A systematic review of care pathways for psychosis in low-and middle-income countries

Lilford, Philippa; Rajapakshe, Onali B.W.; Singh, Swaran P.

doi:10.1016/j.ajp.2020.102237

Cited by 36 publications

(35 citation statements)

References 38 publications

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“…Several systematic reviews and meta-analyses have examined pathways to care for FEP, yet did not include research conducted in the US 3 , 8 – 10 . For instance, two meta-analyses only included studies conducted in Canada and England.…”

Section: Introductionmentioning

confidence: 99%

Systematic review of pathways to care in the U.S. for Black individuals with early psychosis

et al. 2021

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The pathway to receiving specialty care for first episode psychosis (FEP) among Black youth in the US has received little attention despite documented challenges that negatively impact engagement in care and clinical outcomes. We conducted a systematic review of US-based research, reporting findings related to the pathway experiences of Black individuals with FEP and their family members. A systematic search of PubMed, PsycInfo, and Embase/Medline was performed with no date restrictions up to April 2021. Included studies had samples with at least 75% Black individuals and/or their family members or explicitly examined racial differences. Of the 80 abstracts screened, 28 peer-reviewed articles met the inclusion criteria. Studies were categorized into three categories: premordid and prodromal phase, help-seeking experiences, and the duration of untreated psychosis (DUP). Compounding factors such as trauma, substance use, and structural barriers that occur during the premorbid and prodromal contribute to delays in treatment initiation and highlight the limited use of services for traumatic childhood experiences (e.g., sexual abuse). Studies focused on help-seeking experiences demonstrated the limited use of mental health services and the potentially traumatic entry to services (e.g., law enforcement), which is associated with a longer DUP. Although the majority of studies focused on help-seeking experiences and predictors of DUP, findings suggests that for Black populations, there is a link between trauma and substance use in the pathway to care that impacts the severity of symptoms, initiation of treatment, and DUP. The present review also identifies the need for more representative studies of Black individuals with FEP.

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Section: Introductionmentioning

confidence: 99%

Systematic review of pathways to care in the U.S. for Black individuals with early psychosis

et al. 2021

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“…While this approach is still in formative stages in LMICs, there is strong evidence to suggest that mental health services that are patient-centered and responsive to individual needs are linked to improved contact rates with mental health services, better treatment compliance and a high level of patient satisfaction. Given that many people with psychosis in LMICs struggle with continuity of care, social disempowerment and access barriers ( 35 ), integrating a holistic and patient-centered psychosocial response to psychiatric management within facilities in India and Pakistan has the potential to strengthen mental health response and make mental health more equitable and responsive to patient needs.…”

Section: Discussionmentioning

confidence: 99%

Implementing psychosocial interventions within low and middle-income countries to improve community-based care for people with psychosis—A situation analysis

et al. 2022

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BackgroundGlobally, a treatment gap exists for individuals with severe mental illness, with 75% of people with psychosis failing to receive appropriate care. This is most pronounced in low and middle-income countries, where there are neither the financial nor human resources to provide high-quality community-based care. Low-cost, evidence-based interventions are urgently needed to address this treatment gap.AimTo conduct a situation analysis to (i) describe the provision of psychosocial interventions within the context of existing care in two LMICs-India and Pakistan, and (ii) understand the barriers and facilitators of delivering a new psychosocial intervention.MethodA situation analysis including a quantitative survey and individual interviews with clinicians, patients and caregivers was conducted. Quantitative survey data was collected from staff members at 11 sites (private and government run hospitals) to assess organizational readiness to implement a new psychosocial intervention. To obtain in-depth information, 24 stakeholders including clinicians and service managers were interviewed about the typical care they provide and/or receive, and their experience of either accessing or delivering psychosocial interventions. This was triangulated by six interviews with carer and patient representatives.Results and discussionThe results highlight the positive views toward psychosocial interventions within routine care and the enthusiasm for multidisciplinary working. However, barriers to implementation such as clinician time, individual attitudes toward psychosocial interventions and organizational concerns including the lack of space within the facility were highlighted. Such barriers need to be taken into consideration when designing how best to implement and sustain new psychosocial interventions for the community treatment of psychosis within LMICs.

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“…Other reviews refer us to the characteristics of the model of care inherent in early intervention services to develop fidelity scales to standardize its implementation [ 38 , 39 ]. In this sense, the concerns surrounding early intervention programs are based not only on their proliferation but also on their quality indices [ 20 , 40 ]. While the effective outcomes of early intervention programs are understood and their proliferation is noted, they remain an exception rather than a component of mainstream mental health services, [ 20 ] with a wide dispersion in accessibility to these services, as reported by Petrovic and colleagues in their study for Europe, [ 41 ] Lilford about low and middle-income countries [ 40 ], and Aceituno in America Latina [ 42 ].…”

Section: Introductionmentioning

confidence: 99%

“…In this sense, the concerns surrounding early intervention programs are based not only on their proliferation but also on their quality indices [ 20 , 40 ]. While the effective outcomes of early intervention programs are understood and their proliferation is noted, they remain an exception rather than a component of mainstream mental health services, [ 20 ] with a wide dispersion in accessibility to these services, as reported by Petrovic and colleagues in their study for Europe, [ 41 ] Lilford about low and middle-income countries [ 40 ], and Aceituno in America Latina [ 42 ]. On the other hand, we find that in high-income countries, program development has been extensive [ 43 ], while in the middle to low-income countries, progress is very slow [ 30 , 40 ].…”

Section: Introductionmentioning

confidence: 99%

Intervention Programs for First-Episode Psychosis: A Scoping Review Protocol

et al. 2023

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Early intervention programs for first-episode psychosis aim to intervene in the early stages of the disease. They are essential to prevent and delay the progression of the illness to a more advanced stage, but information about their characteristics is not systematized. The scoping review considered all studies of first-episode psychosis intervention programs, regardless of their context (hospital or community), and explored their characteristics. The scoping review was developed according to the Joanna Briggs Institute methodology and PRISMA-ScR guidelines. The PCC mnemonic (population, concept, and context) addressed research questions, the inclusion and exclusion criteria, and the search strategy. The scoping review sought to identify the literature that meets the predefined inclusion criteria. The research was conducted in the following databases: Web of Science Core Collection, MEDLINE, CINAHL Complete and PsycINFO, Scopus, Cochrane Library, and JBI Evidence Synthesis. The search for unpublished studies included OpenGrey (a European repository) and MedNar. It used sources in English, Portuguese, Spanish, and French. It included quantitative, qualitative, and multi-method/mixed methods studies. It also considered gray or unpublished literature. After removing duplicates, two independent reviewers extracted the relevant information after selecting the articles. If there were disagreements, a third reviewer was used. The researchers have developed a tool based on the JBI model that will allow them to extract the relevant information for the review. The results are presented schematically in narratives and tables. This scoping review maps first-episode psychosis intervention programs by identifying their characteristics, participants, and specific implementation contexts and allows researchers to create multicomponent programs tailored to different contexts.

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A systematic review of care pathways for psychosis in low-and middle-income countries

Abstract: Please refer to published version for the most recent bibliographic citation information. If a published version is known of, the repository item page linked to above, will contain details on accessing it.

Cited by 36 publications

References 38 publications

Systematic review of pathways to care in the U.S. for Black individuals with early psychosis

Systematic review of pathways to care in the U.S. for Black individuals with early psychosis

Implementing psychosocial interventions within low and middle-income countries to improve community-based care for people with psychosis—A situation analysis

Intervention Programs for First-Episode Psychosis: A Scoping Review Protocol

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