Pathways to care in first-episode psychosis in low-resource settings: Implications for policy and practice
Singh, Swaran P Winsper, Catherine Mohan, Mohapradeep Birchwood, Max Chadda, Rakesh K Furtado, Vivek Iyer, Srividya N Lilford, Richard J Madan, Jason Meyer, Caroline
Singh, Swaran P
Winsper, Catherine
Mohan, Mohapradeep
Birchwood, Max
Chadda, Rakesh K
Furtado, Vivek
Iyer, Srividya N
Lilford, Richard J
Madan, Jason
Meyer, Caroline
Abstract
Objective: Developing countries such as India face a major mental health care gap. Delayed or inadequate care can have a profound impact on treatment outcomes. We compared pathways to care in first episode psychosis (FEP) between North and South India to inform solutions to bridge the treatment gap.
Methods: Cross-sectional observation study of 'untreated' FEP patients (n = 177) visiting a psychiatry department in two sites in India (AIIMS, New Delhi and SCARF, Chennai). We compared duration of untreated psychosis (DUP), first service encounters, illness attributions and socio-demographic factors between patients from North and South India. Correlates of DUP were explored using logistic regression analysis (DUP ≥ 6 months) and generalised linear models (DUP in weeks).
Results: Patients in North India had experienced longer DUP than patients in South India (β = 17.68, p < 0.05). The most common first encounter in North India was with a faith healer (45.7%), however, this contact was not significantly associated with longer DUP. Visiting a faith healer was the second most common first contact in South India (23.6%) and was significantly associated with longer DUP (Odds Ratio: 6.84; 95% Confidence Interval: 1.77, 26.49). Being in paid employment was significantly associated with shorter DUP across both sites.
Conclusions: Implementing early intervention strategies in a diverse country like India requires careful attention to local population demographics; one size may not fit all. A collaborative relationship between faith healers and mental health professionals could help with educational initiatives and to provide more accessible care.
MIDER Authors
Date
2023-03
Type
Article
Subject
Psychotic Disorders
Collections
Citation
Singh SP, Winsper C, Mohan M, Birchwood M, Chadda RK, Furtado V, Iyer SN, Lilford RJ, Madan J, Meyer C, Ramachandran P, Rangaswamy T, Shah J, Sood M; WIC Consortium. Pathways to care in first-episode psychosis in low-resource settings: Implications for policy and practice. Asian J Psychiatr. 2023 Mar;81:103463. doi: 10.1016/j.ajp.2023.103463. Epub 2023 Jan 11. PMID: 36645973.
Journal / Source Title
Asian Journal of Psychiatry
DOI
10.1016/j.ajp.2023.103463
PMID
Publisher
Elsevier
Publisher’s URL
https://pubmed.ncbi.nlm.nih.gov/36645973/