title: Causal attributions, pathway to care and clinical features of first-episode psychosis: a South African perspective.
abstract: BACKGROUND
  Causal belief systems and help-seeking practices may impact on pathway to care and features of first-episode psychosis (FEP) that have prognostic value. This is particularly relevant in South Africa where many people subscribe to traditional belief systems and consult traditional healers.
  
  
  OBJECTIVE
  To evaluate the relationship between causal attributions and pathway to care and features of FEP that have prognostic value.
  
  
  METHODS
  We tested associations between causal attributions and pathway to care and duration of untreated psychosis (DUP), age of onset, PANSS-rated positive, negative and general symptoms and depressive symptoms (Calgary Depression Scale) in a sample of 54 FEP patients.
  
  
  RESULTS
  Spiritual attribution of cause (49% of patients) was associated with long DUP, while consultation with a traditional healer (39% of patients) was associated with long DUP and high negative symptoms. Only 19% had consulted a psychiatrist. Seventy nine per cent (79%) were referred to hospital by family, police were involved in 44% of admissions, and 81% were admitted involuntarily.
  
  
  CONCLUSIONS
  Spiritual attributions of cause and previous consultation with traditional healers may delay entry to psychiatric care and thereby negatively impact on prognosis of FEP. This highlights the importance of mental health education and developing a positive collaborative relationship with traditional healers, especially in low- and middle-income countries.
authors.affiliation: Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa. burns@ukzn.ac.za
authors.forename: Jonathan K
authors.initials: JK
authors.lastname: Burns
authors.forename: Khatija
authors.initials: K
authors.lastname: Jhazbhay
authors.forename: Martin
authors.initials: M
authors.lastname: Kidd
authors.forename: Robin A
authors.initials: RA
authors.lastname: Emsley
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D016488:Medicine, African Traditional / Q000706:statistics & numerical data; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011618:Psychotic Disorders / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D013019:South Africa; D055815:Young Adult