Epidemiology of Untreated Psychoses in 3 Diverse Settings in the Global South: The International Research Program on Psychotic Disorders in Diverse Settings (INTREPID II)

Craig Morgan; Alex Cohen; Georgina Miguel Esponda; Tessa Roberts; Sujit John; Joni Lee Pow; Casswina Donald; Bola Olley; Olatunde Ayinde; Joseph Lam; Paramasivam Poornachandrika; Paola Dazzan; Fiona Gaughran; Palaniyandi Ponnusamy Kannan; Selvaraju Sudhakar; Jonathan Burns; Bonginkosi Chiliza; Ezra Susser; Helen A. Weiss; Robin M. Murray; Thara Rangaswamy; Oye Gureje; Gerard Hutchinson; Adejoke Agboola; Olawoye Fadahunsi; Olufemi Idowu; Clement Obuene; Akin Ojagbemi; Bamise Olayiwola; Seyi Owoeye; Kulandaiyesu Amaldoss; Jothi Ramadoss Aynkaran; Abirami Balashanmugam; Premalatha Chockalingam; Kruthika Devanathan; Subhashini Gopal; Ramesh Kumar; Padmavati Ramachandran; Karthick Samikannu; Darielle Bharath-Khan; Donella Jadoo; Elysse Marcellin; Elena Raymond; Grace Sooknanan; Lauren Subnaik; Diana Williams

doi:10.1001/jamapsychiatry.2022.3781

Epidemiology of Untreated Psychoses in 3 Diverse Settings in the Global South: The International Research Program on Psychotic Disorders in Diverse Settings (INTREPID II)

Craig Morgan^*, Alex Cohen, Georgina Miguel Esponda, Tessa Roberts, Sujit John, Joni Lee Pow, Casswina Donald, Bola Olley, Olatunde Ayinde, Joseph Lam, Paramasivam Poornachandrika, Paola Dazzan, Fiona Gaughran, Palaniyandi Ponnusamy Kannan, Selvaraju Sudhakar, Jonathan Burns, Bonginkosi Chiliza, Ezra Susser, Helen A. Weiss, Robin M. MurrayThara Rangaswamy, Oye Gureje, Gerard Hutchinson, Adejoke Agboola, Olawoye Fadahunsi, Olufemi Idowu, Clement Obuene, Akin Ojagbemi, Bamise Olayiwola, Seyi Owoeye, Kulandaiyesu Amaldoss, Jothi Ramadoss Aynkaran, Abirami Balashanmugam, Premalatha Chockalingam, Kruthika Devanathan, Subhashini Gopal, Ramesh Kumar, Padmavati Ramachandran, Karthick Samikannu, Darielle Bharath-Khan, Donella Jadoo, Elysse Marcellin, Elena Raymond, Grace Sooknanan, Lauren Subnaik, Diana Williams

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

Importance: Less than 10% of research on psychotic disorders has been conducted in settings in the Global South, which refers broadly to the regions of Latin America, Asia, Africa, and Oceania. There is a lack of basic epidemiological data on the distribution of and risks for psychoses that can inform the development of services in many parts of the world. Objective: To compare demographic and clinical profiles of cohorts of cases and rates of untreated psychoses (proxy for incidence) across and within 3 economically and socially diverse settings in the Global South. Two hypotheses were tested: (1) demographic and clinical profiles of cases with an untreated psychotic disorder vary across setting and (2) rates of untreated psychotic disorders vary across and within setting by clinical and demographic group. Design, Setting, and Participants: The International Research Program on Psychotic Disorders in Diverse Settings (INTREPID II) comprises incidence, case-control, and cohort studies of untreated psychoses in catchment areas in 3 countries in the Global South: Kancheepuram District, India; Ibadan, Nigeria; and northern Trinidad. Participants were individuals with an untreated psychotic disorder. This incidence study was conducted from May 1, 2018, to July 31, 2020. In each setting, comprehensive systems were implemented to identify and assess all individuals with an untreated psychosis during a 2-year period. Data were analyzed from January 1 to May 1, 2022. Main Outcomes and Measures: The presence of an untreated psychotic disorder, assessed using the Schedules for Clinical Assessment in Neuropsychiatry, which incorporate the Present State Examination. Results: Identified were a total of 1038 cases, including 64 through leakage studies (Kancheepuram: 268; median [IQR] age, 42 [33-50] years; 154 women [57.5%]; 114 men [42.5%]; Ibadan: 196; median [IQR] age, 34 [26-41] years; 93 women [47.4%]; 103 men [52.6%]; Trinidad: 574; median [IQR] age, 30 [23-40] years; 235 women [40.9%]; 339 men [59.1%]). Marked variations were found across and within settings in the sex, age, and clinical profiles of cases (eg, lower percentage of men, older age at onset, longer duration of psychosis, and lower percentage of affective psychosis in Kancheepuram compared with Ibadan and Trinidad) and in rates of untreated psychosis. Age- and sex-standardized rates of untreated psychoses were approximately 3 times higher in Trinidad (59.1/100000 person-years; 95% CI, 54.2-64.0) compared with Kancheepuram (20.7/100000 person-years; 95% CI, 18.2-23.2) and Ibadan (14.4/100000 person-years; 95% CI, 12.3-16.5). In Trinidad, rates were approximately 2 times higher in the African Trinidadian population (85.4/100000 person-years; 95% CI, 76.0-94.9) compared with the Indian Trinidadian (43.9/100000 person-years; 95% CI, 35.7-52.2) and mixed populations (50.7/100000 person-years; 95% CI, 42.0-59.5). Conclusions and Relevance: This analysis adds to research that suggests that core aspects of psychosis vary by historic, economic, and social context, with far-reaching implications for understanding and treatment of psychoses globally.

Original language	English
Pages (from-to)	40-48
Number of pages	9
Journal	JAMA Psychiatry
Volume	80
Issue number	1
DOIs	https://doi.org/10.1001/jamapsychiatry.2022.3781
Publication status	Published - 4 Jan 2023

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Morgan, C., Cohen, A., Esponda, G. M., Roberts, T., John, S., Pow, J. L., Donald, C., Olley, B., Ayinde, O., Lam, J., Poornachandrika, P., Dazzan, P., Gaughran, F., Kannan, P. P., Sudhakar, S., Burns, J., Chiliza, B., Susser, E., Weiss, H. A., ... Williams, D. (2023). Epidemiology of Untreated Psychoses in 3 Diverse Settings in the Global South: The International Research Program on Psychotic Disorders in Diverse Settings (INTREPID II). JAMA Psychiatry, 80(1), 40-48. https://doi.org/10.1001/jamapsychiatry.2022.3781

@article{56ef1bfd87bc434e8e135d8304e1c75e,

title = "Epidemiology of Untreated Psychoses in 3 Diverse Settings in the Global South: The International Research Program on Psychotic Disorders in Diverse Settings (INTREPID II)",

abstract = "Importance: Less than 10% of research on psychotic disorders has been conducted in settings in the Global South, which refers broadly to the regions of Latin America, Asia, Africa, and Oceania. There is a lack of basic epidemiological data on the distribution of and risks for psychoses that can inform the development of services in many parts of the world. Objective: To compare demographic and clinical profiles of cohorts of cases and rates of untreated psychoses (proxy for incidence) across and within 3 economically and socially diverse settings in the Global South. Two hypotheses were tested: (1) demographic and clinical profiles of cases with an untreated psychotic disorder vary across setting and (2) rates of untreated psychotic disorders vary across and within setting by clinical and demographic group. Design, Setting, and Participants: The International Research Program on Psychotic Disorders in Diverse Settings (INTREPID II) comprises incidence, case-control, and cohort studies of untreated psychoses in catchment areas in 3 countries in the Global South: Kancheepuram District, India; Ibadan, Nigeria; and northern Trinidad. Participants were individuals with an untreated psychotic disorder. This incidence study was conducted from May 1, 2018, to July 31, 2020. In each setting, comprehensive systems were implemented to identify and assess all individuals with an untreated psychosis during a 2-year period. Data were analyzed from January 1 to May 1, 2022. Main Outcomes and Measures: The presence of an untreated psychotic disorder, assessed using the Schedules for Clinical Assessment in Neuropsychiatry, which incorporate the Present State Examination. Results: Identified were a total of 1038 cases, including 64 through leakage studies (Kancheepuram: 268; median [IQR] age, 42 [33-50] years; 154 women [57.5%]; 114 men [42.5%]; Ibadan: 196; median [IQR] age, 34 [26-41] years; 93 women [47.4%]; 103 men [52.6%]; Trinidad: 574; median [IQR] age, 30 [23-40] years; 235 women [40.9%]; 339 men [59.1%]). Marked variations were found across and within settings in the sex, age, and clinical profiles of cases (eg, lower percentage of men, older age at onset, longer duration of psychosis, and lower percentage of affective psychosis in Kancheepuram compared with Ibadan and Trinidad) and in rates of untreated psychosis. Age- and sex-standardized rates of untreated psychoses were approximately 3 times higher in Trinidad (59.1/100000 person-years; 95% CI, 54.2-64.0) compared with Kancheepuram (20.7/100000 person-years; 95% CI, 18.2-23.2) and Ibadan (14.4/100000 person-years; 95% CI, 12.3-16.5). In Trinidad, rates were approximately 2 times higher in the African Trinidadian population (85.4/100000 person-years; 95% CI, 76.0-94.9) compared with the Indian Trinidadian (43.9/100000 person-years; 95% CI, 35.7-52.2) and mixed populations (50.7/100000 person-years; 95% CI, 42.0-59.5). Conclusions and Relevance: This analysis adds to research that suggests that core aspects of psychosis vary by historic, economic, and social context, with far-reaching implications for understanding and treatment of psychoses globally.",

author = "Craig Morgan and Alex Cohen and Esponda, {Georgina Miguel} and Tessa Roberts and Sujit John and Pow, {Joni Lee} and Casswina Donald and Bola Olley and Olatunde Ayinde and Joseph Lam and Paramasivam Poornachandrika and Paola Dazzan and Fiona Gaughran and Kannan, {Palaniyandi Ponnusamy} and Selvaraju Sudhakar and Jonathan Burns and Bonginkosi Chiliza and Ezra Susser and Weiss, {Helen A.} and Murray, {Robin M.} and Thara Rangaswamy and Oye Gureje and Gerard Hutchinson and Adejoke Agboola and Olawoye Fadahunsi and Olufemi Idowu and Clement Obuene and Akin Ojagbemi and Bamise Olayiwola and Seyi Owoeye and Kulandaiyesu Amaldoss and Aynkaran, {Jothi Ramadoss} and Abirami Balashanmugam and Premalatha Chockalingam and Kruthika Devanathan and Subhashini Gopal and Ramesh Kumar and Padmavati Ramachandran and Karthick Samikannu and Darielle Bharath-Khan and Donella Jadoo and Elysse Marcellin and Elena Raymond and Grace Sooknanan and Lauren Subnaik and Diana Williams",

year = "2023",

month = jan,

day = "4",

doi = "10.1001/jamapsychiatry.2022.3781",

language = "English",

volume = "80",

pages = "40--48",

journal = "JAMA Psychiatry",

issn = "2168-622X",

publisher = "American Medical Association",

number = "1",

}

Morgan, C, Cohen, A, Esponda, GM , Roberts, T, John, S, Pow, JL, Donald, C, Olley, B, Ayinde, O, Lam, J, Poornachandrika, P, Dazzan, P , Gaughran, F, Kannan, PP, Sudhakar, S, Burns, J, Chiliza, B, Susser, E, Weiss, HA, Murray, RM, Rangaswamy, T, Gureje, O, Hutchinson, G, Agboola, A, Fadahunsi, O, Idowu, O, Obuene, C, Ojagbemi, A, Olayiwola, B, Owoeye, S, Amaldoss, K, Aynkaran, JR, Balashanmugam, A, Chockalingam, P, Devanathan, K, Gopal, S, Kumar, R, Ramachandran, P, Samikannu, K, Bharath-Khan, D, Jadoo, D, Marcellin, E, Raymond, E, Sooknanan, G, Subnaik, L & Williams, D 2023, 'Epidemiology of Untreated Psychoses in 3 Diverse Settings in the Global South: The International Research Program on Psychotic Disorders in Diverse Settings (INTREPID II)', JAMA Psychiatry, vol. 80, no. 1, pp. 40-48. https://doi.org/10.1001/jamapsychiatry.2022.3781

TY - JOUR

T1 - Epidemiology of Untreated Psychoses in 3 Diverse Settings in the Global South

T2 - The International Research Program on Psychotic Disorders in Diverse Settings (INTREPID II)

AU - Morgan, Craig

AU - Cohen, Alex

AU - Esponda, Georgina Miguel

AU - Roberts, Tessa

AU - John, Sujit

AU - Pow, Joni Lee

AU - Donald, Casswina

AU - Olley, Bola

AU - Ayinde, Olatunde

AU - Lam, Joseph

AU - Poornachandrika, Paramasivam

AU - Dazzan, Paola

AU - Gaughran, Fiona

AU - Kannan, Palaniyandi Ponnusamy

AU - Sudhakar, Selvaraju

AU - Burns, Jonathan

AU - Chiliza, Bonginkosi

AU - Susser, Ezra

AU - Weiss, Helen A.

AU - Murray, Robin M.

AU - Rangaswamy, Thara

AU - Gureje, Oye

AU - Hutchinson, Gerard

AU - Agboola, Adejoke

AU - Fadahunsi, Olawoye

AU - Idowu, Olufemi

AU - Obuene, Clement

AU - Ojagbemi, Akin

AU - Olayiwola, Bamise

AU - Owoeye, Seyi

AU - Amaldoss, Kulandaiyesu

AU - Aynkaran, Jothi Ramadoss

AU - Balashanmugam, Abirami

AU - Chockalingam, Premalatha

AU - Devanathan, Kruthika

AU - Gopal, Subhashini

AU - Kumar, Ramesh

AU - Ramachandran, Padmavati

AU - Samikannu, Karthick

AU - Bharath-Khan, Darielle

AU - Jadoo, Donella

AU - Marcellin, Elysse

AU - Raymond, Elena

AU - Sooknanan, Grace

AU - Subnaik, Lauren

AU - Williams, Diana

PY - 2023/1/4

Y1 - 2023/1/4

N2 - Importance: Less than 10% of research on psychotic disorders has been conducted in settings in the Global South, which refers broadly to the regions of Latin America, Asia, Africa, and Oceania. There is a lack of basic epidemiological data on the distribution of and risks for psychoses that can inform the development of services in many parts of the world. Objective: To compare demographic and clinical profiles of cohorts of cases and rates of untreated psychoses (proxy for incidence) across and within 3 economically and socially diverse settings in the Global South. Two hypotheses were tested: (1) demographic and clinical profiles of cases with an untreated psychotic disorder vary across setting and (2) rates of untreated psychotic disorders vary across and within setting by clinical and demographic group. Design, Setting, and Participants: The International Research Program on Psychotic Disorders in Diverse Settings (INTREPID II) comprises incidence, case-control, and cohort studies of untreated psychoses in catchment areas in 3 countries in the Global South: Kancheepuram District, India; Ibadan, Nigeria; and northern Trinidad. Participants were individuals with an untreated psychotic disorder. This incidence study was conducted from May 1, 2018, to July 31, 2020. In each setting, comprehensive systems were implemented to identify and assess all individuals with an untreated psychosis during a 2-year period. Data were analyzed from January 1 to May 1, 2022. Main Outcomes and Measures: The presence of an untreated psychotic disorder, assessed using the Schedules for Clinical Assessment in Neuropsychiatry, which incorporate the Present State Examination. Results: Identified were a total of 1038 cases, including 64 through leakage studies (Kancheepuram: 268; median [IQR] age, 42 [33-50] years; 154 women [57.5%]; 114 men [42.5%]; Ibadan: 196; median [IQR] age, 34 [26-41] years; 93 women [47.4%]; 103 men [52.6%]; Trinidad: 574; median [IQR] age, 30 [23-40] years; 235 women [40.9%]; 339 men [59.1%]). Marked variations were found across and within settings in the sex, age, and clinical profiles of cases (eg, lower percentage of men, older age at onset, longer duration of psychosis, and lower percentage of affective psychosis in Kancheepuram compared with Ibadan and Trinidad) and in rates of untreated psychosis. Age- and sex-standardized rates of untreated psychoses were approximately 3 times higher in Trinidad (59.1/100000 person-years; 95% CI, 54.2-64.0) compared with Kancheepuram (20.7/100000 person-years; 95% CI, 18.2-23.2) and Ibadan (14.4/100000 person-years; 95% CI, 12.3-16.5). In Trinidad, rates were approximately 2 times higher in the African Trinidadian population (85.4/100000 person-years; 95% CI, 76.0-94.9) compared with the Indian Trinidadian (43.9/100000 person-years; 95% CI, 35.7-52.2) and mixed populations (50.7/100000 person-years; 95% CI, 42.0-59.5). Conclusions and Relevance: This analysis adds to research that suggests that core aspects of psychosis vary by historic, economic, and social context, with far-reaching implications for understanding and treatment of psychoses globally.

AB - Importance: Less than 10% of research on psychotic disorders has been conducted in settings in the Global South, which refers broadly to the regions of Latin America, Asia, Africa, and Oceania. There is a lack of basic epidemiological data on the distribution of and risks for psychoses that can inform the development of services in many parts of the world. Objective: To compare demographic and clinical profiles of cohorts of cases and rates of untreated psychoses (proxy for incidence) across and within 3 economically and socially diverse settings in the Global South. Two hypotheses were tested: (1) demographic and clinical profiles of cases with an untreated psychotic disorder vary across setting and (2) rates of untreated psychotic disorders vary across and within setting by clinical and demographic group. Design, Setting, and Participants: The International Research Program on Psychotic Disorders in Diverse Settings (INTREPID II) comprises incidence, case-control, and cohort studies of untreated psychoses in catchment areas in 3 countries in the Global South: Kancheepuram District, India; Ibadan, Nigeria; and northern Trinidad. Participants were individuals with an untreated psychotic disorder. This incidence study was conducted from May 1, 2018, to July 31, 2020. In each setting, comprehensive systems were implemented to identify and assess all individuals with an untreated psychosis during a 2-year period. Data were analyzed from January 1 to May 1, 2022. Main Outcomes and Measures: The presence of an untreated psychotic disorder, assessed using the Schedules for Clinical Assessment in Neuropsychiatry, which incorporate the Present State Examination. Results: Identified were a total of 1038 cases, including 64 through leakage studies (Kancheepuram: 268; median [IQR] age, 42 [33-50] years; 154 women [57.5%]; 114 men [42.5%]; Ibadan: 196; median [IQR] age, 34 [26-41] years; 93 women [47.4%]; 103 men [52.6%]; Trinidad: 574; median [IQR] age, 30 [23-40] years; 235 women [40.9%]; 339 men [59.1%]). Marked variations were found across and within settings in the sex, age, and clinical profiles of cases (eg, lower percentage of men, older age at onset, longer duration of psychosis, and lower percentage of affective psychosis in Kancheepuram compared with Ibadan and Trinidad) and in rates of untreated psychosis. Age- and sex-standardized rates of untreated psychoses were approximately 3 times higher in Trinidad (59.1/100000 person-years; 95% CI, 54.2-64.0) compared with Kancheepuram (20.7/100000 person-years; 95% CI, 18.2-23.2) and Ibadan (14.4/100000 person-years; 95% CI, 12.3-16.5). In Trinidad, rates were approximately 2 times higher in the African Trinidadian population (85.4/100000 person-years; 95% CI, 76.0-94.9) compared with the Indian Trinidadian (43.9/100000 person-years; 95% CI, 35.7-52.2) and mixed populations (50.7/100000 person-years; 95% CI, 42.0-59.5). Conclusions and Relevance: This analysis adds to research that suggests that core aspects of psychosis vary by historic, economic, and social context, with far-reaching implications for understanding and treatment of psychoses globally.

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DO - 10.1001/jamapsychiatry.2022.3781

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Epidemiology of Untreated Psychoses in 3 Diverse Settings in the Global South: The International Research Program on Psychotic Disorders in Diverse Settings (INTREPID II)

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