Trauma exposure, depression, suicidal ideation, and alcohol use in people with severe mental disorder in Ethiopia

Ng, Lauren C.; Medhin, Girmay; Hanlon, Charlotte; Fekadu, Abebaw

doi:10.1007/s00127-019-01673-2

Cited by 8 publications

(4 citation statements)

References 46 publications

(67 reference statements)

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“…In rural Ethiopia alcohol use disorder is common, particularly amongst street homeless (Ayano et al, 2017;Fekadu et al, 2014), but it is highly stigmatized and rarely treated (Zewdu et al, 2019) . Attendants described the increased tendency to physically restrain and restrict food for this group, echoing the association between traumatic experiences, including assault, and comorbid mental illness and substance misuse in rural Ethiopia (Ng et al, 2019). Furthermore, attendants generally perceived substance abuse problems to be unsuitable for psychiatric care and only a small minority of clinic attenders were diagnosed with substance use disorder (4.2%).…”

Section: Findings In Contextmentioning

confidence: 97%

“Medical treatments are also part of God’s gift”: Holy water attendants’ perspectives on a collaboration between spiritual and psychiatric treatment for mental illness in Ethiopia

Asher

Birhanu

Baheretibeb

et al. 2021

Transcult Psychiatry

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In Ethiopia, traditional and spiritual treatments, such as holy water, are used by people with mental disorders instead of, or alongside, psychiatric services. Collaborations between traditional and psychiatric providers may increase access to evidence-based treatments and address human rights abuses. This study aimed to explore the perspectives of holy water attendants on a novel collaboration between holy water and psychiatric care, at St Mary’s Clinic, Entoto, Ethiopia, and to characterize the users of this service. Semi-structured interviews were conducted with 14 holy water attendants, who run group houses for holy water residents and are paid by family members. A thematic analysis was conducted. Socio-demographic and clinical data were extracted from the records of all service users who had attended the clinic. A total of 174 individuals have attended the clinic in the three years since it opened. The majority were diagnosed with schizophrenia. Holy water attendants provide a partial gatekeeping role to psychiatric care, selecting which of their clients they think will benefit and, for these individuals, facilitating attendance to the clinic and antipsychotic medication adherence. Psychiatric care was felt to be compatible with holy water by some, but not all, attendants. However, family members often had the “final say” in individuals attending the clinic, in some cases putting up strong resistance to using psychiatric care. A novel collaboration is acceptable to some holy water attendants and may increase access to psychiatric care amongst people with mental illness living at a holy water site in Ethiopia.

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Section: Findings In Contextmentioning

confidence: 97%

“Medical treatments are also part of God’s gift”: Holy water attendants’ perspectives on a collaboration between spiritual and psychiatric treatment for mental illness in Ethiopia

Asher

Birhanu

Baheretibeb

et al. 2021

Transcult Psychiatry

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“…In the PRIME study, 300 people with severe mental illness (85.3% with primary psychosis) were detected in the community [ 28 , 29 ]. Key findings were lifetime and current access gaps for biomedical care of 41.8% and 59.9%, respectively, with corresponding figures for faith and traditional healing of 15.1% and 45.2% [ 7 ]; only 11.3% received minimally adequate biomedical care in current episode [ 7 ]; long DUP (median 5 years); high rates of restraint (25.3% in the preceding 12 months); high exposure to traumatic events [ 7 , 30 ], high lifetime experience of homelessness (36.3%) [ 7 ], higher discrimination in urban residents [ 31 ]; higher poverty [ 32 , 33 ] and food insecurity [ 34 ] compared to population controls. Both the Butajira and PRIME studies were limited by potential prevalence bias and limited recruitment from religious healing sites.…”

Section: Introductionmentioning

confidence: 99%

“…However, there was minimal impact on symptom severity, 10.6% still reported experience of restraint after one year, and mortality was high. High levels of exposure to traumatic events [ 30 ] and undernutrition (23.2% underweight) were also unaddressed [ 74 ]. Furthermore, only 30% received ‘minimally adequate treatment’ over 12 months follow-up [ 15 ], driven by poverty, the lack of outreach and expectation of cure [ 75 ].…”

Section: Introductionmentioning

confidence: 99%

Studying the context of psychoses to improve outcomes in Ethiopia (SCOPE): Protocol paper

Hanlon,

Roberts,

Misganaw

et al. 2024

PLoS ONE

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Background Global evidence on psychosis is dominated by studies conducted in Western, high-income countries. The objectives of the Study of Context Of Psychoses to improve outcomes in Ethiopia (SCOPE) are (1) to generate rigorous evidence of psychosis experience, epidemiology and impacts in Ethiopia that will illuminate aetiological understanding and (2) inform development and testing of interventions for earlier identification and improved first contact care that are scalable, inclusive of difficult-to-reach populations and optimise recovery. Methods The setting is sub-cities of Addis Ababa and rural districts in south-central Ethiopia covering 1.1 million people and including rural, urban and homeless populations. SCOPE comprises (1) formative work to understand care pathways and community resources (resource mapping); examine family context and communication (ethnography); develop valid measures of family communication and personal recovery; and establish platforms for community engagement and involvement of people with lived experience; (2a) a population-based incidence study, (2b) a case-control study and (2c) a cohort study with 12 months follow-up involving 440 people with psychosis (390 rural/Addis Ababa; 50 who are homeless), 390 relatives and 390 controls. We will test hypotheses about incidence rates in rural vs. urban populations and men vs. women; potential aetiological role of khat (a commonly chewed plant with amphetamine-like properties) and traumatic exposures in psychosis; determine profiles of needs at first contact and predictors of outcome; (3) participatory workshops to develop programme theory and inform co-development of interventions, and (4) evaluation of the impact of early identification strategies on engagement with care (interrupted time series study). Findings will inform development of (5) a protocol for (5a) a feasibility cluster randomised controlled trial of interventions for people with recent-onset psychosis in rural settings and (5b) two uncontrolled pilot studies to test acceptability, feasibility of co-developed interventions in urban and homeless populations.

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“…However, there was minimal impact on symptom severity, 10.6% still reported experience of restraint after one year, and mortality was high. High levels of exposure to traumatic events [30] and undernutrition (23.2% underweight) were also unaddressed [73]. Furthermore, only 30% received ‘minimally adequate treatment’ over 12 months follow-up [15], driven by poverty, the lack of outreach and expectation of cure [74].…”

Section: Introductionmentioning

confidence: 99%

Studying the context of psychoses to improve outcomes in Ethiopia (SCOPE): protocol paper

Hanlon,

Roberts,

Misganaw

et al. 2023

Preprint

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BackgroundGlobal evidence on psychosis is dominated by studies conducted in Western, high-income countries. The objectives of the Study of Context Of Psychoses to improve outcomes in Ethiopia (SCOPE) are (1) to generate rigorous evidence of psychosis experience, epidemiology and impacts in Ethiopia that will illuminate aetiological understanding and (2) inform development and testing of interventions for earlier identification and improved first contact care that are scalable, inclusive of difficult-to-reach populations and optimise recovery.MethodsThe setting is sub-cities of Addis Ababa and rural districts in south-central Ethiopia covering 1.1 million people and including rural, urban and homeless populations. SCOPE comprises (i) formative work to understand care pathways and community resources (resource mapping); examine family context and communication (ethnography); develop valid measures of family communication and personal recovery; and establish platforms for community engagement and involvement of people with lived experience; (ii) a population-based incidence study, case-control study and cohort study with 12 months follow-up involving 440 people with psychosis (390 rural/Addis Ababa; 50 who are homeless), 390 relatives and 390 controls. We will test hypotheses about incidence rates in rural vs. urban populations and men vs. women; potential aetiological role of khat (a commonly chewed plant with amphetamine-like properties) and traumatic exposures in psychosis; determine profiles of needs at first contact and predictors of outcome; (iii) participatory workshops to develop programme theory and inform co-development of interventions, (iv) evaluation of the impact of early identification strategies on engagement with care (interrupted time series study); (v) a feasibility cluster randomised controlled trial of interventions for people with recent-onset psychosis in rural settings (10-12 clusters; n=80 participants) with 6 months follow-up to inform a future large-scale trial and investigate implementation processes and outcomes, and (vi) two uncontrolled pilot studies to test acceptability, feasibility of co-developed interventions in urban and homeless populations.

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Trauma exposure, depression, suicidal ideation, and alcohol use in people with severe mental disorder in Ethiopia

Cited by 8 publications

References 46 publications

“Medical treatments are also part of God’s gift”: Holy water attendants’ perspectives on a collaboration between spiritual and psychiatric treatment for mental illness in Ethiopia

“Medical treatments are also part of God’s gift”: Holy water attendants’ perspectives on a collaboration between spiritual and psychiatric treatment for mental illness in Ethiopia

Studying the context of psychoses to improve outcomes in Ethiopia (SCOPE): Protocol paper

Studying the context of psychoses to improve outcomes in Ethiopia (SCOPE): protocol paper

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