JOURNAL CLUB PRESENTATION

BySaad Bin Zafar Mahmood

Title

Perceptions about the cause of Schizophrenia and the subsequent help seeking behaviour in a Pakistani Population - A Cross-sectional

surveyZafar SN, Syed R, Tehseen S, Gowani SA, Waqar S, Zubair A, Yousaf W,

Zubairi AJ & Naqvi HBMC Psychiatry 2008, 8:56

Particulars of the article

Original Research article

Published in BioMed Central Psychiatry

Date of publication : 17th July 2008

Main corresponding author : Syed Nabeel Zafar - AKU

Background & Objectives of study Methodology Results Discussion & Conclusion References

Background

What is Schizophrenia

Severe mental illness characterized by fundamental disturbances in thoughts, emotions and perceptions.

8th leading cause of DALYS in age group of 15-44 years (Rossler et al., 2005)

Background

Wrong perceptions regarding the cause of schizophrenia & various stigmata

Delayed treatment

Studies show favorable prognosis with good family and social support, early diagnosis and management

Objectives

To determine the perceptions regarding the etiology of schizophrenia and the subsequent help seeking behaviour

Methodology

Questionnaire based cross sectional study

Conducted at Agha Khan University Hospital between 18th to 22nd December 2006 (5 days)

Three areas were chosen Community Health Centre (CHC) Consulting Clinics (CC) Inpatient family waiting areas

Methodology

Sample Total of 404 participants Culturally diverse populations Inclusion / Exclusion criteria applied

Inclusion

• all individuals above 18 years

Exclusion

• No medical staff or medical student was interviewed• Attendants of psychiatric patients also excluded• People unable to read urdu were excluded• anyone under the age of 18 years was excluded

Methodology

Questionnaire Developed in Urdu Three sections

Section 1 - Demographic details Age, sex, marital status, education level, religion, religious inclination, Profession Family System (Joint or Nuclear)

Section 2 Questionnaire

Asking the participant views regarding the possible causes for a case of schizophrenia

22 choices were given Four point likert scale used ( main reason, possible

reason, not likely a reason and definitely not a reason) Lastly asked to state the most important cause

Section 3 Questionnaire

Asking the participant regarding the probable approach they would employ if they had a relative with a psychotic problem

15 interventional choices were given Three point likert scale useed (definitely do, will

consider doing and will not do at all) Lastly asked to state the most important step they would

take

Methodology

Ethical considerations Research was in accordance with the Helsinki

declaration Participants were verbally explained the nature

of research, its advantages and disadvantages Confidentiality maintained and no such

information was recorded Written informed consent was taken

Results

Results of the demographic profile Mean age = 31.35 ± 9.93 years 77 % males and 23 & females Majority of participants well educated (62 %

holding bachelor’s degree Majority were Muslim (92 %)

22.3

13.6

10.1

54.0

Cause of Schizophrenia

Mental illness Low IQGod's will Others

Before Categorization

Results

38.4

15.613.4

12.18.4

Cause of Schizophrenia

Biological CauseReligious CausePersonality IssuePsycho-social StressorOther Social Issues and Superstitious beliefs

After Categorization

FemalesNuclear family

Age greater than 47

Primary level of education

Results

40.6

9.78.9

7.4

6.7

26.7

Help seeking behaviour

Visit Psychiatrist Visit Family Physician

Do nothing Pray

Offer sadqa / Khirat Others

Before Categorization

52.2

19.3

14.910.63

Help seeking behaviour

Professional Medical helpReligious RemidiesNo Help seeking behaviourSocial alterationsMagic and Excorcism steps

After Categorization

FemalesNuclear family

Moderately religious

Very religiousLess educated

Joint family system

MalesYoung (17-26 years)

Discussion

Well known that the general population of especially the developing countries attributes non biological beliefs to the cause of schizophrenia

As a result there is an increase in DUP

DUP is a very important factor of prognosis

Discussion

This study shows that those who gave biological causes for the disease were 3 times more likely to seek professional medical help.

Relatives of psychiatric patients have different beliefs than that of general population (Angermeyer et al., 2003)

Discussion

Study shows that there is increased awareness in people living in nuclear family

Underreporting of the disease due to lack of help seeking behaviour

As a result unable to design nationwide strategies

Discussion

Limitations / Biasness in this study The sample population is not representative

of the Pakistani population Sample is highly educated Study was conducted in a hospital setting Likert scale used always have a tendency of bias

Conclusion

The study gives a good impression regarding perceptions of pakistanis

It shows that to decrease the burden of schizophrenia more awareness have to be created

Supporting Articles Javed Z, Naeem F, Kingdon D, Irfan M, Izhar N, Ayub M: Attitude

of the university students and teachers towards mentally ill, in Lahore, Pakistan. J Ayub Med Coll Abbottabad 2006, 18:55-58.

Srinivasan TN, Thara R: Beliefs about causation of schizophrenia: Do Indian families believe in supernatural causes? Soc Psychiatry, Psychiatr Epidemiol 2001, 36:134-140.

Kadri N, Manoudi F, Berrada S, Moussaoui D: Stigma impact on Moroccan families of patients with schizophrenia. Can J Psychiatry, 2004, 49:625-629.

Kulhara P, Avasthi A, Sharma A: Magico-religious beliefs in schizophrenia: a study from north India. Psychopathology 2000, 33:62-68.

References1. Rossler W, Salize HJ, van Os J, Riecher-Rossler A: Size of burden of schizophrenia and psychotic disorders.

Eur Neuropsychopharmacol, 2005, 15:399-409.2. Salloum IM, Moss HB, Daley DC: Substance abuse and schizophrenia: impediments to optimal care. Am J

Drug Alcohol Abuse, 1991, 17:321-336.3. Grover SAA, Chakrabarti S, Kulhara P: Cost of illness of Schizophrenia. J Pak Psych Society 2006, 3:12-20.4. Siegel SJ, Irani F, Brensinger CM, Kohler CG, Bilker WB, Ragland JD, Kanes SJ, Gur RC, Gur RE: Prognostic

variables at intake and long-term level of function in schizophrenia. Am J Psychiatry,2006, 163:433-441.

5. Giron M, Gomez-Beneyto M: Relationship between family attitudes and social functioning in schizophrenia: a nine-month follow-up prospective study in Spain. J Nerv Ment Dis 2004, 192:414-420.

6. Perkins DO, Gu H, Boteva K, Lieberman JA: Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. Am J Psychiatry, 2005, 162:1785-1804.

7. Marshall M, Lewis S, Lockwood A, Drake R, Jones P, Croudace T: Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Arch Gen Psychiatry 2005, 62:975-983.

8. Srinivasan TN, Thara R: Beliefs about causation of schizophrenia: do Indian families believe in supernatural causes? Soc Psychiatry, Psychiatr Epidemiol 2001, 36:134-140.

9. Kadri N, Manoudi F, Berrada S, Moussaoui D: Stigma impact on Moroccan families of patients with schizophrenia. Can J Psychiatry, 2004, 49:625-629.

References10. Jorm AF, Korten AE, Jacomb PA, Christensen H, Rodgers B, Pollitt P: "Mental health literacy": a survey of the

public's ability to recognise mental disorders and their beliefs about the effectiveness of treatment. ed J Aust 1997, 166:182-186.

11. Karim S, Saeed K, Rana MH, Mubbashar MH, Jenkins R: Pakistan mental health country profile. Int Rev Psychiatry 2004, 16:83-92.

12. Javed Z, Naeem F, Kingdon D, Irfan M, Izhar N, Ayub M: Attitude of the university students and teachers towards mentally ill, in Lahore, Pakistan. J Ayub Med Coll Abbottabad 2006, 18:55-58.

13. Sultan SM: Factors delaying psychiatric consultation in first episode psychosis – A retrospective cross-sectional study. J ,Med Sci 2006, 14:21-25.

14. Angermeyer MC, Matschinger H: Causal beliefs and attitudes to people with schizophrenia. Trend analysis based on data from two population surveys in Germany. Br J Psychiatry 2005, 186:331-334.

15. Angermeyer MC, Matschinger H: Lay beliefs about schizophrenic disorder: the results of a population survey in Germany. Acta, Psychiatr Scand Suppl 1994, 382:39-45.

16. Kulhara P, Avasthi A, Sharma A: Magico-religious beliefs in schizophrenia: a study from north India. Psychopathology 2000, 33:62-68.

17. Shibre T, Negash A, Kullgren G, Kebede D, Alem A, Fekadu A, Fekadu D, Madhin G, Jacobsson L: Perception of stigma among family members of individuals with schizophrenia and major affective disorders in rural Ethiopia. Soc Psychiatry Psychiatr Epidemiol, 2001, 36:299-303.

18. Magliano L, De Rosa C, Fiorillo A, Malangone C, Maj M: Perception of patients' unpredictability and beliefs on the causes and consequences of schizophrenia- a community survey. Soc Psychiatry Psychiatr Epidemiol 2004, 39:410-416.

References19. Kapur RL: Mental health care in rural India: a study of existing patterns and their implications

for future policy. Br J Psychiatry, 1975, 127:286-293.20. Large M, Nielssen O: Evidence for a relationship between the duration of untreated psychosis

and the proportion of psychotic homicides prior to treatment. Soc Psychiatry Psychiatr Epidemiol, 2008, 43:37-44.

21. Padmavati R, Thara R, Corin E: A qualitative study of religious practices by chronic mentally ill and their caregivers in South India. Int J Soc Psychiatry 2005, 51:139-149.

22. Saravanan B, David A, Bhugra D, Prince M, Jacob KS: Insight in people with psychosis: the influence of culture. Int Rev Psychiatry, 2005, 17:83-87.

23. Schulze B, Angermeyer MC: Subjective experiences of stigma. A focus group study of schizophrenic patients, their relatives and mental health professionals. Soc Sci Med 2003, 56:299-312.

24. Lysaker PH, Davis LW, Warman DM, Strasburger A, Beattie N: Stigma, social function and symptoms in schizophrenia and schizoaffective disorder: associations across 6 months. Psychiatry Res 2007, 149:89-95.

25. Mann CE, Himelein MJ: Factors associated with stigmatization of persons with mental illness. Psychiatr Serv 2004, 55:185-187.

26. Angermeyer MC, Matschinger H: Relatives' beliefs about the causes of schizophrenia. Acta Psychiatr Scand 1996, 93:199-204.

27. Gaebel W, Baumann A, Witte AM, Zaeske H: Public attitudes towards people with mental illness in six German cities: results of a public survey under special consideration of schizophrenia. Eur Arch Psychiatry Clin Neurosci 2002, 252:278-287.

28. Lauber C, Ajdacic-Gross V, Fritschi N, Stulz N, Rossler W: Mental health literacy in an educational elite – an online survey among university students. BMC Public Health 2005, 5:44