients with SMI consulting the outpatient clinic between January and March 2018. Data was collected by one medical investigator who conducted face-to-face interviews with patients using a questionnaire based on the World Health Organization's "Pathway Questionnaire". Data analysis was done using the SPSS software version 17. A multivariate analysis was performed to study the relation between delayed consultation and socio-demographic and clinical variables. Results A total of 232 patients responded to the questionnaire. The average age was 41.3 years ± 10.1 and the gender ratio was 1.2. More than the third of the study population consulted a traditional healer in the first place and sixty percent of the patients had recourse to a medical doctor. The average consultation delay was 15 months (±23.0) with a median of 6 months. The delay was more than 6 months in around half of the cases. The symptoms that motivated the first consultation were hallucinations, sleep disorders and aggressive behavior. The main reason of delayed consultation was lack of knowledge about psychiatric symptoms followed by illness beliefs and insidious onset of the illness. The multivariate analysis showed a significant relationship between aggressive behavior and non-delayed consultation. Conclusion The principal recommendations are to strengthen public education and awareness about SMI in the Tunisian population and to implement an early detection program of these disorders.
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Affiliation(s)
- Houyem Khiari
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.,Preventive Medicine Department, Tunis, Tunisia
| | - Uta Ouali
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.,Department Psychiatry A, Razi Hospital, Tunis, Tunisia
| | - Yosra Zgueb
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.,Department Psychiatry A, Razi Hospital, Tunis, Tunisia
| | - Ali Mrabet
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.,Preventive Medicine Department, Tunis, Tunisia.,Health Military Directorate, Bab Saadoun, Tunis, Tunisia
| | - Fethi Nacef
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.,Health Military Directorate, Bab Saadoun, Tunis, Tunisia
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Badu E, Mitchell R, O'Brien AP. Pathways to mental health treatment in Ghana: Challenging biomedical methods from herbal- and faith-healing perspectives. Int J Soc Psychiatry 2019; 65:527-538. [PMID: 31277557 DOI: 10.1177/0020764019862305] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The clinical pathways for treating mental illness have received global attention. Several empirical studies have been undertaken on treatment pathways in Ghana. No study, however, has systematically reviewed the literature related to the pathways of mental health treatment in Ghana. AIM This article aims to identify the pathways used to treat mental illnesses; examine the evidence about the possibility of collaboration between biomedical, faith and traditional healing pathways; and draw attention to the barriers hindering such collaboration. METHODS A search of the published literature was conducted using Medline, Embase, PsycINFO, CINAHL (EBSCO), Web of Science and Scopus databases. The search was limited to the articles that were published in English and released between 2000 and June 2018. The review synthesises both qualitative and quantitative data. RESULTS The findings showed that mental illnesses in Ghana are treated using a mixture of biomedical and faith-based and traditional healing services. Faith and traditional healing pathways are typically used as a preliminary source of cultural assessment before seeking biomedical treatment. There is an increasing desire for collaboration between biomedical, faith and traditional healing pathways. However, several individual factors (attitude or stigma, the perceived efficacy of treatment and differences in the treatment process) and health system factors (a lack of policy and regulation, a limited number of biomedical service providers, limited financial support and geographical isolation of services) jointly contribute to barriers precluding establishing such collaboration. CONCLUSION This review recommends that policies, regulations, educational support and financial incentives should be developed to facilitate collaboration between biomedical, faith and traditional healing service provision.
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Affiliation(s)
- Eric Badu
- 1 School of Nursing and Midwifery, The University of Newcastle, Callaghan, NSW, Australia
| | - Rebecca Mitchell
- 2 Faculty of Business and Economics, Macquarie University, Sydney, NSW, Australia
| | - Anthony Paul O'Brien
- 3 Faculty of Health and Medicine, School of Nursing and Midwifery, The University of Newcastle, Callaghan, NSW, Australia
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Vermeiden M, Janssens M, Thewissen V, Akinsola E, Peeters S, Reijnders J, Jacobs N, van Os J, Lataster J. Cultural differences in positive psychotic experiences assessed with the Community Assessment of Psychic Experiences-42 (CAPE-42): a comparison of student populations in the Netherlands, Nigeria and Norway. BMC Psychiatry 2019; 19:244. [PMID: 31387566 PMCID: PMC6685165 DOI: 10.1186/s12888-019-2210-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 07/11/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Previous studies have suggested that culture impacts the experience of psychosis. The current study set out to extend these findings by examining cultural variation in subclinical positive psychotic experiences in students from The Netherlands, Nigeria, and Norway. Positive psychotic experiences were hypothesized to (i) be more frequently endorsed by, and (ii) cause less distress in Nigerian vs. Dutch and Norwegian students. METHODS Psychology students, aged 18 to 30 years, from universities in the Netherlands (n = 245), Nigeria (n = 478), and Norway (n = 162) were assessed cross-sectionally with regard to the frequency of subclinical positive psychotic experiences and related distress, using the Community Assessment of Psychic Experiences (CAPE-42). Multi-group confirmatory factor analysis and multivariate analysis of covariance were performed to assess measurement invariance of the positive symptom dimension (CAPE-Pos) and compare mean frequency and associated distress of positive psychotic experiences across study samples. RESULTS Only CAPE-Pos items pertaining to the dimensions 'strange experiences' and 'paranoia' met assumptions for (partial) measurement invariance. Frequencies of these experiences were higher in the Nigerian sample, compared to both the Dutch and Norwegian samples, which were similar. In addition, levels of experience-related distress were similar or higher in the Nigerian sample compared to respectively the Dutch and Norwegian samples. CONCLUSION Although positive psychotic experiences may be more commonly endorsed in non-Western societies, our findings do not support the notion that they represent a more benign, and hence less distressing aspect of human experience. Rather, the experience of psychotic phenomena may be just as, if not more, distressing in African than in European culture. However, observed differences in CAPE-Pos frequency and distress between samples from different cultural settings may partly reflect differences in the measure rather than in the latent trait. Future studies may therefore consider further cross-cultural adaptation of CAPE-42, in addition to explicitly examining cultural acceptance of psychotic phenomena, and environmental and other known risk factors for psychosis, when comparing and interpreting subclinical psychotic phenomena across cultural groups.
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Affiliation(s)
- Margriet Vermeiden
- Faculty of Psychology and Educational Sciences, Open University, Valkenburgerweg 177, Heerlen, 6419 AT The Netherlands
| | - Mayke Janssens
- Faculty of Psychology and Educational Sciences, Open University, Valkenburgerweg 177, Heerlen, 6419 AT The Netherlands
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Viviane Thewissen
- Faculty of Psychology and Educational Sciences, Open University, Valkenburgerweg 177, Heerlen, 6419 AT The Netherlands
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Esther Akinsola
- Department of Psychology, Faculty of Social Sciences, University of Lagos, Akoka, Lagos Nigeria
| | - Sanne Peeters
- Faculty of Psychology and Educational Sciences, Open University, Valkenburgerweg 177, Heerlen, 6419 AT The Netherlands
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jennifer Reijnders
- Faculty of Psychology and Educational Sciences, Open University, Valkenburgerweg 177, Heerlen, 6419 AT The Netherlands
| | - Nele Jacobs
- Faculty of Psychology and Educational Sciences, Open University, Valkenburgerweg 177, Heerlen, 6419 AT The Netherlands
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Psychosis Studies, Institute of Psychiatry, psychology and Neuroscience, King’s College, London, UK
| | - Johan Lataster
- Faculty of Psychology and Educational Sciences, Open University, Valkenburgerweg 177, Heerlen, 6419 AT The Netherlands
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
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Kaiser BN, Ticao C, Anoje C, Minto J, Boglosa J, Kohrt BA. Adapting culturally appropriate mental health screening tools for use among conflict-affected and other vulnerable adolescents in Nigeria. Glob Ment Health (Camb) 2019; 6:e10. [PMID: 31258924 PMCID: PMC6582460 DOI: 10.1017/gmh.2019.8] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 04/19/2019] [Accepted: 05/13/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The Boko Haram insurgency has brought turmoil and instability to Nigeria, generating a large number of internally displaced people and adding to the country's 17.5 million orphans and vulnerable children. Recently, steps have been taken to improve the mental healthcare infrastructure in Nigeria, including revamping national policies and initiating training of primary care providers in mental healthcare. In order for these efforts to succeed, they require means for community-based detection and linkage to care. A major gap preventing such efforts is the shortage of culturally appropriate, valid screening tools for identifying emotional and behavioral disorders among adolescents. In particular, studies have not conducted simultaneous validation of screening tools in multiple languages, to support screening and detection efforts in linguistically diverse populations. We aim to culturally adapt screening tools for emotional and behavioral disorders for use among adolescents in Nigeria, in order to facilitate future validation studies. METHODS We used a rigorous mixed-method process to culturally adapt the Depression Self Rating Scale, Child PTSD Symptom Scale, and Disruptive Behavior Disorders Rating Scale. We employed expert translations, focus group discussions (N = 24), and piloting with cognitive interviewing (N = 24) to achieve semantic, content, technical, and criterion equivalence of screening tool items. RESULTS We identified and adapted items that were conceptually difficult for adolescents to understand, conceptually non-equivalent across languages, considered unacceptable to discuss, or stigmatizing. Findings regarding problematic items largely align with existing literature regarding cross-cultural adaptation. CONCLUSIONS Culturally adapting screening tools represents a vital first step toward improving community case detection.
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Affiliation(s)
- B. N. Kaiser
- Department of Anthropology, University of California San Diego, La Jolla, CA, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | | | - C. Anoje
- Catholic Relief Services, Abuja, Nigeria
| | | | | | - B. A. Kohrt
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
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Veling W, Burns JK, Makhathini EM, Mtshemla S, Nene S, Shabalala S, Mbatha N, Tomita A, Baumgartner J, Susser I, Hoek HW, Susser E. Identification of patients with recent-onset psychosis in KwaZulu Natal, South Africa: a pilot study with traditional health practitioners and diagnostic instruments. Soc Psychiatry Psychiatr Epidemiol 2019; 54:303-312. [PMID: 30413848 PMCID: PMC6440845 DOI: 10.1007/s00127-018-1623-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 10/30/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE There is considerable variation in epidemiology and clinical course of psychotic disorders across social and geographical contexts. To date, very little data are available from low- and middle-income countries. In sub-Saharan Africa, most people with psychoses remain undetected and untreated, partly due to lack of formal health care services. This study in rural South Africa aimed to investigate if it is possible to identify individuals with recent-onset psychosis in collaboration with traditional health practitioners (THPs). METHODS We developed a strategy to engage with THPs. Fifty THPs agreed to collaborate and were asked to refer help-seeking clients with recent-onset psychosis to the study. At referral, the THPs rated probability of psychosis ("maybe disturbed" or "disturbed"). A two-step diagnostic procedure was conducted, including the self-report Community Assessment of Psychic Experiences (CAPE) as screening instrument, and a semi-structured interview using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Accuracy of THP referrals, and test characteristics of the THP rating and the CAPE were calculated. RESULTS 149 help-seeking clients were referred by THPs, of which 44 (29.5%) received a SCAN DSM-IV diagnosis of psychotic disorder. The positive predictive value of a THP "disturbed" rating was 53.8%. Test characteristics of the CAPE were poor. CONCLUSION THPs were open to identifying and referring individuals with possible psychosis. They recognized "being disturbed" as a condition for which collaboration with formal psychiatric services might be beneficial. By contrast, the CAPE performed poorly as a screening instrument. Collaboration with THPs is a promising approach to improve detection of individuals with recent-onset psychosis in rural South Africa.
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Affiliation(s)
- W Veling
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - J K Burns
- University of Exeter, Exeter, UK
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - E M Makhathini
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - S Mtshemla
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - S Nene
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Health Economics and HIV/AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - S Shabalala
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - N Mbatha
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - A Tomita
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - J Baumgartner
- Duke Global Health Institute, Duke University, Durham, USA
| | - I Susser
- Department of Anthropology, Hunter College and Graduate Center, City University of New York, New York, USA
- Department of Socio-Medical Sciences, Mailman School of Public Health, Columbia University, New York, USA
| | - H W Hoek
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
- Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - E 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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15
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James PB, Wardle J, Steel A, Adams J. Traditional, complementary and alternative medicine use in Sub-Saharan Africa: a systematic review. BMJ Glob Health 2018; 3:e000895. [PMID: 30483405 PMCID: PMC6231111 DOI: 10.1136/bmjgh-2018-000895] [Citation(s) in RCA: 171] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 08/26/2018] [Accepted: 08/27/2018] [Indexed: 12/31/2022] Open
Abstract
Background The WHO estimates that a considerable number of people in Sub-Saharan Africa (SSA) rely on traditional, complementary and alternative medicine (TCAM) to meet their primary healthcare needs, yet there remains a dearth of research evidence on the overall picture of TCAM utilisation in the region. Methods We conducted a literature search of original articles examining TCAM use in SSA between 1 January 2006 and 28 February 2017, employing Medline, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Scopus, ProQuest, PubMed, Embase and African Journals Online databases. A critical appraisal of relevant articles reporting a quantitative or mixed-method design was undertaken. Results Despite the heterogeneity and general low quality of the identified literature, the review highlights a relatively high use of TCAM alone or in combination with orthodox medicine, in both general population and in specific health conditions in SSA. TCAM users compared with non-TCAM users are more likely to be of low socioeconomic and educational status, while there were inconsistencies in age, sex, spatial location and religious affiliation between TCAM users and non-TCAM users. Most TCAM users (55.8%–100%) in SSA fail to disclose TCAM use to their healthcare providers, with the main reasons for non-disclosure being fear of receiving improper care, healthcare providers’ negative attitude and a lack of enquiry about TCAM use from healthcare providers. Conclusion TCAM use in SSA is significant, although most studies emerge from a few countries. Factors associated with TCAM use in SSA are similar to those observed in other regions, but further research may be required to further elucidate challenges and opportunities related to TCAM use specific to SSA.
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Affiliation(s)
- Peter Bai James
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Jon Wardle
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Amie Steel
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- Office of Research, Endeavour College of Natural Health, Brisbane, Queensland, Australia
| | - Jon Adams
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Iheanacho T, Stefanovics E, Ezeanolue EE. Clergy's Beliefs About Mental Illness and Their Perception of Its Treatability: Experience from a Church-Based Prevention of Mother-to-Child HIV Transmission (PMTCT) Trial in Nigeria. JOURNAL OF RELIGION AND HEALTH 2018; 57:1483-1496. [PMID: 29335920 DOI: 10.1007/s10943-017-0545-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Clergy participating in the Healthy Beginning Initiative (N = 45), a program utilizing church workers to integrate packages of care into church activities, completed a 43-item self-administered questionnaire assessing their attitudes and beliefs about mental disorders and perception of their treatability. A majority believed that drug/alcohol use, stress and genetic inheritance could cause mental illness and that society needed to adopt more tolerant attitude toward people with mental disorders. Clergy with contact with people with mental disorders were more likely to perceive depression as treatable. In conclusion, participants had positive attitudes toward mental disorders with some believing that they are treatable.
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Affiliation(s)
- Theddeus Iheanacho
- Department of Psychiatry, Yale University School of Medicine, 300 George St., Suite 901, New Haven, CT, 06511, USA.
| | - Elina Stefanovics
- Department of Psychiatry, Yale University School of Medicine, 300 George St., Suite 901, New Haven, CT, 06511, USA
| | - Echezona E Ezeanolue
- HealthySunrise Foundation, 8752 Castle Ridge Ave, Las Vegas, NV, 89129, USA
- University of Nevada School of Medicine, 2040 W. Charleston Blvd. Suite 402, Las Vegas, NV, 89102, USA
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Ibironke Thomas F, Osasu Olotu S, Ohiole Omoaregba J. Prevalence, factors and reasons associated with missed first appointments among out-patients with schizophrenia at the Federal Neuro-Psychiatric Hospital, Benin City. BJPsych Open 2018; 4:49-54. [PMID: 29971144 PMCID: PMC6020260 DOI: 10.1192/bjo.2017.11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 12/03/2017] [Accepted: 12/08/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Non-attendance to clinic appointments is associated with poorer treatment outcomes. There is a dearth of information about missed first clinic appointments among patients with schizophrenia in Nigeria. AIMS To determine the prevalence, correlates and reasons for missed first appointment among out-patients with schizophrenia at the Federal Neuro-Psychiatric Hospital, Benin City, Nigeria. METHOD A cross-sectional descriptive study among 275 out-patients with schizophrenia, using the Mini International Neuro-Psychiatric Interview and the Brief Psychiatric Rating Scale. RESULTS The prevalence of missed first appointment was 31%. Higher BPRS score was associated with missing the appointment. The main reasons for missed appointments were: forgetting the appointment date and patient's refusal to come to the clinic. CONCLUSIONS Missed first out-patient clinic appointment is common among patients with schizophrenia at the study site, forgetting appointment dates being a common reason. Among other recommendations, methods of reminding patients and caregivers of appointment dates at the study location may need to be explored. DECLARATION OF INTEREST None.
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Affiliation(s)
- Felicia Ibironke Thomas
- Senior Registrar, Department of Clinical Services, Federal Neuro-Psychiatric Hospital, Benin-City, Edo State, Nigeria
| | - Sunday Osasu Olotu
- Consultant Psychiatrist, Department of Clinical Services, Federal Neuro-Psychiatric Hospital, Benin-City, Edo State, Nigeria
| | - Joyce Ohiole Omoaregba
- Consultant Psychiatrist, Department of Clinical Services, Federal Neuro-Psychiatric Hospital, Benin-City, Edo State, Nigeria
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Yalvaç HD, Mutlu EA, Kotan Z, Özer İ, Karslıoğlu EH, Çayköylü A. Explanatory Models of Illness, Help Seeking Behaviours and Related Factors in Patients with Schizophrenia: A Comparative Study from Two Different Provinces of Turkey. Community Ment Health J 2017; 53:951-957. [PMID: 27900651 DOI: 10.1007/s10597-016-0074-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 11/24/2016] [Indexed: 11/26/2022]
Abstract
This study aims to identify the help seeking behaviours of patients from two geographically distinct provinces of Turkey. A questionnaire about sociodemographic characteristics and help seeking ways was applied to 49 schizophrenia patients from Van, 99 from Ankara. The ratio of patients seeking psychiatric help at the beginning of their illness was 76% in Ankara, the capital city, in contrast to 54% in Van (p = 0.01). Twenty-two percent of patients from Ankara and 69% from Van reported that non-psychiatric help seeking was the choice of their families (p < 0.001). Thirty-five percent of all patients sought religious support when their symptoms started. Patients with lower education levels sought more religious help (p = 0.002). Help seeking behaviours show regional variations. Religious help seeking behaviour is a major way of dealing with the illness. Psychoeducation is a crucial need both for patients and families.
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Affiliation(s)
- Hayriye Dilek Yalvaç
- Psychiatry Department, Dr. AY Ankara Oncology Training and Research Hospital, Ankara, Turkey.
| | | | - Zeynep Kotan
- Psychiatry Department, Dr. AY Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - İbrahim Özer
- Psychiatry Department, Dr. AY Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Ersin Hatice Karslıoğlu
- Psychiatry Department, Dr. AY Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Ali Çayköylü
- Department of Psychiatry, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
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Igberase O, Okogbenin E. Beliefs About the Cause of Schizophrenia Among Caregivers in Midwestern Nigeria. Ment Illn 2017; 9:6983. [PMID: 28748057 PMCID: PMC5509959 DOI: 10.4081/mi.2017.6983] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 03/24/2017] [Accepted: 03/24/2017] [Indexed: 11/22/2022] Open
Abstract
Schizophrenia is a devastating illness with a chronic and relapsing course. While Western countries may endorse, biological and psychosocial causes more commonly than supernatural causes, non-western cultures like Nigeria in contrast, tend to endorse supernatural causes. Belief in supernatural causes has been reported to have consequences for treatment seeking behavior. This study aimed to examine the causes of schizophrenia reported by family members of outpatients with schizophrenia in a neuropsychiatric hospital in Midwestern Nigeria. In this study, we recruited a convenient sample of 200 consecutive caregivers of patients visiting the outpatient department of the Psychiatric Hospital, Benin City, Nigeria. These primary caregivers were unpaid relatives who provided support to patients. The patients were service users who fulfilled the diagnostic criteria of the International Classification of Disease [ICD-10; World Health Organization 1993] for schizophrenia and had been on treatment for at least two years. Majority (72.0%) of caregivers endorsed supernatural causes as most important in the etiology of schizophrenia, while 28.0% endorsed natural causes. Every participant without formal education endorsed supernatural attribution. In our study, it was evident that participants embraced multiple causal attributions for schizophrenia.
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Affiliation(s)
- Osayi Igberase
- Shepherd Hospital and Fertility Center, Warri, Delta State
| | - Esther Okogbenin
- Department of Psychiatry, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
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20
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Ibrahim A, Hor S, Bahar OS, Dwomoh D, McKay MM, Esena RK, Agyeponge IA. Pathways to psychiatric care for mental disorders: a retrospective study of patients seeking mental health services at a public psychiatric facility in Ghana. Int J Ment Health Syst 2016; 10:63. [PMID: 27729938 PMCID: PMC5048657 DOI: 10.1186/s13033-016-0095-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 09/23/2016] [Indexed: 11/12/2022] Open
Abstract
Background The process to seek for care by patients who experience episodes of mental disorders may determine how and where they receive the needed treatment. This study aimed to understand the pathways that people with mental disorders traversed for psychiatric services, particularly where these individuals will first seek treatment and the factors that influence such pathways to mental health care. Methods A cross-sectional study conducted at Pantang psychiatric hospital in Accra, Ghana involving 107 patients of ages 18 and older and their family members. The study adapted the World Health Organization’s (WHO) pathway encounter form to collect information about patients’ pathway contacts for psychiatric care. Chi Square test was done to determine patients’ first point of contact and any association between the independent variables (clinical diagnosis and socio-demographic factors) and first pathway contact. Multiple regression analyses were also done to estimate the odds of patients’ first pathway contact. Results Overall, nearly 48 % of patients initially contacted non-psychiatric treatment centers (faith-based, traditional healers and general medical practitioners) as their first point of contact for treatment of mental disorders. A little more than half of the patients went directly to the formal public psychiatric facility as their first point of contact for care of their mental disorders. Patients’ occupation was significantly associated with their first point of contact for psychiatric care (χ2 = 6.91; p < 0.033). Those with secondary education were less likely to initially seek care from the formal public psychiatric hospital compared to those with no formal education (uOR = 0.86; 95 % CI 0.18–4.08). Conclusion Patients used different pathways to seek psychiatric care, namely direct pathway to a psychiatric hospital or through transition from informal non-psychiatric service providers. Since nearly half of patients do not initially seek mental health care directly at the formal psychiatric facility, it is important for the government of Ghana to increase funding to the mental health authorities in Ghana as a matter of priority so that more individuals can be identified and integrated into mainstream psychiatric treatment and general health facilities where there are trained Community Mental Health Officers (CMHO) and Clinical Psychiatric Officers (CPO) to provide early intervention and treatment.
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Affiliation(s)
- Abdallah Ibrahim
- School of Public Health, University of Ghana, P.O. Box LG13, Accra, Ghana
| | - Sidua Hor
- Catholic Relief Services, RT 70 Gumani Residential Area, Tamale, Ghana
| | - Ozge S Bahar
- Silver School of Social Work, New York University, New York, NY 10003 USA
| | - Duah Dwomoh
- School of Public Health, University of Ghana, P.O. Box LG13, Accra, Ghana
| | - Mary M McKay
- Silver School of Social Work, New York University, New York, NY 10003 USA ; The Brown School, Washington University in St. Louis, St. Louis, MO 63130 USA
| | - Reuben K Esena
- School of Public Health, University of Ghana, P.O. Box LG13, Accra, Ghana
| | - Irene A Agyeponge
- School of Public Health, University of Ghana, P.O. Box LG13, Accra, Ghana ; Ghana Health Service, Private Mail Bag, Ministries, Accra, Ghana
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Ikwuka U, Galbraith N, Manktelow K, Chen-Wilson J, Oyebode F, Muomah RC, Igboaka A. Pathways to mental healthcare in south-eastern Nigeria. Transcult Psychiatry 2016; 53:574-94. [PMID: 27460986 DOI: 10.1177/1363461516660903] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In sub-Saharan Africa, traditional and faith healers provide competing services alongside biomedical professionals. This may be associated with delays in reaching specialised mental health services, and hence with longer duration of untreated illness. As first line care constitutes a crucial stage in accessing of psychiatric care, investigating pathways to mental healthcare can highlight help-seeking choices. This study explored the pathways to care for mental illness preferred by a non-clinical sample of the population in south-eastern Nigeria. Multistage sampling was used to select participants (N = 706) who completed questionnaires on help-seeking. Results showed a significant preference for biomedical (90.8%) compared to spiritual (57.8%) and traditional (33.2%) pathways. Higher education predicted preference for the biomedical model, while low education was associated with traditional and spiritual pathways. Protestants preferred the spiritual pathway more than did Catholics. The use of biomedical care is potentially undermined by poor mental health infrastructure, a lack of fit between the culture of biomedical care and the deep-seated cultural/religious worldviews of the people, stigma surrounding mental illness, and the likelihood of a social desirability bias in responses. A complementary model of care is proposed.
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22
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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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Mayston R, Lazarus A, Patel V, Abas M, Korgaonkar P, Paranjape R, Rodrigues S, Prince M. Pathways to HIV testing and care in Goa, India: exploring psychosocial barriers and facilitators using mixed methods. BMC Public Health 2016; 16:765. [PMID: 27516106 PMCID: PMC4982414 DOI: 10.1186/s12889-016-3456-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 08/05/2016] [Indexed: 01/12/2023] Open
Abstract
Background Despite recognition of the importance of timely presentation to HIV care, research on pathways to care is lacking. The adverse impact of depression upon adherence to antiretroviral therapy is established. There is emerging evidence to suggest depression may inhibit initial engagement with care. However, the effect of depression and other psychosocial factors upon the pathway to care is unknown. Methods We used mixed methods to explore pathways to care of people accessing testing and treatment in Goa, India. Questionnaires including measures of common mental disorder, hazardous alcohol use, cognition and assessment of pathways to care (motivations for testing, time since they were first aware of this reason for testing, whether they had been advised to test, who had given this advice, time elapsed since this advice was given) were administered to 1934 participants at the time of HIV testing. Qualitative interviews were carried out with 15 study participants who attended the antiretroviral therapy treatment centre. Interview topic guides were designed to elicit responses that discussed barriers and facilitators of accessing testing and care. Results Pathways were often long and complex. Quantitative findings revealed that Common Mental Disorder was associated with delayed testing when advised by a Doctor (the most common pathway to testing) (AOR = 6.18, 2.16–17.70). Qualitative results showed that triggers for testing (symptoms believed to be due to HIV, and for women, illness or death of their husband) suggested that poor health, rather than awareness of risk was a key stimulus for testing. The period immediately before and after diagnosis was characterised by distress and fear. Stigma was a prominent backdrop to narratives. However, once participants had made contact with care and support (HIV services and non-governmental organisations), these systems were often effective in alleviating fear and promoting confidence in treatment and self-efficacy. Conclusion The effectiveness of formal and informal systems of support around the time of diagnosis in supporting people with mental disorder is unclear. Ways of enhancing these systems should be explored, with the aim of achieving timely presentation at HIV care for all those diagnosed with the disease.
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Affiliation(s)
- Rosie Mayston
- Health Service & Population Research Department, Kings College London, London, SE5 8AF, UK.
| | - Anisha Lazarus
- Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Vikram Patel
- Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK.,Sangath, H No 451 (168), Bhatkar Waddo, Socorro, Porvorim, Bardez, Goa, 403501, India
| | - Melanie Abas
- Health Service & Population Research Department, Kings College London, London, SE5 8AF, UK
| | - Priya Korgaonkar
- Sangath, H No 451 (168), Bhatkar Waddo, Socorro, Porvorim, Bardez, Goa, 403501, India
| | - Ramesh Paranjape
- National AIDS Research Institute, 73, 'G'-Block, MIDC, Bhosari, Pune, 411 026, India
| | - Savio Rodrigues
- Department of Microbiology, Goa Medical College and Hospital, Bambolim, Tiswadi, Goa, India
| | - Martin Prince
- Health Service & Population Research Department, Kings College London, London, SE5 8AF, UK
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Taborda Zapata E, Montoya Gonzalez LE, Gómez Sierra NM, Arteaga Morales LM, Correa Rico OA. [Integrated management of patients with schizophrenia: beyond psychotropic drugs]. REVISTA COLOMBIANA DE PSIQUIATRIA 2016; 45:118-123. [PMID: 27132761 DOI: 10.1016/j.rcp.2015.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 06/25/2015] [Accepted: 07/06/2015] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Schizophrenia is a complex disease with severe functional repercussions; therefore it merits treatment which goes beyond drugs. THEME DEVELOPMENT It requires an approach that considers a diathesis-stress process that includes rehabilitation, psychotherapeutic strategies for persistent cognitive, negative and psychotic symptoms, psychoeducation of patient and communities, community adaptation strategies, such as the introduction to the work force, and the community model, such as a change in the asylum paradigm. DISCUSSION It is necessary to establish private and public initiatives for the integrated care of schizophrenia in the country, advocating the well-being of those with the disease. CONCLUSIONS The integrated management of schizophrenic patients requires a global view of the patient and his/her disease, and its development is essential.
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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: 94] [Impact Index Per Article: 10.4] [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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Uwakwe R, Otakpor A. Public Mental Health - Using the Mental Health Gap Action Program to Put all Hands to the Pumps. Front Public Health 2014; 2:33. [PMID: 24795874 PMCID: PMC4000990 DOI: 10.3389/fpubh.2014.00033] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 03/31/2014] [Indexed: 11/19/2022] Open
Abstract
Although mental ill health constitutes a huge portion of the Global Burden of Disease (GBD), the majority of people with mental health problems do not receive any treatment, a scenario much worse in developing countries where mental health personnel are in gross short supply. The mhGAP was launched to address this gap, especially by training non-mental health professionals to deliver effective services for selected priority mental health problems. Especially in developing countries, many people with mental health problems consult traditional healers either as a first step in the pathway to biomedical mental health care or as the sole mental health service providers. Bridging the gap between mental health needs and available services in developing countries needs to incorporate traditional healers, who are ubiquitously available, easily accessible, and acceptable to the natives. Even though there are barriers in forging collaborations between traditional and biomedical mental health care providers, with mutual respect, understanding, and adapted training using the mhGAP intervention guide, it should be possible to get some traditional healers to understand the core principles of some priority mental health problems identification, treatment, and referral.
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Affiliation(s)
- Richard Uwakwe
- Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nigeria
| | - Alex Otakpor
- Department of Mental Health, University of Benin, Benin City, Nigeria
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