Berhanu Kaleab, Birlie Abayneh, Fiseha Tizibt, Reta Yared, Gebreegziabhere Yohannes
School of Nursing and Midwifery, Asrat Woldeyes Health Sciences College, Debre Berhan University, Debre Berhan, Ethiopia.
School of Public Health, Asrat Woldeyes Health Sciences College, Debre Berhan University, Debre Berhan, Ethiopia.
PLoS One. 2025 Jul 24;20(7):e0328724. doi: 10.1371/journal.pone.0328724. eCollection 2025.
Pathways to care are the steps individuals went through before finally consulting formal psychiatric services. In developing countries, people with mental disorders (PWMDs) often first consult traditional or religious healers, which may delay treatment. Although studies from different part of Ethiopia confirm this trend, factors influencing indirect pathways remain insufficiently explored.
This study aimed to identify pathways to psychiatric care and factors associated with indirect pathways among PWMDs who received psychiatric care from Debre Berhan Comprehensive Specialized Hospital, Ethiopia.
We enrolled 446 PWMDs and used the World Health Organization pathway to psychiatric care encounter form to elicit the pathways to psychiatric care. We conducted a multivariable binary logistic regression analysis to identify factors significantly associated with indirect pathways.
Most of the PWMDs in the study (72.9%) went through indirect pathways. From sociodemographic characteristics, being in the age group between 41-50 years (AOR = 8.27; 95% CI (2.94, 23.18)) and over 50 years (AOR = 6.46; 95% CI (2.00, 20.82)), being female (AOR = 2.51; 95% CI (1.34, 4.73)), being primary school attendees (AOR = 3.00; 95% CI (1.20, 7.40)), being farmer (AOR = 13.00; 95% CI (3.11, 54.31)), and living in the same house with 4-8 people (AOR = 2.77; 95% CI (1.11, 6.95)) were found to be significantly associated with indirect pathways. While from clinical characteristics, a diagnosis of bipolar disorder (AOR = 2.66; 95% CI (1.10, 6.50)) and anxiety (AOR = 3.94; 95% CI (1.37, 11.34)), perceived stigma (AOR = 5.86; 95% CI (3.00, 11.45)), and facing problems during the help-seeking process (AOR = 0.44; 95% CI (0.21, 0.90)) were found to be significantly associated with indirect pathways.
In this population, PWMDs primarily used indirect pathways as their first point of contact. Several demographic and clinical factors were significantly associated with utilizing indirect pathways. This study has implications for reducing delays by enhancing psychiatric service integration and establishing effective referral systems.
就医途径是个体在最终咨询正规精神科服务之前所经历的步骤。在发展中国家，精神障碍患者（PWMDs）通常首先咨询传统或宗教治疗师，这可能会延迟治疗。尽管来自埃塞俄比亚不同地区的研究证实了这一趋势，但影响间接就医途径的因素仍未得到充分探索。
本研究旨在确定埃塞俄比亚德布雷伯汉综合专科医院接受精神科护理的精神障碍患者的精神科护理途径以及与间接途径相关的因素。
我们招募了446名精神障碍患者，并使用世界卫生组织精神科护理接触表单来确定精神科护理途径。我们进行了多变量二元逻辑回归分析，以确定与间接途径显著相关的因素。
研究中的大多数精神障碍患者（72.9%）采用了间接途径。在社会人口学特征方面，年龄在41 - 50岁之间（调整后比值比[AOR]=8.27；95%置信区间[CI](2.94, 23.18)）和50岁以上（AOR = 6.46；95% CI(2.00, 20.82)）、女性（AOR = 2.51；95% CI(1.34, 4.73)）、小学学历（AOR = 3.00；95% CI(1.20, 7.40)）、农民（AOR = 13.00；95% CI(3.11, 54.31)）以及与4 - 8人同住一屋（AOR = 2.77；95% CI(1.11, 6.95)）被发现与间接途径显著相关。而在临床特征方面，双相情感障碍诊断（AOR = 2.66；95% CI(1.10, 6.50)）和焦虑症（AOR = 3.94；95% CI(1.37, 11.34)）、感知到的耻辱感（AOR = 5.86；95% CI(3.00, 11.45)）以及在寻求帮助过程中遇到问题（AOR = 0.44；95% CI(0.21, 0.90)）被发现与间接途径显著相关。
在这一人群中，精神障碍患者主要将间接途径作为他们的首次接触点。几个人口统计学和临床因素与采用间接途径显著相关。本研究对于通过加强精神科服务整合和建立有效的转诊系统来减少延迟具有启示意义。
