The psychosis treatment gap and its consequences in rural Ethiopia

 

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dc.contributor.author Fekadu, Abebaw
dc.contributor.author Medhin, Girmay
dc.contributor.author Lund, Crick
dc.contributor.author DeSilva, Mary
dc.contributor.author Selamu, Medhin
dc.contributor.author Alem, Atalay
dc.contributor.author Asher, Laura
dc.contributor.author Birhane, Rahel
dc.contributor.author Patel, Vikram
dc.contributor.author Hailemariam, Maji
dc.contributor.author Shibre, Teshome
dc.contributor.author Thornicroft, Graham
dc.contributor.author Prince, Martin
dc.contributor.author Hanlon, Charlotte
dc.date.accessioned 2019-12-10T09:01:12Z
dc.date.available 2019-12-10T09:01:12Z
dc.date.issued 2019-10-29
dc.identifier.citation BMC Psychiatry. 2019 Oct 29;19(1):325
dc.identifier.uri https://doi.org/10.1186/s12888-019-2281-6
dc.identifier.uri http://hdl.handle.net/11427/30674
dc.description.abstract 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.
dc.subject Treatment gap
dc.subject The Butajira treatment gap questionnaire
dc.subject Treatment coverage
dc.subject Treatment access
dc.subject Severe mental disorder
dc.subject Low and middle-income country
dc.subject Developing country
dc.title The psychosis treatment gap and its consequences in rural Ethiopia
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dc.type
dc.date.updated 2019-11-03T04:19:02Z
dc.language.rfc3066 en
dc.rights.holder The Author(s).


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