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A systematic review of care pathways for psychosis in low-and middle-income countries
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Lilford, Philippa, Wickramaseckara Rajapakshe, Onali Bimalka and Singh, Swaran P. (2020) A systematic review of care pathways for psychosis in low-and middle-income countries. Asian Journal of Psychiatry, 54 . 102237. doi:10.1016/j.ajp.2020.102237 ISSN 1876-2018.
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WRAP-systematic-review-care-pathways-psychosis-low-and-middle-income-countries-Singh-2020.pdf - Accepted Version - Requires a PDF viewer. Available under License Creative Commons Attribution Non-commercial No Derivatives 4.0. Download (2196Kb) | Preview |
Official URL: http://dx.doi.org/10.1016/j.ajp.2020.102237
Abstract
Pathways to care for psychosis in high-income countries have been well studied, with the finding of an association between longer duration of untreated psychosis (DUP) and poorer outcomes focusing interest on care pathways to minimise treatment delay. Little is known about how people with psychosis in low-to middle-income countries (LMIC) present for help and specific care pathways that might be associated with treatment delays in those contexts. We conducted a systematic review using electronic databases (MEDLINE, PsychINFO, Embase, Ovid) to explore what proportion of patients with psychosis in LMIC are accessing care through traditional healers and whether this is associated with treatment delay. Studies were included if they assessed the pathway to care for participants with a psychotic illness in a LMIC. From 3929 results, 15 studies met our inclusion criteria. In 7 out of 15 studies first contact for the majority of patients were traditional health practitioners (THPs). In 5 out of 15 studies, mental health practitioners (MHPs) were most often the initial care pathway and in 3 studies first contact was with primary care. DUP ranged from a mean of 30 weeks to 225 weeks. Accessing THPs as initial contact was associated with a longer DUP.
In LMICs, a large proportion of patients use THP as their first point of contact for accessing care. This is associated with longer DUP. Services in these countries need to focus both on raising public awareness and collaborative working with THPs to facilitate access to biomedical care.
| Item Type: | Journal Article | |||||||||
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| Subjects: | R Medicine > RC Internal medicine | |||||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Mental Health and Wellbeing Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Psychoses -- Treatment, Schizophrenia, Outcome assessment (Medical care), Traditional medicine | |||||||||
| Journal or Publication Title: | Asian Journal of Psychiatry | |||||||||
| Publisher: | Elsevier | |||||||||
| ISSN: | 1876-2018 | |||||||||
| Official Date: | December 2020 | |||||||||
| Dates: |
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| Volume: | 54 | |||||||||
| Article Number: | 102237 | |||||||||
| DOI: | 10.1016/j.ajp.2020.102237 | |||||||||
| Status: | Peer Reviewed | |||||||||
| Publication Status: | Published | |||||||||
| Access rights to Published version: | Restricted or Subscription Access | |||||||||
| Date of first compliant deposit: | 26 June 2020 | |||||||||
| Date of first compliant Open Access: | 6 September 2021 | |||||||||
| RIOXX Funder/Project Grant: |
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