A survey of psychosis risk symptoms in Kenya

Abstract

Defining the pre-psychotic state in an effort to prevent illness progression, and the development of disorders such as schizophrenia, is a rapidly growing area of psychiatry. The presentation of psychotic symptoms can be influenced by culture; however there has not been any previous assessment of psychosis-risk symptoms in the continent of Africa. Our study aimed to measure the prevalence of psychosis-risk in a community sample in Nairobi, Kenya, and to evaluate the effects of key demographic variables. A culturally modified version of the 12-item PRIME-Screen (mPRIME) was self-administered by 2,758 youth (aged 14–29) recruited through house-to-house visits in Nairobi, Kenya. The prevalence and severity of psychosis-risk items from the mPRIME, and the effects of gender and age on symptoms were evaluated. k-Means cluster analysis was used to identify symptom groups. Depending on the mPRIME item, 1.8–19.5% of participants reported certainty of having had a psychosis-risk symptom. Overall, 45.5% reported having had any psychosis-risk symptom. Females had a significantly higher mean severity score on items evaluating persecutory ideation and auditory hallucinations. Symptom severity on five items showed a modest (R=0.09–0.13) but significant correlation with age. Cluster analysis identified four groups of participants: normative (55%), high symptom (11%), intermediate symptom (19%), and grandiose symptom (15%). Psychosis-risk symptoms appear to be highly prevalent in Kenyan youth. Longitudinal studies are needed to determine the correlation of identified symptoms with transition to psychotic illness, as well as the associated functionality and distress, in order to develop appropriate intervention strategies.

Validation of a modified version of the PRIME screen for psychosis-risk symptoms in a non-clinical Kenyan youth sample

“…Written and signed consent was obtained from the study participants and the study was approved by the institutional review board of Washington University Medical School, the Kenyan Medical Research Institute, and the Ministry of Education, Science, and Technology, Kenya. A total of 2758 individuals between the ages of 14 and 29 were recruited for our prior survey using mPRIME, as detailed in Mamah et al [25]. …”

“…Our group previously examined psychosis risk in young Kenyan populations using a slightly modified version of the PRIME screen to account for cultural differences in screen item interpretation (mPRIME), and found that 45.5% of participants aged 14 to 29 reported having had a psychosis risk symptom (i.e., a score of ‘6’) on the screen [25]. The main goal for the current study was to evaluate the validity of the mPRIME as a screening tool for general youth populations, using the SIPS as the reference standard.…”

Advancing Research to Action in Global Child Mental Health

“…72 A community study of youth aged 14 to 29 years from Kenya reported that 45% of the sample endorsed at least 1 psychotic risk symptom. 73 These experiences do not necessarily predict the onset of a psychotic disorder; rather, they are apt to be indicators of risk for a variety of mental disorders (including depression, bipolar disorder, and sometimes schizophrenia). Even when psychotic symptoms do represent a prodrome for psychotic disorders (usually schizophrenia spectrum disorders), approximately 18% to 36% of people defined as high risk go on to transition to a mental disorder, with the risk of transition increasing over time.…”

“…Identifying who is at risk to transition to a psychotic disorder, and intervening early, remains a critical area for investigation. Efforts to harmonize data across research sites in HICs enrich these research activities, but questions remain about the validity of commonly used measures to assess those who may be at high risk for psychosis in low-income country settings 73 (see Table 1). …”

Informed consent in the psychosis prodrome: ethical, procedural and cultural considerations

“…Differences in health care systems and patterns of referral for specialized care affect the ways in which high risk individuals can be identified for research purposes and the implementation of intervention research. Base rates of self-reported psychosis prodrome symptoms appear to differ among countries [ 21 , 22 ], thus impacting estimates of prevalence and conversion rates. Translation and validation of the measures used to detect the psychosis risk state facilitates data sharing and integration across countries and cultures.…”