Naik Sujit Kumar, Pattanayak Sanjay, Gupta Chandra Shekhar, Pattanayak Raman Deep
Department of Psychiatry, Chhattisgarh Institute of Medical Sciences (CIMS), Bilaspur, Chhattisgarh, India.
Indian J Psychol Med. 2012 Oct;34(4):338-45. doi: 10.4103/0253-7176.108214.
India is a country of several diversities and cultures, which may influence the help-seeking behavior of mentally ill patients and families. Only a few Indian studies have focused on help seeking, especially for severe mental disorders.
The study aimed to describe and compare the help-seeking behaviors among caregivers of psychotic patients visiting psychiatric clinics at two distinct cities of India.
This was a cross-sectional exploratory study of key caregivers (N=50) of patients with a DSM-IV TR diagnosis of schizophrenia and other psychotic disorders, visiting psychiatric out-patient departments of VIMHANS, New Delhi, and CIMS, Bilaspur, Chhattisgarh. After due informed consent was taken, a semi-structured proforma was administered for socio-demographic profile, illness details, causative beliefs, and information on help seeking.
Supernatural forces were held responsible by 40% of the Bilaspur sample in contrast to 8% in New Delhi sample. Faith-healers were initial contacts for 56% and 64% of sample, respectively, at New Delhi and Bilaspur. Faith-healers followed by a psychiatrist formed the commonest pathway of care at both centers (32% and 36%, respectively). The sample at New Delhi spent significantly more money (median: $4000 vs. $10) and traveled greater distances (median: 35 km vs. 10 km) for faith-healers during the course of illness. Two-thirds of sample in New Delhi and one-third at Bilaspur were aware of the nearby psychiatrist at the time of initial help seeking; however, only 28% and 12%, respectively, chose psychiatrist as an initial contact. The New Delhi sample reported a fear of medication adverse effects and stigma as perceived disadvantages of psychiatric help. The median time lost at both the centers was 1 month, with a maximum of 8.4 years in New Delhi and 4.9 years in Bilaspur. Of the total, 16% caregivers at New Delhi and 32% at Bilaspur center reported an intention to continue with faith-healing practices alongside psychiatric care.
In spite of differing causal attributions, the patients and families across these cities may not be as different when it comes to behaviors related to help seeking for mental illness. Future large-scale studies across various regions of India may help in determining sociocultural and regional patterns of help seeking in greater detail.
印度是一个具有多种多样性和文化的国家，这可能会影响精神病患者及其家庭寻求帮助的行为。只有少数印度研究关注寻求帮助的行为，尤其是针对严重精神障碍的情况。
本研究旨在描述和比较印度两个不同城市的精神病患者照料者在精神科诊所寻求帮助的行为。
这是一项对50名关键照料者的横断面探索性研究，这些照料者所照料的患者根据《精神疾病诊断与统计手册》第四版修订版（DSM-IV TR）被诊断为精神分裂症和其他精神病性障碍，他们前往新德里的VIMHANS和恰蒂斯加尔邦比拉斯布尔的CIMS的精神科门诊部就诊。在获得充分的知情同意后，使用一份半结构化表格收集社会人口学资料、疾病详情、病因信念以及寻求帮助的信息。
在比拉斯布尔的样本中，40%的人认为是超自然力量导致了疾病，而在新德里的样本中这一比例为8%。在新德里和比拉斯布尔，分别有56%和64%的样本最初联系的是信仰治疗师。在两个中心，最常见的就医途径都是先找信仰治疗师，然后再找精神科医生（分别为32%和36%）。在患病期间，新德里的样本为信仰治疗师花费的钱显著更多（中位数：4000美元对10美元），出行距离也更远（中位数：35公里对10公里）。在新德里，三分之二的样本以及在比拉斯布尔三分之一的样本在最初寻求帮助时知道附近有精神科医生；然而，分别只有28%和12%的人选择精神科医生作为最初的求助对象。新德里的样本报告称，担心药物不良反应和污名化是他们认为精神科帮助存在的不利之处。两个中心患者延误治疗的时间中位数均为1个月，新德里最长延误了8.4年，比拉斯布尔最长延误了4.9年。总体而言，新德里16%的照料者和比拉斯布尔中心32%的照料者表示打算在接受精神科治疗的同时继续采用信仰治疗方法。
尽管病因归因不同，但在与精神疾病寻求帮助相关的行为方面，这些城市的患者及其家庭可能并没有那么大的差异。未来在印度各个地区开展的大规模研究可能有助于更详细地确定寻求帮助的社会文化和地区模式。
