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Limbu S, Nepal S, Mishra SK. Duration of untreated psychosis and its associated sociodemographic and clinical factors in first-episode psychosis: A study from Eastern Nepal. Int J Psychiatry Med 2024:912174241247611. [PMID: 38621675 DOI: 10.1177/00912174241247611] [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] [Indexed: 04/17/2024]
Abstract
OBJECTIVE Duration of untreated psychosis (DUP) is considered an important factor in outcome. Individual, familial and illness factors may prolong DUP. Little data on this issue is available from the country of Nepal. The purpose of the present study was to assess DUP in patients with first-episode psychosis and identify associations with patients' socio-demographic and clinical factors. METHODS A cross-sectional, descriptive study was conducted in the department of psychiatry, of Tertiary Hospital in the Eastern part of Nepal. Eighty-six patients were enrolled. ICD-10 was used to make the diagnosis. Nottingham Onset Schedule-DUP version (NOS-DUP) was used to assess DUP. Positive and Negative Syndrome Scale (PANSS) was used to assess patients' clinical symptoms. RESULTS The mean (SD) DUP was 21.4 (42.1) months and median DUP was 3.0 months (IQR = 23.5). Participants from mountainous region, the unemployed, having an insidious onset of illness, and patients with a diagnosis of schizophrenia had significantly longer DUP (P < .005). Duration of untreated psychosis was also positively correlated with negative symptoms (r = .42, (P < .001) and total PANSS score (r = .42, P < .001). CONCLUSION Duration of untreated psychosis in first-episode psychotic patients was relatively long (compared to studies in other countries), and was found to be positively associated with mountainous regions of Nepal, being unemployed, having an insidious onset of illness, and having a diagnosis of schizophrenia. Programs and educational efforts are needed to ensure early treatment of patients with first-episode psychosis, especially in the mountainous rural areas of Nepal.
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Affiliation(s)
- Suren Limbu
- Department of Psychiatry, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Suraj Nepal
- Department of Psychiatry, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Sanjeev Kumar Mishra
- Department of Psychiatry, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
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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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3
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Takizawa N, Melle I, Barrett EA, Nerhus M, Ottesen AA. The Influence of Mental Health Literacy, Migration, and Education on the Duration of Untreated Psychosis. Front Public Health 2021; 9:705397. [PMID: 34368068 PMCID: PMC8342803 DOI: 10.3389/fpubh.2021.705397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/28/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Duration of untreated psychosis (DUP) is associated with outcome in psychotic disorders and influenced by contextual factors such as immigration. Here we aimed to investigate the effect of mental health literacy (MHL) on duration of untreated psychosis considering the influence of migration and education. Methods: A total of 269 participants who received their first adequate medical treatment for a psychotic disorder within the current or past year were included to the Thematically Organized Psychosis study in Oslo, Norway. Sociodemographic and clinical information was collected through systematic interviews. MHL was measured as “recognition of psychotic symptoms” and assessed by “The Attitudes and Beliefs about Mental Health Problems” schizophrenia version. Influence of education, migration and MHL on DUP was analyzed with hierarchical block-wise multiple regression analysis. Results: Recognition of psychotic symptoms explained a small but unique variance (2.3%) in DUP after the effects of other important predictors were controlled for. Longer DUP was also associated with less education, lower premorbid social, and academic functioning, a diagnosis within schizophrenia spectrum disorder, and earlier age of onset. The model explained 26% of variance in DUP. Migration after the age of six and length of education were associated with MHL but did not have a significant interaction with MHL in predicting DUP. Conclusions: MHL, measured as recognition of psychotic symptoms, has a small but significant independent effect on DUP. The effect of MHL was larger than years of education and migration history, and did not interact with either, in predicting DUP. This suggests that MHL is an independent factor in prevention strategies for early psychosis.
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Affiliation(s)
- Naomi Takizawa
- Department of Community Medicine, Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Ingrid Melle
- NORMENT; Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, and Oslo University Hospital, Oslo, Norway
| | - Elizabeth Ann Barrett
- NORMENT; Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, and Oslo University Hospital, Oslo, Norway.,Early Intervention in Psychosis Advisory Unit for South East Norway (TIPS Sør-Øst), Division of Mental Health and Addiction, Oslo University Hospital Trust, Oslo, Norway
| | - Mari Nerhus
- NORMENT; Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, and Oslo University Hospital, Oslo, Norway.,Division of Mental Health, Department for Specialized Psychiatry, Akershus University Hospital, Lørenskog Municipality, Norway
| | - Akiah A Ottesen
- NORMENT; Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, and Oslo University Hospital, Oslo, Norway
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4
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Takizawa P, Hakham P, Sirikul C, Sarapat W, Mongkolnaowarat W, Kinorn P, Wanna P, Ichikawa M. Characteristics of delayed and timely treatment seekers for first-episode schizophrenia in Thailand. COGENT PSYCHOLOGY 2021. [DOI: 10.1080/23311908.2020.1869377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Patcharapim Takizawa
- Department of Global Public Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Pimchanok Hakham
- Department of Psychiatry, Prasrimahabhodi Psychiatric Hospital, Ubon Ratchathani, Thailand
| | - Chanon Sirikul
- Department of Psychiatry, King Narai Hospital, Lop Buri, Thailand
| | - Wiwat Sarapat
- Department of Psychiatry, Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand
| | - Warith Mongkolnaowarat
- Department of Psychiatry, HRH Princess Maha Chakri Sirindhorn Medical Center (MSMC), Nakhon Nayok, Thailand
| | - Patraporn Kinorn
- Department of Psychiatry, Princess Mother National Institute on Drug Abuse Treatment (PMNIDAT), Pathum Thani, Thailand
| | - Piyanut Wanna
- Department of Psychiatry, Sisaket Hospital, Sisaket, Thailand
| | - Masao Ichikawa
- Department of Global Public Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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5
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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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6
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Li W, Jorm AF, Wang Y, Lu S, He Y, Reavley N. Development of Chinese mental health first aid guidelines for psychosis: a Delphi expert consensus study. BMC Psychiatry 2020; 20:443. [PMID: 32912167 PMCID: PMC7488132 DOI: 10.1186/s12888-020-02840-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 08/27/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Family and friends of a person developing a mental illness or in a mental health crisis can help the person until treatment is received or the crisis resolves. Guidelines for providing this 'mental health first aid' have been developed and disseminated in high-income countries. However, they may not be appropriate for use in China due to cultural and health care system differences. The aim of this study was to use the Delphi expert consensus method to develop culturally appropriate guidelines for a member of the public providing mental health first aid to someone with psychosis in mainland China. METHODS A Chinese-language survey, comprising statements about how to provide mental health first aid to a person with psychosis, was developed. This was based on the endorsed items from the first round of the English-language questionnaire for high-income countries. These statements were rated by two expert panels from mainland China - a mental health professional panel (N = 31) and a lived experience panel (N = 41) - on how important they believed each statement was for a member of the public providing first aid to a person with psychosis in China. There were three Delphi rounds, with experts able to suggest additional items in Round 1. Items had to have at least 80% endorsement from both panels for inclusion. RESULTS Out of 208 statements, 207 were endorsed for inclusion in the Chinese-language guidelines. Eight new statements were also included. Compared to the English-language guidelines, the importance of family involvement was emphasized in the development of the Chinese-language guidelines. CONCLUSIONS While many of the actions in the English-language guidelines were endorsed by Chinese participants, a number of additional items point to the importance of developing culturally appropriate mental health first aid guidelines. These guidelines will form the basis for the development of Chinese Mental Health First Aid course aiming at training members of the public on how to provide first aid to someone with a mental health problem.
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Affiliation(s)
- Wenjing Li
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Level 4, 207 Bouverie Street, Carlton, VIC, 3053, Australia.
| | - Anthony F. Jorm
- grid.1008.90000 0001 2179 088XCentre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Level 4, 207 Bouverie Street, Carlton, VIC 3053 Australia
| | - Yan Wang
- grid.415630.50000 0004 1782 6212Shanghai Mental Health Centre, Shanghai, China
| | - Shurong Lu
- grid.1008.90000 0001 2179 088XThe Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC Australia
| | - Yanling He
- grid.415630.50000 0004 1782 6212Shanghai Mental Health Centre, Shanghai, China
| | - Nicola Reavley
- grid.1008.90000 0001 2179 088XCentre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Level 4, 207 Bouverie Street, Carlton, VIC 3053 Australia
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7
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Kaminga AC, Dai W, Liu A, Myaba J, Banda R, Wen SW. Effects of socio-demographic characteristics, premorbid functioning, and insight on duration of untreated psychosis in first-episode schizophrenia or schizophreniform disorder in Northern Malawi. Early Interv Psychiatry 2019; 13:1455-1464. [PMID: 30706661 PMCID: PMC6900171 DOI: 10.1111/eip.12794] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 12/24/2018] [Accepted: 01/13/2019] [Indexed: 11/27/2022]
Abstract
AIM Long duration of untreated psychosis (DUP) is prevalent and has been shown to be associated with poorer prognosis. Thus, knowledge of its determinants may help to target early interventions to reduce DUP on the needed population. Previous studies seeking to understand determinants of DUP have been inconclusive. Therefore, this study aimed to investigate the effects of socio-demographic characteristics, premorbid functioning, and insight on DUP in patients with first-episode schizophrenia or schizophreniform disorder. METHODS This cross-sectional study recruited 110 subjects (aged 18-65) during a pilot early intervention service for psychosis in Northern Malawi, between June 2009 and September 2012. Short DUP was defined as ≤6 months, whereas long DUP was defined as >6 months. Unadjusted and adjusted analyses were performed to identify determinants of DUP. RESULTS Of the 110 subjects, 99 (90%) had schizophrenia. Median DUP was 27.5 months, while mean (SD) DUP was 71.24 (92.32) months. In addition, at least 75% had long DUP, which was associated with lower level of education, poor insight, younger age at onset, and at least one parent deceased. CONCLUSIONS Long DUP is prevalent in Northern Malawi. Thus, early interventions to reduce DUP are warranted in this population. Although having at least one parent deceased predicted long DUP in this study, this remains speculative because factors, such as timing of parents' death and grief reactions of the patients were not assessed. Therefore, further investigations incorporating these factors are needed to ascertain this result.
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Affiliation(s)
- Atipatsa C. Kaminga
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaHunanChina
- Department of Mathematics and StatisticsMzuzu UniversityMzuzuMalawi
| | - Wenjie Dai
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaHunanChina
| | - Aizhong Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaHunanChina
| | - Japhet Myaba
- Department of Clinical Medicine, Mental Health Research SectionSaint John of God Community ServicesMzuzuMalawi
| | - Richard Banda
- Department of Clinical Medicine, Mental Health Research SectionSaint John of God Community ServicesMzuzuMalawi
| | - Shi W. Wen
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaHunanChina
- OMNI Research Group, Department of Obstetrics and Gynecology, Faculty of MedicineUniversity of OttawaOttawaOntarioCanada
- Ottawa Hospital Research InstituteClinical Epidemiology ProgramOttawaOntarioCanada
- School of Epidemiology, Public Health, and Preventive Medicine, Faculty of MedicineUniversity of OttawaOttawaOntarioCanada
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Martin R, Moro MR, Benoit L. Is early management of psychosis designed for migrants? Improving transcultural variable collection when measuring duration of untreated psychosis. Early Interv Psychiatry 2019; 13:347-357. [PMID: 29927107 DOI: 10.1111/eip.12701] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 02/15/2018] [Accepted: 05/16/2018] [Indexed: 11/27/2022]
Abstract
AIM A background of migration is an established risk factor for psychosis. At the same time, over the last 25 years, many countries have developed specialized services for the assessment and care of people with early psychosis. Evaluation of these services often focuses on the duration of untreated psychosis (DUP). METHODS We conducted a systematic review with an electronic search of key words in 3 databases to determine the extent to which studies measuring DUP consider transcultural variables, including migration status, national origin, ethnicity and language. RESULTS We identified 18 studies that included transcultural variables and measured DUP. They differed in their design, aims and methodology, and could not be directly compared. Common themes nonetheless appeared. CONCLUSIONS Most of the studies exploring DUP took little account of transcultural variables. Definitions of transcultural indicators were heterogeneous and often vague. Lack of language proficiency was often an exclusion criterion, and none of the studies used interpreters. We propose some basic transcultural variable and recommendations to include in future studies and recommendations to improve their internal and external validity.
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Affiliation(s)
- Robin Martin
- Maison de Solenn, Maison des Adolescents - Integrated Youth Friendly Health Service, Cochin Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,Department of Medicine, University of Toulouse 3 Paul Sabatier, 118 route de Narbonne, 31062 Toulouse, France
| | - Marie Rose Moro
- Maison de Solenn, Maison des Adolescents - Integrated Youth Friendly Health Service, Cochin Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,Center for Research and Epidemiology and Population Health - Centre de recherche en épidémiologie et santé des populations(CESP), French National Institute of Health and Medical research (Inserm), Villejuif, France.,Deparment of Clinical Psychology, Psychopathology, Psychoanalysis - EA 4056 (PCPP), University of Paris Descartes, Paris, France
| | - Laelia Benoit
- Maison de Solenn, Maison des Adolescents - Integrated Youth Friendly Health Service, Cochin Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,Center for Research and Epidemiology and Population Health - Centre de recherche en épidémiologie et santé des populations(CESP), French National Institute of Health and Medical research (Inserm), Villejuif, France.,School of Public Health - Ecole Doctorale de Santé Publique (EDSP) U1018, University of Paris Saclay, Le Kremlin-Bicêtre, France
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9
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Qiu Y, Li L, Gan Z, Wang J, Zheng L, Zhao J, Guan N, Wei Q. Factors related to duration of untreated psychosis of first episode schizophrenia spectrum disorder. Early Interv Psychiatry 2019; 13:555-561. [PMID: 29164787 DOI: 10.1111/eip.12519] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 08/28/2017] [Accepted: 09/30/2017] [Indexed: 01/22/2023]
Abstract
AIM Duration of untreated psychosis (DUP) is associated with outcome and functioning. It is expected that scientists will find factors that modulate DUP, but thus far, research on this topic has shown inconsistent results. Furthermore, similar studies in China are insufficient. This study aims to explore social and clinical factors for DUP in South China and to learn the influence that family plays on DUP through their awareness of psychosis. METHODS Participants included 216 patients with first episode schizophrenia spectrum disorder. The Nottingham Onset Schedule was used to assess DUP. The relationship between DUP and social and clinical characteristics were then analysed by correlation analysis, survival analysis and Cox regression analysis. The awareness of the patient's family for the cause of psychosis, the reason for treatment and the cause for delay of treatment were investigated using a questionnaire. RESULTS The median DUP was 64.5 days. Insidious onset and being unemployed were found to be risk factors for a long DUP. The family attributed the main cause of psychosis to stress. The main cause for the delay of treatment was because families misjudged the patients' disease. More family members of long DUP patients compared to short DUP patients thought the causes were due to ideological problems or puberty, rather than to mental health. CONCLUSION The results of this study indicated that some social or clinical characteristics influence DUP. The family's awareness plays an important role when seeking help. To reduce DUP, the public needs more knowledge of mental illness.
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Affiliation(s)
- Yong Qiu
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Leijun Li
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhaoyu Gan
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jihui Wang
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Liangrong Zheng
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jiaoshi Zhao
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Nianhong Guan
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Qinling Wei
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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10
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A scoping review of health-related stigma outcomes for high-burden diseases in low- and middle-income countries. BMC Med 2019; 17:17. [PMID: 30764819 PMCID: PMC6376728 DOI: 10.1186/s12916-019-1250-8] [Citation(s) in RCA: 148] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 01/02/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Stigma is associated with health conditions that drive disease burden in low- and middle-income countries (LMICs), including HIV, tuberculosis, mental health problems, epilepsy, and substance use disorders. However, the literature discussing the relationship between stigma and health outcomes is largely fragmented within disease-specific siloes, thus limiting the identification of common moderators or mechanisms through which stigma potentiates adverse health outcomes as well as the development of broadly relevant stigma mitigation interventions. METHODS We conducted a scoping review to provide a critical overview of the breadth of research on stigma for each of the five aforementioned conditions in LMICs, including their methodological strengths and limitations. RESULTS Across the range of diseases and disorders studied, stigma is associated with poor health outcomes, including help- and treatment-seeking behaviors. Common methodological limitations include a lack of prospective studies, non-representative samples resulting in limited generalizability, and a dearth of data on mediators and moderators of the relationship between stigma and health outcomes. CONCLUSIONS Implementing effective stigma mitigation interventions at scale necessitates transdisciplinary longitudinal studies that examine how stigma potentiates the risk for adverse outcomes for high-burden health conditions in community-based samples in LMICs.
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11
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Nishio A, Horita R, Marutani T, Yamamoto M. Factors that influence delaying initial psychiatric treatment in rural Cambodia: A pilot study. PLoS One 2018; 13:e0206882. [PMID: 30383851 PMCID: PMC6211740 DOI: 10.1371/journal.pone.0206882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 10/22/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The WHO reported the gap between the need for treatment and its provision is huge in low- and middle-income countries. It is estimated there are lots of burden to obtain treatment in these countries. This survey intended to show the delay of their first visit to a psychiatric department and the factors that influence the delay. To elucidate the factors affecting medical accessibility for people with mental illness, we propose the concept of duration of untreated mental illness (DUM), which is the duration between the onset or first symptom of mental illness and the first visit to a psychiatric department or clinic. METHODS Participants were 109 Cambodian adults (18 years old and up) who had a psychiatric consultation in one of the following hospitals. We analyzed the relationships between DUM and patients' background; age, gender, economic status, education level, occupation, hospital access, and diagnosis. RESULTS The average DUM of all participants was 34.8 ± 42.4 months, ranging from 0 to 240 There was no significant difference in DUM by difference in hospital, gender, age, hospital access, education level, occupation, or economic status. Only patient diagnosis was related to DUM. The DUM for patients with schizophrenia and epilepsy was long, while the DUM for patients with neurosis and substance use were short. CONCLUSION To compare DUM with that of other low- and middle-income countries, DUM of our survey is extremely long. However, those reports were from urban areas within the low- and middle-income countries. We considered our report to include a very important sample showing the condition of psychiatric services in rural areas of low-income countries.
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Affiliation(s)
- Akihiro Nishio
- Health Administration Center, Gifu University, Gifu, Japan
- Department of Psychopathology, Division of Neuroscience, Graduate School of Medicine, Gifu University, Gifu, Japan
- * E-mail:
| | - Ryo Horita
- Health Administration Center, Gifu University, Gifu, Japan
| | - Toshiyuki Marutani
- Health Administration Center, Gifu University, Gifu, Japan
- Health Support Center, Tokyo Institute of Technology, Yokohama, Japan
| | - Mayumi Yamamoto
- Health Administration Center, Gifu University, Gifu, Japan
- United Graduate School of Drug Discovery and Medical Information Sciences, Gifu University, Gifu, Japan
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