Schizophrenia in women and children: A selective review of literature from developing countries

Abstract

Women and children with psychotic disorders in developing countries may be vulnerable and have considerable social disadvantages. Gender disadvantage has implications for all health outcomes including mental illnesses. In the more relevant gender-related context we discuss several important issues which affect women with schizophrenia, namely stigma, caregiver burden, functional outcome, marriage, victimization and help-seeking. The findings indicate that there are variations in clinical and functional outcomes and age of onset of illness between different regions. Drug side effects, such as metabolic syndrome appear to be quite common, adding to disease burden in women from developing countries. Victimization and coercion may contribute to poor quality of life and health concerns such as STIs and HIV. Stigma among women with schizophrenia appears to play a major role in help-seeking, caregiver burden and issues such as marriage and parenting. Gender-sensitive care and practices are few and not well documented. Research in the area of psychoses in children and adolescents from LAMI countries is sparse and is mainly restricted to a few clinic-based studies. More research is needed on organic and medical factors contributing to childhood psychoses, pathways to care, help-seeking, and impact of early detection and community care.

Stigma of mental illness: A study in the Indian Armed Forces

“…Studies have reported that women and children with psychotic disorders in developing countries may be vulnerable and have considerable social disadvantages such as having difficulty in getting married, being thrown out of the house by the in-laws due to mental illness and the fear of being a burden to their parents. 16,17 The findings indicate that stigma is pervasive irrespective of the educational status or rank.…”

“He can send her to her parents”: The interaction between marriageability, gender and serious mental illness in rural Ethiopia

“…In most low- and middle-income countries (LMICs), women with SMI experience multiple adversities due to untreated symptoms, functional impairment, limited access to treatment options, stigma, social exclusion and, more broadly, due to the sociocultural context that may disadvantage women in general [3, 4]. Women with SMI are at elevated risk of gender-based violence.…”

“…For example, in a study from Nigeria, women with schizophrenia were at increased risk of intimate partner violence [5]. These gender disadvantages may translate into worse general health, economic, and social outcomes of SMI than men [3]. SMI is inextricably linked with poverty in most LMICs due to out of pocket healthcare financing and the long-term nature of the illness [6, 7].…”

“…For example, even in high income countries such as Sweden, ‘stigma by association’ was reported to be common with family members of a person with SMI being distanced [15]. Similarly, studies from other LMICs (mainly India) indicate that not just the individual with SMI, but also their families and close relatives experience lower chances of marriageability [3, 16]. Nevertheless, literature focusing on marriageability, gender and family roles in Sub-Saharan Africa, especially in Ethiopia is limited.…”

Cost-effectiveness of the Mental Health and Development model for schizophrenia-spectrum and bipolar disorders in rural Kenya

“…A meta-analysis of studies from mostly high-income countries suggests that men with schizophrenia have almost equal recovery rates to women, with about one in seven people recovering over time (Jääskeläinen et al 2012). A literature review from low- to middle-income countries, however, suggests that there are sex differences in clinical and functional outcomes with psychotic women having poorer prognoses than their male counterparts, because of greater stigma, coercion and victimization, contributing to less help-seeking (Chandra et al 2012). If this is the case, then comparison outcomes from a mostly male sample would overestimate recovery, making our estimates of MHD outcomes conservative.…”