1. Table 2: Clinical Characteristics
Treatment Delay and Pathways to Psychiatric Care among People with schizophrenia:
Data from a Rural Psychiatric Center
Anish V. Cherian1, Shishir Kumar1, Aneesh Bhat1, Santosh Prabhu1, Praveen A2, Divya Prabha D’Souza1, Shrinivasa Bhat U. 1, Naveen Chandra Shetty 3, Satheesh Rao1
1 K. S. Hegde Medical Academy, Nitte University, Mangalore, India, 2 Kasturba Medical College, Manipal, India
3 Nitte Rural Psychiatric Center, Nitte University, Nitte, India
INTRODUCTION
METHODS
‘Duration of untreated psychosis’ (DUP) remains a major predictor of poor outcome among people with schizophrenia. Hence, reducing DUP remains a significant public health concern.
There are studies from various low-middle income countries, demonstrating that large number of people with schizophrenia remain untreated in the community for a long time.
However, there is paucity of data from rural India on DUP and its association with clinical factors and pathways to care.
Sample: n = 106
Source of data: Nitte Rural Psychiatric Center, Nitte, Karnataka, Jan – Apr 2015
Criteria: Primary diagnosis of International Classification of Disorders (ICD-10) criteria for schizophrenia
Assessment Tools: Socio-demographic proforma, World Health Organization (WHO) Encounter Form, Positive and Negative Symptom Scale (PANSS) and Indian Disability Evaluation and Assessment Scale (IDEAS)
Outcome measures: ‘Duration of Untreated Psychosis’ was evaluated by measuring duration between onset of first psychotic symptom to the first contact of psychiatrist.
RESULTS
Table 3: onset related information
Table 1: Demographic characteristics
Variable
Mean (SD)
Age of onset of illness (in years)
27.09 ± 12.25
Age of first psychiatric consultation (in years)
31.34 ± 12.76
Duration of Illness (in years)
10.93 ± 9.59
Duration of Untreated Psychosis (DUP) (in years)
Mean
Median
Minimum – maximum DUP
4.44 ± 6.87 2
15 Days to 34 years
First gateway of care provider
Native/religious healer
Medical Practitioner
Psychiatrist
91 (85.8)
5 (4.7)
10 (9.4)
Variable
Mean (SD) / N (%)
Age (in years)
38.73 ± 13.08
Female
57 (53.8)
Education (in years)
7.03 ± 4.32
Marital status
Single
Married
Widow/er
Separated
44 (41.5)
48 (45.3)
7 (6.6)
Hindu
94 (88.7)
Rural background
99 (93.4)
Nuclear family structure
74 (69.8)
Employment
Homemaker
Employed (full time or part time)
Unemployed
46 (43.4)
22 (20.8)
37 (35.0)
Monthly family income Rs Rs Rs
21 (19.8)
Table 4: Linear Regression Analyses to identify predictors of longer duration of untreated psychosis (DUP)
Predictor Variable
Beta t p
95%CI (OR)
Age of onset of illness
-1.883
0.859
0.03
– (-0.168)
Summary of Results :
The patients were predominantly young adults, female, from a rural and low-middle income background.
The mean DUP was ± 6.87 years.
The longest time to contact was 34 years but 80% had a DUP shorter than 5 years.
Earlier onset of illness was associated with longer DUP.
It was seen that there were three gateways to care, with native/ faith healers being the most popular gateway of care (85.8%).
Table 2: Clinical Characteristics
Variable
Mean (SD)
PANSS Score
Positive
Negative Score
General Score
72.02 ± 26.06
17.24 ± 7.17
19.02 ± 8.47
35.76 ± 13.40
IDEAS Score
8.69 ± 3.5
WHODAS Score
62.16 ± 29.30
Insight Score
10.29 ± 4.22
CONCLUSIONS
In rural India, the people with schizophrenia usually takes longer time to seek psychiatric help after their first psychotic episodes compared with their urban counterparts.
The results emphasize the essentiality of developing culturally acceptable early identification strategies such as improving mental health literacy and community based intervention for people with schizophrenia which has been found to be effective in reducing delay in reducing untreated duration of schizophrenia. in developed countries
ACKNOLEDGEMENT
This study was funded by the Nitte University Seed Grant to Dr. Anish V. Cherian. Dr. Anish V. Cherian also been support by Public Health Research Initiative (PHRI) Fellowship jointly awarded by Public Health Foundation of India, New Delhi and Department of Science & Technology (DST), New Delhi.
REFERENCES
1. Mishra N, Nagpal SS, Chadda RK, Sood M. Help-seeking behavior of patients with mental health problems visiting a tertiary care centre in north India. Indian J Psychiatry 2011;53(3):234-8.
2. Al Fayez H, Lappin J, Murray R, Boydell J. Duration of untreated psychosis and pathway to care in Riyadh, Saudi Arabia. Early Interv Psychiatry. 2015 [Epub ahead of print]