Morgan C, John S, Esan O, Hibben M, Patel V, Weiss H, Murray R M, Hutchinson G, Gureje O, Thara R, Cohen A
Health Service and Population Research Department,Society and Mental Health Research Group,Centre for Epidemiology and Public Health,Institute of Psychiatry, King's College London,UK.
Schizophrenia Research Foundation,Chennai,India.
Psychol Med. 2016 Jul;46(9):1923-33. doi: 10.1017/S0033291716000441. Epub 2016 Mar 28.
There are striking global inequities in our knowledge of the incidence, aetiology, and outcome of psychotic disorders. For example, only around 10% of research on incidence of psychotic disorders originates in low- and middle-income countries. We established INTREPID I to develop, implement, and evaluate, in sites in India (Chengalpet), Nigeria (Ibadan), and Trinidad (Tunapuna-Piarco), methods for identifying and recruiting untreated cases of psychosis, as a basis for investigating incidence and, subsequently, risk factors, phenomenology, and outcome. In this paper, we compare case characteristics and incidence rates across the sites.
In each site, to identify untreated cases of psychoses in defined catchment areas, we established case detection systems comprising mental health services, traditional and spiritual healers, and key informants.
Rates of all untreated psychoses were 45.9 (per 1 00 000 person-years) in Chengalpet, 31.2 in Ibadan, and 36.9 in Tunapuna-Piarco. Duration of psychosis prior to detection was substantially longer in Chengalpet (median 232 weeks) than in Ibadan (median 13 weeks) and Tunapuna-Piarco (median 38 weeks). When analyses were restricted to cases with a short duration (i.e. onset within preceding 2 years) only, rates were 15.5 in Chengalpet, 29.1 in Ibadan, and 26.5 in Tunapuna-Piarco. Further, there was evidence of age and sex differences across sites, with an older average age of onset in Chengalpet and higher rates among women in Ibadan.
Our findings suggest there may be differences in rates of psychoses and in the clinical and demographic profiles of cases across economically and socially distinct settings.
在精神病性障碍的发病率、病因及预后方面，全球存在显著的不平等现象。例如，关于精神病性障碍发病率的研究仅有约10%来自低收入和中等收入国家。我们开展了“无畏计划一（INTREPID I）”，在印度（金奈佩特）、尼日利亚（伊巴丹）和特立尼达（图纳普纳 - 皮亚尔科）的研究点开发、实施并评估识别和招募未治疗精神病病例的方法，以此作为调查发病率以及后续危险因素、现象学和预后的基础。在本文中，我们比较了各研究点的病例特征和发病率。
在每个研究点，为识别特定集水区内未治疗的精神病病例，我们建立了由心理健康服务机构、传统及精神治疗师以及关键信息提供者组成的病例检测系统。
金奈佩特所有未治疗精神病的发病率为45.9（每100000人年），伊巴丹为31.2，图纳普纳 - 皮亚尔科为36.9。金奈佩特在确诊前精神病的持续时间（中位数232周）显著长于伊巴丹（中位数13周）和图纳普纳 - 皮亚尔科（中位数38周）。当分析仅局限于病程较短（即发病在过去2年内）的病例时，金奈佩特的发病率为15.5，伊巴丹为29.1，图纳普纳 - 皮亚尔科为26.5。此外，各研究点存在年龄和性别差异的证据，金奈佩特的平均发病年龄较大，伊巴丹女性的发病率较高。
我们的研究结果表明，在经济和社会背景不同的地区，精神病的发病率以及病例的临床和人口统计学特征可能存在差异。
