Academic journal article East Asian Archives of Psychiatry

Relationship between First Treatment Contact and Supernatural Beliefs in Caregivers of Patients with Schizophrenia

Academic journal article East Asian Archives of Psychiatry

Relationship between First Treatment Contact and Supernatural Beliefs in Caregivers of Patients with Schizophrenia

Article excerpt


Schizophrenia imposes a significant burden on the individual, family, and community due to its chronic course, associated disability, social dysfunction, along with poor adherence with treatment, and need for frequent hospitalisation. (1) Functional recovery in patients with schizophrenia is influenced by several factors such as pre-morbid functioning, symptom profile, and duration of illness (including duration of untreated psychosis). (2) Delay in institution of appropriate treatment is closely linked with the community's awareness about causes and available treatment modalities, which further directs their help-seeking behaviour and pathways.

Explanatory models refer to patients' and their families' causal attributions of illness (3) and have been shown to affect their coping, (4, 5) treatment preferences, (5) compliance, and outcome. (6) Thus, investigating family members' causal beliefs regarding schizophrenia is an important step in the management of the illness as it further influences the help-seeking pathway of individuals with schizophrenia. (7)

Pathways of psychiatric care have been defined as the sequence of contacts with individuals and organisations, initiated by the patients or families in their effort to seek appropriate help. (8) Such studies provide vital information regarding the individual's help-seeking and illness behaviour, and possible sources of delay in presenting to appropriate treatment facilities. Knowledge about these parameters, subsequently, helps in organising mental health services, coordinating psychiatric referrals, and enhancing the treatment-seeking attitude. (9)

Few studies have evaluated the aetiological models (mostly, by using semi-structured interviews) including supernatural beliefs held by patients with schizophrenia and their caregivers from developed (3, 10-14) and developing countries including India. (5, 7, 15-27) Non-biomedical causal models of schizophrenia including magico-religious causes were more commonly reported from developing countries. (5, 18, 25)

Few studies have also evaluated pathways to care in patients with psychiatric disorders, and most of these are from developed countries (28-31); few are from developing countries like China (32) and Nigeria. (33) The Indian literature on help-seeking patterns in psychiatric populations is mainly about common mental disorders, (34-40) with only few studies on schizophrenia.26, 27

Although studies have evaluated the aetiological models and pathways to care, none of the studies has evaluated the relationship of supernatural beliefs with pathways to care and initial help-seeking behaviour. In India, family provides supports to patients with psychosis, and when a patient is ill, the help-seeking behaviour is more or less determined by the caregivers. In view of this, the present study aimed to evaluate the relationship between the magico-religious beliefs held by the primary caregivers of patients with schizophrenia and first treatment contact pathways to care.


Study Setting and Sample Selection

The study was carried out at the outpatient clinic of the psychiatry department in a multi-specialty tertiary care hospital in North India. Consecutive newly registered patients diagnosed with schizophrenia by a qualified psychiatrist were approached. To be included in the study, the patients were required to be aged [greater than or equal to] 15 years and fulfil the diagnosis of schizophrenia as per the ICD-10. (41) Those with co-morbid mental retardation and organic brain syndromes were excluded. Informed consent was sought from all patients and their caregivers. In case a patient was incompetent, consent was obtained from the primary caregiver.

Family members accompanying the patients were included in the study if they were living with the patients and were involved in their care for [greater than or equal to] 1 year. …

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