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Patel K, Cardno A, Isherwood T. ' Like I said about culture. You don't talk about mental health ' : An interpretative phenomenological analysis of the experience of first-episode psychosis in South Asian individuals. Early Interv Psychiatry 2023; 17:771-783. [PMID: 36639135 DOI: 10.1111/eip.13368] [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: 06/03/2022] [Revised: 09/27/2022] [Accepted: 01/02/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND There is strong evidence of inequalities in mental healthcare access, experiences and outcomes for service users belonging to Black and Asian Minority Ethnic groups experiencing psychosis. Clinicians and academics have speculated that cultural variation in conceptualisations of psychosis, alongside inequitable service provision may explain disparities. There is, however, a dearth of literature exploring this in a South Asian population, despite this ethnic group being the second largest in the United Kingdom. The present study aimed to explore how people from this minority group have experienced and made sense of first-episode psychosis (FEP). METHODS A qualitative approach was used to explore the lived experience and sense-making of South Asian individuals experiencing FEP and accessing early intervention services. Eight people were interviewed using a semi-structured format. The data were analysed using Interpretative Phenomenological Analysis. RESULTS Three superordinate themes were identified in the group analysis: (1) Disconnection from self and others (2) Doubt and dispute (3) Power and shame. CONCLUSIONS Distinctive ethnic, cultural and systemic influences were strongly evident in how people conceptualized their experiences, how they managed their sense-making and where they sought support. Experiences were discussed in the context of power and shame, and this research proposes that socio-cultural context and racialised discourses have an impact on self-concept, the experiences of help-seeking (formal and informal), and fundamentally how services help individuals from marginalized communities.
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Affiliation(s)
- Krisna Patel
- School of Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Alastair Cardno
- Psychological & Social Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Tom Isherwood
- School of Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Farooq S, Sheikh S, Dikomitis L, Haq MMU, Khan AJ, Sanauddin N, Ali MW, Ali J, Khan MF, Chaudhry I, Husain N, Gul M, Irfan M, Andrews G, Kaistha P, Shah SMU, Azeemi I, Hamid S, Minhaz A, Mallen C, Lewis M. Traditional healers working with primary care and mental health for early intervention in psychosis in young persons: protocol for the feasibility cluster randomised controlled trial. BMJ Open 2023; 13:e072471. [PMID: 37451736 PMCID: PMC10351321 DOI: 10.1136/bmjopen-2023-072471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVES In low/middle-income countries (LMICs), more than half of patients with first-episode psychosis initially seek treatment from traditional and religious healers as their first care. This contributes to an excessively long duration of untreated psychosis (DUP). There is a need for culturally appropriate interventions to involve traditional and spiritual healers to work collaboratively with primary care practitioners and psychiatrists through task-shifting for early detection, referral and treatment of first episode of psychosis. METHODS To prevent the consequences of long DUP in adolescents in LMICs, we aim to develop and pilot test a culturally appropriate and context-bespoke intervention. Traditional HEalers working with primary care and mental Health for early interventiOn in Psychosis in young pErsons (THE HOPE) will be developed using ethnographic and qualitative methods with traditional healers and caregivers. We will conduct a randomised controlled cluster feasibility trial with a nested qualitative study to assess study recruitment and acceptability of the intervention. Ninety-three union councils in district Peshawar, Pakistan will be randomised and allocated using a 1:1 ratio to either intervention arm (THE HOPE) or enhanced treatment as usual and stratified by urban/rural setting. Data on feasibility outcomes will be collected at baseline and follow-up. Patients, carers, clinicians and policymakers will be interviewed to ascertain their views about the intervention. The decision to proceed to the phase III trial will be based on prespecified stop-go criteria. ETHICS AND DISSEMINATION Ethical approval has been obtained from Keele University Ethical Review Panel (ref: MH210177), Khyber Medical University Ethical Review Board (ref: DIR/KMU-EB/IG/001005) and National Bioethics Committee Pakistan (ref no. 4-87/NBC-840/22/621). The results of THE HOPE feasibility trial will be reported in peer-reviewed journals and academic conferences and disseminated to local stakeholders and policymakers. TRIAL REGISTRATION NUMBER ISRCTN75347421.
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Affiliation(s)
- Saeed Farooq
- School of Primary, Community and Social Care, Keele University, Keele, UK
- Midlands Partnership NHS Foundation Trust, Stafford, UK
| | - Saima Sheikh
- School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Lisa Dikomitis
- Kent and Medway Medical School, University of Kent, Canterbury, UK
| | | | - Abdul Jalil Khan
- Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Noor Sanauddin
- Department of Sociology, University of Peshawar, Peshawar, Pakistan
| | | | - Johar Ali
- Department of Sociology, University of Peshawar, Peshawar, Pakistan
| | | | - Imran Chaudhry
- Pakistan Institute of Living and Learning, Karachi, Pakistan
- Ziauddin University Hospital, Karachi, Pakistan
| | - Nusrat Husain
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
| | - Muhammad Gul
- Research and Innovation, Midlands Partnership NHS Foundation Trust, Stafford, UK
| | - Muhammad Irfan
- Department of Mental Health, Psychiatry & Behavioral Sciences, Peshawar Medical College, Peshawar, Pakistan
- Riphah International University, Islamabad, Pakistan
| | - Gabrielle Andrews
- Research and Innovation, Midlands Partnership NHS Foundation Trust, Stafford, UK
| | | | | | - Ishfaq Azeemi
- Department of Sociology, University of Peshawar, Peshawar, Pakistan
| | - Shumaila Hamid
- Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Aaliya Minhaz
- Department of Chemistry, Shaheed Benazir Bhutto Women University, Peshawar, Pakistan
| | - Christian Mallen
- School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Martyn Lewis
- School of Primary, Community and Social Care, Keele University, Keele, UK
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Ayinde OO, Fadahunsi O, Kola L, Malla LO, Nyame S, Okoth RA, Cohen A, Appiah-Poku J, Othieno CJ, Seedat S, Gureje O. Explanatory models, illness, and treatment experiences of patients with psychosis using the services of traditional and faith healers in three African countries: Similarities and discontinuities. Transcult Psychiatry 2023; 60:521-536. [PMID: 34913379 DOI: 10.1177/13634615211064370] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
As part of formative studies to design a program of collaborative care for persons with psychosis, we explored personal experience and lay attributions of illness as well as treatment among persons who had recently received care at traditional and faith healers' (TFHs) facilities in three cultural groups in Sub-Saharan Africa. A purposive sample of 85 individuals in Ibadan (Nigeria), Kumasi (Ghana), and Nairobi (Kenya) were interviewed. Data was inductively explored for themes and analysis was informed by the Framework Method. Across the three sites, illness experiences featured suffering and disability in different life domains. Predominant causal attribution was supernatural, even when biological causation was also acknowledged. Prayer and rituals, steeped in traditional spiritual beliefs, were prominent both in traditional faith healing settings as well as those of Christianity and Islam. Concurrent or consecutive use of TFHs and conventional medical services was common. TFHs provided services that appear to meet the therapeutic goals of their patients even when harmful treatment practices were employed. Cultural and linguistic differences did not obscure the commonality of a core set of beliefs and practices across these three groups. This similarity of core worldviews across diverse cultural settings means that a collaborative approach designed in one cultural group would, with adaptations to reflect differences in context, be applicable in another cultural group. Studies of patients' experience of illness and care are useful in designing and implementing collaborations between biomedical and TFH services as a way of scaling up services and improving the outcome of psychosis.
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Affiliation(s)
| | | | | | | | | | | | - Alex Cohen
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine
| | | | | | - Soraya Seedat
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine
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Zacharia T. An intercultural perspective toward supporting antipsychotic medication adherence in clinical practice. BJPsych Bull 2023; 47:38-43. [PMID: 35388782 PMCID: PMC10028547 DOI: 10.1192/bjb.2022.19] [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: 02/04/2023] Open
Abstract
In the UK, the incidence of schizophrenia appears highest in Black Caribbean and Black African communities (four- to six-fold that of the White British population). The incidence of psychosis in other minority ethnic groups is also raised, but to a lesser magnitude. Although there are numerous environmental confounding factors, the data stresses the importance of optimising treatment in high-risk (minority) groups. Antipsychotic nonadherence is the most common reason for schizophrenia relapse, and is associated with increased rates of relapse, readmission to hospital and suicide. This article examines available literature to discover how culture can affect antipsychotic nonadherence, and considers culture-based solutions that could enhance antipsychotic adherence. Acknowledging the importance of the therapeutic alliance and sociocultural aspects in antipsychotic adherence, I argue that current cultural competence training provided to clinicians is inadequate. Organisational- and system-level approaches are required to reduce oppressive practise and promote culturally competent, person-centred care.
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Loch AA, Lopes-Rocha AC, Fekih-Romdhane F, van de Bilt MT, Salazar de Pablo G, Fusar-Poli P. Inequality and barriers in psychosis prevention: A systematic review on clinical high-risk for psychosis studies from developing countries. Front Psychiatry 2023; 14:1148862. [PMID: 37113551 PMCID: PMC10126325 DOI: 10.3389/fpsyt.2023.1148862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/20/2023] [Indexed: 04/29/2023] Open
Abstract
Background The clinical high-risk for psychosis (CHR) paradigm is one of the best studied preventive paradigms in psychiatry. However, most studies have been conducted in high-income countries. It is unclear if knowledge from such countries applies to low and middle-income countries (LAMIC), and if there are specific limitations hindering CHR research there. Our aim is to systematically review studies on CHR from LAMIC. Methods A multistep PRISMA-compliant literature search was performed in PubMed and Web of Science for articles published until 1/03/2022, conducted in LAMIC, addressing the concept and correlates of CHR. Study characteristics as well as limitations were reported. Corresponding authors of the included studies were invited to answer an online poll. Quality assessment was done with the MMAT. Results A total of 109 studies were included in the review: none from low-income countries, 8 from lower middle-income countries, and 101 from upper middle-income countries. The most frequent limitations were small sample size (47.9%), cross-sectional design (27.1%), and follow-up issues (20.8%). Mean quality of included studies was of 4.4. Out of the 43 corresponding authors, 12 (27.9%) completed the online poll. They cited further limitations as few financial resources (66.7%), no involvement of population (58.2%) and cultural barriers (41.7%). Seventy five percent researchers reported that CHR research should be conducted differently in LAMIC compared to high-income countries, due to structural and cultural issues. Stigma was mentioned in three out of five sections of the poll. Discussion Results show the discrepancy of available evidence on CHR in LAMIC, given the shortage of resources in such countries. Future directions should aim to increase the knowledge on individuals at CHR in such settings, and to address stigma and cultural factors that may play a role in the pathways toward care in psychosis. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=316816, CRD42022316816.
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Affiliation(s)
- Alexandre Andrade Loch
- Laboratorio de Neurociencias (LIM 27), Faculdade de Medicina, Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
- Conselho Nacional de Desenvolvimento Cientifico e Tecnológico, Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), São Paulo, Brazil
- *Correspondence: Alexandre Andrade Loch,
| | - Ana Caroline Lopes-Rocha
- Laboratorio de Neurociencias (LIM 27), Faculdade de Medicina, Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Feten Fekih-Romdhane
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
- Department of Psychiatry Ibn Omrane, The Tunisian Center of Early Intervention in Psychosis, Razi Hospital, Tunis, Tunisia
| | - Martinus Theodorus van de Bilt
- Laboratorio de Neurociencias (LIM 27), Faculdade de Medicina, Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
- Conselho Nacional de Desenvolvimento Cientifico e Tecnológico, Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), São Paulo, Brazil
| | - Gonzalo Salazar de Pablo
- Early Psychosis - Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, IiSGM, CIBERSAM, Universidad Complutense, Madrid, Spain
| | - Paolo Fusar-Poli
- Early Psychosis - Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Outreach and Support in South London (OASIS) Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
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Pigeon-Gagné É, Vigu T, Kadio K, Bonnet E, Ridde V. Explanatory models of psychotic-like experiences in rural Burkina Faso: A qualitative study among indigents and their community. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Zemestani M, Davoudi F, Farhadi A, Gallagher MW. A preliminary examination of unified protocol for transdiagnostic treatment of emotional disorders in patients with panic disorder: a single-case experimental design in Iran. ANXIETY, STRESS, AND COPING 2022; 35:701-718. [PMID: 34632890 DOI: 10.1080/10615806.2021.1990269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 09/11/2021] [Accepted: 10/01/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVES The majority of patients suffering from anxiety disorders in low- and middle-income countries do not receive evidence-based treatments. The Unified Protocol (UP) for the Transdiagnostic Treatment of Emotional Disorders is an evidence-based cognitive-behavioral intervention designed to treat the range of emotional disorders. DESIGN AND METHODS Using a single-case experimental design five patients with panic disorder were assigned to a 3-week baselines assessment phase followed by eight sessions of UP treatment and 4-week follow-up phases. Multiple outcome measures of panic severity, anxiety sensitivity, affectivity, and overall anxiety severity and impairment were administered weekly during the baseline, intervention, and follow-up phases. RESULTS At post treatment, all participants showed significant reductions in outcome measures, with changes functionally related to treatment and most improvements maintained at 4-week follow-up. CONCLUSION Findings provide preliminary cross-cultural support for UP and add to the growing body of literature showing UP can be useful for patients with anxiety disorders in low- and middle-income countries with non-Western cultures.
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Affiliation(s)
- Mehdi Zemestani
- Department of Psychology, University of Kurdistan, Sanandaj, Iran
| | - Fatemeh Davoudi
- Department of Psychology, University of Kurdistan, Sanandaj, Iran
| | - Ali Farhadi
- Department of Social Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Matthew W Gallagher
- Department of Psychology, University of Houston, Houston, TX, USA
- Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, Houston, TX, USA
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Khattak MI, Dikomitis L, Khan MF, Haq MU, Saeed U, Awan NR, Haq ZU, Shepherd T, Mallen CD, Farooq S. Patients’ and healthcare professionals’ perspectives on a community-based intervention for schizophrenia in Pakistan: A focus group study. PLoS One 2022; 17:e0273286. [PMID: 36037187 PMCID: PMC9423632 DOI: 10.1371/journal.pone.0273286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 08/05/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To explore the perceptions and experiences of schizophrenia from patients, their care givers, health care providers, spiritual and traditional healers to develop a community-based intervention for improving treatment adherence for people with schizophrenia in Pakistan. Methods This qualitative study involved four focus group discussions (FGD) with a total of 26 participants: patients and carers (n = 5), primary care staff (n = 7), medical technicians (n = 8) and traditional and spiritual healers (n = 6). The participants were selected using purposive sampling method. FGDs were audio-recorded and transcribed. A thematic analysis was applied to the data set. Results The themes identified were (i) Schizophrenia is not merely a biomedical problem: participants believed that poverty and an inferiority complex resulting from social disparity caused schizophrenia and contributed to non-adherence to medications; (ii) Spiritual healing goes hand in hand with the medical treatment: participants regarded spiritual and traditional treatment methods as an inherent part of schizophrenia patients’ well-being and rehabilitation; (iii) Services for mental illness: mental health is not covered under primary health in a basic health unit: participants believed that the lack of services, training and necessary medication in primary care are major issues for treating schizophrenia in community; (iv) Barriers to community-based interventions: primary care staff believed that multiple pressures on staff, lack of incentives, non-availability of medication and lack of formal referral pathways resulted in disintegration of dealing with schizophrenia patients in primary care facilities. Conclusion The study has identified a number of barriers and facilitators to developing and delivering a psychosocial intervention to support people living with schizophrenia in Pakistan. In particular, the importance of involving spiritual and traditional healers was highlighted by our diverse group of stakeholders.
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Affiliation(s)
- Maria Ishaq Khattak
- Institute of Public Health & Social Sciences, Khyber Medical University, Pakistan Khyber Medical University Peshawar, Peshawar, Pakistan
| | - Lisa Dikomitis
- Kent and Medway Medical School, University of Kent and Canterbury Christ Church University, Canterbury, United Kingdom
| | | | - Mukhtar Ul Haq
- Postgraduate Medical Institute, Lady Reading Hospital, Peshawar, Pakistan
| | - Umaima Saeed
- Institute of Public Health & Social Sciences, Khyber Medical University, Pakistan Khyber Medical University Peshawar, Peshawar, Pakistan
| | - Naila Riaz Awan
- Postgraduate Medical Institute, Lady Reading Hospital, Peshawar, Pakistan
| | - Zia Ul Haq
- Institute of Public Health & Social Sciences, Khyber Medical University, Pakistan Khyber Medical University Peshawar, Peshawar, Pakistan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Thomas Shepherd
- School of Medicine, Keele University, Staffordshire, United Kingdom
| | | | - Saeed Farooq
- School of Medicine, Keele University, Staffordshire, United Kingdom
- Midlands Partnership Foundation Trust, St. George’s Hospital, Stafford, United Kingdom
- * E-mail:
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Zemestani M, Mohammed AF, Ismail AA, Vujanovic AA. A Pilot Randomized Clinical Trial of a Novel, Culturally Adapted, Trauma-Focused Cognitive-Behavioral Intervention for War-Related PTSD in Iraqi Women. Behav Ther 2022; 53:656-672. [PMID: 35697429 DOI: 10.1016/j.beth.2022.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 01/20/2022] [Accepted: 01/29/2022] [Indexed: 12/12/2022]
Abstract
Trauma-focused cognitive-behavioral therapy (TF-CBT), broadly, is one of the leading evidence-based treatments for youth with posttraumatic stress disorder (PTSD). Generally, few culturally adapted TF-CBT interventions have been examined among war trauma-affected populations in low- and middle-income countries. Using a randomized clinical trial design, a total of 48 war trauma-exposed women in Iraq, Mage (SD) = 32.91 (5.33), with PTSD were randomly assigned to either TF-CBT or wait-list control (WLC) conditions. The intervention group received 12 individual weekly sessions of a culturally adapted TF-CBT intervention. Significant reductions in PTSD symptom severity were reported by women in the TF-CBT condition from pre- to posttreatment. Women in the TF-CBT condition reported significantly greater reductions in PTSD symptoms compared to WLC at 1-month follow-up. Additionally, levels of depression, anxiety, stress, and use of maladaptive emotion regulation strategies were significantly lower in the TF-CBT condition at posttreatment and 1-month follow-up, compared to the WLC condition. Women in the TF-CBT condition also reported significant improvements in various domains of quality of life at posttreatment and 1-month follow-up. This clinical trial provides preliminary cross-cultural support for the feasibility and efficacy of TF-CBT for the treatment of PTSD symptoms among women in non-Western cultures. Future directions and study limitations are discussed.
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van Beek A, de Zeeuw J, de Leeuw M, Poplawska M, Kerkvliet L, Dwarkasing R, Nanda R, Veling W. Duration of untreated psychosis and pathways to care in Suriname: a qualitative study among patients, relatives and general practitioners. BMJ Open 2022; 12:e050731. [PMID: 35110311 PMCID: PMC8811554 DOI: 10.1136/bmjopen-2021-050731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Psychosis is a severe mental health problem and is responsible for poor health outcomes, premature mortality and morbidity, especially in low- and middle-income countries. The duration of untreated psychosis (DUP), that is the time period between onset of symptoms until initiation of appropriate treatment by a healthcare professional, is one of the main determinants for successful treatment in western settings. This study aims to explore the factors related to the DUP among Surinamese patients using the perspectives from patients, their families and first-line healthcare professionals in Suriname. METHODS Semi-structured interviews were conducted with patients having a history of psychosis, family members and general practitioners between February 2019 and April 2019 in Suriname. Interviews were tape-recorded and transcribed verbatim. Data were analysed using a thematic analysis for which an inductive and deductive approach was applied. RESULTS In total, 28 patients, 13 family members and 8 general practitioners were interviewed. Five patients were excluded from the study. A median DUP of 4 months was found (IQR 1-36). Identified themes related to DUP included presentation of symptoms and illness awareness, help-seeking behaviour and alternative medicine, social support and stigma, financial and practical factors. CONCLUSION Multiple factors were related to DUP, of which poor illness awareness, traditional medicine, stigma and social support were predominant. Poor illness awareness and use of alternative medicine were related to a longer DUP. Stigma was often an obstacle for patients and their families. Social and family support was important in helping patients to get medical help sooner. Other explored factors including financial and practical factors did not contribute to DUP.
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Affiliation(s)
- Atousa van Beek
- Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands
- Department of Psychiatry, University Medical Centre Groningen, Groningen, The Netherlands
| | - Janine de Zeeuw
- Department of Health Sciences, Global Health Unit, University Medical Centre Groningen, Groningen, The Netherlands
| | - Menno de Leeuw
- Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands
- Department of Psychiatry, University Medical Centre Groningen, Groningen, The Netherlands
| | - Mia Poplawska
- Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands
- Department of Psychiatry, University Medical Centre Groningen, Groningen, The Netherlands
| | - Lise Kerkvliet
- Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands
- Department of Psychiatry, University Medical Centre Groningen, Groningen, The Netherlands
| | | | | | - Wim Veling
- Department of Psychiatry, University Medical Centre Groningen, Groningen, The Netherlands
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Kengne Kamga K, De Vries J, Nguefack S, Munung NS, Wonkam A. Explanatory models for the cause of Fragile X Syndrome in rural Cameroon. J Genet Couns 2021; 30:1727-1736. [PMID: 34145661 PMCID: PMC8642261 DOI: 10.1002/jgc4.1440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 04/04/2021] [Accepted: 05/01/2021] [Indexed: 11/18/2022]
Abstract
Among the myriad causes of intellectual disability (ID), Fragile X Syndrome (FXS) is the leading genetic cause. Yet, little is known of how people affected by this condition make sense of it. The present study aimed to investigate the explanatory models for the causes of FXS in an extended family mainly affected by this condition and members of the village from which they originated in Cameroon. Using an ethnographic approach, 92 participants were interviewed (59 females and 33 males) through 10 focus group discussions and 23 in‐depth interviews between April 2018 and February 2020. Data analysis revealed four explanatory models regarding the etiologies of FXS in the community. Firstly, the curse model described a curse from the chief because of the belief that his wives did not mourn his intellectually disabled servant. Secondly, the spiritual model relates FXS to a punishment from God. Thirdly, the socioeconomic model attributes FXS to events in the prenatal and perinatal periods. Finally, the genetic model describes the pattern of inheritance of the disease in the family. This paper helps to understand the explanatory disease models that exist for FXS in rural Cameroon and could inform genetic counseling practices, community genetic education, and policymakers when drafting protocols for public engagement activities.
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Affiliation(s)
- Karen Kengne Kamga
- Division of Human Genetics, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Jantina De Vries
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Séraphin Nguefack
- Department of Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Nchangwi Syntia Munung
- Division of Human Genetics, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Ambroise Wonkam
- Division of Human Genetics, Department of Pathology, University of Cape Town, Cape Town, South Africa.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Kang E, Omigbodun O, Oduguwa A, Kim W, Qin L, Ogunmola O, Akinkuotu F, Derenoncourt M, Abdurahman H, Adejumo O, Lawal K, Bella-Awusah T. If we build it, they will come: Caregiver decision to use an accessible outpatient psychiatric service for children and adolescents in Nigeria. Soc Sci Med 2021; 279:113972. [PMID: 33990075 DOI: 10.1016/j.socscimed.2021.113972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/05/2021] [Accepted: 04/23/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE If child and adolescent psychiatric (CAP) services were accessible in lower-middle-income countries (LMIC) such as Nigeria, what individual and socio-cultural factors would influence caregivers' willingness to use these services when they are needed? METHODS To address this question, we conducted structured interviews with a stratified random sampling of 442 adult caregivers of children aged 5 to 19-years who lived within 10 km of an established CAP outpatient service in Ibadan, Nigeria. RESULTS Based on structural equation modeling, our cross-sectional findings indicated that caregivers were generally willing to use the accessible outpatient CAP service for a narrow range of overtly disruptive and developmentally atypical child behavior. However, their decisions were not influenced by their recognition of child and adolescent mental health (CAMH) conditions, competing life stressors, caregiver wellness, nor stigma as we had initially hypothesized. Rather caregivers pragmatically considered a range of approaches to address CAMH concerns. Post-hoc hypotheses confirmed that caregivers' beliefs about etiology and treatment effectiveness for CAMH conditions shaped their help-seeking decisions and stigmatization of CAP services. Specifically, caregivers who attributed CAMH conditions to physical causes regarded biomedical interventions as the most effective treatment while spiritual interventions were deemed to be the least effective. CONCLUSIONS Taken together our results suggested that caregivers were receptive and willing to use outpatient psychiatric services for their children. However, their beliefs about the etiology and treatment effectiveness of CAMH conditions shaped how they intended to engage the services. These findings underscored the importance of scaling up a broader spectrum of accessible complementary CAMH intervention and prevention services in Nigeria that extend beyond indigenous or biomedical models. In doing so caregivers will come.
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Affiliation(s)
- Ezer Kang
- Howard University, Department of Psychology, Washington, DC, USA.
| | - Olayinka Omigbodun
- University of Ibadan, College of Medicine, Centre for Child and Adolescent Mental Health, Ibadan, Nigeria; University College Hospital, Department of Child & Adolescent Psychiatry, Ibadan, Nigeria.
| | - Adeola Oduguwa
- University of Ibadan, College of Medicine, Centre for Child and Adolescent Mental Health, Ibadan, Nigeria
| | - Woojae Kim
- Howard University, Department of Psychology, Washington, DC, USA
| | - Lu Qin
- Howard University, Department of Psychology, Washington, DC, USA
| | - Olusegun Ogunmola
- University of Ibadan, College of Medicine, Centre for Child and Adolescent Mental Health, Ibadan, Nigeria
| | | | | | - Haleem Abdurahman
- University of Ibadan, College of Medicine, Centre for Child and Adolescent Mental Health, Ibadan, Nigeria; University College Hospital, Department of Child & Adolescent Psychiatry, Ibadan, Nigeria
| | - Olurotimi Adejumo
- University College Hospital, Department of Child & Adolescent Psychiatry, Ibadan, Nigeria; Hertfordshire Partnership, University NHS Foundation Trust, UK
| | - Kehinde Lawal
- University of Ibadan, College of Medicine, Centre for Child and Adolescent Mental Health, Ibadan, Nigeria; University College Hospital, Department of Child & Adolescent Psychiatry, Ibadan, Nigeria
| | - Tolulope Bella-Awusah
- University of Ibadan, College of Medicine, Centre for Child and Adolescent Mental Health, Ibadan, Nigeria; University College Hospital, Department of Child & Adolescent Psychiatry, Ibadan, Nigeria
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Gamieldien F, Galvaan R, Myers B, Syed Z, Sorsdahl K. Exploration of recovery of people living with severe mental illness (SMI) in low/middle-income countries (LMICs): a scoping review. BMJ Open 2021; 11:e045005. [PMID: 33762242 PMCID: PMC7993175 DOI: 10.1136/bmjopen-2020-045005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 02/02/2021] [Accepted: 02/24/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To examine the literature on how recovery of people with severe mental illness (SMI) is conceptualised in low/middle-income countries (LMICs), and in particular what factors are thought to facilitate recovery. DESIGN Scoping review. DATA SOURCES AND ELIGIBILITY We searched 14 electronic databases, hand searched citations and consulted with experts during the period May-December 2019. Eligible studies were independently screened for inclusion and exclusion by two reviewers. Unresolved discrepancies were referred to a third reviewer. DATA EXTRACTION AND SYNTHESIS All bibliographical data and study characteristics were extracted using a data charting form. Selected studies were analysed through a thematic analysis emerging from extracted data. RESULTS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram offers a summary of the results: 4201 titles, 1530 abstracts and 109 full-text articles were screened. Ten articles were selected for inclusion: two from Turkey, two from India, and one each from China, Swaziland, Indonesia, Egypt, South Africa and Vietnam. Although most studies used qualitative methods, data collection and sampling methods were heterogeneous. One study reported on service provider perspectives while the rest provided perspectives from a combination of service users and caregivers. Three themes emerged from the data analysis. First, studies frame recovery as a personal journey occurring along a continuum. Second, there was an emphasis on social relationships as a facilitator of recovery. Third, spirituality emerged as both a facilitator and an indicator of recovery. These themes were not mutually exclusive and some overlap exists. CONCLUSION Although there were commonalities with how high-income countries describe recovery, we also found differences in conceptualisation. These differences in how recovery was understood reflect the importance of framing the personal recovery concept in relation to local needs and contextual issues found in LMICs. This review highlighted the current sparse evidence base and the need to better understand recovery from SMI in LMICs.
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Affiliation(s)
- Fadia Gamieldien
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town Faculty of Health Sciences, Rondebosch, Western Cape, South Africa
- Division of Occupational Therapy, Department of Health and Rehabilitation Sciences, University of Cape Town Faculty of Health Sciences, Observatory, Western Cape, South Africa
- Inclusive Practices Africa Research Group, University of Cape Town, Cape Town, South Africa
| | - Roshan Galvaan
- Division of Occupational Therapy, Department of Health and Rehabilitation Sciences, University of Cape Town Faculty of Health Sciences, Observatory, Western Cape, South Africa
- Inclusive Practices Africa Research Group, University of Cape Town, Cape Town, South Africa
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, Western Cape, South Africa
- Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town Faculty of Health Sciences, Observatory, Western Cape, South Africa
| | - Zarina Syed
- Division of Occupational Therapy, Department of Health and Rehabilitation Sciences, University of Cape Town Faculty of Health Sciences, Observatory, Western Cape, South Africa
| | - Katherine Sorsdahl
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town Faculty of Health Sciences, Rondebosch, Western Cape, South Africa
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Subandi MA, Praptomojati A, Marchira CR, DelVecchio Good MJ, Good BJ. Cultural explanations of psychotic illness and care-seeking of family caregivers in Java, Indonesia. Transcult Psychiatry 2021; 58:3-13. [PMID: 32290788 DOI: 10.1177/1363461520916290] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The cultural understanding of illness among caregivers of first-episode psychotic persons is a crucial issue. Not only does it influence caregivers' care-seeking behavior and length of time until receiving medical treatment (known as the 'duration of untreated psychosis' or DUP), but it also predicts the outcome of the illness. This article aims to explore cultural understanding and care-seeking behavior among caregivers of psychotic patients in Java, Indonesia. Data for this article have been taken from two studies conducted by our research group in Yogyakarta, Indonesia. Methods of data collection include surveys, case studies, ethnographic fieldwork, and in-depth interviews. Results of analyses, within and across studies, indicate that caregivers have employed diverse cultural explanatory models in order to understand psychotic illness. Local cultural beliefs, including possession and forms of black magic, were among the most common initial concepts held by family members in relation to psychosis. This echoes broader cultural beliefs in Java. However, it was not uncommon for caregivers to also understand illness in psychological terms (such as frustration, disappointment, and stress) and attached medical explanations. Caregivers' understanding of illness also changed over time following the changing course of the illness. Both models of illness and the rapidity of care-seeking are also related to the acuteness of onset. This article concludes that it is important for mental health providers, as well as those designing systems of care, to understand the diversity and changing nature of caregivers' cultural understanding of psychotic illness.
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Culturally adapted trauma-focused CBT-based guided self-help (CatCBT GSH) for female victims of domestic violence in Pakistan: feasibility randomized controlled trial. Behav Cogn Psychother 2020; 49:50-61. [PMID: 32993831 DOI: 10.1017/s1352465820000685] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cognitive behaviour therapy (CBT), self-help and guided self-help interventions have been found to be efficacious and cost effective for victims of trauma, but there are limited data from low- and middle-income countries on culturally adapted interventions for trauma. AIMS To investigate the feasibility and acceptability of culturally adapted trauma-focused CBT-based guided self-help (CatCBT GSH) for female victims of domestic violence in Pakistan. METHOD This randomized controlled trial (RCT) recruited 50 participants from shelter homes in Karachi and randomized them to two equal groups. The intervention group received GSH in nine sessions over 12 weeks. The control group was a waitlist control. The primary outcomes were feasibility and acceptability. Secondary outcomes included Impact of Event Scale-Revised (IES-R), Hospital Anxiety and Depression Scale (HADS) and the WHO Disability Assessment Schedule 2 (WHO DAS 2). Assessments were carried out at baseline and at 12 weeks. RESULTS Out of 60 clients who met DSM-5 criteria for post-traumatic stress disorder (PTSD), 56 (93.3%) agreed to participate in the study. Retention to the intervention group was excellent, with 92% (23/25) attending more than six sessions. Statistically significant differences were noted post-intervention in secondary outcomes in favour of the intervention. CONCLUSIONS A trial of CatCBT GSH was feasible and the intervention was acceptable to Pakistani women who had experienced domestic violence. Furthermore, it may be helpful in improving symptoms of PTSD, depression, anxiety and overall functioning in this population. The results provide a rationale for a larger, confirmatory RCT of CatCBT GSH.
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Husain MO, Zehra SS, Umer M, Kiran T, Husain M, Soomro M, Dunne R, Sultan S, Chaudhry IB, Naeem F, Chaudhry N, Husain N. Stigma toward mental and physical illness: attitudes of healthcare professionals, healthcare students and the general public in Pakistan. BJPsych Open 2020; 6:e81. [PMID: 32741419 PMCID: PMC7453804 DOI: 10.1192/bjo.2020.66] [Citation(s) in RCA: 8] [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] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The evidence base for stigma in mental health largely originates from high-income countries. AIMS This study from Pakistan aimed to address the gap in literature on stigma from low- and middle-income countries. METHOD This cross-sectional study surveyed 1470 adults from Karachi, Pakistan. Participants from three groups (healthcare professionals, healthcare students and the general public) completed the adapted Bogardus Social Distance Scale (SDS) as a measure of stigma. RESULTS All three groups reported higher scores of stigma toward mental disorders compared with physical disorders. SDS scores for mental illness in the general public were significantly higher than in healthcare students (mean difference (MD) 6.93, 95% CI 5.45-8.45, P < 0.001) and healthcare professionals (MD 6.93, 95% CI 5.48-8.38, P < 0.001). However, SDS scores between healthcare students and healthcare professionals were not significantly different (MD 0.003, 95% CI -1.14-1.14, P > 0.99). Being female was associated with lower stigma scores and being over the age of 30 years was associated with higher stigma scores. CONCLUSIONS Stigma campaigns in Pakistan need to target the general population. However, evidence of negative attitudes toward mental illness in healthcare students and healthcare professionals supports the need for stronger emphasis on psychiatric education within undergraduate and postgraduate training in Pakistan.
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Affiliation(s)
- Muhammad Omair Husain
- Division of General Psychiatry, Centre for Addiction and Mental Health; and University of Toronto, Canada
| | | | - Madeha Umer
- Pakistan Institute of Living and Learning, Pakistan
| | | | - Mina Husain
- General Adult Psychiatry, South London and Maudsley NHS Foundation Trust, UK
| | | | - Ross Dunne
- Later Life Psychiatry, Greater Manchester Mental Health NHS Foundation Trust; and University of. Manchester, UK
| | - Sarwat Sultan
- Department of Applied Psychology, Bahauddin Zakariya University, Pakistan
| | | | - Farooq Naeem
- Department of Psychiatry, University of Toronto; and Centre for Addiction and Mental Health, Canada
| | | | - Nusrat Husain
- Division of Psychology & Mental Health, University of Manchester, UK
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Melton R, Blajeski S, Glasser D. Understanding Individual and Family Experiences Associated with DUP: Lessons from the Early Assessment and Support Alliance (EASA) Program in Oregon, USA. Community Ment Health J 2020; 56:1121-1127. [PMID: 32157514 DOI: 10.1007/s10597-020-00599-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 03/06/2020] [Indexed: 10/24/2022]
Abstract
Research shows that a longer duration of untreated psychosis (DUP) is associated with worse psychiatric outcomes, with average length of DUP of 73 weeks in the U.S. The aim was to examine the DUP period for first episode psychosis in Oregon, with a focus on the processes between the first positive symptoms and first treatment. To investigate DUP, researchers used methods consistent with grounded theory to collect data from 9 participants and their families about the process between onset of psychotic symptoms and entrance into treatment. Results suggest that recognition of symptoms was the primary driver of help-seeking in this study, and this was influenced by type of symptom as well as the presence or absence of supportive others, which in most cases was regular family contact. Implications indicate a need for in-depth research on individual and family recognition of symptoms, as well as underscoring the need for community education.
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Affiliation(s)
- Ryan Melton
- Regional Research Institute (RRI), Portland State University, Suite 918, 1600 SW 4th Ave., Portland, OR, 97201, USA.
| | - Shannon Blajeski
- Regional Research Institute (RRI), Portland State University, Suite 918, 1600 SW 4th Ave., Portland, OR, 97201, USA
| | - Diana Glasser
- Regional Research Institute (RRI), Portland State University, Suite 918, 1600 SW 4th Ave., Portland, OR, 97201, USA
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Tamming T, Otake Y. Linking coping strategies to locally-perceived aetiologies of mental distress in northern Rwanda. BMJ Glob Health 2020; 5:e002304. [PMID: 32665374 PMCID: PMC7365432 DOI: 10.1136/bmjgh-2020-002304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 05/06/2020] [Accepted: 05/11/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION How and why people in a particular setting turn to a specific coping strategy for their distress is pivotal for strengthening mental healthcare and this needs to be understood from a local point of view. Prior research in northern Rwanda documented common local concepts of distress for the population that cannot receive assistance despite severe adversities; however, the locally-perceived causes, manifestation and coping strategies and their associations are still unclear. METHODS The qualitative study in the Musanze district, northern Rwanda, was informed by Interpretative Phenomenological Analysis. In-depth interviews were conducted with people with lived experience and those in close contact with people with lived experience of distress. Ethnographic observation was conducted and the analyses were complimented by an earlier ethnography in the same village. RESULTS Study participants (n=15) included community members with lived experience of mental distress and/or those with close friends or family with lived experience. The perceived manifestations of the mental distresses were diverse and the causal attributions shifted from more social, concrete and explainable (eg, loss) towards magical, more abstract and unexplainable (eg, poisoning). Finally, participants sought coping strategies in accordance with their causal attribution in ways that made sense to them. CONCLUSION The coping strategies were chosen according to the perceived aetiology of the symptoms and they were perceived to be effective for their distress. Local coping strategies that match people's help-seeking patterns should therefore be supported in policy and programmes. In Rwanda this requires a mutual training of medical professionals and traditional healers and establishing co-treatment within two parallel systems. This also requires the support for programmes and initiatives that strengthen positive interactions and change in circumstances.
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Affiliation(s)
- Teisi Tamming
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Yuko Otake
- School of Anthropology and Museum Ethnography, University of Oxford, Oxford, Oxfordshire, United Kingdom
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Mathews M, Bhola P, Herbert H, Chaturvedi SK. Explanatory models of mental illness among family caregivers of persons in psychiatric rehabilitation services: A pilot study. Int J Soc Psychiatry 2019; 65:589-602. [PMID: 31385555 DOI: 10.1177/0020764019866228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Understanding the explanatory models of family caregivers is particularly important in interdependent contexts like India, where they often play a significant role in the help-seeking behaviours, treatment decision-making and long-term care of those diagnosed with mental illness. AIMS This study was planned to explore the diversity of explanatory models among family caregivers at a centre for recovery-oriented rehabilitation services in South India. METHODS The sample for this study included 60 family caregivers of patients referred to Psychiatric Rehabilitation Services within a tertiary-care hospital for mental health and neurosciences. Bart's Explanatory Model Inventory, including a semi-structured interview and a checklist, assessed the family caregivers' explanatory model of distress on five domains: identity, cause, timeline, consequences and control/cure/treatment. RESULTS The results indicated the coexistence of multiple causal explanatory models including psychosocial, supernatural, situational and behavioural contributors. While 36.7% of the caregivers displayed two explanatory models, 33.3% of the caregivers held three explanatory models and 16.6% of the caregivers endorsed four explanatory models. Caregivers shared their concerns about varied consequences of mental illness but less than half of them were aware of the name of the psychiatric disorder. While they accessed various forms of treatments and adjunctive supports such as prayer, medication was the most frequently used treatment method. CONCLUSIONS The findings have implications for collaborative goal setting in recovery-oriented services for persons with mental illness and their families.
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Affiliation(s)
- Manila Mathews
- 1 Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Poornima Bhola
- 1 Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Hesi Herbert
- 1 Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Santosh K Chaturvedi
- 2 Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
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Mutiso VN, Pike KM, Musyimi CN, Rebello TJ, Tele A, Gitonga I, Thornicroft G, Ndetei DM. Changing patterns of mental health knowledge in rural Kenya after intervention using the WHO mhGAP-Intervention Guide. Psychol Med 2019; 49:2227-2236. [PMID: 30345938 DOI: 10.1017/s0033291718003112] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Despite the high prevalence of mental disorders, mental health literacy has been comparatively neglected. People's symptom-management strategies will be influenced by their mental health literacy. This study sought to determine the feasibility of using the World Health Organization mhGAP-Intervention Guide (IG) as an educational tool for one-on-one contact in a clinical setting to increase literacy on the specified mental disorders. METHODS This study was conducted in 20 health facilities in Makueni County, southeast Kenya which has one of the poorest economies in Kenya. It has no psychiatrist or clinical psychologist. We recruited 3267 participants from a community that had already been exposed to community mental health services. We used Mental Health Knowledge Schedule to measure the changing patterns of mental health knowledge after a period of 3 months, following a training intervention using the WHO mhGAP-IG. RESULTS Overall, there was a significant increase in mental health related knowledge [mean range 22.4-23.5 for both post-test and pre-test scores (p < 0.001)]. This increase varied with various socio-demographic characteristics such as sex, marital status, level of education, employment status and wealth index. CONCLUSIONS mhGAP-IG is a feasible tool to increase mental health literacy in low-resource settings where there are no mental health specialists. Our study lends evidence that the WHO Mental Health Action Plan 2013-2020 and reduction of the treatment gap may be accelerated by the use of mhGAP-IG through improving knowledge about mental illness and potentially subsequent help seeking for early diagnosis and treatment.
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Affiliation(s)
- V N Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - K M Pike
- Columbia University, Global Mental Health Program, New York, USA
| | - C N Musyimi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - T J Rebello
- Columbia University, Global Mental Health Program, New York, USA
| | - A Tele
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - I Gitonga
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - G Thornicroft
- Institute of Psychiatry, King's College London, London, UK
| | - D M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
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Dutta M, Spoorthy MS, Patel S, Agarwala N. Factors responsible for delay in treatment seeking in patients with psychosis: A qualitative study. Indian J Psychiatry 2019; 61:53-59. [PMID: 30745654 PMCID: PMC6341933 DOI: 10.4103/psychiatry.indianjpsychiatry_234_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Patients with psychosis often seek treatment at a later date after the onset of illness. There are a multitude of factors behind the treatment delay in these patients, reduction of this delay will help in better prognosis of these patients. MATERIALS AND METHODS A cross sectional study was conducted to understand the various reasons responsible for treatment delay in patients with psychosis. 25 subjects were selected by purposive sampling and their family members were interviewed. Qualitative analysis was carried out to identify various factors. RESULTS Reasons for treatment delay were at several levels like illness related, patient related, treatment related, family related factors. However the most common themes among these were unawareness of illness, explanatory models of illness, stigma, financial constraints. Other themes like relation of symptoms with premorbid personality, life events, absence of paternal support were also unfolded in the current study. CONCLUSIONS There is significant delay between onset of psychosis and treatment seeking. Several factors are responsible for treatment delay in patients with psychotic illness. However they vary depending upon the socio-cultural background of the patient and their family members. Hence the interventions devised towards reducing the delay should be individualised.
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Affiliation(s)
- Mithun Dutta
- Department of Psychiatry, Raipur Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | | | - Shrimaan Patel
- Department of Psychiatry, Raipur Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Nitish Agarwala
- Department of Psychiatry, Raipur Institute of Medical Sciences, Raipur, Chhattisgarh, India
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Böge K, Hahn E, Cao TD, Fuchs LM, Martensen LK, Schomerus G, Dettling M, Angermeyer M, Nguyen VT, Ta TMT. Treatment recommendation differences for schizophrenia and major depression: a population-based study in a Vietnamese cohort. Int J Ment Health Syst 2018; 12:70. [PMID: 30473728 PMCID: PMC6234672 DOI: 10.1186/s13033-018-0247-6] [Citation(s) in RCA: 3] [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: 07/16/2018] [Accepted: 11/02/2018] [Indexed: 11/10/2022] Open
Abstract
Background In Vietnam, the mental health care infrastructure is on the verge of transformation with an increase in the demand for access to adequate and effective mental health care services. Public attitudes towards mental illness, as well as corresponding treatment options influence help-seeking behaviors of patients and caregivers, affecting the course of their treatment. This study assesses attitudes towards treatment options for depression and schizophrenia, as the two most common psychiatric disorders in Vietnam, accounting for at least 75% of all psychiatric inpatients. Methods A general population-based survey was conducted in Hanoi, Vietnam between April and August 2013. Participants received a description of a person with symptoms of either depression (n = 326) or schizophrenia (n = 403) and were asked to give recommendations for adequate sources of mental health support and treatment options. Multiple analyses on a single item level compared the likelihood of recommendation between schizophrenia and depression. Results Overall, respondents recommended health care services, ranging from seeking mental health care professionals, psychotherapists, and psychiatrists for both disorders. Psychotherapy was the most favored treatment method, whereas further treatment options, such as concentration and relaxation exercises, meditation or yoga and psychotropic medication were also endorsed as helpful. For the schizophrenia vignette condition, psychotherapy, visiting a psychiatrist or psychotherapist received stronger endorsement rates as compared to the depression vignette. Furthermore, ECT, Feng Shui-based practices, praying and visiting natural healers were recommended less by respondents for the depression vignette in comparison with the schizophrenia vignette. Conclusions The Vietnamese public endorsed evidence-based treatment recommendations from a variety of treatments options. Differences in the treatment recommendations between depression and schizophrenia reflected the perceived severity of each disorder. Further developments of the Vietnamese mental health care system concerning mental health care providers, as well as the legal regulations surrounding the provision of psychotherapy are needed.
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Affiliation(s)
- Kerem Böge
- 1Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Eric Hahn
- 1Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Tien Duc Cao
- Department of Psychiatry and Psychological Medicine, Hospital 103, Military Medical University, Hanoi, Vietnam
| | - Lukas Marian Fuchs
- 1Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Lara Kim Martensen
- 1Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Georg Schomerus
- 3Center for Public Mental Health, Untere Zeile 13, 3482 Gösing am Wagram, Austria
| | - Michael Dettling
- 1Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Matthias Angermeyer
- 4Department of Psychiatry, Ernst Moritz Arndt University, Greifswald, Germany
| | - Van Tuan Nguyen
- 5Department of Psychiatry, Hanoi Medical University, Hanoi, Vietnam
| | - Thi Minh Tam Ta
- 1Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.,6Berlin Institute of Health, Berlin, Germany
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van der Watt ASJ, van de Water T, Nortje G, Oladeji BD, Seedat S, Gureje O. The perceived effectiveness of traditional and faith healing in the treatment of mental illness: a systematic review of qualitative studies. Soc Psychiatry Psychiatr Epidemiol 2018; 53:555-566. [PMID: 29696304 DOI: 10.1007/s00127-018-1519-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 04/13/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE This work complements a quantitative review by Nortje et al. (Lancet Psychiatry 3(2):154-170, 2016) by exploring the qualitative literature in regard to the perceived effectiveness of traditional and faith healing of mental disorders. METHOD Qualitative studies focusing specifically on traditional and/or faith healing practices for mental illness were retrieved from eight databases. Data were extracted into basic coding sheets to facilitate the assessment of the quality of eligible papers using the COREQ. RESULTS Sixteen articles met the inclusion criteria. Despite methodological limitations, there was evidence from the papers that stakeholders perceived traditional and/or faith healing to be effective in treating mental illness, especially when used in combination with biomedical treatment. CONCLUSION Patients will continue to seek treatment from traditional and/or faith healers for mental illness if they perceive it to be effective regardless of alternative biomedical evidence. This provides opportunities for collaboration to address resource scarcity in low to middle income countries.
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Affiliation(s)
- A S J van der Watt
- Department of Psychiatry, Stellenbosch University, Francie van Zijl Drive, Tygerberg, South Africa.
| | - T van de Water
- Department of Psychiatry, Stellenbosch University, Francie van Zijl Drive, Tygerberg, South Africa
| | - G Nortje
- Department of Psychiatry, Stellenbosch University, Francie van Zijl Drive, Tygerberg, South Africa
| | - B D Oladeji
- Department of Psychiatry, University of Ibadan, Ibadan, 900001, Oyo State, Nigeria
| | - S Seedat
- Department of Psychiatry, Stellenbosch University, Francie van Zijl Drive, Tygerberg, South Africa
| | - O Gureje
- Department of Psychiatry, University of Ibadan, Ibadan, 900001, Oyo 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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Antoniades J, Mazza D, Brijnath B. Becoming a patient-illness representations of depression of Anglo-Australian and Sri Lankan patients through the lens of Leventhal's illness representational model. Int J Soc Psychiatry 2017; 63:569-579. [PMID: 28786331 DOI: 10.1177/0020764017723669] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Depression is prevalent globally. While the uptake of mental health services is poor in the general community, the lack of service engagement is particularly profound in migrant and refugee communities. To understand why there is under-utilisation cross-cultural comparisons of how people make sense of mental illnesses such as depression are essential. AIMS To verify how differing cultural aetiologies about depression influence mental health service use, this study investigated illness representational models of depression held by Sri Lankan migrants and Anglo-Australians living with depression. METHODS In-depth interviews ( n = 48) were conducted with Sri Lankan migrants and Anglo-Australians living with depression to explore their illness beliefs. Data were analysed using Leventhal's illness representational model. RESULTS Significant overlaps in illness representational models were noted but distinctive differences were found between causal and chronicity beliefs; Sri Lankan migrants more frequently endorsed depression as a time-limited condition underpinned by situational factors, whereas Anglo-Australians endorsed a chronic, biopsychosocial model of depression. DISCUSSION AND CONCLUSION Findings highlight the importance of forging a shared understanding of patient beliefs in the clinical encounter to ensure that interventions are coherent with illness beliefs or at least work towards improving mental health literacy. Differences in illness beliefs also provide insights into possible interventions. For example, psychosocial interventions that align with their illness beliefs may be more suited to Sri Lankan migrants than pharmaceutical or psychological ones.
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Affiliation(s)
- Josefine Antoniades
- 1 Department of General Practice, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, VIC, Australia
| | - Danielle Mazza
- 1 Department of General Practice, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, VIC, Australia
| | - Bianca Brijnath
- 2 School of Occupational Therapy and Social Work, Curtin University, Bentley, WA, Australia
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26
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Abstract
PURPOSE OF REVIEW Patient and physician perspectives about mental health, illness, and recovery, which affect different aspects of help seeking and healthcare, needs to be understood and theorized. RECENT FINDINGS People seem to simultaneously hold multiple and contradictory illness beliefs and seek help from diverse sources of cure and healing. Explanatory models elicited at baseline do not predict outcomes of illness, change over time, and are dependent on the interaction between the trajectory of individual's illness and the sociocultural milieu. Illness narratives contextualize the patient, describe the patient's reality and his/her ways of coping, and attempt to make sense of illness experiences, control them, and improve quality of life. On the other hand, diversity of beliefs among psychiatrists, family physicians, and public health specialists is dependent on their disciplinary perspectives. Nevertheless, the variability within psychiatric syndromes and the inability to predict individual trajectories of illness support cultural beliefs about uncertainties of life. These are identified by cultures through idioms and metaphors and labeled as luck, chance, karma, fate, punishment by God, evil spirits, black magic, disease and so on. SUMMARY There is a need for a broad-based approach to mental health, which allows individuals to make sense of their contexts and find meaning in life.
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Dhanasekaran S, Loganathan S, Dahale A, Varghese M. Cultural considerations in the diagnosis and treatment of schizophrenia: A case example from India. Asian J Psychiatr 2017; 27:113-114. [PMID: 28558880 DOI: 10.1016/j.ajp.2017.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 02/19/2017] [Accepted: 02/19/2017] [Indexed: 11/25/2022]
Abstract
Culture plays an important role in the presentation, help seeking, treatment and outcomes of psychiatric illnesses like schizophrenia. We report a case of paranoid schizophrenia in a 35-year-old lady, from South India, whose clinical presentation was influenced by various sociocultural factors. These cultural constructs were taken into consideration to formulate an acceptable and effective management plan. A detailed case description using a cultural formulation to highlight the etic and emic perspectives and challenges in treatment and management are discussed.
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Affiliation(s)
- Saranya Dhanasekaran
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore 560029, India.
| | - Santosh Loganathan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Ajit Dahale
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
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Maraj A, Anderson KK, Flora N, Ferrari M, Archie S, McKenzie KJ. Symptom profiles and explanatory models of first-episode psychosis in African-, Caribbean- and European-origin groups in Ontario. Early Interv Psychiatry 2017; 11:165-170. [PMID: 26353924 DOI: 10.1111/eip.12272] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 07/06/2015] [Accepted: 08/17/2015] [Indexed: 11/30/2022]
Abstract
AIM To assess variability in symptom presentation and explanatory models of psychosis for people from different ethnic groups. METHODS Clients with first-episode psychosis (n = 171) who identified as black African, black Caribbean or white European were recruited from early intervention programmes in Toronto and Hamilton. We compared results by ethnic group for symptom profiles and explanatory models of illness. RESULTS Clients of black Caribbean origin had a lower odds of reporting that they were speaking incomprehensibly (OR = 0.36; 95% CI: 0.14-0.90) and black African clients had a greater odds of reporting persistent aches or pains (OR = 2.92; 95% CI: 1.32-6.50). Black African clients had a lower odds of attributing the cause of psychosis to hereditary factors (OR = 0.41; 95% CI: 0.19-0.89) or to substance abuse (OR = 0.29; 95% CI: 0.13-0.67) and had a lower odds of assigning responsibility for their illness to themselves (OR = 0.41; 95% CI: 0.19-0.89). CONCLUSIONS Understanding the differences in illness models for ethnic minority groups may help improve the cultural competence of mental health services.
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Affiliation(s)
- Anika Maraj
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Kelly K Anderson
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Nina Flora
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Manuela Ferrari
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,School of Health Policy and Management, York University, Toronto, Ontario, Canada
| | - Suzanne Archie
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Kwame J McKenzie
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Husain MI, Chaudhry IB, Rahman RR, Hamirani MM, Mehmood N, Haddad PM, Hodsoll J, Young AH, Naeem F, Husain N. Pilot study of a culturally adapted psychoeducation (CaPE) intervention for bipolar disorder in Pakistan. Int J Bipolar Disord 2017; 5:3. [PMID: 28155203 PMCID: PMC5307423 DOI: 10.1186/s40345-017-0074-8] [Citation(s) in RCA: 9] [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: 11/01/2016] [Accepted: 01/11/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Despite the use of maintenance medication, recurrence rates in bipolar affective disorder (BPAD) are high. To date, there are no clinical trials that have investigated the use of psychological interventions in bipolar disorder in Pakistan. AIM The purpose of the study was to assess the feasibility and acceptability of a culturally adapted bipolar psychoeducation programme (CaPE) in Pakistan. METHODS Thirty-four euthymic bipolar I and II outpatients were randomized to either 12 weekly sessions of individual psychoeducation plus Treatment As Usual (Intervention) or Treatment As Usual (TAU) (Control). Outcomes were assessed using the Young Mania Rating Scale (YMRS), Beck Depression Inventory (BDI), EuroQoL (EQ-5D), Bipolar Knowledge and Attitudes and Questionnaire (BKAQ), and a self-reported measure of medication adherence (Morisky Medication Adherence Scale-4 items, MMAS-4). Effect sizes were derived from baseline adjusted standardized regression coefficients. RESULTS Retention in the study was good, 80% of patients in the TAU follow-up assessment and 100% of patients in the CaPE group attended all 12 sessions. Patient satisfaction was higher in the CaPE group relative to control (ES = 1.41). Further, there were large effect sizes shown for CaPE versus TAU for medication adherence (MMAS-4: ES = 0.81), knowledge and attitudes towards bipolar (BKAQ: ES = 0.68), mania (YMRS: ES = 1.18), depression (BDI: ES = 1.17) and quality of life measures (EQ-5D: ES ⇒ 0.88). CONCLUSIONS Culturally adapted psychoeducation intervention is acceptable and feasible, and can be effective in improving mood symptoms and knowledge and attitudes to BPAD when compared with TAU. Larger scale studies are needed to confirm our findings. TRIAL REGISTRATION Clinicaltrials.gov identifier NCT02210390.
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Affiliation(s)
- Muhammad Ishrat Husain
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London, NW1 0PE, UK.
| | - Imran B Chaudhry
- Pakistan Institute of Living and Learning, Karachi, Sindh, Pakistan
| | - Raza R Rahman
- Department of Psychiatry, Dow University of Health Sciences, Karachi, Pakistan
| | - Munir M Hamirani
- Department of Psychiatry, Abbasi Shaheed Hospital, Karachi, Pakistan
| | - Nasir Mehmood
- Pakistan Institute of Living and Learning, Karachi, Sindh, Pakistan
| | | | - John Hodsoll
- Centre for Affective Disorders, Institute of PsychiatryPsychology and Neuroscience, King's College London, London, UK
| | - Allan H Young
- Centre for Affective Disorders, Institute of PsychiatryPsychology and Neuroscience, King's College London, London, UK
| | - Farooq Naeem
- Department of Psychiatry, Queens' University, Kingston, ON, Canada
| | - Nusrat Husain
- University of Manchester, Oxford Road, Manchester, UK
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Cohen A, Padmavati R, Hibben M, Oyewusi S, John S, Esan O, Patel V, Weiss H, Murray R, Hutchinson G, Gureje O, Thara R, Morgan C. Concepts of madness in diverse settings: a qualitative study from the INTREPID project. BMC Psychiatry 2016; 16:388. [PMID: 27829384 PMCID: PMC5103598 DOI: 10.1186/s12888-016-1090-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 10/25/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In order to facilitate case identification of incident (untreated and recent onset) cases of psychosis and controls in three sites in India, Nigeria and Trinidad, we sought to understand how psychoses (or madness) were conceptualized locally. The evidence we gathered also contributes to a long history of research on concepts of madness in diverse settings. METHODS We conducted focus group discussions and individual interviews to collect information about how informants in each site make sense of and respond to madness. A coding framework was developed and analyses of transcripts from the FGDs and interviews were conducted. RESULTS Analyses suggest the following: a) disturbed behaviors are the primary sign of madness; b) madness is attributed to a wide range of causes; and, c) responses to madness are dictated by cultural and pragmatic factors. These findings are congruent with similar research that has been conducted over the past 50 years. CONCLUSIONS The INTREPID research suggests that concepts about madness share similar features across diverse settings: a) terms for madness are often derived from a common understanding that involves disruptions in mental processes and capacities; b) madness is recognized mostly by disruptive behaviours or marked declines in functioning; c) causal attributions are varied; and, d) help-seeking is a complex process.
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Affiliation(s)
- Alex Cohen
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Maia Hibben
- Department of Psychiatry, University of the West Indies, St Augustine, Trinidad
| | - Samuel Oyewusi
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Sujit John
- Schizophrenia Research Foundation, Chennai, India
| | - Oluyomi Esan
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Vikram Patel
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen Weiss
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Robin Murray
- Psychosis Studies Department, Institute of Psychiatry, King’s College London, London, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK
| | - Gerard Hutchinson
- Department of Psychiatry, University of the West Indies, St Augustine, Trinidad
| | - Oye Gureje
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | | | - Craig Morgan
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College London, London, UK
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Devi Thakoor JP, Dong H, Zhang X, Wang G, Huang H, Xiang Y, Hao W. Duration of Untreated Psychosis in Chinese and Mauritian: Impact of Clinical Characteristics and Patients' and Families' Perspectives on Psychosis. PLoS One 2016; 11:e0157083. [PMID: 27281125 PMCID: PMC4900673 DOI: 10.1371/journal.pone.0157083] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 05/24/2016] [Indexed: 12/30/2022] Open
Abstract
Background Duration of untreated psychosis (DUP) is a potentially modifiable prognostic factor of course and prognosis of psychiatric disorders. Few studies have demonstrated that different cultural backgrounds or perspectives on psychosis may be important factors to the DUP. This study attempted to explore whether the DUP was different in Chinese and Mauritians and to clarify potential influencing factors to a long DUP (>3 months). Methods 200 patients from China and 100 patients from Mauritius were enrolled in the study. Their respective family members were also recruited. Demographic and clinical characteristics were collected, and the Internalized Stigma of Mental Illness (ISMI) scale was adapted to measure the stigma in all subjects. Binary logistic regression analysis was used to find the potential influencing factors to the long DUP. Results 35.3% of the enrolled patients had a long DUP. No significant difference was found in frequency of long DUP between the two countries. Chinese patients had relatively less perceptions of stigma. Furthermore, Chinese patients with a long DUP had more perception of breakup due to mental illness (OR = 2.22, p = 0.04) and more families’ perception of the patient being disinherited due to mental illness (OR = 6.47, p = 0.01). Mauritian patients with a long DUP were less likely to have high monthly income (OR = 0.12, p<0.01), while they had less patients’ awareness of mental illness (OR = 0.31, p<0.05) and less families’ awareness of mental illness (OR = 0.14, p<0.01). Conclusion The results of this study underlined the importance of DUP in economic conditions, racial and sociocultural factors, and public awareness on psychosis in developing countries.
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Affiliation(s)
| | - Huixi Dong
- Mental Health Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiaojie Zhang
- Mental Health Institute, Second Xiangya Hospital, Central South University, Changsha, China
- Brain Research Center, University of British Columbia, Vancouver, Canada
| | - Gang Wang
- Mental Health Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Hui Huang
- Mental Health Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Yutao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Wei Hao
- Mental Health Institute, Second Xiangya Hospital, Central South University, Changsha, China
- * E-mail: ;
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Naeem F, Johal R, McKenna C, Rathod S, Ayub M, Lecomte T, Husain N, Kingdon D, Farooq S. Cognitive Behavior Therapy for psychosis based Guided Self-help (CBTp-GSH) delivered by frontline mental health professionals: Results of a feasibility study. Schizophr Res 2016; 173:69-74. [PMID: 26971071 DOI: 10.1016/j.schres.2016.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 03/01/2016] [Accepted: 03/04/2016] [Indexed: 11/17/2022]
Abstract
Availability of Cognitive Behavior Therapy for psychosis (CBTp) is limited in spite of strong evidence base. The purpose of this study was to determine the feasibility of a CBTp based Guided Self-help (CBTp-GSH) in comparison to Treatment As Usual (TAU). The secondary outcomes were a reduction of symptoms of schizophrenia using Positive and Negative Symptom Scale (PANSS) & Disability (WHO DAS 2.0). A total of 33 adults with a DSM-IV diagnosis of schizophrenia was recruited from community mental health services in Kingston, ON, Canada, and randomly assigned to the 12-16week intervention with TAU (Treatment), or TAU alone (Control). End of therapy (16weeks) comparisons between the two groups were made on an Intention To Treat (ITT) basis. Post-intervention scores on measures of psychopathology were compared using Analysis of Covariance (ANCOVA) to adjust for baseline measurements. Recruitment proved feasible, retention rates were high and participants reported a high level of acceptability. There was significant "treatment group by outcome interaction" for Positive and Negative Symptoms, General Psychopathology, measures of disability, such that individuals who received the Treatment improved more than those in Control group. The results of this feasibility study indicate that CBTp based Guided Self-help is feasible and acceptable to the participants, and it can lead to improvement in psychopathology and the level of disability. Individuals in this study had a moderate degree of psychopathology and relatively low level of disability and, therefore, caution is warranted in applying these results to individuals with severe symptoms and with high levels of disability. An adequately powered randomized controlled trial of the intervention is warranted.
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Nortje G, Oladeji B, Gureje O, Seedat S. Effectiveness of traditional healers in treating mental disorders: a systematic review. Lancet Psychiatry 2016; 3:154-70. [PMID: 26851329 DOI: 10.1016/s2215-0366(15)00515-5] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 11/10/2015] [Accepted: 11/11/2015] [Indexed: 10/22/2022]
Abstract
Traditional healers form a major part of the mental health workforce worldwide. Despite this, little systematic examination has been done of their effectiveness in treating mental illness or alleviating psychological distress. In this Review, we aim to fill this gap, with a focus on quantitative outcomes. We searched four databases and reference lists for papers that explicitly measured the effectiveness of traditional healers on mental illness and psychological distress. Eligible papers were assessed for quality, and outcomes and other details were extracted with the use of a standardised template. 32 eligible papers from 20 countries were included. The published literature on this topic is heterogeneous and studies are generally of poor quality, although some findings emerge more consistently. Some evidence suggests that traditional healers can provide an effective psychosocial intervention. Their interventions might help to relieve distress and improve mild symptoms in common mental disorders such as depression and anxiety. However, little evidence exists to suggest that they change the course of severe mental illnesses such as bipolar and psychotic disorders. Nevertheless, qualitative changes that are captured poorly by conventional rating scales might be as important as the quantitative changes reviewed here. We conclude by outlining the challenges involved in assessing the effectiveness of traditional healers.
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Affiliation(s)
- Gareth Nortje
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa.
| | | | - Oye Gureje
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
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Thippeswamy H, Dahale A, Desai G, Chandra PS. What is in a name? Causative explanatory models of postpartum psychosis among patients and caregivers in India. Int J Soc Psychiatry 2015; 61:818-23. [PMID: 26238989 DOI: 10.1177/0020764015597016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Explanatory models (EMs) influence decision-making related to treatment and compliance. There is little knowledge about belief systems related to postpartum psychosis in different cultures. AIMS To study EMs of illness among women with postpartum psychosis and their family members in India. METHOD A total of 123 women with postpartum psychosis and their caregivers were assessed to understand their beliefs regarding causes of postpartum psychosis using Short Explanatory Model Interview (SEMI). Local names were listed and emerging themes were analysed. RESULTS Respondents often held more than one EM and only one-third held a biomedical EM. Other common models included stressors unique to childbirth, marital stress and supernatural causes. Local names reflected the underlying models. CONCLUSION Non-biomedical EMs are common in women with postpartum psychosis. Cultural and social factors unique to childbirth appear to influence these models. There is a need to enhance awareness and knowledge about this serious disorder in the community.
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Affiliation(s)
- Harish Thippeswamy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Ajit Dahale
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Prabha S Chandra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
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Sebergsen K, Norberg A, Talseth AG. Being in a process of transition to psychosis, as narrated by adults with psychotic illnesses acutely admitted to hospital. J Psychiatr Ment Health Nurs 2014; 21:896-905. [PMID: 24784573 PMCID: PMC4263308 DOI: 10.1111/jpm.12158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2014] [Indexed: 12/01/2022]
Abstract
To assist in improving early interventions for psychosis, this study explored how adult people narrated their experience of becoming psychotic, and how contact with mental health personnel was established. Narrative interviews were conducted with 12 participants with psychotic illnesses recruited from acute psychiatric wards. The interviews were content analysed. Participants described being in a process of transition to psychosis as follows: experiencing changes as well-known signs of psychosis, experiencing sudden unexpected changes as signs of psychosis and experiencing unidentified changes as signs of illness. Our results show that participants and their close others who knew the signs of psychosis established a dialogue with mental health personnel and were better equipped to prevent and mitigate the psychosis. Our results demonstrate that participants who did not perceive the signs of psychosis and did not have other people to advocate for them were at risk for delayed treatment, poor communication and coercive interventions. Furthermore, participants who did not know the signs of psychosis perceived these changes as deterioration in their health and awareness of illness. We suggest that participants' experiential knowledge of transitioning to psychosis and an awareness of illness can be used to improve the communication during interventions for psychosis.
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Affiliation(s)
- K Sebergsen
- Division of General Psychiatry, University Hospital of North Norway, Tromsø, Norway
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Lewis-Fernández R, Aggarwal NK, Bäärnhielm S, Rohlof H, Kirmayer LJ, Weiss MG, Jadhav S, Hinton L, Alarcón RD, Bhugra D, Groen S, van Dijk R, Qureshi A, Collazos F, Rousseau C, Caballero L, Ramos M, Lu F. Culture and psychiatric evaluation: operationalizing cultural formulation for DSM-5. Psychiatry 2014; 77:130-54. [PMID: 24865197 PMCID: PMC4331051 DOI: 10.1521/psyc.2014.77.2.130] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Outline for Cultural Formulation (OCF) introduced with DSM-IV provided a framework for clinicians to organize cultural information relevant to diagnostic assessment and treatment planning. However, use of the OCF has been inconsistent, raising questions about the need for guidance on implementation, training, and application in diverse settings. To address this need, DSM-5 introduced a cultural formulation interview (CFI) that operationalizes the process of data collection for the OCF. The CFI includes patient and informant versions and 12 supplementary modules addressing specific domains of the OCF. This article summarizes the literature reviews and analyses of experience with the OCF conducted by the DSM-5 Cross-Cultural Issues Subgroup (DCCIS) that informed the development of the CFI. We review the history and contents of the DSM-IV OCF, its use in training programs, and previous attempts to render it operational through questionnaires, protocols, and semi-structured interview formats. Results of research based on the OCF are discussed. For each domain of the OCF, we summarize findings from the DCCIS that led to content revision and operationalization in the CFI. The conclusion discusses training and implementation issues essential to service delivery.
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