Laura Asher1,2, Abebaw Fekadu3,4, Charlotte Hanlon5,6. 1. University of Nottingham, Division of Epidemiology and Public Health, Nottingham. 2. London School of Hygiene and Tropical Medicine, Department of Population Health, Centre for Global Mental Health, London, UK. 3. Addis Ababa University, College of Health Sciences, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia. 4. Brighton and Sussex Medical School, Global Health & Infection Department, Brighton, UK. 5. Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa, Ethiopia. 6. King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research Department, Centre for Global Mental Health, London, UK.
Abstract
PURPOSE OF REVIEW: The aim was to synthesize recent evidence on schizophrenia illness experience and outcomes and models of care in low and middle-income countries (LMICs). RECENT FINDINGS: There is a plurality of explanatory models for psychosis and increasing evidence that context influences experiences of stigma. People with schizophrenia in LMICs are vulnerable to food insecurity, violence and physical health problems, in addition to unmet needs for mental healthcare. Family support may help to improve outcomes if present, but caregivers may be overwhelmed by the challenges faced. Despite efforts to increase availability, evidence-based care remains inaccessible to many people with schizophrenia. Non-randomized evaluations in South Africa and Mexico indicate that psychosocial support groups for people with schizophrenia and caregivers may be acceptable and useful. Randomized controlled trials in Pakistan and China show that culturally adapted cognitive-behavioural therapy can reduce symptom severity. There is emerging evidence that alternative medicine, such as Tai Chi, may be beneficial, but to date most studies are of low quality. The challenges of biomedical-traditional provider collaborations have been highlighted. Evaluations of integrated mental healthcare in primary care are underway and promise to provide vital information about how to scale-up quality care. SUMMARY: Acceptable and effective responses to schizophrenia in LMICs should be cognisant of both cultural context and universal concerns. Efforts to enhance the quality of family support should be central to models of care.
PURPOSE OF REVIEW: The aim was to synthesize recent evidence on schizophrenia illness experience and outcomes and models of care in low and middle-income countries (LMICs). RECENT FINDINGS: There is a plurality of explanatory models for psychosis and increasing evidence that context influences experiences of stigma. People with schizophrenia in LMICs are vulnerable to food insecurity, violence and physical health problems, in addition to unmet needs for mental healthcare. Family support may help to improve outcomes if present, but caregivers may be overwhelmed by the challenges faced. Despite efforts to increase availability, evidence-based care remains inaccessible to many people with schizophrenia. Non-randomized evaluations in South Africa and Mexico indicate that psychosocial support groups for people with schizophrenia and caregivers may be acceptable and useful. Randomized controlled trials in Pakistan and China show that culturally adapted cognitive-behavioural therapy can reduce symptom severity. There is emerging evidence that alternative medicine, such as Tai Chi, may be beneficial, but to date most studies are of low quality. The challenges of biomedical-traditional provider collaborations have been highlighted. Evaluations of integrated mental healthcare in primary care are underway and promise to provide vital information about how to scale-up quality care. SUMMARY: Acceptable and effective responses to schizophrenia in LMICs should be cognisant of both cultural context and universal concerns. Efforts to enhance the quality of family support should be central to models of care.
Authors: Felipe Botero-Rodríguez; María Camila Hernandez; José Miguel Uribe-Restrepo; Camilo Cabariqe; Catherine Fung; Stefan Priebe; Carlos Gómez-Restrepo Journal: BMC Psychiatry Date: 2021-05-06 Impact factor: 3.630
Authors: Tessa Roberts; Oye Gureje; Rangaswamy Thara; Gerard Hutchinson; Alex Cohen; Helen Anne Weiss; Sujit John; Joni Lee Pow; Casswina Donald; Bola Olley; Georgina Miguel Esponda; Robin M Murray; Craig Morgan Journal: BMJ Open Date: 2020-06-21 Impact factor: 2.692