Community outreach for untreated schizophrenia in rural India: a follow-up study of symptoms, disability, family burden and costs.
BACKGROUND
In resource-poor countries, there remains an alarming treatment gap for people with schizophrenia, particularly those living in rural areas. Decentralization of mental health services, including community-based outreach programmes, represents one obvious strategy for bringing appropriate care to these communities. This study set out to assess the costs and effects of such a programme in rural Karnataka in India.


METHODS
Eight rural communities were visited by an outreach team, who identified cases of drug-naive or currently untreated schizophrenia. Recruited cases were provided with appropriate psychotropic medication and psychosocial support, and after obtaining informed consent were assessed every 3 months over one and a half years on symptomatology, disability, family burden, resource use and costs. A repeated-measures analysis was carried out to test for significant change in these outcome measures over this period.


RESULTS
A total of 100 cases of untreated schizophrenia were recruited, of whom 28% had never received antipsychotic medication and the remaining 72% had not been on medication for the past 6 months. Summary scores for psychotic symptoms, disability and family burden were all reduced significantly, with particular improvement observed at the first follow-up assessment. Increases in treatment and community outreach costs over the follow-up period were accompanied by reductions in the costs of informal-care sector visits and family care-giving time.


CONCLUSIONS
Efforts to organize community-based care such as outreach services for people with schizophrenia living in more remote areas of resource-constrained countries can bring substantial benefits to patients and families alike.
Srinivasa Murthy
R
R
Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India.
Kishore Kumar
K V
KV
Chisholm
D
D
Thomas
T
T
Sekar
K
K
Chandrashekari
C R
CR
D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000627:therapeutic use; D003153:Community Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D003159:Community-Institutional Relations; D017281:Cost of Illness; D003906:Developing Countries; D006233:Persons with Disabilities / Q000523:psychology*; D005192:Family Health; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012424:Rural Population; D012559:Schizophrenia / Q000188:drug therapy* / Q000191:economics / Q000208:ethnology*; D016896:Treatment Outcome
D014150:Antipsychotic Agents