| Abstrakt: |
Background Patients with schizophrenia go through several non-medical and non-psychiatric pathways before reaching proper psychiatric treatment in Nepal. It also includes faith healer and spiritual leaders. Supernatural beliefs about causation of mental illness have shown to affect their behavior in studies from India. However, there is no study from Nepal. Methods This study is a part of ongoing teaching hospital survey since August 2018. Seventy-one participants were mainly from Terai belt (plains) of Nepal (Parsa, Bara, Rautahat and Siraha districts). Clinic attending patients who were diagnosed schizophrenia as per ICD 10 criteria were approached. Patients and family members who gave consent for participation were assessed after ruling out medical comorbidity. This was a cross sectional assessment of pathways to care from beginning till current health service. A semi-structured questionnaire was designed and was used along with Supernatural Attitude Questionnaire (SAQ). SAQ has been validated scale in local language. They have been used in previous study from India. Important clinical details were also assessed along with sociodemographic profile. Results The mean duration of untreated psychosis was more in females (8.86±20.64 months) than in males (5.89±14.47 months). The average number of help sought was 6.68±6.68 service providers which contained faith healers, physicians, paramedics and psychiatrists. However, the mean number of help sought before reaching a psychiatrist was 3.11±5.22. Most of the first contacts i.e. 76.1% were non-psychiatrists. Forty five percent of the patients had faith healers as first contact of treatment. Sixty percent of the family members believed in black magic and 56.3% of them believed that faith healing can improve their patients' behavior. However, 83.1% of the patients were taken to faith healer and 88.7% performed rituals or worship during current episode of illness. There was significant association between belief in black magic, ghosts, curse of Gods/Goddesses, celestial influence, unsatisfied spirit in causation and recent visit to faith healer (Pearson Chi-Square p0.001, 0.016, 0.001, 0.046 and 0.023 respectively). Sixty two percent of the patients took concomitant faith healing along with psychiatric treatment. The mean score of supernatural Attitude Questionnaire (SAQ) was higher in male (9.21±3.59) than in females (6.30±4.95) (Independent T-test significance 0.006). Similarly, males had significantly more belief in black magic (p0.01), heavenly influence (p0.018), God/Goddess's curse (p0.028), and wrong deeds of previous life (p0.002) as causation of mental illness. Family members of male patients believed that faith healing can improve their behavior in comparison to those of female patients (p0.043). Visits to faith healers and performing rituals were significantly more for male patients than female (p0.001 and 0.006). Discussion Supernatural factors as the causes and faith healing as help seeking means were very common in patients of schizophrenia in our region. Despite of psychiatric treatment, people are likely to seek concomitant faith healing in desperation to 'cure' their patients. Females suffering from schizophrenia remain the neglected group either for medical treatment or for faith healing. This is the time when faith healers can be incorporated in governmental health policy to guide patients for proper treatment. This is also a call for nationwide study. [ABSTRACT FROM AUTHOR] |
