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: 9076537
• 负责人: Ashok Malla
• 金额: $ 10.68万
• 依托单位: MCGILL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-08 至 2017-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9076537
• 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，一直发现发展中国家治疗精神分裂症的结果比发达国家好。然而，人们对为什么会这样知之甚少。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所关注的精选和狭窄定义的临床和功能结果。鉴于这些重要的知识差距，拟议项目的长期目标是一个持续的研究计划，将揭示精神疾病结果的跨文化差异的本质和机制。具体而言，该项目涉及印度在精神分裂症文化相关研究方面具有互补优势的两个团队之间的合作，以及加拿大开创性的首发精神病研究。以往对跨文化差异精神病结果的调查常常受到混杂因素的限制，如未治疗精神病和接受治疗的持续时间的差异。为了避免这一陷阱，拟议的研究将集中在印度金奈和加拿大蒙特利尔的未治疗的首发精神病患者身上，他们将接受明确定义的类似治疗，为期两年。主要目的是调查一系列结果域和家庭因素的位点间差异，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，这在很大程度上可以解释印度精神病患者更好的治疗结果。本研究的具体假设为：(1)治疗2年后，印度患者的功能、主观和临床结局均优于加拿大患者。他们更有可能在工作或上学，报告生活质量更好，症状得到更大、更持久的改善。他们也更有可能继续参与治疗，而不是退出治疗。(2)印度患者更有可能有家庭成员参与其治疗，并享有更高水平的特定类型的家庭支持和参与，包括一般的心理支持和促进治疗依从性和康复的特定支持。此外，家庭因素将介导临床结果的位点间差异。将采用定量和定性相结合的研究方法。在这两个地方，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年轻精神病患者生活中的角色。该项目的研究结果将促进我们对印度早期精神病病程的理解；精神分裂症预后的跨文化差异；以及家庭如何为印度带来更好的结果。这一认识将影响印度文化上适当的家庭和早期干预服务的发展，并为改善西方精神分裂症结果提出策略，从而减轻（即使部分减轻）精神分裂症所带来的严重负担，无论文化背景如何。