Literature Review on Psychosis in Sub-Saharan Africa

Mkpoikanke Sunday Otu

doi:10.18860/psikoislamika.v21i2.29446

Literature Review on Psychosis in Sub-Saharan Africa

Mkpoikanke Sunday Otu

Abstract

Abstract: The scoping review explores the prevalence, diagnosis, and treatment of psychosis in Sub-Saharan Africa, highlighting the unique cultural and systemic challenges faced in the region. Despite an estimated global psychosis prevalence of 3%, Sub-Saharan Africa experiences a disproportionate burden, exacerbated by poverty, under-resourced healthcare systems, and cultural stigmas. Studies report a varying prevalence of psychotic symptoms across different countries, such as Kenya (8%) and Tanzania (3.9%). However, due to minimal mental health resources, psychosis often remains undiagnosed or untreated, particularly in rural areas. The review emphasizes the cultural lens through which psychosis is viewed, with many communities attributing symptoms to witchcraft, spiritual possession, or divine punishment. Consequently, individuals frequently seek care from traditional healers before accessing formal psychiatric services. The stigma surrounding mental illness further deters timely medical intervention, often leading to prolonged untreated psychosis and poor health outcomes. Diagnosis of psychosis in Sub-Saharan Africa faces additional barriers due to the reliance on Western diagnostic tools, such as the DSM-5 and ICD-10, which may not align with local cultural norms. Behaviors considered psychotic in Western contexts might be interpreted as spiritual experiences in African settings. As such, the absence of culturally adapted diagnostic instruments complicates accurate diagnosis and treatment. The treatment landscape is similarly complex, with limited access to psychotropic medications and mental health professionals. The scarcity of community-based mental health services results in long treatment delays and high relapse rates. The review calls for developing culturally appropriate diagnostic tools, expanding mental health services, and addressing stigma to improve psychosis care in Sub-Saharan Africa. Addressing these issues is essential to reducing the burden of untreated mental illness and enhancing mental health outcomes in the region.
Keywords: Psychosis; Sub-Saharan Africa; mental health; diagnosis; Treatment.

Keywords

Psychosis, Sub-Saharan Africa, mental health, diagnosis, Treatment

Full Text:

PDF

References

Abbo, C. (2011). Profiles and outcome of traditional healing practices for severe mental illnesses in two districts of Eastern Uganda. Global Health Action 4. PMCID: PMC3150106 DOI: https://doi.org /10.3402/gha.v4i0.7117

Alem, A., Jacobsson, L., Araya, M., Kebede, D., & Kullgren, G. (1999). How are mental disorders seen and where is help sought in a rural Ethiopian community? Acta Psychiatrica Scandinavica, 100(SUPPL.S397). https://doi.org/10.1111/j.1600-0447.1999.tb10693.x

Arksey, H., & O’Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology: Theory and Practice, 8(1). https://doi.org/10.1080/1364557032000119616

Atilola, O. (2015). Cross-cultural child and adolescent psychiatry research in developing countries. Global Mental Health, 2. https://doi.org/10.1017/gmh.2015.8.

Ayinde, O. O., Fadahunsi, O., Kola, L., Malla, L. O., Nyame, S., Okoth, R. A., Cohen, A., Appiah-Poku, J., Othieno, C. J., Seedat, S., & Gureje, O. (2023). Explanatory models, illness, and treatment experiences of patients with psychosis using the services of traditional and faith healers in three African countries: Similarities and discontinuities. Transcultural Psychiatry, 60(3). https://doi.org/10.1177/13634615211064370

Becker, A. E., & Kleinman, A. (2013). Mental Health and the Global Agenda. New England Journal of Medicine, 369(1). https://doi.org/10.1056/nejmra1110827

Burns, J. K. (2011). The mental health gap in South Africa: A human rights issue. The Equal Rights Review, 6(99), 99-113.

Collins, P. Y., Patel, V., Joestl, S. S., March, D., Insel, T. R., Daar, A. S., Bordin, I. A., Costello, E. J., Durkin, M., Fairburn, C., Glass, R. I., Hall, W., Huang, Y., Hyman, S. E., Jamison, K., Kaaya, S., Kapur, S., Kleinman, A., Ogunniyi, A., … Walport, M. (2011). Grand challenges in global mental health. In Nature, 475, (7354). https://doi.org/10.1038/475027a

Eaton, J., McCay, L., Semrau, M., Chatterjee, S., Baingana, F., Araya, R., Ntulo, C., Thornicroft, G., & Saxena, S. (2011). Scale up of services for mental health in low-income and middle-income countries. The Lancet, 378, (9802). https://doi.org/10.1016/S0140-6736(11)60891-X

Girma, E., Ametaj, A., Alemayehu, M., Milkias, B., Yared, M., Misra, S., Stevenson, A., Koenen, K. C., Gelaye, B., & Teferra, S. (2022). Measuring traumatic experiences in a sample of Ethiopian adults: Psychometric properties of the life events checklist-5. European Journal of Trauma and Dissociation, 6(4). https://doi.org/10.1016/j.ejtd.2022.100298

Gureje, O., Olowosegun, O., Adebayo, K., & Stein, D. J. (2010). The prevalence and profile of non-affective psychosis in the Nigerian Survey of Mental Health and Wellbeing. World Psychiatry, 9(1). https://doi.org/10.1002/j.2051-5545.2010.tb00269.x

Jack-Ide, Makoro, Bip-Bari P, & Azibiri B. (2013). Pathways to mental health care services in the Niger Delta region of Nigeria 1. Journal of Research in Nursing and Midwifery, 2(2).

Jenkins, R., Mbatia, J., Singleton, N., & White, B. (2010). Prevalence of psychotic symptoms and their risk factors in Urban Tanzania. International Journal of Environmental Research and Public Health, 7(6), 2514–2525. https://doi.org/10.3390/ijerph7062514

Jenkins, R., Njenga, F., Okonji, M., Kigamwa, P., Baraza, M., Ayuyo, J., Singleton, N., Mcmanus, S., & Kiima, D. (2012). Psychotic symptoms in Kenya - prevalence, risk factors, and relationship with common mental disorders. International Journal of Environmental Research and Public Health, 9(5). https://doi.org/10.3390/ijerph9051748

Jenkins, R., Othieno, C., Ongeri, L., Ogutu, B., Sifuna, P., Kingora, J., Kiima, D., Ongecha, M., & Omollo, R. (2015). Adult psychotic symptoms, their associated risk factors and changes in prevalence in men and women over a decade in a poor rural district of Kenya. International Journal of Environmental Research and Public Health, 12(5). https://doi.org/10.3390/ijerph120505310

Levac, D., Colquhoun, H., & O'brien, K. K. (2010). Scoping studies: advancing the methodology. Implementation science, 5, 1-9.

Lund, C., Breen, A., Flisher, A. J., Kakuma, R., Corrigall, J., Joska, J. A., Swartz, L., & Patel, V. (2010). Poverty and common mental disorders in low and middle income countries: A systematic review. Social Science and Medicine, 71(3). https://doi.org/10.1016/j.socscimed.2010.04.027

Lund, C., Myer, L., Stein, D. J., Williams, D. R., & Flisher, A. J. (2013). Mental illness and lost income among adult South Africans. Social Psychiatry and Psychiatric Epidemiology, 48(5). https://doi.org/10.1007/s00127-012-0587-5

Makanjuola, V., Esan, Y., Oladeji, B., Kola, L., Appiah-Poku, J., Harris, B., Othieno, C., Price, L., Seedat, S., & Gureje, O. (2016). Explanatory model of psychosis: impact on perception of self-stigma by patients in three sub-saharan African cities. Social Psychiatry and Psychiatric Epidemiology, 51(12). https://doi.org/10.1007/s00127-016-1274-8

Morgan, C., Cohen, A., & Roberts, T. (2024). Psychosis: Global Perspectives. Oxford University Press.

Morgan, C., McKenzie, K., & Fearon, P. (2008). Society and psychosis: future directions and implications. Society and psychosis, 238.

Mwesiga, E. K., Nakasujja, N., Ongeri, L., Semeere, A., Loewy, R., & Meffert, S. (2019). A cross-sectional mixed methods protocol to describe correlates and explanations for a long duration of untreated psychosis among patients with first episode psychosis in Uganda. BMJ Open, 9(7). https://doi.org/10.1136/bmjopen-2018-028029

Nadkarni, A., Hanlon, C., & Patel, V. (2024). Mental health care models in low-and middle-income countries. In Tasman’s Psychiatry (pp. 3347-3393). Cham: Springer International Publishing.

Olugbile, O., Zachariah, M. P., Kuyinu, A., Coker, A., Ojo, O., & Isichei, B. (2009). Yoruba world view and the nature of psychotic illness. African Journal of Psychiatry (South Africa), 12(2). https://doi.org/10.4314/ajpsy.v12i2.43733

Patel, V., Flisher, A. J., Hetrick, S., & McGorry, P. (2007). Mental health of young people: a global public-health challenge. Lancet 369, (9569). https://doi.org/10.1016/S0140-6736(07)60368-7

Patel, V., & Prince, M. (2010). Global mental health: a new global health field comes of age. Jama, 303(19), 1976-1977.

Saraceno, B., van Ommeren, M., Batniji, R., Cohen, A., Gureje, O., Mahoney, J., ... & Underhill, C. (2007). Barriers to improvement of mental health services in low-income and middle-income countries. The Lancet, 370(9593), 1164-1174.

Sorsdahl, K., Stein, D. J., Grimsrud, A., Seedat, S., Flisher, A. J., Williams, D. R., & Myer, L. (2009). Traditional healers in the treatment of common mental disorders in South Africa. Journal of Nervous and Mental Disease, 197(6). https://doi.org/10.1097/NMD.0b013e3181a61dbc

Thornicroft, G., Ahuja, S., Barber, S., Chisholm, D., Collins, P. Y., Docrat, S., ... & Zhang, S. (2019). Integrated care for people with long-term mental and physical health conditions in low-income and middle-income countries. The Lancet Psychiatry, 6(2), 174-186.

Thornicroft, G., Deb, T., & Henderson, C. (2016). Community mental health care worldwide: current status and further developments. World Psychiatry, 15(3), 276-286. https://doi.org/10.1002/wps.20349

Tognon-Tchégnonsi, F., Adoukonou, T., Djidonou, A., Iréti, E. A., & Gandaho, P. (2020). Prevalence of mental disorders in an rural community in Northern Benin: A door-to-door survey. Annales Medico-Psychologiques, 178(9), 908–912. https://doi.org/10.1016/j.amp.2020.01.009

Tomita, A., Burns, J. K., King, H., Baumgartner, J. N., Davis, G. P., Mtshemla, S., Nene, S., & Susser, E. (2015). Duration of untreated psychosis and the pathway to care in KwaZulu-Natal, South Africa. Journal of Nervous and Mental Disease, 203(3). https://doi.org/10.1097/NMD.0000000000000268

Veling, W., Burns, J. K., Makhathini, E. M., Mtshemla, S., Nene, S., Shabalala, S., Mbatha, N., Tomita, A., Baumgartner, J., Susser, I., Hoek, H. W., & Susser, E. (2019). Identification of patients with recent-onset psychosis in KwaZulu Natal, South Africa: a pilot study with traditional health practitioners and diagnostic instruments. Social Psychiatry and Psychiatric Epidemiology, 54(3). https://doi.org/10.1007/s00127-018-1623-x

Ventevogel, P. (2014). Integration of mental health into primary healthcare in low-income countries: Avoiding medicalization. International Review of Psychiatry, 26(6). https://doi.org/10.3109/09540261.2014.966067

World Health Organization. (‎2015)‎. Mental health atlas 2014. World Health Organization. https://iris.who.int/handle/10665/178879

DOI: https://doi.org/10.18860/psikoislamika.v21i2.29446