Early Psychosis in India and Canada: Investigating outcomes and family factors

印度和加拿大的早期精神病：调查结果和家庭因素

• 批准号: 8852184
• 负责人: Ashok Malla
• 金额: $ 42.66万
• 依托单位: MCGILL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-17 至 2017-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8852184
• 关键词: Accounting; Address; Aftercare; Canada; Clinical; Collaborations; Developed Countries; Developing Countries; Development; Disease remission; Drops; Early Intervention; Employment; Family; Family health status; Family member; Focus Groups; Goals; Health; Health Personnel; India; Indigenous; Individual; Interpersonal Relations; Investigation; Knowledge; Light; Mediating; Mental disorders; Methodology; Methods; Modeling; Nature; Outcome; Outcomes Research; Patients; Persons; Phase; Play; Process; Psychiatry; Psychotic Disorders; Qualitative Methods; Qualitative Research; Quality of life; Recovery; Reporting; Research; Research Methodology; Role; Schizophrenia; Schools; Services; Shapes; Site; Social support; Symptoms; System; Testing; Trust; United States; Variant; Work; base; first episode psychosis; follow-up; functional outcomes; improved; insight; novel; programs; psychologic; therapy development; tool; treatment adherence

DESCRIPTION (provided by applicant): In cultural psychiatry and schizophrenia outcome research, it is consistently found that the outcomes of treated schizophrenia are better in developing countries than in developed ones. Yet, little is known about why this is so. It is not known whether this difference extends to all outcome domains or is limited to the select and narrowly defined clinical and functional outcomes that existing research has focused on. Given these significant knowledge gaps, the long-term goal of the proposed project is a sustained research program that will reveal the nature of and the mechanisms underlying cross-cultural variation in psychosis outcomes. Specifically, the project involves collaboration between two teams with complementary strengths in culturally relevant schizophrenia research in India and pioneering first-episode psychosis research in Canada. Previous investigations of cross-culturally varied psychosis outcomes have often been limited by confounding factors such as differences in the duration of untreated psychosis and treatments received. To avoid this pitfall, the proposed study will focus on patients with previously untreated first-episode psychosis in Chennai, India and Montreal, Canada who will receive clearly defined and similar treatment for two years. Key objectives are to investigate inter-site differences in a range of outcome domains and family factors and whether the differences in family factors contribute to variation in outcomes. Our premise is that the better outcomes of psychosis in India can be largely explained by the comparatively higher levels of family support available to persons with psychosis in India as compared to in developed countries such as Canada. The specific hypotheses of this study are: (1) Two years after treatment, the Indian patients will have better functional, subjective, and clinical outcomes than the Canadian ones. They will be likelier to be working or in school, report a better quality of life, and have higher and more sustained improvement in symptoms. They will also be likelier to stay engaged in and not drop out from treatment. (2) The Indian patients will be more likely to have family members involved in their treatment and enjoy higher levels of specific types of family support and involvement, both general psychological support and support specific to promoting treatment adherence and recovery. Further, family factors will mediate the inter-site variation in clinical outcomes. A combination of quantitative and qualitative research methods will be deployed. At both sites, qualitative methods will especially help understand how patients regard recovery and how family members and patients perceive the family's role in the lives of young people with psychosis. The project's findings will advance our understanding of the course of early psychosis in India; of cross-cultural variation in schizophrenia outcomes; and of how families contribute to better outcomes in India. This understanding will shape the development of culturally appropriate family and early intervention services in India and suggest strategies for improving schizophrenia outcomes in the West, thus alleviating (even if partially) the severe burden that schizophrenia imposes irrespective of cultural setting.

描述（由申请人提供）：在文化精神病学和精神分裂症结果研究中，一致发现发展中国家精神分裂症治疗的结果优于发达国家。然而，人们对为什么会这样却知之甚少。目前尚不清楚这种差异是否扩展到所有结果领域，还是仅限于现有研究关注的特定且狭义定义的临床和功能结果。鉴于这些重大的知识差距，拟议项目的长期目标是一个持续的研究计划，该计划将揭示精神病结果跨文化差异的本质和机制。具体来说，该项目涉及两个在印度文化相关的精神分裂症研究和加拿大首例精神病研究方面具有互补优势的团队之间的合作。先前对跨文化不同精神病结果的调查常常受到混杂因素的限制，例如未经治疗的精神病的持续时间和接受的治疗的差异。为了避免这个陷阱，拟议的研究将重点关注印度金奈和加拿大蒙特利尔先前未经治疗的首发精神病患者，他们将接受两年明确的类似治疗。主要目标是调查一系列结果领域和家庭因素的站点间差异，以及家庭因素的差异是否会导致结果的变化。我们的前提是，与加拿大等发达国家相比，印度精神病患者获得的家庭支持水平相对较高，这很大程度上可以解释为印度精神病患者获得的家庭支持水平相对较高。本研究的具体假设是：（1）治疗两年后，印度患者的功能、主观和临床结果将优于加拿大患者。他们更有可能去工作或上学，生活质量更高，症状改善程度更高、更持续。他们也更有可能继续参与治疗，而不会退出治疗。 (2) 印度患者更有可能让家庭成员参与治疗，并享受更高水平的特定类型的家庭支持和参与，包括一般心理支持和促进治疗依从性和康复的特定支持。此外，家庭因素将调节临床结果的不同部位的差异。将采用定量和定性研究方法相结合的方法。在这两个地点，定性方法将特别有助于了解患者如何看待康复，以及家庭成员和患者如何看待家庭在患有精神病的年轻人的生活中所扮演的角色。该项目的研究结果将增进我们对印度早期精神病过程的理解；精神分裂症结果的跨文化差异；以及家庭如何为印度取得更好的成果做出贡献。这种理解将影响印度文化上适当的家庭和早期干预服务的发展，并提出改善西方精神分裂症结果的策略，从而减轻（即使是部分地）精神分裂症带来的严重负担，无论文化背景如何。