title: Duration of untreated psychosis and the pathway to care in KwaZulu-Natal, South Africa.
abstract: Considerable controversy surrounds the role of traditional health practitioners (THPs) as first-contact service providers and their influence on the duration of untreated psychosis (DUP) in sub-Saharan Africa. This study examined first-contact patterns and pathways to psychiatric care among individuals with severe mental illness in South Africa. A cross-sectional study was conducted at a referral-based tertiary psychiatric government hospital in KwaZulu-Natal Province. Information on pathways to care was collected using the World Health Organization's Encounter Form. General hospital was the most common first point of contact after mental disorder symptom onset and the strongest link to subsequent psychiatric treatment. Family members were the most common initiators in seeking care. First contact with THPs was associated with longer DUP and higher number of provider contacts in the pathway based on adjusted regression analyses. Strengthening connections between psychiatric and general hospitals and provision of culturally competent family-based psychoeducation to reduce DUP are warranted.
authors.affiliation: *Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; †Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; ‡Duke Global Health Institute, Duke University, Durham, NC; §New York State Psychiatric Institute, New York, NY; and ∥Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Andrew
authors.initials: A
authors.lastname: Tomita
authors.forename: Jonathan K
authors.initials: JK
authors.lastname: Burns
authors.forename: Howard
authors.initials: H
authors.lastname: King
authors.forename: Joy Noel
authors.initials: JN
authors.lastname: Baumgartner
authors.forename: Glen P
authors.initials: GP
authors.lastname: Davis
authors.forename: Sisanda
authors.initials: S
authors.lastname: Mtshemla
authors.forename: Siphumelele
authors.initials: S
authors.lastname: Nene
authors.forename: Ezra
authors.initials: E
authors.lastname: Susser
mesh_terms: D000328:Adult; D005260:Female; D006769:Hospitals, General / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D016488:Medicine, African Traditional / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011618:Psychotic Disorders / Q000208:ethnology / Q000628:therapy*; D013019:South Africa / Q000208:ethnology; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D055815:Young Adult