Epidemiology of Untreated Psychoses in 3 Diverse Settings in the Global South: The International Research Program on Psychotic Disorders in Diverse Settings (INTREPID II).
Epidemiology of Untreated Psychoses in 3 Diverse Settings in the Global South: The International Research Program on Psychotic Disorders in Diverse Settings (INTREPID II).
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DOI：
10.1001/jamapsychiatry.2022.3781
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发表时间：
2023-01-01
期刊：
影响因子：
25.8
通讯作者：
Williams, Diana
中科院分区：
文献类型：
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作者：
Morgan, Craig;Cohen, Alex;Esponda, Georgina Miguel;Roberts, Tessa;John, Sujit;Pow, Joni Lee;Donald, Casswina;Olley, Bola;Ayinde, Olatunde;Lam, Joseph;Poornachandrika, Paramasivam;Dazzan, Paola;Gaughran, Fiona;Kannan, Palaniyandi Ponnusamy;Sudhakar, Selvaraju;Burns, Jonathan;Chiliza, Bonginkosi;Susser, Ezra;Weiss, Helen A;Murray, Robin M;Rangaswamy, Thara;Gureje, Oye;Hutchinson, Gerard;Agboola, Adejoke;Fadahunsi, Olawoye;Idowu, Olufemi;Obuene, Clement;Ojagbemi, Akin;Olayiwola, Bamise;Owoeye, Seyi;Amaldoss, Kulandaiyesu;Aynkaran, Jothi Ramadoss;Balashanmugam, Abirami;Chockalingam, Premalatha;Devanathan, Kruthika;Gopal, Subhashini;Kumar, Ramesh;Ramachandran, Padmavati;Samikannu, Karthick;Bharath-Khan, Darielle;Jadoo, Donella;Marcellin, Elysse;Raymond, Elena;Sooknanan, Grace;Subnaik, Lauren;Williams, Diana
这项队列研究调查了全球南方不同地区精神病患者的临床和人口学特征以及未治疗精神病的比率是否存在差异。在全球南方不同的环境中，未经治疗的精神病患者（和发病率）的临床和人口学概况（发病率的代表）是否有所不同？在这项以人群为基础的队列研究中，1038名未经治疗的精神病患者的研究结果表明，全球南方在临床、性别和年龄特征以及未经治疗的精神病发病率方面存在差异（例如，特立尼达与印度和尼日利亚的发病率较高；非洲与印度特立尼达的发病率较高）。这项研究的结果进一步表明，精神病的核心方面因经济和社会背景而异，这对全球理解和治疗精神病具有重要意义。不到10%的精神障碍研究是在全球南方进行的，全球南方广泛指拉丁美洲、亚洲、非洲和大洋洲地区。缺乏关于精神病的分布和风险的基本流行病学数据，这些数据可以为世界许多地方的服务发展提供信息。比较全球南方3个不同经济和社会环境中病例队列和未治疗精神病发生率（发病率代表）的人口统计学和临床概况。我们检验了两个假设：(1)未治疗的精神病病例的人口学和临床概况在不同的环境中有所不同；(2)未治疗的精神病发病率在不同的临床和人口统计学群体中有所不同。不同环境下精神障碍国际研究项目（INTREPID II）包括全球南方3个国家集水区未治疗精神病的发病率、病例对照和队列研究：印度Kancheepuram地区；尼日利亚伊巴丹;和特立尼达北部。参与者是患有未经治疗的精神障碍的个体。该发病率研究于2018年5月1日至2020年7月31日进行。在每一种情况下，实施了全面的系统来识别和评估2年期间所有未经治疗的精神病患者。数据分析时间为2022年1月1日至5月1日。未经治疗的精神障碍的存在，使用神经精神病学临床评估表进行评估，其中包括当前状态检查。共确定1038例，其中64例通过渗漏研究（Kancheepuram: 268例，中位[IQR]年龄42[33-50]岁，女性154例（57.5%），男性114例（42.5%），Ibadan: 196例，中位[IQR]年龄34[26-41]岁，女性93例（47.4%），男性103例（52.6%），Trinidad: 574例，中位[IQR]年龄30[23-40]岁，女性235例（40.9%），男性339例（59.1%））。在性别、年龄和病例的临床特征（例如，与伊巴丹和特立尼达相比，Kancheepuram的男性比例较低，发病年龄较大，精神病持续时间较长，情感性精神病的比例较低）以及未治疗精神病的比率方面，发现了跨环境和内部环境的显著差异。与坎奇普兰（20.7/10万人年，95% CI, 18.2-23.2）和伊巴丹（14.4/10万人年，95% CI, 12.3-16.5）相比，特立尼达（59.1/10万人年，95% CI, 54.2-64.0）的年龄和性别标准化精神病未治疗率大约高出3倍。在特立尼达，非洲特立尼达人的发病率（85.4/10万人-年，95% CI, 76.0-94.9）大约是印度特立尼达人（43.9/10万人-年，95% CI, 35.7-52.2）和混合人群（50.7/10万人-年，95% CI, 42.0-59.5）的2倍。这一分析补充了一些研究，表明精神病的核心方面因历史、经济和社会背景而异，对全球精神病的理解和治疗具有深远的影响。
This cohort study investigates if the clinical and demographic profiles of individuals with, and rates of, untreated psychoses vary across diverse settings in the Global South. Do the clinical and demographic profiles of individuals with (and rates of) untreated psychoses (a proxy for incidence) vary across diverse settings in the Global South? In this population-based cohort study of 1038 individuals with untreated psychoses, results suggest that there were variations across settings in the Global South in clinical, sex, and age profiles and in rates of untreated psychotic disorders (eg, high rates in Trinidad vs India and Nigeria; in African vs Indian Trinidadian). Findings of this study add to research that suggests that core aspects of psychosis vary by economic and social context, with implications for understanding and treatment of psychoses globally. Less than 10% of research on psychotic disorders has been conducted in settings in the Global South, which refers broadly to the regions of Latin America, Asia, Africa, and Oceania. There is a lack of basic epidemiological data on the distribution of and risks for psychoses that can inform the development of services in many parts of the world. To compare demographic and clinical profiles of cohorts of cases and rates of untreated psychoses (proxy for incidence) across and within 3 economically and socially diverse settings in the Global South. Two hypotheses were tested: (1) demographic and clinical profiles of cases with an untreated psychotic disorder vary across setting and (2) rates of untreated psychotic disorders vary across and within setting by clinical and demographic group. The International Research Program on Psychotic Disorders in Diverse Settings (INTREPID II) comprises incidence, case-control, and cohort studies of untreated psychoses in catchment areas in 3 countries in the Global South: Kancheepuram District, India; Ibadan, Nigeria; and northern Trinidad. Participants were individuals with an untreated psychotic disorder. This incidence study was conducted from May 1, 2018, to July 31, 2020. In each setting, comprehensive systems were implemented to identify and assess all individuals with an untreated psychosis during a 2-year period. Data were analyzed from January 1 to May 1, 2022. The presence of an untreated psychotic disorder, assessed using the Schedules for Clinical Assessment in Neuropsychiatry, which incorporate the Present State Examination. Identified were a total of 1038 cases, including 64 through leakage studies (Kancheepuram: 268; median [IQR] age, 42 [33-50] years; 154 women [57.5%]; 114 men [42.5%]; Ibadan: 196; median [IQR] age, 34 [26-41] years; 93 women [47.4%]; 103 men [52.6%]; Trinidad: 574; median [IQR] age, 30 [23-40] years; 235 women [40.9%]; 339 men [59.1%]). Marked variations were found across and within settings in the sex, age, and clinical profiles of cases (eg, lower percentage of men, older age at onset, longer duration of psychosis, and lower percentage of affective psychosis in Kancheepuram compared with Ibadan and Trinidad) and in rates of untreated psychosis. Age- and sex-standardized rates of untreated psychoses were approximately 3 times higher in Trinidad (59.1/100 000 person-years; 95% CI, 54.2-64.0) compared with Kancheepuram (20.7/100 000 person-years; 95% CI, 18.2-23.2) and Ibadan (14.4/100 000 person-years; 95% CI, 12.3-16.5). In Trinidad, rates were approximately 2 times higher in the African Trinidadian population (85.4/100 000 person-years; 95% CI, 76.0-94.9) compared with the Indian Trinidadian (43.9/100 000 person-years; 95% CI, 35.7-52.2) and mixed populations (50.7/100 000 person-years; 95% CI, 42.0-59.5). This analysis adds to research that suggests that core aspects of psychosis vary by historic, economic, and social context, with far-reaching implications for understanding and treatment of psychoses globally.