The incidence of psychoses in diverse settings, INTREPID (2): a feasibility study in India, Nigeria, and Trinidad

Abstract

Background. There are striking global inequities in our knowledge of the incidence, aetiology, and outcome of psychotic disorders. For example, only around 10% of research on incidence of psychotic disorders originates in low-and middleincome countries. We established INTREPID I to develop, implement, and evaluate, in sites in India (Chengalpet), Nigeria (Ibadan), and Trinidad (Tunapuna-Piarco), methods for identifying and recruiting untreated cases of psychosis, as a basis for investigating incidence and, subsequently, risk factors, phenomenology, and outcome. In this paper, we compare case characteristics and incidence rates across the sites.Method. In each site, to identify untreated cases of psychoses in defined catchment areas, we established case detection systems comprising mental health services, traditional and spiritual healers, and key informants.Results. Rates of all untreated psychoses were 45.9 (per 1 00 000 person-years) in Chengalpet, 31.2 in Ibadan, and 36.9 in Tunapuna-Piarco. Duration of psychosis prior to detection was substantially longer in Chengalpet (median 232 weeks) than in Ibadan (median 13 weeks) and Tunapuna-Piarco (median 38 weeks). When analyses were restricted to cases with a short duration (i.e. onset within preceding 2 years) only, rates were 15.5 in Chengalpet, 29.1 in Ibadan, and 26.5 in Tunapuna-Piarco. Further, there was evidence of age and sex differences across sites, with an older average age of onset in Chengalpet and higher rates among women in Ibadan.Conclusion. Our findings suggest there may be differences in rates of psychoses and in the clinical and demographic profiles of cases across economically and socially distinct settings.

Identification of patients with recent-onset psychosis in KwaZulu Natal, South Africa: a pilot study with traditional health practitioners and diagnostic instruments

“…THPs recognized "being disturbed" as a condition for which collaboration with psychiatric mental health care might be beneficial. As researchers of other recent projects also have noted [3,23], the prerequisite for such collaboration is building of trust, which takes longterm engagement and mutual respect. When these conditions are met, it seems feasible to build partnerships with THPs who are the primary health care providers in many areas where formal health care is virtually absent.…”

“…While the 1992 World Health Organization (WHO) Collaborative Study on the Determinants of Outcome of Severe Mental Disorders (DOSMeD) 10-country study included data from Nigeria [1], and researchers in Butajira, Ethiopia, in the early 2000s [2] found some incident cases in their community prevalence study of severe mental disorders, methodological limitations meant that incidence rates could not be calculated. Recently, Morgan and colleagues reported incidence rates from a pilot study in Ibadan, Nigeria [3]. They detected 48 individuals with psychotic disorders and estimated incidence rates of 31.2/100,000 person years for all psychotic disorders and 27.5/100,000 person years for schizophrenia.…”

“…It is important to study psychotic disorders in these countries, in the first place to advance mental health care infrastructures and to increase detection and access to care for patients who remain largely untreated. The few studies that investigated rates of psychotic disorders in LMIC were of different methodological quality and generally did not identify patients outside mental health care settings [3]. It is therefore likely that most patients with psychotic disorder were still missed in these studies.…”

Concepts of madness in diverse settings: a qualitative study from the INTREPID project

“…Previous publications describe for each of the sites: a) the nature of their mental health systems [1]; and, b) the findings from our pilot study about incidence rates of psychosis [2]. In brief, the sites were distinguished by: a) the presence of numerous spiritual and traditional healers in Ibadan; b) the large number of persons in Chengalpet who had never received biomedical treatments; and, c) readily available professional services in Tunapuna-Piarco but, at the same time, frequent and concurrent reliance on spiritual and traditional healers.…”

“…Previous publications review our establishment of case-finding networks and our detailed documentation of the nature of mental health systems in the research sites [1], as well as our findings regarding variations in the rates of psychosis and the clinical and demographic characteristics of cases in and across the sites [2]. In this paper we describe our efforts to understand how, in each site, madness is conceptualized.…”