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Association between referral source and duration of untreated psychosis in pathways to care among first episode psychosis patients in Northern Malawi.
Early Interv Psychiatry. 2020 10; 14(5):594-605.EI

Abstract

AIMS

To examine the association between referral source and duration of untreated psychosis (DUP) and explore determinants of referral source; when adjusting for pathways to care, positive and negative symptoms, diagnosis and socio-demographic characteristics.

METHODS

A total of 140 subjects with first episode psychosis (FEP) were enrolled from a pilot early intervention service for psychosis in Northern Malawi between June 2009 and September 2012. Logistic regression analyses were used to quantify the associations between variables of interest.

RESULTS

Age ranged between 18 and 65 at assessment, with median, 33. Median DUP was 12.5 months. First contact did not independently determine DUP. Long DUP (>6 months) was associated with referral from community based volunteer (CBV) or traditional healer (TH), a unit increase in severity of negative symptoms and having schizophrenia, which was also associated with referral from CBV or TH. Additionally, being unemployed was associated with referral from CBV or TH. However, a unit increase in the number of times religious advice (RA) was sought, GP was contacted and severity of positive symptoms was associated with referral by GP.

CONCLUSIONS

Mental health awareness is justified for this population and collaboration with THs in identifying and treating patients with psychosis may help reduce treatment delays. Access to mental health services ought to improve, particularly for the unemployed group. Future studies should consider adjusting for referral source when ascertaining first contact source as a predictor of DUP.

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Authors+Show Affiliations

Kaminga AC
Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China. Department of Mathematics and Statistics, Mzuzu University, Luwinga, Malawi.
Myaba J
Department of Clinical Medicine, Mental Health Research Section, Saint John of God Community Services, Mzuzu, Malawi.
Dai W
Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.
Liu A
Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.
Chilale HK
Department of Clinical Medicine, Mental Health Research Section, Saint John of God Community Services, Mzuzu, Malawi.
Kubwalo PF
Department of Mathematics and Statistics, Mzuzu University, Luwinga, Malawi.
Madula P
Department of Communication Studies, Mzuzu University, Mzuzu, Malawi.
Banda R
Department of Clinical Medicine, Mental Health Research Section, Saint John of God Community Services, Mzuzu, Malawi.
Pan X
Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.
Wen SW
Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China. OMNI Research Group, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. School of Epidemiology, Public Health, and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.

MeSH

AdolescentAdultCritical PathwaysEarly Intervention, EducationalFemaleHumansMalawiMaleMental Health ServicesPsychotic DisordersReferral and ConsultationSchizophreniaTime FactorsTime-to-TreatmentYoung Adult

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31657157

Citation

Kaminga, Atipatsa C., et al. "Association Between Referral Source and Duration of Untreated Psychosis in Pathways to Care Among First Episode Psychosis Patients in Northern Malawi." Early Intervention in Psychiatry, vol. 14, no. 5, 2020, pp. 594-605.
Kaminga AC, Myaba J, Dai W, et al. Association between referral source and duration of untreated psychosis in pathways to care among first episode psychosis patients in Northern Malawi. Early Interv Psychiatry. 2020;14(5):594-605.
Kaminga, A. C., Myaba, J., Dai, W., Liu, A., Chilale, H. K., Kubwalo, P. F., Madula, P., Banda, R., Pan, X., & Wen, S. W. (2020). Association between referral source and duration of untreated psychosis in pathways to care among first episode psychosis patients in Northern Malawi. Early Intervention in Psychiatry, 14(5), 594-605. https://doi.org/10.1111/eip.12885
Kaminga AC, et al. Association Between Referral Source and Duration of Untreated Psychosis in Pathways to Care Among First Episode Psychosis Patients in Northern Malawi. Early Interv Psychiatry. 2020;14(5):594-605. PubMed PMID: 31657157.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association between referral source and duration of untreated psychosis in pathways to care among first episode psychosis patients in Northern Malawi. AU - Kaminga,Atipatsa C, AU - Myaba,Japhet, AU - Dai,Wenjie, AU - Liu,Aizhong, AU - Chilale,Harris K, AU - Kubwalo,Paul F, AU - Madula,Precious, AU - Banda,Richard, AU - Pan,Xiongfeng, AU - Wen,Shi W, Y1 - 2019/10/27/ PY - 2019/02/11/received PY - 2019/08/13/revised PY - 2019/09/26/accepted PY - 2019/10/28/pubmed PY - 2021/5/4/medline PY - 2019/10/29/entrez KW - duration of untreated psychosis KW - early intervention KW - first episode psychosis KW - pathways to care KW - schizophrenia SP - 594 EP - 605 JF - Early intervention in psychiatry JO - Early Interv Psychiatry VL - 14 IS - 5 N2 - AIMS: To examine the association between referral source and duration of untreated psychosis (DUP) and explore determinants of referral source; when adjusting for pathways to care, positive and negative symptoms, diagnosis and socio-demographic characteristics. METHODS: A total of 140 subjects with first episode psychosis (FEP) were enrolled from a pilot early intervention service for psychosis in Northern Malawi between June 2009 and September 2012. Logistic regression analyses were used to quantify the associations between variables of interest. RESULTS: Age ranged between 18 and 65 at assessment, with median, 33. Median DUP was 12.5 months. First contact did not independently determine DUP. Long DUP (>6 months) was associated with referral from community based volunteer (CBV) or traditional healer (TH), a unit increase in severity of negative symptoms and having schizophrenia, which was also associated with referral from CBV or TH. Additionally, being unemployed was associated with referral from CBV or TH. However, a unit increase in the number of times religious advice (RA) was sought, GP was contacted and severity of positive symptoms was associated with referral by GP. CONCLUSIONS: Mental health awareness is justified for this population and collaboration with THs in identifying and treating patients with psychosis may help reduce treatment delays. Access to mental health services ought to improve, particularly for the unemployed group. Future studies should consider adjusting for referral source when ascertaining first contact source as a predictor of DUP. SN - 1751-7893 UR - https://www.unboundmedicine.com/medline/citation/31657157/Association_between_referral_source_and_duration_of_untreated_psychosis_in_pathways_to_care_among_first_episode_psychosis_patients_in_Northern_Malawi_ L2 - https://doi.org/10.1111/eip.12885 DB - PRIME DP - Unbound Medicine ER -