Department of Psychiatry, McGill University, Montreal, Canada; Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Canada.
Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Canada.
Schizophr Res. 2024 May;267:75-83. doi: 10.1016/j.schres.2024.03.006. Epub 2024 Mar 22.
Despite their acknowledged value, patient-reported outcome measures (PROMs) are infrequently used in psychosis, particularly in low-and middle-income countries. We compared ratings on two single-item PROMs, Self-Rated Health (SRH) and Self-Rated Mental Health (SRMH), of persons receiving similar early psychosis services in Chennai, India and Montreal, Canada. We hypothesized greater improvements in SRH and SRMH in the Chennai (compared to the Montreal) sample.
Participants (Chennai N = 159/168 who participated in the larger study; Montreal N = 74/165 who participated in the larger study) completed the SRH and SRMH during at least two out of three timepoints (entry, months 12 and 24). Repeated measures proportional odds logistic regressions examined the effects of time (baseline to month 24), site, and relevant baseline (e.g., gender) and time-varying covariates (i.e., symptoms) on SRH and SRMH scores.
SRH (but not SRMH) scores significantly differed between the sites at baseline, with Chennai patients reporting poorer health (OR: 0.33; CI: 0.18, 0.63). While Chennai patients reported similar significant improvements in their SRH (OR: 7.03; CI: 3.13; 15.78) and SRMH (OR: 2.29, CI: 1.03, 5.11) over time, Montreal patients only reported significant improvements in their SRMH. Women in Chennai (but not Montreal) reported lower mental health than men. Higher anxiety and longer durations of untreated psychosis were associated with poorer SRH and SRMH, while negative symptoms were associated with SRH.
As hypothesized, Chennai patients reported greater improvements in health and mental health. The marked differences between health and mental health in Montreal, in contrast to the overlap between the two in Chennai, aligns with previous findings of clearer distinctions between mind and body in Western societies. Cross-context (e.g., anxiety) and context-specific (e.g., gender) factors influence patients' health perceptions. Our results highlight the value of integrating simple PROMs in early psychosis.
尽管患者报告结局测量（PROMs）具有公认的价值，但在精神病学中，尤其是在中低收入国家，其应用仍不广泛。我们比较了在印度钦奈和加拿大蒙特利尔接受类似早期精神病服务的患者对两项单项目 PROM（自我报告健康（SRH）和自我报告心理健康（SRMH））的评分。我们假设在钦奈（与蒙特利尔相比）样本中，SRH 和 SRMH 的改善程度更大。
参与者（参加更大规模研究的钦奈组 N=159/168；参加更大规模研究的蒙特利尔组 N=74/165）在至少三个时间点（入组、12 个月和 24 个月）中完成了 SRH 和 SRMH。重复测量比例优势逻辑回归检验了时间（基线至 24 个月）、地点以及相关基线（例如性别）和时变协变量（即症状）对 SRH 和 SRMH 评分的影响。
SRH（但不是 SRMH）评分在基线时在两个地点之间存在显著差异，钦奈患者报告的健康状况较差（OR：0.33；CI：0.18，0.63）。尽管钦奈患者报告了其 SRH（OR：7.03；CI：3.13；15.78）和 SRMH（OR：2.29，CI：1.03，5.11）随时间显著改善，但蒙特利尔患者仅报告了其 SRMH 的显著改善。钦奈的女性（而非蒙特利尔）报告的心理健康状况低于男性。较高的焦虑和更长的未治疗精神病持续时间与较差的 SRH 和 SRMH 相关，而阴性症状与 SRH 相关。
正如假设的那样，钦奈患者报告了健康和心理健康方面的更大改善。与钦奈的身心之间存在重叠不同，蒙特利尔的健康和心理健康之间存在明显差异，这与西方社会中身心之间更清晰的区别相一致。跨情境（例如焦虑）和情境特定（例如性别）因素影响患者的健康感知。我们的研究结果强调了在早期精神病学中整合简单 PROMs 的价值。
