Help seeking and suicidality among people with epilepsy in a rural low income country setting: cross-sectional survey

Abstract

BackgroundsEpilepsy is a serious neurological disorder associated with a high level of psychiatric comorbidity. Suicidality is a recognised complication of epilepsy. As part of developing an integrated service for people with epilepsy (PWE) and priority psychiatric disorders within primary care, a cross-sectional study was conducted in a rural district in Ethiopia to investigate patterns of help-seeking, suicidality and the association with duration of untreated epilepsy (DUE) among PWE.MethodsCases were identified through community key informants and diagnosis was confirmed by trained primary care clinicians. Severity of epilepsy, depression and suicidality were assessed using standardised methods. Multivariable regression analysis was used to test the hypothesis that suicidality was associated with DUE.ResultsThe majority of PWE sought help from both religious and biomedical healing centres. The lifetime treatment gap for biomedical care was 26.9%, with a 12 month treatment gap of 56.7%. Close to one-third (29.9%) of participants reported using traditional and cultural healing practices. Nearly one-third (30.2%) of participants reported suicidality (suicidal ideation, plan or attempt) in the previous 1 year. The median (IQR) DUE was 24 months (4–72). There was no association between DUE and suicidality. In the multivariable model, being married [odds ratio (OR) 2.81, 95% CI 1.22, 6.46], increased depressive symptoms (OR 1.17, 95% CI 1.10, 1.26) and perceived poorer wealth relative to others (OR 2.67, 95% CI 1.07, 6.68) were associated independently with suicidality.ConclusionIn this study, PWE sought help from both biomedical and religious healing centres. Suicidality and depression have a high prevalence in PWE in this setting. Integrated mental and neurological health care within primary care is needed for improved holistic management of epilepsy.

<p>Treatment-Seeking Behavior Towards Epilepsy Among Rural Residents in Ethiopia: A Cross-Sectional Study</p>

“…9 It is also lower than in a study conducted in low-income countries in which about 80% of respondents did not seek any treatment. 21 In the current study, 41.7% of participants did not seek help from modern health institutions; this result is supported by a study conducted from Nigeria in which 55.8% of participants did not take epileptic patients to a hospital during a seizure. 22 This may be a result of cultural influences regarding the causes of and treatment options for seizure, as people in many developing countries believe that epilepsy cannot be cured by modern treatment, but rather by traditional treatments.…”

Prevalence and risk factors of depression and anxiety among patients with convulsive epilepsy in rural West China

“…Tsigebrhan et al found that poorer patients were susceptible to depression, and their economic level was associated with suicidal behavior in a rural low-income country. 27 The annual income of the OR P 95% CI The bold values are statistically significant (P<0.05).…”

Biomedical drugs and traditional treatment in care seeking pathways for adults with epilepsy in Masindi district, Western Uganda: a household survey

“…A study in Malawi among people with epilepsy indicated that they sought both traditional and modern medicine to treat their condition [13]. Other countries in Africa face this multiplicity of health providers like in Ghana [14] South Africa [15] and Ethiopia [16,17]. It has been noted that biomedical treatment offered at health facilities is not adequate.…”