Duration of Untreated Psychosis and Associated Factors in First Episode Psychosis in Mzuzu in Northern Malawi

Abstract

Objective: Early intervention is said to improve outcome in first episode psychosis, yet studies in developed countries have persistently found that many individuals with first episode psychosis delay significantly, before they access mental health services. Whether these findings apply to Malawi is not known. This study, therefore, aims to assess the average Duration of Untreated Psychosis (DUP), defined as the interval from first psychotic symptoms to first effective treatment, and assess factors that are associated with DUP in Mzuzu, Malawi. Methodology: The study was conducted in a catchment area with a population of 1,022,417. A total of 140 patients were recruited and assessed using Structured Clinical Interview for DSM-IV-TR (SCID), schedule for the assessment of positive and negative symptoms, Beiser Scale, and Global Assessment of Functioning (GAF) Scale. The data were analysed using Statistical Package for Social Sciences (SPSS). DUP was assessed using Beiser Scale, and in-depth interview from carers. Pearson Chi-square was used to analyse factors associated with DUP. Results: The mean DUP was 51.70 months. Low level of education, unemployment, diagnosis of schizophrenia, low GAF and negative symptoms were associated with a longer DUP. Most patients were assisted by family members in accessing services, and traditional healers were most commonly the first resource used. Those who first consulted traditional healers had a longer DUP than those who first consulted a health care service. Conclusion: The findings indicate that individuals with schizophrenia in Mzuzu have long Dup this could be due to difficulties in accessing health services and that several factors are associated with this delay.