Patterns of treatment seeking behavior for mental illnesses in Southwest Ethiopia: a hospital based study

"Trust in God, but tie your donkey": Holy water priest healers' views on collaboration with biomedical mental health services in Addis Ababa, Ethiopia

This exploratory qualitative study examines holy water priest healers' explanatory models and general treatment approaches toward mental illness, and their views and reflections on a collaborative project between them and biomedical practitioners. The study took place at two holy water treatment sites in Addis Ababa, Ethiopia. Twelve semi-structured interviews with holy water priest healers found eight notable themes: they held multiple explanatory models of illness, dominated by religious and spiritual understanding; they emphasized spiritual healing and empathic understanding in treatment, and also embraced biomedicine as part of an eclectic healing model; they perceived biomedical practitioners' humility and respect as key to their positive views on the collaboration; they valued recognition of their current role and contribution in providing mental healthcare; they recognized and appreciated the biomedical clinic's effectiveness in treating violent and aggressive patients; they endorsed the collaboration and helped to overcome patient and family reluctance to the use of biomedicine; they lamented the lack of spiritual healing in biomedical treatment; and they had a number of dissatisfactions and concerns, particularly the one-way referral from religious healers to the biomedical clinic. The study results show diversity in the religious healers' etiological understanding, treatment approaches and generally positive attitude and views on the collaboration. We present insights and explorations of factors affecting this rare, but much needed collaboration between traditional healers and biomedical services, and potential ways to improve it are discussed.

Patterns of help-seeking behavior among people with mental illness in Ethiopia: a systematic review and meta-analysis

Background

Despite the availability of evidence-based and effective treatments, significant numbers of people living with mental illness do not receive treatment or do not seek help from providers of formal modern treatment. Although numerous primary studies have been conducted on patterns of help-seeking behavior among individuals with mental illness with respect to modern therapy, the evidence has not been aggregated nationwide. Therefore, the aim of this review was to investigate pooled data on patterns of help-seeking behavior among individuals with mental illness in Ethiopia.

Methods

All available primary studies were searched via the Google Scholar, HINARI, and PubMed databases from June 22 to December 20, 2023; 912 articles were identified. Sixteen articles were included in the final review; data from them were extracted to an Excel spreadsheet and exported to Stata version 17 for analysis. The search terms used were: "Pattern of help-seeking behavior'' OR "Pattern of treatment-seeking behavior" OR "Health care-seeking behavior" OR "Help-seeking intention" OR "Help-seeking preferences" OR "Perceived need" OR "Pathways to psychiatric care", AND "Common mental disorders" OR "Mental illness" OR "Mental health problems" OR "Depression", AND "Predictors" OR "Determinate factors" OR "Associated factors", AND "Ethiopia". The quality of the studies included was critically appraised using the modified The Joanna Briggs Institute (JBI) Joanna Briggs Institute quality assessment tool, adapted for observational studies. During critical appraisal, disagreements between the two authors conducting the assessment were resolved by the involvement of a third author. Effect sizes were pooled using the random effects model, and the presence of publication bias was detected based on asymmetry of the funnel plot and a statistically significant result of Egger's test (p<0.05).

Results

The pooled rate of positive help-seeking behavior with respect to modern treatment among people living with mental illness was 42.21% (95% CI: 29.29, 55.12; I2 = 99.37%, P=0.00). Factors significantly associated with a positive pattern of help-seeking behavior were: having a secondary education or above (AOR=5.47, 95% CI: 2.33, 12.86); believing that mental illness requires treatment (AOR=2.76, 95% CI: 2.02, 3.78); having strong social support (AOR=2.00, 95% CI: 1.64, 2.44); having a family history of mental illness (AOR=2.68, 95% CI: 1.38, 3.97); having awareness of the availability of treatment (AOR=2.92, 95% CI: 1.56, 5.46); having previously engaged in positive help-seeking behavior (AOR=3.28, 95% CI: 1.63, 6.60); having comorbid disorders (AOR=4.25, 95% CI: 1.69, 10.66); not using alcohol (AOR=3.29, 95% CI: 1.73, 6.27); and the perceived severity of mental illness (AOR=2.54, 95% CI: 1.490, 4.33).

Conclusions

The majority of people with mental illness in Ethiopia exhibited a poor pattern of help-seeking behavior with respect to modern treatment. Therefore, mobilization of the community should be encouraged via regular public awareness campaigns regarding mental illness and the availability of evidence-based and effective modern treatment in Ethiopia. Moreover, the design of effective community-based mental health interventions is recommended in order to improve public attitudes and rates of help-seeking behavior in relation to mental health problems.

Factors Influencing Delay in Seeking Care for Mental Illness Among a Sample of Adult Saudi Arabian Patients

BACKGROUND

 Treatment and prognosis of psychiatric disorders could be negatively affected by delay in seeking mental health care. The development of mental health services depends on understanding the reasons for delays in help-seeking and pathways to care and the duration of illness before treatment is initiated.

OBJECTIVES

The aim of the present study is to examine the reasons why patients with psychiatric symptoms delay their visits to psychiatry clinics in Saudi Arabia.

METHODS

This was a cross-sectional, observational, survey-based study that included 268 patients, of which 60.8% were males. Data were collected through a questionnaire (either online or distributed to patients who attend the outpatient psychiatric clinics) in Taif, Saudi Arabia.

RESULTS

Most patients were married males below 40 years old, with a university degree level, employed, and having average financial status. The most common symptom reported by responders was anxiety (41.8%). The most common reason in both age groups was the fear of side effects of medication (31.9% in those over 40 years and 18.4% below 40 years), followed by the patient belief that these are non-psychiatric symptoms and will disappear with time. The trial of folk medicine was the least common reason for both age groups (1.8% in patients below 40 years and 0% for patients above 40 years).

CONCLUSION

Fear of psychotropic drug adverse effects was the most frequent reason given for postponing mental health counseling. This could be due to some unpleasant or intolerable effects. Anxiety was the most common psychiatric symptom among patients delaying their first psychiatric consultation. These findings serve as a guide for the improvement of mental health services and psychoeducation in Saudi Arabia.

Delayed treatment seeking and its associated factors among people with schizophrenia spectrum disorders who are on follow-up at Dilla University Referral Hospital in the southern region of Ethiopia, 2022: a cross-sectional study

Background

Delay in psychiatric treatment leads to increased morbidity and mortality, as well as the emergence of several psychiatric and physical comorbidities and the use of life-threatening and life-altering self-treatments (such as licit and illicit substance misuse). Delaying detection and taking preventive measures against its modifiable factors are crucial for a better prognosis.

Objective

To assess delayed treatment seeking and its associated factors among people with schizophrenia spectrum disorders who are on follow-up at Dilla University Referral Hospital in the southern region of Ethiopia.

Method

An institution-based cross-sectional study was conducted between 8 June and 11 September at Dilla University Referral Hospital in the southern region of Ethiopia in 2022. Epicollect was used to collect data from 414 randomly selected participants using an interviewer-administered questionnaire. Delayed treatment seeking was determined using participants' medical records and a semi-structured questionnaire. The data were analyzed using Statistical Package for Social Sciences (SPSS) version 26. A logistic regression analysis was conducted to identify the explanatory variables for delayed treatment.

Results

The magnitude of delayed treatment seeking was 49.8% (95%CI = 44.9, 54.3). Study participants with disengaged family cohesion [AOR = 3.97, 95%CI = (2.999, 7.193)], inflexible family adaptability [AOR = 2.00, 95%CI = (1.686, 4.044)], who lack awareness about the availability of psychiatric treatment [AOR = 1.63, 95%CI = (1.362, 2.626)], high internalized stigma [AOR = 3.24, 95%CI = (2.770, 5.514)], and those with a negative attitude toward psychiatric treatment [AOR = 2.88, 95%CI = (2.034, 4.469)] had delayed seeking treatment. However, the participants whose educational status was higher than diploma [AOR = 0.040, 95%CI = (0.026, 0.077)] and high school [AOR = 0.09, 95%CI = (0.071, 0.204)] were less likely to have delayed seeking treatment.

Conclusions

There is a significant delay in seeking modern psychiatric treatment. Stigma, a lack of awareness of where treatment is available, disengaged family cohesion, inflexible family adaptability, distance to a health facility >5 km, and a negative attitude toward psychiatric treatment were barriers to seeking appropriate care.

Understandings of depression among community members and primary healthcare attendees in rural Ethiopia: A qualitative study

Available evidence in Africa suggests that the prevalence of depression in primary care settings is high but it often goes unrecognized. In this study, we explored how depression is conceptualized and communicated among community members and primary care attendees diagnosed with depression in rural Ethiopia with the view to informing the development of interventions to improve detection. We conducted individual interviews with purposively selected primary care attendees with depression (n = 28; 16 females and 12 males) and focus group discussions (FGDs) with males, females, and priests (n = 21) selected based on their knowledge of their community. Data were analyzed using thematic analysis. None of the community members identified depression as a mental illness. They considered depressive symptoms presented in a vignette as part of a normal reaction to the stresses of life. They considered medical intervention only when the woman's condition in the vignette deteriorated and "affected her mind." In contrast, participants with depression talked about their condition as illness. Symptoms spontaneously reported by these participants only partially matched symptoms listed in the current diagnostic criteria for depressive disorders. In all participants' accounts, spiritual explanations and traditional healing were prominent. The severity of symptoms mediates the decision to seek medical help. Improved detection may require an understanding of local conceptualizations in order to negotiate an intervention that is acceptable to affected people.

What barriers could impede access to mental health services for children and adolescents in Africa? A scoping review

BACKGROUND

Few studies have examined the mental health needs of African children and teenagers. Based on this gap, this scoping review aims to identify barriers to mental health services, treatments and services sought, and where mental health services are received.

METHODS

To pursue the stated objectives, we searched the following databases a) PsycINFO, b) CINAHL, c) Medline, and d) Web of Science. The search yielded 15,956 records in total.

RESULTS

Studies included in this review were conducted in six African countries: Ethiopia, Mali, Egypt, South Africa, Nigeria, and Tunisia. The majority of the studies were conducted in South Africa (33.32%), followed by Ethiopia (25%), and Egypt (16.67%). In terms of treatments and services sought, both professional and traditional/alternative treatments were reported. The most frequently noted services were psychiatric treatments (25%), screening and diagnostic assessment (16.67%), as well as psychiatric and psychological consultations (16.67%). The most frequently reported treatment centers were psychiatric hospitals. As for treatment barriers, the three most frequently encountered barriers were: a preference for traditional/alternative and complementary treatments (33.33%), followed by stigma (25%), and a lack of knowledge/unfamiliarity with the mental health condition (25%).

CONCLUSION

The results of this study are alarming due to the significant barriers to accessing mental health services coupled with the use of potentially harmful interventions to treat those mental health conditions. We hope this scoping review will help shed light on this important issue and help tomorrow's generation reach its full potential.

Pathways to care in alcohol use disorders: A cross-sectional study from a tertiary hospital in South India

The study examined the pathway patients with alcohol use disorders followed to access tertiary care psychiatry services. We assessed 110 patients and one family member for each patient who sought psychiatry care for alcohol-related problems for the first time using the WHO encounter form. Only 5.5% of patients followed a direct pathway. The rest reached the tertiary hospital after third, fourth, and fifth encounters with other service providers such as traditional and faith healers, medical practitioners, and general hospitals. Although the family decided to seek the first consultation, medical professionals played a pivotal role in referring patients to psychiatry care.

Exploring the trend of Schizophrenia at Hiwot Fana specialized university referral hospital, Eastern, Ethiopia (2016-2020): A 5-year retrospective analysis

Schizophrenia is one of the most troublesome psychiatric problems requiring long-term antipsychotic treatments. There is a scarcity of data regarding its overtime trend in Ethiopia.

Change in attitude and help-seeking pattern of caregivers and patients with mental disorders in the community - Recent findings from India

Knowledge of factors related to patients' and primary caregivers' health-seeking behaviour is required for a complete early intervention for the management of mental illness. Previous research has found that men are more likely to seek care and that a considerable proportion of patients seek help from native healers before obtaining psychiatric help. The goal of this study was to see if there had been any changes in the paths to psychiatric care, as well as the socio-demographic characteristics that were linked to early help-seeking behaviour among patients with mental illnesses in metropolitan eastern India.

Method

The researchers utilised a cross-sectional study design. A face-to-face interview was used to collect data using the WHO Encounter Form. Using a successive sample technique, patients with various diagnoses of mental illness undergoing Psychiatry outpatient therapy at a tertiary care medical college were included in the study.

Results

In terms of gender, ladies (53.3%) were seen to use psychiatric services more than males (46.7%) from an urban or semi-urban background. For dissociative disorders, the median time from onset to first contact with a care provider was 0.1 years; 0.3 years for mood episodes; 0.6 years for anxiety disorders; one year for psychotic disorders; and seven years for Substance Use Disorders (SUD). However, interaction with current psychiatric services took an average of six months for dissociation; 3.5 years for mood disorders; three years for anxiety disorders; six years for psychotic disorders; and a maximum of seventeen years for SUD. Participants in the study who had a family history of mental illness sought care more quickly (OR = 4.3, 95 percent CI 1.19 to 7.11, P = 0.03). The fact that 73 percent of patients have a GP or mental health professional as their first point of contact for various mental diseases is good. Higher education status, urban background, dwelling closer to the mental health centre, and having a biological attribution model for psychological illness were the other clinical and demographic characteristics important for quicker paths to mental health treatment.

Conclusions

In most cases of psychosis and SUD (substance use disorders), there is still a significant delay in receiving modern psychiatric therapy. The number of initial contacts with Native Healers ha s decreased. The majority of people said mental illness was caused by environmental or biological factors. Education and scientific information regarding mental health have aided the process of seeking treatment, and there should be a provision of training programmes for family physicians and community health professionals to facilitate the process of help-seeking behavior of psychiatric patients in the Indian subcontinent.

Mental health stigma and discrimination in Ethiopia: evidence synthesis to inform stigma reduction interventions

BACKGROUND

People with mental illnesses are at an increased risk of experiencing human rights violations, stigma and discrimination. Even though mental health stigma and discrimination are universal, there appears to be a higher burden in low- and middle-income countries. Anti-stigma interventions need to be grounded in local evidence. The aim of this paper was to synthesize evidence on mental health stigma and discrimination in Ethiopia to inform the development of anti-stigma interventions.

METHODS

This evidence synthesis was conducted as a part of formative work for the International Study of Discrimination and Stigma Outcomes (INDIGO) Partnership research program. Electronic searches were conducted using PubMed for scientific articles, and Google Search and Google Scholar were used for grey literature. Records fulfilling eligibility criteria were selected for the evidence synthesis. The findings were synthesized using a framework designed to capture features of mental health stigma to inform cultural adaptation of anti-stigma interventions.

RESULTS

A total of 37 records (2 grey literature and 35 scientific articles) were included in the evidence synthesis. Some of these records were described more than once depending on themes of the synthesis. The records were synthesized under the themes of explanatory models of stigma (3 records on labels and 4 records on symptoms and causes), perceived and experienced forms of stigma (7 records on public stigma, 6 records on structural stigma, 2 records on courtesy stigma and 4 records on self-stigma), impact of stigma on help-seeking (6 records) and interventions to reduce stigma (12 records). Only two intervention studies assessed stigma reduction- one study showed reduced discrimination due to improved access to effective mental health care, whereas the other study did not find evidence on reduction of discrimination following a community-based rehabilitation intervention in combination with facility-based care.

CONCLUSION

There is widespread stigma and discrimination in Ethiopia which has contributed to under-utilization of available mental health services in the country. This should be addressed with contextually designed and effective stigma reduction interventions that engage stakeholders (service users, service providers, community representatives and service developers and policy makers) so that the United Nations universal health coverage goal for mental health can be achieved in Ethiopia.

Stigma and determinant factors among patients with mental disorders: Institution-based cross-sectional study

Objectives:

To assess prevalence and its associated factors of perceived stigma among patients with mental disorders who had appointment for treatment at Debre Markos, Finote Selam, and Felege Hiwot Hospitals, Ethiopia, 2019.

Methods:

At selected hospitals in the Amhara Region, an institution-based cross-sectional study was conducted from 1 February to 1 March 2019. Participants were selected using systematic random sampling technique and data were collected using a standardized questionnaire. The Internalized Stigma Scale was designed to examine the stigma associated with mental disorders. The data were coded and enter into Epi data version 4.4.2.1 before being exported to SPSS version 20 for analysis. Odds ratios and 95% confidence interval were used to show the strength of the association.

Results:

A total of 610 participants were participated, with a response rate of 98.6%, and 215 (35.2%) of them reported a high level of perceived stigma. Being single (adjusted odds ratio = 1.84, 95% confidence interval: 1.12, 3.02), accessing their medication freely (adjusted odds ratio = 1.70, 95% confidence interval: 1.08, 2.67), having suicidal thoughts (adjusted odds ratio = 1.95, 95% confidence interval: 1.25, 3.03), having low social support (adjusted odds ratio = 5.09, 95% confidence interval: 2.95, 8.76), age 25–34 years (adjusted odds ratio = 1.94, 95% confidence interval: 1.11, 3.40), age 35–44 years (adjusted odds ratio = 2.10, 95% confidence interval: 1.06–4.18), and age > 44 years (adjusted odds ratio = 3.48, 95% confidence interval: 1.67, 7.24) were revealed to be significantly associated with high perceived stigma after multivariable logistic regression analysis ( p < 0.05).

Conclusion:

The prevalence of high perceived stigma was 35.2%, which is found to be high among people who have mental disorders in this study. Being single, accessing their medication freely, having suicidal thoughts, having low social support, and being within the age of (25–34), (35–44), > 44 were all found to be significantly associated with high perceived stigma ( p < 0.05). But married, access medication by fee, have no suicidal thought, having moderate and strong social support, and young age were significantly associated with low perceived stigma.

Factors Influencing Formal Mental Treatment - Seeking Behaviour among Caretakers of Mentally Ill Patients in Zanzibar

Background

Mental illnesses are health conditions which are associated with changes in emotion, thinking, or behaviour (or a combination of these). Healthcare-seeking behaviour for formal mental health treatment is lacking all over the world, particularly in low and middle-income countries. Inappropriate health-seeking behaviours are reported to result in delays in seeking appropriate care and thus increase the risk of complications in mentally ill patients. The study aimed to assess factors influencing formal mental treatment-seeking behaviour among caretakers of mentally ill patients in Zanzibar.

Methods

A community-based cross-sectional study design was conducted from January to June, 2021. A total of 246 caretakers of mentally ill patients were recruited for the study using multi-stage sampling technique. An interviewer-administered semi-structured questionnaire was used to collect information from caretakers. Bivariate and multivariable logistic regression models were applied to determine the factors influencing formal mental treatment-seeking behaviour.

Results

Majority of caretakers 187(76%) were aware of formal mental treatment. Also, majority of the participants 145(58.9%) had appropriate healthcare-seeking behaviour toward formal mental treatment. Factors influencing formal mental treatment-seeking behaviour were; perceived severity (AOR 4.651 at 95% CI 2,397-9.021 p<.001) and being aware (AOR 2.907at 95% CI 2.349-2.326 p=.004).

Conclusion

Majority of caretakers were aware of formal mental illness treatment. Also, more than half of the caretakers had appropriate healthcare-seeking behaviour. Factors associated with formal mental treatment-seeking behaviour were awareness of formal mental treatment and perceived severity of mental illness. The study recommends a community sensitisation campaign to raise community awareness and perception towards formal mental treatment. Community sensitisation is crucial for improving formal mental treatment-seeking behaviour.

Mortality rate of mental disorder trends in China from 2002 to 2020

BACKGROUND

The number of people with mental disorders is increasing in China, but there are few studies on the temporal trends and population distribution of mental disorder mortality.

METHODS

The mortality of mental disorders were derived from the China Health Statistics Yearbook published by the National Health and Family Planning Commission. Temporal trends in mortality were examined with a joinpoint regression using annual percent change (APC) and average annual percent change (AAPC). A Poisson regression model was utilized to test the population-level risk factors associated with the death of people with mental disorders.

RESULTS

The mortality of mental disorders in rural Chinese residents showed a decreasing trend from 2002 to 2020 [AAPC -2.06%, 95% confidence interval (CI) -3.16 to -0.91%]. The mortality of mental disorders in urban Chinese residents declined between 2005 and 2011 (APC -13.01%, 95% CI -21.08 to -4.13%). The mortality rate of mental disorders has decreased for urban males with an APC of -2.71% (95% CI -4.52 to -0.71) from 2002 to 2020. Urban women showed an increase in mental disorder mortality from 2002 to 2005 and from 2012 to 2020 with APCs of 19.65% (95% CI 0.64-42.32%) and 6.16% (95% CI 2.22-10.33%), respectively. Age was a significant risk factor for mental disorder mortality (odds ratio 1.28, 95% CI 1.23-1.32).

CONCLUSION

The dissemination of medical and health information, investment in medical and health resources, and the modification and optimization of regulations have led to a decrease in mental disorder mortality in China. It is vital to devote greater attention to elderly individuals suffering from mental disorders.

Mapping the steps to reach psychiatric care in Singapore: An examination of services utilized and reasons for seeking help

OBJECTIVE

The aim of this study is to shed light on the types of services utilized and map the steps taken by patients in their pathways to receiving psychiatric care in Singapore.

METHODS

Participants were outpatients who were recruited from a psychiatric tertiary hospital (n = 323). Pathways to psychiatric care form was administered to collect information on sources of care utilized, reasons for seeking help and the time point of each contact made. Pathways taken by patients to reach psychiatric care were mapped, and reasons for seeking help were reviewed and analyzed. Quantile regression was conducted to explore association between sociodemographic and clinical factors with duration between onset of problem and receiving psychiatric care.

RESULTS

The need to manage symptoms was most commonly endorsed by participants as the reason that first prompted them to seek help. Prior to receiving psychiatric care, participants on average obtained services from 1.2 other care providers and the main pathway to psychiatric services was via primary care and community services (37.2%). The median duration between onset of problem and receiving psychiatric care was 6 months, and age was found to be significantly associated with shorter median duration (β = -0.172, p = 0.009).

CONCLUSIONS

Patients often consult different care providers prior to obtaining psychiatric services and contact was made more frequently via primary care and community care providers. Findings from this study reiterate the need for engaging community partners to render timely and relevant support for individuals with mental health issues.

Correlates of self-reported history of mental health help-seeking: a cross-sectional study among individuals with symptoms of a mental or substance use disorder initiating care for HIV in Cameroon

BACKGROUND

Mental health and substance use disorders (MSDs) increase the risk of poor human immunodeficiency virus (HIV) care outcomes among people living with HIV (PLWH). Receipt of mental health care may improve these adverse outcomes. We aimed to identify correlates of prior mental health help-seeking among PLWH with symptoms of an MSD in Cameroon.

METHODS

We characterize prior mental health help-seeking from formal (mental health specialist/general medical provider) and informal (traditional healer/religious leader) sources among 161 people with symptoms of depression (Patient Health Questionnaire-9 scores> 9), anxiety (General Anxiety Disorder-7 scores> 9), probable post-traumatic stress disorder (PTSD Checklist for DSM-5 scores> 30), or possible alcohol use disorder (Alcohol Use Disorders Identification Test scores≥16) who were newly entering HIV care at three healthcare facilities in Cameroon between June 2019 and March 2020. Help-seeking was defined as ever speaking to a formal or informal source about emotional problems, sadness, or the way they were feeling or behaving. We estimated the association between sociodemographic and psychosocial measures and lifetime mental health help-seeking from each type of source using log-binomial regression.

RESULTS

Overall, 55.3% of 161 PLWH with MSD symptoms reported prior mental health help-seeking, with 24.2% and 46.0% seeking help from formal and informal sources, respectively. Religious leaders were the most common source of help (40.4%), followed by general medical professionals (22.4%), traditional healers (16.8%), and mental health specialists (7.4%). Individuals with higher depressive, anxiety, and trauma symptom severity scores were more likely to have sought help than those with lower scores. Individuals with possible alcohol use disorder were the least likely to have sought help. Prior help-seeking was more common among those reporting a higher number of lifetime traumatic events (prevalence ratio [PR]: 1.06; 95% confidence interval [CI]: 1.01, 1.11) and those with a history of emotional intimate partner violence (PR: 1.34; 95% CI: 1.01, 1.80).

CONCLUSIONS

Prior mental health help-seeking was associated with psychosocial stressors. Help-seeking from informal networks was more common than formal help-seeking. Training in the provision of evidence-based mental health support for informal networks could improve access to mental health care for PLWH with MSDs in Cameroon.

Perceived cause and determinants of help-seeking behavior of schizophrenia among Gondar Zuria district residents, Northwest Ethiopia

INTRODUCTION

The cause of schizophrenia could be a genetic predisposition, environment, viral infections, exposure to poison substances, living in a highly-populated area, and prenatal exposure to hunger mainly in the first three months. Evidence showed that the perceived cause of schizophrenia is supernatural, biological, spiritual, and social causes. Studies in Ethiopia showed that most of the general population perceived the causes of schizophrenia as traditional and the help they seek ranges to medical, religious, and social.

OBJECTIVE

This study aimed to assess perceived cause and determinants of help-seeking behavior of schizophrenia among Gondar Zuria district residents, 2020.

METHODS

A community-based cross-sectional study was conducted from December 3 to 25, 2020. A simple random sampling technique was employed to select 435 study participants. Data were collected through a face-to-face interview, entered into EPI DATA version 3, and analyzed using SPSS version 21. Bivariable and multivariable binary logistic regression analyses were employed to identify factors significantly associated with help-seeking behavior for schizophrenia. Statistical significance was declared at p-value < 0.05 with 95% confidence interval.

RESULTS

Nearly two-thirds (63.8%), the majority (90.8%), and more than half (52.5%) of the participants seek medical, religious, and social help for schizophrenia respectively. Being student (AOR = 3.43; 95% CI: 1.44, 8.15), unemployed (AOR = 4.87; 95% CI: 1.4, 16.40), perceived biological cause (AOR = 1.7; 95% CI: 1.01, 2.89), perceived religious cause (AOR = 0.48; 95% CI: 0.29, 0.80), and perceived social cause (AOR = 2.05; 95% CI: 1.29, 3.25) were significantly associated with medical help seeking. Attending primary school (AOR = 0.17; 95% CI: 0.04, 0.76), employed (AOR = 0.12; 95% CI: 0.02, 0.64), perceived religious cause (AOR = 2.34; 95% CI: 1.06, 5.11) were significantly associated with religious help. Being in the age group of 18-24 years (AOR = 3.5; 95% CI: 1.33, 9.18) and 25-44 years (AOR = 1.94; 95% CI: 1.03, 3.68) were significantly associated with social intervention.

CONCLUSION

Nearly two-thirds, the majority, and more than half of the respondents seek medical, religious, and social help for schizophrenia respectively. Being student, unemployed, perceived biological case, and perceived social cause increases the odds of seeking medical help while perceived religious cause decreases it. Being unemployed, attending primary school decreases the odds of seeking religious help whereas perceived religious cause increases it. Young adults have higher odds of social help-seeking behavior. It is better to create awareness for the community and consider integrating religious and social interventions into medical interventions.

Prevalence, determinants and knowledge about herbal medicine and non-hospital utilisation in southwest Nigeria: a cross-sectional study

OBJECTIVES

To examine the prevalence, determinants, safety perceptions, effectiveness and knowledge of herbal medicines (HMs) and reasons for non-hospital utilisation.

DESIGN

Cross-sectional study.

SETTING

Ekiti state, southwest Nigeria.

PARTICIPANTS

A representative sample (n=1600) of adults (18 years or above) currently living in Ekiti state, southwest Nigeria for at least 2 years, at the time of study.

RESULTS

The majority of the respondents (85% n=1265) have used HMs in the last 2 years. Across economic classes use, middle income (88.3%) was the highest (p<0.001), suggesting poverty is not a major factor, even with income inequality. Their use was the most common among respondents with a primary level of education (91.4%, p=0.001); and 100% use (p=0.009) of respondents practising African traditional religion; farmers and those 70 years or above. Our study also reveals more men (p<0.001) used HMs (89.9%) than women (78.6%) and effectiveness was a major reason for use (39.6%) followed by affordability (31.9%). Although the majority of the respondents (90%) knew the difference between certified and uncertified HMs, uncertified ones were the most commonly used (37.3%) in the population.

CONCLUSION

Although there is a cultural history of HM use within the study population, the choice of use was based on their effectiveness. Therefore, a scientifically valid analysis of this claim within the study population may help achieve a cheaper and affordable healthcare alternative which will be safe. This is important, considering that uncertified HMs were chosen over certified ones, even though a large majority of respondents were aware of differences and likely consequences. This study highlights the need for further investment by the government, individuals and corporate stakeholders in HM research and improvement of conventional healthcare system. This is in addition to public health awareness on the danger of use of uncertified herbal products.

Community Perception and Attitude Towards People with Schizophrenia Among Residents of Arba Minch Zuria District, Arba Minch Health and Demographic Surveillance Sites System (AM-HDSS), Ethiopia: Cross-Section Study

Background

Mental health disorders have identified as being one of the public health issues throughout the world. Recent evidence reveals that more than 21 million people diagnosed with schizophrenia. However, there is little information about community perception and attitude towards people with Schizophrenia in Ethiopia.

Objective

The aim of this study was to assess the community perception and attitude towards people with Schizophrenia among residents of Arba Minch Zuria Districts, Southern Ethiopia.

Methods

A community-based cross-sectional study was conducted among 617 randomly selected adults. Interviewer-administered standard tool was used to collect the data. Descriptive statistics like frequency, mean, and median computed. A binary logistic regression model used to identify factors affecting community perception and attitude towards people with schizophrenia.

Results

Of the study population, 469 (76%) of respondents had good perception and 390 (63.2%) had positive attitudes towards people with schizophrenia. The study participants identified talkativeness and self-neglect behaviors as the most common manifestations of schizophrenia. Besides, this study identified substance misuse and head injury as the perceived cause and spiritual or traditional methods as a preferred treatment for people with schizophrenia. Moreover, the study participants preferred spiritual or traditional methods for the treatment of schizophrenia. Young age [AOR=2.03, 95% CI: 1.21, 3.40], females [AOR=2.32, 95% CI: 1.58, 3.41], good perception towards people with schizophrenia [AOR=4.95, 95% CI: 3.25, 7.54] and no formal educational status [AOR=2.75, 95% CI: 1.33, 5.70], and primary education [AOR=3.72, 95% CI: 1.87, 7.39] were significantly associated with the attitude towards people with schizophrenia.

Conclusion

The findings of this study indicate that approximately one-third of the residents had unfavorable attitudes towards people with schizophrenia. Therefore, giving special attention to male, elders and those who were educated, and individuals who have poor perceptions of people with schizophrenia is crucial.

Self-stigma and medication adherence among patients with mental illness treated at Jimma University Medical Center, Southwest Ethiopia

Background

Self-stigma associated with mental illness has remained a global public health issue affecting social interactions, health care, productivity and acceptance among others. It is one of important factors contributing to non-adherence to medication that leads to increased hospitalization and higher healthcare costs. Hence, the study aimed to assess self-stigma and medication adherence among patients with mental illness treated at the psychiatric clinic of Jimma University Medical Center (JUMC).

Methods

A cross-sectional, community-level study was conducted at Jimma town. The patient’s data was collected from records between April and June 2017 and the collected data was analyzed using SPSS version 21. The Internalized Stigma of Mental Illness (ISMI) tool was utilized to measure internalized stigma. Linear regression analysis was performed to get the final model. Statistical significance association was considered at p-values less than 0.05 and 95% confidence interval was used.

Results

Males comprised more than half (61%) of the total sample of 300 respondents and with a mean age of 34.99 (SD ± 11.51) years. About one-third (32%) of patients had a working diagnosis of schizophrenia followed by major depressive disorder (24.3%). More than half of them, 182 (60.7%) were adherent to their psychotropic medication. The overall mean value of self-stigma was 2.16 (SD = 0.867) and 84 (28%) of the respondents had moderate to high self-stigma. Using ISMI the mean score of alienation was 2.26 (SD = 0.95), stereotype endorsement 2.14 (SD = 0.784), perceived discrimination 2.18 (SD = 0.90), social withdrawal 2.10 (SD = 0.857) and stigma resistance 2.11 (SD = 0.844). Increasing age of the patients (std. β = − 0.091, p = 0.009) and living with kids and spouse (std. β = − 0.099, p = 0.038) were negatively associated with self-stigma whereas increased world health organization disability assessment schedule (WHODAS) score (β = 0.501, p < 0.001), number of relapses (std. β = 0.183, p < 0.01) and medication non-adherence (std. β = 0.084, p = 0.021) were positively associated with self-stigma.

Conclusion

The study revealed that there was high self-stigma among patients with mental illness and a significant association between overall ISMI score and level of medication adherence. These require mental health professionals and policy-makers should give attention to ways to overcome self-stigma and increase medication adherence among patients with mental illness.

Pathways to psychiatric care and factors associated with delayed help-seeking among patients with mental illness in Northern Ethiopia: a cross-sectional study

OBJECTIVE

This study aimed to assess pathways to psychiatric care and factors associated with delayed help-seeking among patients with mental illness in Northern Ethiopia using the WHO Pathway Study Encounter Form.

DESIGN

A cross-sectional study design was used.

SETTING

Data were collected using face-to-face interview from patients with various diagnoses of mental illness attending outpatient treatment at Ayder Comprehensive Specialized Hospital in Mekelle City, Tigray, Northern Ethiopia.

PARTICIPANTS

Participants who came to attend outpatient treatment during the study period were included in the study using consecutive sampling technique.

OUTCOME MEASURES

Pathways to psychiatric care, delayed psychiatric treatment and factors affecting delayed psychiatric treatment.

RESULTS

The median duration from problem onset to contact with first care provider was 4 weeks, whereas contact with modern psychiatric services was 52.0 weeks. Study participants who were single (adjusted OR (AOR)=2.91, 95% CI 1.19 to 7.11), divorced (AOR=3.73, 95% CI 1.33 to 10.49) and who perceived mental illness as shameful (AOR=3.29, 95% CI 1.15 to 9.41) had delayed treatment-seeking behaviour, whereas participants with no history of substance use (AOR=0.43, 95% CI 0.20 to 0.92) were less likely to have delayed treatment-seeking behaviour.

CONCLUSIONS

There is significant delay in seeking modern psychiatric treatment. Religious healers were the first source of help for mental illness. Majority of the respondents described that mental illness was due to supernatural causes. Stigma and lack of awareness about where treatment is available were barriers to seeking appropriate care.

A meta-analysis of depressive symptoms among Ethiopian prisoners and a narrative description of its associated factors: a country based systematic review and meta-analysis study

BACKGROUND

The burden of depression in prisoners is increasing and factors such as co-existence of medical illness, lack of social support and longer duration of sentences are contributing to it. However, no pooled evidence on the magnitude and factors of depression in prisoners existed in Ethiopia. The current meta-analysis was therefore aimed to have aggregate evidence on the magnitude and factors of depression in prisoners of Ethiopia.

METHODS

A search of databases on PubMed, Scopus, and EMBASE was carried out systematically. Besides, grey literature sources were extensively investigated. Moreover, the reference lists of the articles selected were searched. Random effects and quality-effects models were used to describe the pooled prevalence of depressive symptoms with 95% CI. We also detect heterogeneity between studies using Cochran's Q- statistic and the Higgs I² test. A sensitivity analysis was also implemented. Publication bias was checked with Egger's test and funnel plots visually.

RESULTS

Among 232 papers identified through the specified database searches only 17 full-text articles were assessed for eligibility and only nine (9) studies fulfilled the prespecified criteria and incorporated in the final meta-analysis. The pooled prevalence of Depressive symptoms among prisoners was 53.40%(95% CI: 41.33, 65.46). The pooled prevalence of Depressive symptoms in prisoners was 41.9% in Southwest Ethiopia, 44.43% in North West of Ethiopia, 59.05% in Addis Ababa, and 72.7% Southern Ethiopia. Besides, the pooled Depression symptoms prevalence among prisoners was 51.24% as measured with PHQ-9 and 56.15% with BDI-II. Besides, studies that utilized a relatively large sample size (≥350) yields a smaller pooled prevalence of Depression symptoms, 51.93% than those which utilized smaller sample sizes (< 350); 54.13%.

CONCLUSION

The pooled magnitude of depression in prisoner's population is very high, 53.40%. This pooled effect size for the Depression symptoms was significantly higher in the southern region of the country than in the southwest region. Besides, the pooled prevalence was significantly higher as measured by the BDI-II tool than by PHQ-9. Also, studies that utilized a larger sample size provided a significantly lower pooled magnitude of symptoms of depression than studies that utilized a smaller sample size.

Mental distress, perceived need, and barriers to receive professional mental health care among university students in Ethiopia

BACKGROUND

There is limited evidence on the extent of the perceived need and barriers to professional mental health service delivery to university students with mental distress in low- and middle-income countries (LMICs). This study was designed to assess the prevalence of mental distress, perceived need for professional mental health care and barriers to the delivery of services to affected undergraduate university students in Ethiopia.

METHODS

A multi-stage sampling technique was used to recruit 1135 undergraduate university students. Symptoms of mental distress were evaluated using the Self-Reported Questionnaire (SRQ-20) and a score of above seven was used to identify positive cases. The perceived need for professional mental health care was assessed using a single 'yes or no' response item and barriers to mental health care were assessed using Barriers to Access to Care Evaluation (BACE-30) tool. Percentage, frequency, mean, and standard deviation were employed to summarize demographic characteristics of the participants and to identify common barriers to mental health care service. Moreover, the association of demographic variables with total mean scores of BACE-III sub-scales was modeled using multiple linear regression.

RESULTS

The prevalence of mental distress symptoms was 34.6% and the perceived need for professional mental health care was 70.5% of those with mental distress. The top five barriers to receiving professional mental health service were (a) thinking the problem would get better with no intervention, (b) being unsure where to go to get professional help, (c) wanting to solve the problem without intervention, (d) denying a mental health problem existed, and (e) preferring to get alternative forms of mental care. Coming from a rural background, being a second and fourth-year student, and a family history of mental illness were significantly associated with barriers to receive professional mental health service.

CONCLUSION

The high prevalence of mental distress, the paucity of mental health care, and the report of barriers to access what professional mental health care there is among Ethiopian undergraduate students is a call to address the disparity.

Knowledge, attitude, and practice towards epilepsy among religious cleric and traditional healers of Addis Ababa, Ethiopia

PURPOSE

Understanding clerics and healers' knowledge, attitude, and practice towards epilepsy are crucial to identify the mechanisms of epilepsy stigma in Ethiopia. The objective of this study is to characterize the social and demographic determinants of knowledge, attitude, and practices of clerics and healers towards people with epilepsy in Addis Ababa, Ethiopia.

METHODS

A total of 440 clerics and healers were interviewed by trained data collectors using a pretested structured questionnaire. The count sum of outcome variables was grouped into "biological and cultural" knowledge attitude and practice scores. Ordinal regression analysis was performed for each outcome variable against socio-demographic variables of interest.

RESULTS

The percentage of responses matching cultural causes (58%) surpassed biological causes. The most frequently mentioned cultural cause was an evil spirit (22.5%). While the most frequently mentioned biological cause was a head injury (12%). Consistent with the above findings, cultural treatment responses (77%) exceeded biological treatment responses. The most commonly referred cultural treatment response was Church healing session (12%). The type of faith followed by the study participants positively correlated with higher cultural knowledge, attitude, and practice score.

CONCLUSIONS

Clerics and traditional healers in Ethiopia have a partiality to the cultural epilepsy explanation model. Cultural metaphors attached to an evil spirit, curse of God, and witchcraft have formed and fostered existing 'epilepsy societal norms' in Ethiopia. The findings of this study contribute to the understanding of epilepsy stigma and treatment gap. Besides, it provided direction to design and implement epilepsy stigma intervention programs in Ethiopia.

"He can send her to her parents": The interaction between marriageability, gender and serious mental illness in rural Ethiopia

BACKGROUND

For women in most low- and middle-income countries, the diagnosis with serious mental illness (SMI) leads to stigma and challenges related to starting or maintaining marriages. The purpose of this qualitative study was to explore perspectives on marriage, divorce and family roles of women with SMI in rural Ethiopia.

METHODS

A qualitative study was conducted in a rural setting of Butajira, South Central Ethiopia. A total of 39 in-depth interviews were carried out with service users (n = 11), caregivers (n = 12), religious leaders (n = 6), health extension workers (n = 4), police officers (n = 2), teachers (n = 2) and government officials (n = 2). Data were analyzed using a thematic approach.

RESULTS

Three themes emerged. (1) Marriage and SMI: Chances of getting married for individuals with SMI in general was perceived to be lower: Individuals with SMI experienced various challenges including difficulty finding romantic partner, starting family and getting into a long-term relationship due to perceived dangerousness and the widespread stigma of mental illness. (2) Gendered experiences of marriageability: Compared to men, women with SMI experienced disproportionate levels of stigma which often continued after recovery. SMI affects marriageability for men with SMI, but mens' chances of finding a marital partner increases following treatment. For women in particular, impaired functioning negatively affects marriageability as ability to cook, care and clean was taken as the measure of suitability. (3) Acceptability of divorce and separation from a partner with SMI: Divorce or separation from a partner with SMI was considered mostly acceptable for men while women were mostly expected to stay married and care for a partner with SMI. For men, the transition from provider to dependent was often acceptable. However, women who fail to execute their domestic roles successfully were considered inept and would be sent back to their family of origin.

CONCLUSION

Women with SMI or those married to partners with SMI are at greater disadvantage. Reducing vulnerabilities through stigma reduction efforts such as community outreach and mental health awareness raising programs might contribute for better social outcomes for women with SMI.

The Role of Depression Screening and Treatment in Achieving the UNAIDS 90-90-90 Goals in Sub-Saharan Africa

Despite widespread HIV screening and treatment programs across sub-Saharan Africa, many countries are not on course to meet the Joint United Nations Program on HIV/AIDS 90–90–90 targets. As mental health disorders such as depression are prevalent among people living with HIV, investment in understanding and addressing comorbid depression is increasing. This manuscript aims to assess depression and HIV management in sub-Saharan Africa using a 90–90–90 lens through a discussion of: depression and the HIV care continuum; the state of depression screening and treatment; and innovations such as task-shifting strategies for depression management. Due to the lack of mental health infrastructure and human resources, task-shifting approaches that integrate mental health management into existing primary and community health programs are increasingly being piloted and adopted across the region. Greater integration of such mental health care task-shifting into HIV programs will be critical to realizing the 90–90–90 goals and ending the HIV epidemic.

Factors associated with pasung (physical restraint and confinement) of schizophrenia patients in Bogor regency, West Java Province, Indonesia 2017

BACKGROUND

Schizophrenia is a chronic mental disorder affecting more than 21 million worldwide. In Indonesia, 14.3% of households have a patient with a mental disorder, and the majority of these are in rural areas. Family members in Indonesia use repressive social measures like pasung (physical restraint and confinement) for these patients. A study was conducted with the objective to determine the factors associated with pasung among patients with schizophrenia in Bogor Regency, West Java Province, Indonesia 2017.

METHODS

A case-control study was conducted in Bogor Regency from May-June 2017. A case subject was defined as a patient with schizophrenia who was ever subjected to pasung and a control subject was defined as a patient with schizophrenia residing in the same geographical area and never subjected to pasung. Multi-stage sampling was used to select case and control subjects from the registered reports of the Health Service of Bogor Regency (2012-16) in 34 sub districts and 59 health centers. Multivariate logistic regression was used to identify the factors associated with pasung. Attributable and population attributable risks (AR, PAR) for pasung were calculated.

RESULTS

A total of 114 case and 136 control subjects were studied. Patient's aggressive or violent behavior (AdjOR: 4.49, 95%CI: 2.52-8.0), unemployment (AdjOR: 2.74, 95%CI: 1.09-6.9) and informal employment (AdjOR: 2.5, 95%CI: 1.1-5.84) in the family and negative attitude of the family towards the patient (AdjOR: 2.52, 95%CI: 1.43-4.43) were associated with pasung. Patient's aggressive or violent behavior (PAR = 44.3%) and unemployment in the family (PAR = 49.3%) were the predominant factors of pasung.

CONCLUSIONS

Patient's aggressive or violent behavior, negative attitude of the family towards the patient and unemployment in the family were associated with pasung. We recommend health education and encouraging family members to shift patients with schizophrenia exhibiting aggressive or violent behavior to a mental health facility. Strengthening of basic mental health services and involving family members while treating patients with schizophrenia to develop positive attitudes could be considered. Creating employment opportunities and a social support system for treated patients with schizophrenia and family members could further avert pasung.

Conceptualizations of subjective recovery from recent onset psychosis and its associated factors: A systematic review

AIM

There is no standard definition of "subjective recovery" from psychosis, its nature is currently contested and debated among service-users and professionals. Individual studies have explored conceptualizations of subjective recovery from recent onset psychosis, but there have been no previously published systematic reviews on the topic. The aim of this review was to examine and synthesize quantitative and qualitative studies examining the concept of subjective recovery from recent onset psychosis and identify common factors associated with this recovery process.

METHODS

Relevant electronic databases (Medline, CINAHL, PsychInfo and ProQuest Dissertations and Theses) were searched and hand searches were also carried out. Publications in each database from the inceptions of the databases to April 12, 2017 were included. Data from selected articles were extracted using a piloted extraction form and thematic integrative analysis was performed.

RESULTS

Ten studies with different study designs were included in this review. Subjective recovery was conceptualized into 3 main themes: "recovery as outcome", "recovery as process" and "endeavours during recovery". Factors contributing to subjective recovery were categorized into 4 main themes; "treatment related", "illness related", "individual related" and "social environment" related. Non-linear and subjective nature of the process of recovery were reinforced by the review findings.

CONCLUSIONS

Studies in subjective recovery from recent onset psychosis are limited to developed countries. Acquiring hope and self-confidence, overcoming symptoms and stigma through mobilizing all resources available were accentuated in conceptualizing subjective recovery and related factors. Recovery-oriented health care services should acknowledge individual differences and involve service users in their care decisions.

Help-seeking behavior of Jimma university students with common mental disorders: A cross-sectional study

BACKGROUND

Globally, the mental health help-seeking behavior of university students is reported to be poor; less than one-third of university students with common mental disorders (CMDs) report having sought help from formal sources. Failure to seek treatment is associated with prolonged disability and poor mental health outcomes, including suicide. In Ethiopia, little is known about the help-seeking behavior of university students for CMDs.

OBJECTIVE

This study aimed to assess the prevalence and determinants of help seeking, and sources of help sought by Jimma University undergraduate students with CMDs.

METHOD

Seven hundred and sixty students were selected to participate in this cross-sectional study using multi-stage sampling. Sources of help were identified using the Actual Help-Seeking Questionnaire. CMDs were assessed using the 10-item Kessler Psychological Distress Scale. Binary logistic regression analysis was used for both univariate and multivariable analysis.

RESULTS

Of the sampled students, 58.4% were found to have current CMDs. Of those with current CMDs, 78.4% had sought help for their problems. The majority (83.8%) of participants who sought help did so from informal sources. Compared to students who had 'very good' overall levels of satisfaction with life, those who had 'good', 'fair', and 'poor or very poor' overall level of satisfaction with life were less likely to seek help (p-value = 0.021, 0.014, and 0.011, respectively). Lastly, having no previous history of help-seeking was significantly associated with seeking help for CMDs (p-value<0.001).

CONCLUSION

More than half of Jimma University students were found to have a high risk of CMDs and the majority of those with CMDs sought help from informal sources. Future studies are needed to explore the barriers of seeking help from formal resources, and the effects of not receiving help from formal sources for CMDs symptoms.

Help-seeking behaviour for depressive disorders among adult cardiovascular outpatient cardiac clinic Jimma University Teaching Hospital, Jimma, South-West Ethiopia: crosssectional study

BACKGROUND

Depression in healthy person without cardiac disease has been associated with the development of coronary artery disease and cardiovascular disease also risk factor for development of depression. This has devastating effect the patient's quality of live, illness progression, morbidity and mortality. Despite this fact help seeking behavior of cardiovascular patients with depression has not been addressed in Ethiopia.

OBJECTIVE

To assess help-seeking behaviors of adult cardiovascular patients with depression for their depressive disorders in Jimma university teaching hospital.

METHOD

Institution based cross sectional study conducted October to December in 2014. The study was conducted on 353 cardiovascular patients who attended at cardiac clinic. Depression was assessed using patient health questionnaire version nine (PHQ-9), which is validated in Ethiopia, Help seeking behavior using actual help seeking questionnaire and social support using Oslo social support-3 item scale.

RESULT

From the total of 339 participants, 57.5% (n = 195) of them fulfill the case definition of depression and 12.1% (n = 41) of participant reported idea of hurting themselves. Only 33.3% sought help for their depression. Of those participants who sought help, 88.6% sought help from one or more of an informal help source. Occupation (odds of = 4.24, 95% confidence interval (CI) 1. 31, 13.78), education level (AOR 7.6, CI 2. 13, 27.11), the presence of a history of mental illness in the family (AOR 7.33, CI 2. 72, 19.80), ideal of hurting themselves, knowing the availability of the psychiatric service in this hospital and having previous seeking help were significantly associated with help seeking behavior.

CONCLUSION AND RECOMMENDATION

The number of patients not seeking help for depression is high. There for scaling up mental health service in tertiary hospitals through multidisciplinary approach should be given high priority.

Evaluation of attitudes and knowledge toward mental disorders in a sample of the Chinese population using a web-based approach

BACKGROUND

People with mental disorders often encounter stigmatizing attitudes related to their conditions. Stigma often represents one of the critical obstacles that stand in the way of delivering mental health care. The main aim of the study was to assess the knowledge and attitudes toward mental disorders in a sample of the Chinese population; furthermore, we also aimed to identify and explore the socio-demographic characteristics associated with specific knowledge and attitudes towards psychiatric disorders.

METHODS

A cross-sectional survey was created and delivered through an Internet chat application over the period June-December 2017. The Mental Health Knowledge Questionnaire and the Perceived Devaluation and Discrimination Scale were used to evaluate the participants' mental health knowledge and attitudes toward mental disorders.

RESULTS

A total of 1087 participants were recruited in for our survey. The mean score of the MHKQ and PDD were (15.89 ± 2.69) and (33.77 ± 6.66), respectively. Univariate analyses showed that young people and rural residents tended to show more positive attitudes toward mental disorders with respect to older people and urban residents (P < 0.05). People with higher education levels, those who had contact with people with mental disorders, and those who learned about mental disorders by personal encounter resulted to have had higher MHKQ scores (P < 0.05).

CONCLUSIONS

In our sample of the Chinese population, negative attitudes toward mental disorders were often reported. General education programs may not be an effective way to decrease stigma, while anti-stigma campaigns targeted for specific groups, such as urban residents and the older people, should be carried out in the future in China.

Traditional, complementary and alternative medicine use in Sub-Saharan Africa: a systematic review

Background

The WHO estimates that a considerable number of people in Sub-Saharan Africa (SSA) rely on traditional, complementary and alternative medicine (TCAM) to meet their primary healthcare needs, yet there remains a dearth of research evidence on the overall picture of TCAM utilisation in the region.

Methods

We conducted a literature search of original articles examining TCAM use in SSA between 1 January 2006 and 28 February 2017, employing Medline, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Scopus, ProQuest, PubMed, Embase and African Journals Online databases. A critical appraisal of relevant articles reporting a quantitative or mixed-method design was undertaken.

Results

Despite the heterogeneity and general low quality of the identified literature, the review highlights a relatively high use of TCAM alone or in combination with orthodox medicine, in both general population and in specific health conditions in SSA. TCAM users compared with non-TCAM users are more likely to be of low socioeconomic and educational status, while there were inconsistencies in age, sex, spatial location and religious affiliation between TCAM users and non-TCAM users. Most TCAM users (55.8%–100%) in SSA fail to disclose TCAM use to their healthcare providers, with the main reasons for non-disclosure being fear of receiving improper care, healthcare providers’ negative attitude and a lack of enquiry about TCAM use from healthcare providers.

Conclusion

TCAM use in SSA is significant, although most studies emerge from a few countries. Factors associated with TCAM use in SSA are similar to those observed in other regions, but further research may be required to further elucidate challenges and opportunities related to TCAM use specific to SSA.

Pathways to care among psychiatric outpatients in a tertiary mental health institution in Singapore

BACKGROUND

Pathways to care studies in Singapore are of high interest given the cultural diversity and various sources of help available for those with mental illnesses, ranging from the more traditional to tertiary-level mental health care services.

AIM

The current study aimed to explore the associations of patients' socio-demographic characteristics with pathways to first contact and duration of untreated mental illness.

METHOD

A total of 402 participants were recruited through convenience sampling. A pathway to care form was used to gather systematic information about the sources of care utilized by participants before approaching a mental health professional. Data were analysed using multinomial logistic regression and multiple linear regression models to assess the associations.

RESULTS

Majority of participants reported primary care (36.0%) as their first point of contact, followed by non-formal sources of help (33.8%), specialist care (21.8%), police/court (4.0%), websites/media (3.3%) and religious/traditional treatment (1.3%). Those belonging to Malay and Indian ethnicity (vs Chinese) were more likely to make first contact with non-formal sources of help than primary care. Those who received a diagnosis of any mood or anxiety disorder (vs schizophrenia and related psychoses) were less likely to make first contact with specialist care or non-formal sources of help than primary care. Those who were separated/divorced/widowed were significantly associated with higher duration of untreated illness compared to those who were single. Participants whose family/relative initiated the first contact were significantly associated with a shorter duration of untreated illness compared to those who initiated first contact on their own.

CONCLUSION

Findings suggest the determinants of the pathways to first contact and duration of untreated illness included diagnosis, ethnicity, marital status and family initiating the first contact. The pathways adopted by these participants need to be kept in mind for planning mental health programmes.

Community mental health services in Pakistan: Review study from Muslim world 2000-2015

Aim

This study attempted to analyse the potential of two primary sources of mental health service delivery at a grassroots level, religious/faith healers and community/lady health workers, and how they can be effectively used to deliver mental health services in a resource-scarce country like Pakistan.

Method

A literature review was carried out for relevant studies conducted in Muslim countries between 2000 to 2015 reporting empirical results. Using the inclusion criteria, thirteen studies were selected for the review.

Results

The presented studies suggest that the main proportion of mental health patients in countries with major Muslim population including Pakistan, visit religious/faith healers first for treatment, however all studies are silent about the outcomes through these healers. The only potential visible outcome of contacting religious/faith healers is the identification of mental health cases. However, community/lady health workers with minimal training appeared to be a beneficial source of mental health service delivery in communities.

Conclusion

In a resource scarce country like Pakistan, networking with religious/faith healers can be established for effective identification and referral of mental health cases whereas strong and already existing community/lady health workers system can be used as a first level to deliver mental health service at the doorstep.

The sociocultural factors and patterns of help-seeking among patients with mental illness in the sub-Himalayan region

CONTEXT

Selection of first help in psychiatric illnesses depends on various sociodemographic and environmental factors. In integrated societies like India careers also contribute in deciding help-seeking behavior of psychiatric patients. In this study, we explored these factors and the role of education of decision maker, i.e., person who is final authority in deciding the course of management.

AIMS

This study aims to study sociocultural factors and patterns of help-seeking behavior of psychiatric patients in rural sub-Himalayan region.

SETTINGS AND DESIGN

A cross-sectional study conducted in a tertiary care teaching hospital.

SUBJECTS AND METHODS

Factors affecting help-seeking behavior such as age, sex, education, occupation, income, accessibility to psychiatric treatment, expenses on faith healers and general practitioners, and education of "decision maker were assessed.

STATISTICAL ANALYSIS USED

Data were analyzed with GraphPad InStat, using appropriate statistical tests.

RESULTS

In this study of 250 patients, psychiatrists were chosen as first help by 98 (39%), faith healers by 84 (34%), and general medical practitioners (GMPs) by 68 (27%) patients. Mean "years of education" of patients in psychiatrist group, faith healer group, and GMP group were 9.98, 8.81, and 7.99, respectively (P = 0.08). Mean "years of education" of decision makers for these groups were 11.64, 8.36, and 10.93, respectively (P < 0.001). Time required in reaching psychiatric facility form the residence of patient was maximum in those who consulted faith healers first compared to those who consulted psychiatrist (P < 0.001) or GMP (P < 0.01). Expenses on faith healers were significantly high compared to GMPs (P < 0.001).

CONCLUSIONS

Psychiatrists, faith healers, and GMPs were equally chosen as first help for psychiatric illness. Education of decision maker and accessibility affect help-seeking behavior significantly. Faith healers were more expensive than GMPs.

Perceptions about pasung (physical restraint and confinement) of schizophrenia patients: a qualitative study among family members and other key stakeholders in Bogor Regency, West Java Province, Indonesia 2017

Background

The UN resolution recommends treating all mentally ill patients with humanity and respect. However, social stigma continues to prevail for patients with schizophrenia. Physical restraint and confinement of the mentally ill is a well-known phenomenon in Indonesia and is termed as pasung.

Objective

To explore the perceptions of family members of patients of schizophrenia and other key stakeholders concerning pasung in Bogor Regency, West Java Province 2017.

Methods

This qualitative exploratory study was conducted in Bogor Regency, West Java Province from May to June 2017. This study involved 12 key stakeholders including family members, neighbors, community leaders, and mental health officers. In-depth interviews were conducted with family members (n = 3) who practiced pasung for patients with schizophrenia and key informant interviews of neighbors, community leaders (two household heads and one from a health cadre) (n = 3) and mental health officers of puskesmas (three midwives). Data triangulation was performed by interviewing residents and mental health workers. Content analysis was conducted and themes were identified based on valid inference and interpretation.

Results

Family members and society in general perceived that pasung is necessary for security reasons due to the patient’s aggressive behavior such as physical violence to neighbors, stealing food etc. According to community leaders, families often do not respond to patient’s request to be released from pasung. Family members had financial constraints to seek mental healthcare and were also dissatisfied with available services. Healthcare providers highlighted the poor knowledge and prevailing misconceptions about schizophrenia in the community.

Conclusion

Concurrent efforts to strengthen basic mental health services and health education regarding schizophrenia, prevalent misconceptions, and importance of timely and appropriate treatment are needed, especially in rural settings.

Pathways to mental healthcare in high-income and low-income countries

Understanding the way in which people seek care for mental disorders is important for planning services, training and referral mechanisms. Pathways to care fall broadly into three categories: via primary care physicians; via native healers; and via patient choice (patients can have direct access to mental health professionals). The pattern and nature of access to service in low-income countries are different from those in high-income countries. In many societies, deep-seated cultural beliefs on the part of patients and families about the causes of mental disorders are a major barrier to the receipt of modern psychiatric care.

Perceptions of the causes of schizophrenia and associated factors by the Holy Trinity Theological College students in Ethiopia

INTRODUCTION

There is a cultural variability around the perception of what causes the syndrome of schizophrenia. As far as the cause of schizophrenia by the general public concerned, people living in western countries focus mainly on biological and social risk factors such as genetic vulnerability, disease of the brain, infection or stressful social conditions or personal weakness, but the predominant views held by people living in non-western countries focus mainly on supernatural and religious factors. Awareness and beliefs about the causes of mental illnesses influence the preferred treatments. The aim of this study was to determine the perceptions regarding the etiology of schizophrenia and the associated factors by theology students.

METHODS

An institution-based cross-sectional study was conducted among Holy Trinity Theological College students from May to June 2016. Self-administered Short Explanatory Model Interview was used to assess the perception of what causes the syndrome of schizophrenia. Data entry was performed by Epi-info version 3.5.3 and the Statistical Program for Social Science (SPSS version 20) was used for data clearance, and analyses.

RESULTS

A total of 409 students were involved in the survey. The mean age of the participants was 33.3 years (standard deviation ± 8.3) and almost all 94.4% of them were males. The majority (81.7%) of the participant recognized schizophrenia as a mental illness. Only 16.9% of the participants attributed supernatural phenomenon as a cause of schizophrenia and most of them 76.5% (313) thought of psychosocial problems as the cause of schizophrenia. About 40.1% of the participant endorsed biological factors as a cause of schizophrenia. About two-thirds (68.2%) of the participant thought schizophrenia as severe but not fatal illness and about 22.2% of them thought both severe and fatal illness. As far as the course concerned majority (88.5%) of the participants thought schizophrenia as a chronic illness and about 11.5% thought acute illness. Regarding the treatment, almost all (99.8%) of reported schizophrenia is treatable. Moreover, concerning the consequences of the illness about 18.8% reported the death as a consequence and about 66.7, 34.7 and 7.8% reported madness, family disintegration and losing a job, respectively. Urban residency and holding other degree were significantly associated with biological factors as a cause of schizophrenia (p < 0.05). Whereas getting information from mass media and health professional, marital status (married) and urban residence were significantly associated with psychosocial factors as the cause of schizophrenia. Furthermore, rural residency was significantly associated with the supernatural phenomenon as the cause of schizophrenia.

CONCLUSION

In the current study, the majority of the participant recognized schizophrenia as a mental illness and a treatable syndrome. A vast majority of the participant thought of psychosocial problems as the cause of schizophrenia about two-thirds of the participant thought schizophrenia as a severe but not fatal illness. As far as the course concerned majority (88.5%) of the participants thought schizophrenia as a chronic illness. Concerning the consequences of the illness, about 18.8% reported the death as a consequence and about 66.7, 34.7, and 7.8% reported madness, family disintegration and losing a job, respectively. Residency, marital status, and source of information were significantly associated with perceived causes of schizophrenia. Linking mental health service with spiritual care to address community mental health care needs and for early detection as well as referral linkage of mentally ill patients is warranted.

Depression and Its Help Seeking Behaviors: A Systematic Review and Meta-Analysis of Community Survey in Ethiopia

BACKGROUND

Depression is one of the most common mental illnesses affecting around 322 million individual in the world. Although the prevalence of depression is high and its treatment is effective, little is known about its pooled prevalence and help seeking behaviors in the community settings of Ethiopia. Thus, this study aimed to determine the pooled prevalence of depression and its help seeking behaviors in Ethiopia.

METHODS

A systematic literature search in the databases of Pub-Med, Cochrane, and Google Scholar was performed. The quality of studies was assessed using the Newcastle-Ottawa quality assessment tool adapted for cross-sectional studies. Heterogeneity test and evidence of publication bias were assessed. Moreover, sensitivity test was also performed. Pooled prevalence of depression and its help seeking behavior were calculated using random effects model.

RESULTS

A total 13 studies for depression, 4 studies for help seeking intention, and 5 studies for help seeking behaviour were included in this review. The pooled prevalence of depression and help seeking intention and behaviour was found to be 20.5% (95% CI; 16.5% -24.4%), 42% (95% CI; 23%-60%), and 38% (95% CI; 23%-52%), respectively. There is no significant heterogeneity for depression (I² = 0%, p =0.620), help seeking intention (I² = 0%, p =0.996), and behaviour (I² = 0%, p =0.896). There is no publication bias for depression egger's test (p =0.689).

CONCLUSION

More than one in every five individuals were experiencing depression. Less than one-third of individuals with depression seek help from modern treatment. Authors suggest community based mental health screening and treatment.

Health care seeking behavior for depression in Northeast Ethiopia: depression is not considered as illness by more than half of the participants

BACKGROUND

Depression is one of the most disabling and chronic mental illnesses. Despite its high burden, many people suffering from depression did not perceive that they had a treatable illness and consequently most of them did not seek professional help. The aim of this study was to assess the level of professional help-seeking behavior and associated factors among individuals with depression.

METHODS AND MATERIALS

The community-based cross-sectional study was conducted among residents of Dessie, Northeast Ethiopia. First, 1165 residents were screened for depression using patient health questionnaire and then 226 individuals who were screened positive for probable depression were interviewed with General Help-Seeking Questionnaire to assess the professional help-seeking behavior of participants with depression. Major associated variables were identified using logistic regression with 95% confidence interval (CI), and variables with a p value less than 0.05 were considered statistically significant.

RESULTS

Among the total participants with depressive symptoms, only 25.66% of them did seek professional help. Being female [adjusted odds ratio (AOR) = 2.769, 95% CI (1.280, 5.99)], current alcohol drinking [AOR = 2.74, 95% CI (1.265, 5.940)], co-morbid medical-surgical illness [AOR = 4.49, 95% CI (1.823, 11.071)], perceiving depression as illness [AOR = 2.44, 95% CI (1.264, 4.928)], having moderate depressive symptoms [AOR = 2.54, 95% CI (1.086, 5.928)] and moderately severe depressive symptoms [AOR = 7.67, 95% CI (2.699, 21.814)] were significantly associated with help seeking behavior of participants.

CONCLUSIONS

Level of professional help-seeking behavior is as low as previous studies in different countries. The severity of depressive symptoms, co-morbidity of medical-surgical illness, current drinking of alcohol, being female, and perceiving depression as illness were significantly associated with professional help-seeking behavior for depressive symptoms. Working on mental health literacy in the community is important to increase help-seeking behavior.

Research on help-seeking for mental illness in Africa: Dominant approaches and possible alternatives

There is growing concern within the global mental health arena that interventions currently being executed to scale up mental health services in Africa will be ineffective unless simultaneous steps are taken to address people's help-seeking behaviour. Drawing upon two conceptual tools arising from science and technology studies (STS), those of a "classification system" and "the black box," this paper looks critically at discursive constructions of help-seeking in Africa within mental health research over the last decade. Research in this area can be divided into two dominant traditions: the knowledge-belief-practice survey and indigenous-knowledge-system approaches. Although the content and value-codes between these approaches differ, structurally they are very similar. Both are mediated by the same kind of system of classification, which demarcates the world into homogenous entities and binary oppositions. This system of ordering is one of the most stubborn and powerful forms of classification buried in the "black box" of the modernist/colonial knowledge archive and is fraught with many questionable Eurocentric epistemological assumptions. I consider whether there might be other ways of understanding help-seeking for mental illness in Africa and discuss two studies that illustrate such alternative approaches. In conclusion, I discuss some of the challenges this alternative kind of research faces in gaining more influence within contemporary global mental health discourse and practice.

Concepts of madness in diverse settings: a qualitative study from the INTREPID project

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.

Pathways to psychiatric care for mental disorders: a retrospective study of patients seeking mental health services at a public psychiatric facility in Ghana

Background

The process to seek for care by patients who experience episodes of mental disorders may determine how and where they receive the needed treatment. This study aimed to understand the pathways that people with mental disorders traversed for psychiatric services, particularly where these individuals will first seek treatment and the factors that influence such pathways to mental health care.

Methods

A cross-sectional study conducted at Pantang psychiatric hospital in Accra, Ghana involving 107 patients of ages 18 and older and their family members. The study adapted the World Health Organization’s (WHO) pathway encounter form to collect information about patients’ pathway contacts for psychiatric care. Chi Square test was done to determine patients’ first point of contact and any association between the independent variables (clinical diagnosis and socio-demographic factors) and first pathway contact. Multiple regression analyses were also done to estimate the odds of patients’ first pathway contact.

Results

Overall, nearly 48 % of patients initially contacted non-psychiatric treatment centers (faith-based, traditional healers and general medical practitioners) as their first point of contact for treatment of mental disorders. A little more than half of the patients went directly to the formal public psychiatric facility as their first point of contact for care of their mental disorders. Patients’ occupation was significantly associated with their first point of contact for psychiatric care (χ² = 6.91; p < 0.033). Those with secondary education were less likely to initially seek care from the formal public psychiatric hospital compared to those with no formal education (uOR = 0.86; 95 % CI 0.18–4.08).

Conclusion

Patients used different pathways to seek psychiatric care, namely direct pathway to a psychiatric hospital or through transition from informal non-psychiatric service providers. Since nearly half of patients do not initially seek mental health care directly at the formal psychiatric facility, it is important for the government of Ghana to increase funding to the mental health authorities in Ghana as a matter of priority so that more individuals can be identified and integrated into mainstream psychiatric treatment and general health facilities where there are trained Community Mental Health Officers (CMHO) and Clinical Psychiatric Officers (CPO) to provide early intervention and treatment.

Psychosis and help-seeking behavior in rural KwaZulu Natal: unearthing local insights

Background

Growing interest in strategies regarding early intervention for psychosis has led to a parallel interest in understanding help-seeking behavior, especially in low- and middle-income countries (LMICs). Nevertheless, few LMIC studies have examined individuals with psychosis in non-urban, non-hospital settings. Using the perspective of formal and informal community service providers, we aimed to uncover descriptions of people with psychosis in a rural South African community and illuminate the potential complexities of their help-seeking journeys.

Methods

We conducted a qualitative study of 40 key informant interviews and seven focus groups with stakeholders (traditional leaders, traditional healers, religious leaders, health care nurses, heads of non-governmental organizations, schoolteachers, community caregivers) in a rural Zulu community (Vulindlela). Thematic analysis of the data was performed using the inductive analysis approach.

Results

Interviewees discussed 32 individuals with probable psychosis in their community and provided rich descriptions of their symptoms. A complex picture of help-seeking behavior, primarily involving informal mental health service providers, emerged. Over half of the reported cases had no contact with formal health services in the course of their help-seeking journey; while more than two-thirds never attended a hospital and only 1 in 8 accessed a psychiatric hospital.

Conclusions

Our results highlight the important role of informal care providers in LMICs as well as the need for more research on mental illness and local providers in non-hospital contexts. Community stakeholders can contribute to a fuller understanding of these issues, thereby assisting in the creation of appropriate and effective mental health interventions for rural South African communities like Vulindlela.

Pathways and access to mental health care services by persons living with severe mental disorders and epilepsy in Uganda, Liberia and Nepal: a qualitative study

BACKGROUND

Access to mental health care services for patients with neuropsychiatric disorders remains low especially in post-conflict, low and middle income countries. Persons with mental health conditions and epilepsy take many different paths when they access formal and informal care for their conditions. This study conducted across three countries sought to provide preliminary data to inform program development on access to care. It thus sought to assess the different pathways persons with severe mental disorders and epilepsy take when accessing care. It also sought to identify the barriers to accessing care that patients face.

METHODS

Six in depth interviews, 27 focus group discussions and 77 key informants' interviews were conducted on a purposively selected sample of health care workers, policy makers, service users and care takers in Uganda, Liberia and Nepal. Data collected along predetermined themes was analysed using Atlas ti software in Uganda and QSR Nvivo 10 in Liberia and Nepal

RESULTS

Individual's beliefs guide the paths they take when accessing care. Unlike other studies done in this area, majority of the study participants reported the hospital as their main source of care. Whereas traditional healers lie last in the hierarchy in Liberia and Nepal, they come after the hospital as a care option in Uganda. Systemic barriers such as: lack of psychotropic medicines, inadequate mental health specialists and services and negative attitudes of health care workers, family related and community related barriers were reported.

CONCLUSION

Access to mental health care services by persons living with severe mental disorders and epilepsy remains low in these three post conflict countries. The reasons contributing to it are multi-faceted ranging from systemic, familial, community and individual. It is imperative that policies and programming address: negative attitudes and stigma from health care workers and community, regular provision of medicines and other supplies, enhancement of health care workers skills. Ultimately reducing the accessibility gap will also require use of expert clients and families to strengthen the treatment coalition.

Patterns and Determinants of Treatment Seeking among Previously Untreated Psychotic Patients in Aceh Province, Indonesia: A Qualitative Study

Immediate treatment of first-episode psychosis is essential in order to achieve a positive outcome. However, Indonesian psychiatric patients often delay accessing health services, the reason for which is not yet fully understood. The current study aimed to understand patterns of treatment seeking and to reveal determinants of the delay in accessing psychiatric care among first-time user psychotic patients. Qualitative interviews were conducted with sixteen family members who accompanied the patients to a psychiatric hospital. Many families expressed beliefs that mental illness appertains to village sickness and not hospital sickness; therefore, they usually take the patients to traditional or religious healers before taking them to a health professional. They also identified various factors that potentially delay accessing psychiatric treatment: low literacy and beliefs about the cause of the illness, stigmatisation, the role of extended family, financial problems, and long distance to the psychiatric hospital. On the other hand, the family mentioned various factors related to timely help seeking, including being a well-educated family, living closer to health facilities, previous experience of successful psychotic therapy, and having more positive symptoms of psychosis. The findings call for mental health awareness campaigns in the community.

Duration of Untreated Psychosis in Chinese and Mauritian: Impact of Clinical Characteristics and Patients' and Families' Perspectives on Psychosis

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.

Effectiveness of traditional healers in treating mental disorders: a systematic review

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.

Task shifting--Ghana's community mental health workers' experiences and perceptions of their roles and scope of practice

Background

Because of the absence of adequate numbers of psychiatrists, the bulk of mental health care at the community level in Ghana is provided by community mental health workers (CMHWs).

Objective

To examine the role and scope of practice of CMHWs in Ghana from their own perspectives and to make recommendations to improve the care they provide.

Design

We conducted a cross-sectional survey of 164 CMHWs from all the 10 administrative regions of Ghana, comprising 71 (43.3%) community psychiatric nurses (CPNs), 19 (11.6%) clinical psychiatric officers (CPOs), and 74 (45.1%) community mental health officers (CMHOs).

Results

Overall, only 39 (23.8%) CMHWs worked closely with psychiatrists, 64 (39%) worked closely with social workers, 46 (28%) worked closely with psychologists and 13 (7.9%) worked closely with occupational therapists. A lower proportion of CMHOs worked closely with psychiatrists, psychologists, and social workers compared with CPOs and CPNs. There was no significant difference in the proportion of the different CMHW types who expressed confidence in their ability to diagnose any of the commonly named mental health conditions except personality disorders. However, a lower proportion of CMHOs than CPOs and CPNs expressed confidence in their ability to treat all the disorders. The CMHWs ranked schizophrenia as the most frequently treated mental health condition and there was no statistically significant difference in the reported frequency with which the three groups of CMHWs treated any of the mental health conditions.

Conclusions

Mental health policy makers and coordinators need to thoroughly review the training curriculum and also evaluate the job descriptions of all CMHWs in Ghana to ensure that they are consistent with the demands and health-care needs of patients they care for in their communities. For example, as CMHOs and CPNs prescribe medication even though they are not expected to do so, it may be worth exploring the merits of including the prescription of common psychotropic medication in their training curriculum and job descriptions.

Participatory planning of a primary care service for people with severe mental disorders in rural Ethiopia

Little is understood about the feasibility and acceptability of primary care-based models of task-sharing care for people with severe mental disorders (SMDs) in low- and middle-income countries (LMICs). A participatory planning approach was adopted in preparation for the transition from hospital-delivered psychiatric care for SMD to a primary care-based, task-sharing model in a rural Ethiopian community. In this article, we present findings from community consultation meetings (n = 4), focus group discussions (n = 7) and in-depth interviews (n = 11) with key stakeholders (healthcare administrators and providers, caregivers, service-users and community leaders) which were carried out over a 2-year period in the context of ongoing dialogue with the community. The principle of local delivery of mental health services was agreed upon by all stakeholder groups. Key reasons for supporting local delivery were increased access for the majority due to proximity, reduced cost and reduced stress related to transportation. However, acceptance of the new service was qualified by concerns about the competence of staff to deliver a comprehensive and dependable service of equal quality to that currently provided at the hospital. Adequate training and support, as well as ensuring consistency of medication supply were identified as key components to ensure success. Encouragingly, our results suggest that there is significant support for the service change and an interest for the mobilization of community resources to support this. One of the study strengths was that we were able to present the different perspectives of multiple stakeholder groups. By nesting the study in an ongoing community-based cohort of people with SMD we were able to interview a more representative and empowered group of caregivers and service users than is often available in LMICs. Despite this, the extent to which service-users are able to express their opinions is likely limited by their marginalized role in rural Ethiopian society.