Perceptions about the cause of Schizophrenia and the subsequent help seeking behaviour in a Pakistani Population - A Cross-sectional survey Zafar SN, Syed R, Tehseen S, Gowani SA, Waqar S, Zubair A, Yousaf W, Zubairi AJ & Naqvi H BMC Psychiatry 2008, 8:56
Original Research article Published in BioMed Central Psychiatry Date of publication : 17th July 2008 Main corresponding author : Syed Nabeel Zafar - AKU
What is Schizophrenia Severe mental illness characterized by fundamental disturbances in thoughts, emotions and perceptions. 8th leading cause of DALYS in age group of 15-44 years (Rossler et al., 2005)
Wrong perceptions regarding the cause of schizophrenia & various stigmata Delayed treatment Studies show favorable prognosis with good family and social support, early diagnosis and management
To determine the perceptions regarding the etiology of schizophrenia and the subsequent help seeking behaviour
Questionnaire based cross sectional study Conducted at Agha Khan University Hospital between 18th to 22nd December 2006 (5 days) Three areas were chosen Community Health Centre (CHC) Consulting Clinics (CC) Inpatient family waiting areas
Sample Total of 404 participants Culturally diverse populations Inclusion / Exclusion criteria applied Inclusion Exclusion • all individuals • No medical staff or medical above 18 years student was interviewed • Attendants of psychiatric patients also excluded • People unable to read urdu were excluded • anyone under the age of 18 years was excluded
Questionnaire Developed in Urdu Three sections Section 1 - Demographic details Age, sex, marital status, education level, religion, religious inclination, Profession Family System (Joint or Nuclear)
Section 2 Questionnaire Asking the participant views regarding the possible causes for a case of schizophrenia 22 choices were given Four point likert scale used ( main reason, possible reason, not likely a reason and definitely not a reason) Lastly asked to state the most important cause
Section 3 Questionnaire Asking the participant regarding the probable approach they would employ if they had a relative with a psychotic problem 15 interventional choices were given Three point likert scale useed (definitely do, will consider doing and will not do at all) Lastly asked to state the most important step they would take
Ethical considerations Research was in accordance with the Helsinki declaration Participants were verbally explained the nature of research, its advantages and disadvantages Confidentiality maintained and no such information was recorded Written informed consent was taken
Results of the demographic profile Mean age = 31.35 ± 9.93 years 77 % males and 23 & females Majority of participants well educated (62 % holding bachelor’s degree Majority were Muslim (92 %)
Before Categorization After CategorizationCause of Schizophrenia Cause of Schizophrenia Primary level of education 8.4 22.3 12.1 54.0 13.6 38.4 Females 13.4 10.1 Nuclear family 15.6 Age greater than 47 Biological Cause Mental illness Low IQ Religious Cause Gods will Others Personality Issue Psycho-social Stressor Other Social Issues and Superstitious beliefs
Before Categorization After Categorization Help seeking behaviour Help seeking behaviour 10.6 3 26.7 Males 14.9Young (17-26 years) 40.6 Very religious 52.2 6.7Less educated Females 7.4 19.3 8.9 9.7Nuclear family Joint family system Moderately religious Visit Psychiatrist Professional Medical help Visit Family Physician Religious Remidies Do nothing No Help seeking behaviour Pray Social alterations Offer sadqa / Khirat Magic and Excorcism steps Others
Well known that the general population of especially the developing countries attributes non biological beliefs to the cause of schizophrenia As a result there is an increase in DUP DUP is a very important factor of prognosis
This study shows that those who gave biological causes for the disease were 3 times more likely to seek professional medical help. Relatives of psychiatric patients have different beliefs than that of general population (Angermeyer et al., 2003)
Study shows that there is increased awareness in people living in nuclear family Underreporting of the disease due to lack of help seeking behaviour As a result unable to design nationwide strategies
Limitations / Biasness in this study The sample population is not representative of the Pakistani population Sample is highly educated Study was conducted in a hospital setting Likert scale used always have a tendency of bias
The study gives a good impression regarding perceptions of pakistanis It shows that to decrease the burden of schizophrenia more awareness have to be created
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