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

Abstract

BackgroundEarly recognition of the signs and symptoms of mental health disorders is important because early intervention is critical to restoring the mental as well as the physical and the social health of an individual. This study sought to investigate patterns of treatment seeking behavior and associated factors for mental illness.MethodsA quantitative, institution-based cross sectional study was conducted among 384 psychiatric patients at Jimma University Specialized Hospital (JUSH) located in Jimma, Ethiopia from March to April 2010. Data was collected using a pretested WHO encounter format by trained psychiatric nurses. Data was analyzed using SPSS V.16.ResultMajor depression disorder 186 (48.4%), schizophrenia 55 (14.3%) and other psychotic disorders 47 (12.2%) were the most common diagnoses given to the respondents. The median duration of symptoms of mental illness before contact to modern mental health service was 52.1 weeks. The main sources of information for the help sought by the patients were found to be family 126 (32.8%) and other patients 75 (19.5%). Over a third of the patients 135 (35.2%), came directly to JUSH. Half of the patients sought traditional treatment from either a religious healer 116 (30.2%) or an herbalist 77 (20.1%) before they came to the hospital. The most common explanations given for the cause of the mental illness were spiritual possession 198 (51.6%) and evil eye 61 (15.9%), whereas 73 (19.0%) of the respondents said they did not know the cause of mental illnesses. Nearly all of the respondents 379 (98.7%) believed that mental illness can be cured with modern treatment. Individuals who presented with abdominal pain and headache were more likely to seek care earlier. Being in the age group 31-40 years had significant statistical association with delayed treatment seeking behavior.ConclusionsThere is significant delay in modern psychiatric treatment seeking in the majority of the cases. Traditional healers were the first place where help was sought for mental illness in this population. Most of the respondents claimed that mental illnesses were caused by supernatural factors. In contrast to their thoughts about the causes of mental illnesses however, most of the respondents believed that mental illnesses could be cured with biomedical treatment. Interventions targeted at improving public awareness about the causes and treatment of mental illness could reduce the delay in treatment seeking and improve treatment outcomes.

Pathway to care for psychiatric patients in a developing country: Malawi

“…Native and religious healers form a significant part of the health delivery system in Malawi because of cultural and spiritual beliefs, and it is not surprising to see that a significant number of patients had them as their first carer before referral. This finding confirms earlier findings from studies in Nigeria (Abiodun, 1995) and Ethiopia (Alem, Jacobsson, Araya, Kebede, & Kullgren, 1999;Girma & Tesfaye, 2011) where traditional/native healers play a significant role in provision of care to people with mental health problems. While it is important to appreciate the role played by native and religious healers in the pathway to care for people with psychological problems, there is need to also look at the reasons why most patients who saw them as the first carer spent more than 2 weeks before referral.…”

“…This is unlike in Mexico where most patients preferred seeing the primary health practitioner as the first carer (Gater et al, 1991). This finding is similar to findings in Ilorin, Nigeria (Abiodun, 1995) and Jimma, Ethiopia (Girma & Tesfaye, 2011), but No diagnosis 0 (0.0%) 1 (2.0%) 1 (8.3%) 2 (1.6%) Dementia in Alzheimer's disease, unspecified 0 (0.0%) 1 (2.0%) 0 (0.0%) 1 (0.8%) Unspecified dementia 0 (0.0%) 4 (8.2%) 0 (0.0%) 4 (3.1%) Other specified mental disorders due to brain damage and dysfunction 1 (1.5%) 2 (4.0%) 1 (8.3%) 4 (3.1%) Unspecified mental disorder due to brain damage and dysfunction 1 (1.5%) 1 (2.0%) 0 (0.0%) 2 (1.6%) Unspecified organic or symptomatic mental disorder 4 (6.0%) 0 (0.0%) 0 (0.0%) 4 (3.1%) Mental and behavioural disorders due to use of alcohol 1 (1.5%) 3 (6.1%) 1 (8.3%) 5 (3.9%) Mental and behavioural disorders due to use of opioids 0 (0.0%) 2 (4.0%) 0 (0.0%) 2 (1.6%) Mental and behavioural disorders due to use of cannabinoids 16 (23.9%) 4 (8.2%) 0 (0.0%) 20 (15.6%) Mental and behavioural disorders due to multiple drug use 0 (0.0%) 1 (2.0%) 0 (0.0%) 1 (0.8%) Paranoid schizophrenia 2 (3.0%) 0 (0.0%) 2 (16.7%) 4 (3.1%) Schizophrenia, unspecified 15 (22.4%) 11 (22.4%) 3 (25%) 29 (22.7%) Acute and transient psychotic disorder, unspecified 5 (7.5%) 11 (22.4%) 0 (0.0%) 16 (12.5%) Schizoaffective disorder, unspecified 2 (3.0%) 0 (0.0%) 0 (0.0%) 2 (1.6%) Other non-organic psychotic disorders 1 (1.5%) 0 (0.0%) 0 (0.0%) 1 (0.8%) Hypomania 0 (0.0%) 0 (0.0%) 1 (8.3%) 1 (0.8%) Mania without psychotic symptoms 1 (1.5%) 0 (0.0%) 0 (0.0%) 1 (0.8%) Mania with psychotic symptoms 1 (1.5%) 0 (0.0%) 0 (0.0%) 1 (0.8%) Manic episode, unspecified 1 (1.5%) 0 (0.0%) 0 (0.0%) 1 (0.8%) Bipolar affective disorder, unspecified 5 (7.5%) 4 (8.2%) 0 (0.0%) 9 (7.0%) Mild depressive episode 1 (1.5%) 0 (0.0%) 2 (16.7%) 3 (2.3%) Severe depressive episode without psychotic symptoms 1 (1.5%) 0 (0.0%) 0 (0.0%) 1 (0.8%) Severe depressive episode with psychotic symptoms 2 (3.0%) 0 (0.0%) 0 (0.0%) 2 (1.6%) Depressive episode, unspecified 1 (1.5%) 1 (2.0%) 0 (0.0%) 2 (1.6%) Anxiety disorder, unspecified 3 (4.5%) 0 (0.0%) 0 (0.0%) 3 (2.3%) Nonorganic sleep disorder, unspecified 0 (0.0%) 1 (2.0%) 0 (0.0%) 1 (0.8%) Puerperal mental disorder, unspecified 2 (3.0%) 1 (2.0%) 1 (8.3%) 4 (3.1%) Moderate mental retardation 1 (1.5%) 0 (0.0%) 0 (0.0%) 1 (0.8%) Unspecified mental retardation 0 (0.0%) 1 (2.0%) 0 (0.0%) 1 (0.8%) Total 67 49 12 128 ICD-10: International Classification of Diseases-10th Revision.…”

“…Majority of patients seen in the psychiatric units received a diagnosis of a psychotic illness followed by drug-related problems with mood and anxiety disorders accounting for 16% and 4%, respectively. Like in other studies in Jimma and Addis Ababa in Ethiopia, most patients had a diagnosis of schizophrenia at the psychiatric services (Bekele, Flisher, Alem, & Baheretebeb, 2009;Girma & Tesfaye, 2011).…”

454 – Correlates of mental health service utilization in married women in tehran 2011

“…Study of health service utilization could help policy makers, managers and directors in health sector. These data are useful in determining outreach populations, correlates of services use, over/under use of services based on global standards and unmet needs, and estimation of resources need for service provision (20-21). …”

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

“…Their trajectories to care differ and are guided by their belief about the cause of the disorder. Community values and beliefs associate mental disorders to shame and fear thus influencing treatment seeking behavior and treatment outcomes [13]. Participants of East London First Episode Psychosis Study (ELFEPS) first sought care in descending order from: community health and social care agencies (35 %), criminal justice system (25 %), native and religious healer (21 %) [14].…”