Introduction
Searching for psychosis
Inclusion criteria |
Age 18–64 years; resident in catchment area at time of case detection; evidence of psychotic symptoms or experiences in past 12 months; not treated with anti-psychotics for 3 continuous months prior to the start of recruitment |
Exclusion criteria |
Evidence of psychotic symptoms precipitated by an organic cause; central nervous system disease; transient psychotic symptoms resulting from acute intoxication |
Authors | Year | Location | Sample | Case finding methodsa
|
---|---|---|---|---|
Menezes et al. | 1993 | São Paulo, Brazil |
n = 124 Any psychosis Age 15–44 years Prevalent cases | Hospital admissions Cases identified through three psychiatric hospitals and the psychiatric ward of the general hospital in the study catchment area in Sao Paulo, Brazil |
Ran et al. | 2001 | Sichuan, China |
n = 510 Schizophrenia No age criteria Prevalent cases | Community survey A cross-sectional survey of rural communities in the six townships of Xinjin County, China |
Kebede et al. | 2004 | Butajira, Ethiopia |
n = 318 Schizophrenia Age 15–49 years Prevalent cases | Community survey A two-stage community survey of rural communities in Butajira, Ethiopia. First-stage screen; second-stage assessment of screen positives and proportion of screen negatives |
Kulhara et al. | 1978 | Chandigarh, India |
n = 174 Schizophrenia Age15–60 years Incident cases | Hospital admissions and outpatient clinics Cases identified through the Department of Psychiatry, Postgraduate Institute of Medical Education and Research in Chandigarh, India |
Kulhara et al. | 1986 | Chandigarh, India |
n = 112 Schizophrenia Age 15–56 years Prevalent cases | Hospital admissions and outpatient clinics Members of the Department of Psychiatry, Postgraduate Institute of Medical Education and Research, were asked to refer patients with diagnosis of schizophrenia to the research team |
Verghese et al. | 1990 | Multi-site study, India |
n = 386 Schizophrenia (with duration of illness of less than 2 years) Age 15–45 years Incident cases | Outpatient clinics Consecutive patients who attended the psychiatry clinics of the participating centres |
Thara et al. | 1994 | Madras Longitudinal Study, India |
n = 90 Schizophrenia Age 15–45 years Incident cases | Hospital admissions or outpatient clinics Patients seen at the Department of Psychiatry, Government General Hospital, Madras, India |
Padmavati et al. | 1998 | Chennai, India |
n = 261 Any psychosis Mean age 36 years Prevalent cases | Community Survey Door-to-door survey of two residential areas with a population of around 100,000 |
Murthy et al. | 2005 | Rural Karnataka, India |
n = 100 Schizophrenia Age: not specified Prevalent cases | Outpatient clinics Patients attending eight outreach clinics and who were drug naive or had discontinued treatment after initial contact and had not received antipsychotic treatment for the previous 6 months |
Kurihara et al. | 2000 | Bali, Indonesia |
n = 59 Schizophrenia Mean age 27 years (unclear if this is at baseline or 5-year follow-up) Prevalent cases | Hospital admissions Consecutive patients with no prior admissions admitted to Bangli State Mental Hospital |
Hickling et al. | 1995 | Jamaica |
n = 317 Non-affective psychoses Age 15–54 years Incident cases | Outpatient clinics and community services All patients presenting to mental health services for the first time |
Makanjoula et al. | 1987 | Ilesa, NIgeria |
n = 116 Schizophreniform Age: not specified Prevalent cases | Hospital admissions Consecutive new patients presenting to a psychiatric unit |
Oosthuizen et al. | 2005 | Cape Town, South Africa |
n = 57 Non-affective psychoses Age 16–55 years Incident cases | Hospital admissions Individuals with a first-episode psychosis presenting to the Stikland–Tygerberg Hospital |
Bhugra et al. | 1996 | Trinidad |
n = 56 Any psychosis Age 15–54 years Incident cases | Hospital admissions, outpatient clinics and community services All patients with a possible psychosis presenting to mental health services (including prison in-reach service, the private sector, and mental health officers) for a first time |
Ganev et al. | 1998 | Sofia, Bulgaria |
n = 60 Any psychosis Age 16–45 years Prevalent cases | Hospital admissions and outpatient clinics Cases with an onset of illness of less than 2 years at the time of assessment |
Hopper et al. | 2007 | China |
n = 89 Schizophrenia Mean age 42 years Prevalent cases | Community survey Persons living in 8 defined urban catchment areas and diagnosed with schizophrenia in the first national epidemiological survey of mental disorders in 1982 |
Hopper et al. | 2007 | Cali, Colombia (WHO IPSS Study) |
n = 101 Schizophrenia Age 15–45 years Mainly incident cases | Hospital admissions Inpatients San Isidro Psychiatric Hospital; 90 % was first episode |
Hopper et al. | 2007 | Agra, India (WHO IPSS Study) |
n = 140 Schizophrenia Age 15–45 years Prevalent cases | Outpatient clinics Patients attending the outpatient department of Agra Mental Hospital |
Jablensky et al. (WHO Determinants of Outcome of Severe Mental Disorders Study) | 1992 | Multi-Country |
n = 586 from developing countries (Agra, Cali Chandigarh, Ibadan) Any psychosis Age 15–54 years Incident cases | All mental health services, healers and informants In addition, mental health facilities outside the study catchment areas were monitored; leakage studies were conducted. Details of screening of healers and informants are limited (a) Centres that applied the case finding without modification: Aarhus (Denmark), Chandigarh (India), Dublin (Ireland), Honolulu (Hawaii), Moscow (Soviet Union), Nagasaki (Japan) and Nottingham (UK) (b) Centres that had to introduce modifications: Agra (India); Cali (Colombia); Ibadan (Nigeria); Prague (Czechoslovakia); Rochester (USA) |
Health care systems
Aim
Methods
India | Nigeria | Trinidad and Tobago | |||
---|---|---|---|---|---|
National | Tamil Nadu†
| National | Oyo State††
| National†††
| |
Urban population (a, b) (2011) | 31.2 % (3.8 % increase since 2001) | 48.5 % (4.4 % increase since 2001) | 49.6 % (5.7 % increase since 2001) | No data^
| 13.7 % (2.9 % increase since 2001) |
Projected annual rate of urbanisation (a) (2010–2015, estimated) | 2.4 % | No data** | 3.8 % | No data^
| 2.9 % |
Economic (GDP) growth (d) | |||||
2006–2010 (average per year) | 7.1 % | 9.5 % | 4.1 % | No data | 3.0 % |
2012 | 3.2 % | 9.4 % | 6.5 % | No data | 1.5 % |
Poverty (c) (i.e., living on less than $1.25 per day) (2010) | 32.7 % | 32.4 % | 68.0 % | No data | 4.0 % |
Income Gini‡ coefficient (c) (2010) | 33.4 | No data | 48.8 | No data | No data |
Human Development Index (c) (2012) | 0.55 | 0.74 | 0.47 | No data | 0.76 |
Infant mortality per 1,000 live births (c) (2010) | 47 | 22 | 78 | 22 | 25 |
Life expectancy at birth (years) (c) (2012) | 65.8 | 72.4 | 52.3 | No data | 70.3 |
Literacy, 15 + years (c, e, f) (2010–2011) | |||||
Men | 82.1 % | 86.9 % | 72.1 % | 76.3 % | 99.2 % |
Women | 65.5 % | 73.9 % | 50.4 % | 65.8 % | 98.5 % |
Chengalpet (a) India 2011 | Ibadan (b) Nigeria 2006 | Tunapuna–Piarco (c) Trinidad 2011 | ||
---|---|---|---|---|
Ibadan South East | Ona Ara | |||
Total population | 412,289 | 266,457 | 265,571 | 248,656 |
Men | 209,310 | 130,334 | 130,615 | 123,232 |
Women | 202,979 | 136,123 | 134,956 | 125,424 |
Population aged 18–65 years* | 259,742†
| 152,404** | 148,852** | 169,042 |
Men | 131,865†
| 73,046** | 71,443** | 84,239 |
Women | 127,877†
| 79,358** | 77,409** | 84,803 |
Identifying providers and informants
Engagement
Information collated
Findings
Chennai, India (see supplementary Table 1 for detail) | Ibadan, Nigeria (see supplementary Table 2 for detail) | Trinidad (see supplementary Table 3 for detail) | ||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
In catchment area | Outside catchment area | In catchment area | Outside catchment area | In catchment area | Outside catchment area | |||||||||||||
No.a
| Beds | Costsb
| No.a
| Beds | Costsb
| No.a
| Beds | Costsb
| No.a
| Beds | Costsb
| No.a
| Beds | Costsb
| No.a
| Beds | Costsb
| |
Professional sector | ||||||||||||||||||
Public | 2 (2) | 10 | None | 4 (0) | 1882 | Nominal | 0 (–) | 0 | – | 2 (2) | 88 | $70c
| 4 (4) | 0i
| None | 1 (1) | 958 | None |
NGO | 1 (1) | 12 | None | 2 (1) | 150 | $0–$40 | 0 (–) | 0 | – | 0 (–) | 0 | – | 0 (–) | 0 | – | 0 (–) | 0 | – |
Private | 4 (4) | 33 | $5–$480 | 123 (2)f
| 100g
| $16–$399 | 0 (–) | 0 | – | 1 (1) | 36 | [?] | 1 (1) | 0i
| $62–$109 | 0 (–) | 0 | – |
Folk sector | ||||||||||||||||||
Healing sites, healers | 3 (3)d
| 18–22e
| $16–$1610 | – | – | – | 19 (19) | 200 | $31–$737h
| – | – | – | 23 (12) | 0 | Unknown | – | – | – |
Popular sector | ||||||||||||||||||
Key informants | 619 (361) | – | – | – | – | – | 54 (54) | – | – | – | – | – | 1 (1) | – | – | – | – | – |