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The psychosis treatment gap and its consequences in rural Ethiopia

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The psychosis treatment gap and its consequences in rural Ethiopia. / Fekadu, Abebaw; Medhin, Girmay; Lund, Crick; DeSilva, Mary; Selamu, Medhin; Alem, Atalay; Asher, Laura; Birhane, Rahel; Patel, Vikram; Hailemariam, Maji; Shibre, Teshome; Thornicroft, Graham; Prince, Martin; Hanlon, Charlotte.

In: BMC Psychiatry, Vol. 19, No. 1, 325, 29.10.2019, p. 325.

Research output: Contribution to journalArticle

Harvard

Fekadu, A, Medhin, G, Lund, C, DeSilva, M, Selamu, M, Alem, A, Asher, L, Birhane, R, Patel, V, Hailemariam, M, Shibre, T, Thornicroft, G, Prince, M & Hanlon, C 2019, 'The psychosis treatment gap and its consequences in rural Ethiopia', BMC Psychiatry, vol. 19, no. 1, 325, pp. 325. https://doi.org/10.1186/s12888-019-2281-6

APA

Fekadu, A., Medhin, G., Lund, C., DeSilva, M., Selamu, M., Alem, A., ... Hanlon, C. (2019). The psychosis treatment gap and its consequences in rural Ethiopia. BMC Psychiatry, 19(1), 325. [325]. https://doi.org/10.1186/s12888-019-2281-6

Vancouver

Fekadu A, Medhin G, Lund C, DeSilva M, Selamu M, Alem A et al. The psychosis treatment gap and its consequences in rural Ethiopia. BMC Psychiatry. 2019 Oct 29;19(1):325. 325. https://doi.org/10.1186/s12888-019-2281-6

Author

Fekadu, Abebaw ; Medhin, Girmay ; Lund, Crick ; DeSilva, Mary ; Selamu, Medhin ; Alem, Atalay ; Asher, Laura ; Birhane, Rahel ; Patel, Vikram ; Hailemariam, Maji ; Shibre, Teshome ; Thornicroft, Graham ; Prince, Martin ; Hanlon, Charlotte. / The psychosis treatment gap and its consequences in rural Ethiopia. In: BMC Psychiatry. 2019 ; Vol. 19, No. 1. pp. 325.

Bibtex Download

@article{3a047ddb56e7474598a72802ae68522d,
title = "The psychosis treatment gap and its consequences in rural Ethiopia",
abstract = "BACKGROUND: The {"}treatment gap{"} (TG) for mental disorders, widely advocated by the WHO in low-and middle-income countries, is an important indicator of the extent to which a health system fails to meet the care needs of people with mental disorder at the population level. While there is limited research on the TG in these countries, there is even a greater paucity of studies looking at TG beyond a unidimensional understanding. This study explores several dimensions of the TG construct for people with psychosis in Sodo, a rural district in Ethiopia, and its implications for building a more holistic capacity for mental health services.METHOD: The study was a cross-sectional survey of 300 adult participants with psychosis identified through community-based case detection and confirmed through subsequent structured clinical evaluations. The Butajira Treatment Gap Questionnaire (TGQ), a new customised tool with 83 items developed by the Ethiopia research team, was administered to evaluate several TG dimensions (access, adequacy and effectiveness of treatment, and impact/consequence of the treatment gap) across a range of provider types corresponding with the WHO pyramid service framework.RESULTS: Lifetime and current access gap for biomedical care were 41.8 and 59.9{\%} respectively while the corresponding figures for faith and traditional healing (FTH) were 15.1 and 45.2{\%}. Of those who had received biomedical care for their current episode, 71.7{\%} did not receive minimally adequate care. Support from the community and non-governmental organisations (NGOs) were negligible. Those with education (Adj. OR: 2.1; 95{\%} CI: 1.2, 3.8) and history of use of FTH (Adj. OR: 3.2; 95{\%} CI: 1.9-5.4) were more likely to use biomedical care. Inadequate biomedical care was associated with increased lifetime risk of adverse experiences, such as history of restraint, homelessness, accidents and assaults.CONCLUSION: This is the first study of its kind. Viewing TG not as a unidimensional, but as a complex, multi-dimensional construct, offers a more realistic and holistic understanding of health beliefs, help-seeking behaviors, and need for care. The reconceptualized multidimensional TG construct could assist mental health services capacity building advocacy and policy efforts and allow community and NGOs play a larger role in supporting mental healthcare.",
keywords = "Developing country, Low and middle-income country, Severe mental disorder, The Butajira treatment gap questionnaire, Treatment access, Treatment coverage, Treatment gap",
author = "Abebaw Fekadu and Girmay Medhin and Crick Lund and Mary DeSilva and Medhin Selamu and Atalay Alem and Laura Asher and Rahel Birhane and Vikram Patel and Maji Hailemariam and Teshome Shibre and Graham Thornicroft and Martin Prince and Charlotte Hanlon",
year = "2019",
month = "10",
day = "29",
doi = "10.1186/s12888-019-2281-6",
language = "English",
volume = "19",
pages = "325",
journal = "BMC Psychiatry",
issn = "1471-244X",
publisher = "BioMed Central",
number = "1",

}

RIS (suitable for import to EndNote) Download

TY - JOUR

T1 - The psychosis treatment gap and its consequences in rural Ethiopia

AU - Fekadu, Abebaw

AU - Medhin, Girmay

AU - Lund, Crick

AU - DeSilva, Mary

AU - Selamu, Medhin

AU - Alem, Atalay

AU - Asher, Laura

AU - Birhane, Rahel

AU - Patel, Vikram

AU - Hailemariam, Maji

AU - Shibre, Teshome

AU - Thornicroft, Graham

AU - Prince, Martin

AU - Hanlon, Charlotte

PY - 2019/10/29

Y1 - 2019/10/29

N2 - BACKGROUND: The "treatment gap" (TG) for mental disorders, widely advocated by the WHO in low-and middle-income countries, is an important indicator of the extent to which a health system fails to meet the care needs of people with mental disorder at the population level. While there is limited research on the TG in these countries, there is even a greater paucity of studies looking at TG beyond a unidimensional understanding. This study explores several dimensions of the TG construct for people with psychosis in Sodo, a rural district in Ethiopia, and its implications for building a more holistic capacity for mental health services.METHOD: The study was a cross-sectional survey of 300 adult participants with psychosis identified through community-based case detection and confirmed through subsequent structured clinical evaluations. The Butajira Treatment Gap Questionnaire (TGQ), a new customised tool with 83 items developed by the Ethiopia research team, was administered to evaluate several TG dimensions (access, adequacy and effectiveness of treatment, and impact/consequence of the treatment gap) across a range of provider types corresponding with the WHO pyramid service framework.RESULTS: Lifetime and current access gap for biomedical care were 41.8 and 59.9% respectively while the corresponding figures for faith and traditional healing (FTH) were 15.1 and 45.2%. Of those who had received biomedical care for their current episode, 71.7% did not receive minimally adequate care. Support from the community and non-governmental organisations (NGOs) were negligible. Those with education (Adj. OR: 2.1; 95% CI: 1.2, 3.8) and history of use of FTH (Adj. OR: 3.2; 95% CI: 1.9-5.4) were more likely to use biomedical care. Inadequate biomedical care was associated with increased lifetime risk of adverse experiences, such as history of restraint, homelessness, accidents and assaults.CONCLUSION: This is the first study of its kind. Viewing TG not as a unidimensional, but as a complex, multi-dimensional construct, offers a more realistic and holistic understanding of health beliefs, help-seeking behaviors, and need for care. The reconceptualized multidimensional TG construct could assist mental health services capacity building advocacy and policy efforts and allow community and NGOs play a larger role in supporting mental healthcare.

AB - BACKGROUND: The "treatment gap" (TG) for mental disorders, widely advocated by the WHO in low-and middle-income countries, is an important indicator of the extent to which a health system fails to meet the care needs of people with mental disorder at the population level. While there is limited research on the TG in these countries, there is even a greater paucity of studies looking at TG beyond a unidimensional understanding. This study explores several dimensions of the TG construct for people with psychosis in Sodo, a rural district in Ethiopia, and its implications for building a more holistic capacity for mental health services.METHOD: The study was a cross-sectional survey of 300 adult participants with psychosis identified through community-based case detection and confirmed through subsequent structured clinical evaluations. The Butajira Treatment Gap Questionnaire (TGQ), a new customised tool with 83 items developed by the Ethiopia research team, was administered to evaluate several TG dimensions (access, adequacy and effectiveness of treatment, and impact/consequence of the treatment gap) across a range of provider types corresponding with the WHO pyramid service framework.RESULTS: Lifetime and current access gap for biomedical care were 41.8 and 59.9% respectively while the corresponding figures for faith and traditional healing (FTH) were 15.1 and 45.2%. Of those who had received biomedical care for their current episode, 71.7% did not receive minimally adequate care. Support from the community and non-governmental organisations (NGOs) were negligible. Those with education (Adj. OR: 2.1; 95% CI: 1.2, 3.8) and history of use of FTH (Adj. OR: 3.2; 95% CI: 1.9-5.4) were more likely to use biomedical care. Inadequate biomedical care was associated with increased lifetime risk of adverse experiences, such as history of restraint, homelessness, accidents and assaults.CONCLUSION: This is the first study of its kind. Viewing TG not as a unidimensional, but as a complex, multi-dimensional construct, offers a more realistic and holistic understanding of health beliefs, help-seeking behaviors, and need for care. The reconceptualized multidimensional TG construct could assist mental health services capacity building advocacy and policy efforts and allow community and NGOs play a larger role in supporting mental healthcare.

KW - Developing country

KW - Low and middle-income country

KW - Severe mental disorder

KW - The Butajira treatment gap questionnaire

KW - Treatment access

KW - Treatment coverage

KW - Treatment gap

UR - http://www.scopus.com/inward/record.url?scp=85074337968&partnerID=8YFLogxK

U2 - 10.1186/s12888-019-2281-6

DO - 10.1186/s12888-019-2281-6

M3 - Article

C2 - 31664977

VL - 19

SP - 325

JO - BMC Psychiatry

JF - BMC Psychiatry

SN - 1471-244X

IS - 1

M1 - 325

ER -

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