Duration of Untreated Psychosis and the Pathway to Care in KwaZulu-Natal, South Africa

Tomita, Andrew; Burns, Jonathan K.; King, Howard; Baumgartner, Joy Noel; Davis, Glen P.; Mtshemla, Sisanda; Nene, Siphumelele; Susser, Ezra

doi:10.1097/nmd.0000000000000268

Cited by 14 publications

(20 citation statements)

References 11 publications

(11 reference statements)

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“…The studies included in this literature review show that religious figures have an important role not only in offering religious cures and social support, but also in re-directing people to health services. This aspect differs from reports from other middle income countries like Mexico and Cuba, where the search for religious agencies for mental disorders appears scarce [ 12 ], but is similar to India, Indonesia and South Africa where religious healers are common in PMHC [ 11 , 49 ].…”

Section: Discussioncontrasting

confidence: 63%

“…The found rate of direct access to the CAPS (17%) was similar to the rates to specialized MH care in other middle-income countries (MIC), such as Bangladesh, Bulgaria, India and Indonesia [ 11 ]. The proportion of access from GP referrals (30%) was considerable higher than in South Africa (4%) [ 49 ], another MIC, but much lower than in Cuba, Spain and the UK (70–85%), middle and high income countries with a strong gatekeeping role by primary care and very low percentage of direct access (0–2.5%) [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

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Systematic review of pathways to mental health care in Brazil: narrative synthesis of quantitative and qualitative studies

Amaral

Campos

Oliveira

et al. 2018

Int J Ment Health Syst

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BackgroundPathways to care are actions and strategies employed by individuals in order to get help for health-related distress and the related processes of care providers. On several systematic reviews regarding pathways to mental health care (PMHC), studies regarding South American countries were not present. This review synthesizes qualitative and quantitative research about PMHC in Brazil.MethodsLILACS, MEDLINE and SCIELO databases were searched for papers regarding PMHC in Brazil. The results were organized in pathway stages, based on Goldberg and Huxley’s ‘model of Levels and Filters’ and on Kleinman’s framework of ‘Popular, Folk and Professional health sectors’. Analysis also considered the changes in national mental health policy over time.Results25 papers were found, with data ranging from 1989 to 2013. Complex social networks were involved in the initial recognition of MH issues. The preferred points of first contact also varied with the nature and severity of problems. A high proportion of patients is treated in specialized services, including mild cases. There is limited capacity of primary care professionals to identify and treat MH problems, with some improvement from collaborative care in the more recent years. The model for crisis management and acute care remains unclear: scarce evidence was found over the different arrangements used, mostly stressing lack of integration between emergency, hospital and community services and fragile continuity of care.ConclusionsThe performance of primary care and the regulation of acute demands, especially crisis management, are the most critical aspects on PMHC. Although primary care performance seems to be improving, the balanced provision and integration between services for adequate acute and long-term care is yet to be achieved.Electronic supplementary materialThe online version of this article (10.1186/s13033-018-0237-8) contains supplementary material, which is available to authorized users.

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Section: Discussioncontrasting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Systematic review of pathways to mental health care in Brazil: narrative synthesis of quantitative and qualitative studies

Amaral

Campos

Oliveira

et al. 2018

Int J Ment Health Syst

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“…Naqvi et al’s [ 8 ] study in Pakistan mentioned no significant association between DUP and gender, marital status, or education. Tomita et al’s [ 9 ] study in South Africa mentioned that young people with lower income, higher education, and a more stable relationship status had longer DUP. There was no significant association between DUP and gender, race/ethnicity, or hospital access.…”

Section: Discussionmentioning

confidence: 99%

Factors that influence delaying initial psychiatric treatment in rural Cambodia: A pilot study

et al. 2018

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BackgroundThe WHO reported the gap between the need for treatment and its provision is huge in low- and middle-income countries. It is estimated there are lots of burden to obtain treatment in these countries. This survey intended to show the delay of their first visit to a psychiatric department and the factors that influence the delay. To elucidate the factors affecting medical accessibility for people with mental illness, we propose the concept of duration of untreated mental illness (DUM), which is the duration between the onset or first symptom of mental illness and the first visit to a psychiatric department or clinic.MethodsParticipants were 109 Cambodian adults (18 years old and up) who had a psychiatric consultation in one of the following hospitals. We analyzed the relationships between DUM and patients’ background; age, gender, economic status, education level, occupation, hospital access, and diagnosis.ResultsThe average DUM of all participants was 34.8 ± 42.4 months, ranging from 0 to 240 There was no significant difference in DUM by difference in hospital, gender, age, hospital access, education level, occupation, or economic status. Only patient diagnosis was related to DUM. The DUM for patients with schizophrenia and epilepsy was long, while the DUM for patients with neurosis and substance use were short.ConclusionTo compare DUM with that of other low- and middle-income countries, DUM of our survey is extremely long. However, those reports were from urban areas within the low- and middle-income countries. We considered our report to include a very important sample showing the condition of psychiatric services in rural areas of low-income countries.

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“…Both findings have public health significance. Long durations of untreated psychosis have been reported in Sub-Saharan Africa compared to high income countries and have been associated with poorer outcomes [54][55][56]. Late onset of psychotic illnesses is often associated with a less severe course and better outcomes [57].…”

Section: Age Of Initial Presentation With a First Episode Of Psychosismentioning

confidence: 99%

One year prevalence of psychotic disorders among first treatment contact patients at the National Psychiatric Referral and Teaching Hospital in Uganda

et al. 2020

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Introduction Hospital based studies for psychotic disorders are scarce in low and middle income countries. This may impact on development of intervention programs. Objective We aimed to determine the burden of psychotic disorders among first treatment contact patients at the national psychiatric referral hospital in Uganda. Methods A retrospective patient chart-file review was carried out in March 2019 for all patients presenting to the hospital for the first time in the previous year. Patients were categorised into those with and without psychotic disorders. We collected sociodemographic data on age, gender, occupation, level of education, ethnicity, religion and home district. We determined the one year prevalence of psychotic disorders among first treatment contact patients. Using logistic regression models, we also determined the association between psychotic disorders and various exposure variables among first treatment contact patients. Results In 2018, 63% (95% CI: 60.2-65.1) of all first time contact patients had a psychosis related diagnosis. Among the patients with psychotic disorders, the median age was 29 years (IQR 24-36). Most of the patients were male (62.8%) and unemployed (63.1%). After adjusting for patients' residence, psychotic disorders were found to be more prevalent among the female gender [OR 1.58 (CI1.46-1.72)] and those of Pentecostal faith [OR 1.25 (CI 1.10-1.42)].

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Duration of Untreated Psychosis and the Pathway to Care in KwaZulu-Natal, South Africa

Cited by 14 publications

References 11 publications

Systematic review of pathways to mental health care in Brazil: narrative synthesis of quantitative and qualitative studies

Systematic review of pathways to mental health care in Brazil: narrative synthesis of quantitative and qualitative studies

Factors that influence delaying initial psychiatric treatment in rural Cambodia: A pilot study

One year prevalence of psychotic disorders among first treatment contact patients at the National Psychiatric Referral and Teaching Hospital in Uganda

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