Patients who seek traditional magico-religious treatments: Are they different from patients who seek medical treatments? A case-control study

Introduction: A patient’s decision to seek help for mental health symptoms (and from who) depends on a number of sociodemographic and illness related factors, as well as accessibility and affordability of care. Traditionally magico-religious healers have constituted an important source of health-care for a significant proportion of mentally ill patients in India. The concern however, is that these consultations may also delay patients en route their pathway to medical or psychiatric carethus potentially adding to the duration of untreated illness and associated poor outcomes. Aims: The present study aimed to examine whether patients who seek traditional magico-religious treatments were different from those who seek medical or mental health care for their symptoms. Methodology: Ninety-one patients were recruited from the Outpatient and emergency departments of the Institute of Medical Psychology, Asha hospital in Hyderabad, Telangana. After gaining informed consent, carers (key informants) for these patients were interviewed to enquire about the patient’s first and subsequent care contacts, as well as for a number of background sociodemographic and illness details. Subjects whose first contact was with a traditional magico-religious healer were compared with subjects who sought help from a medical or mental health professional (psychiatrist/ physician/ registered or unregistered medical practitioner/ medical specialist/ community nurse) for their symptoms. Results: Thirty three (36.3%) of the subjects had sought care from magico-religious healers in the first instance. The rest (63.7%) consulted various other healthcare providers like medical practitioners, psychiatrists, medical specialists like neurologists, community nurses/ social workers, etc. Subjects who sought care from magico-religious healers were similar to those did not, with respect to their age, sex-distribution, residence, social status and incomes, but the latter group was more educated than the former (p<0.05). The groups did not differ with respect to their diagnostic distribution or the duration of untreated illness. However, the magico-religious treatment subjects sought care (from the magico-religious healer) substantially sooner than those who sought care from elsewhere. They also had more health-care contacts than the non-magico-religious treatment group (p<0.05), despite the duration of untreated illness being comparable between the two groups. Discussion and Implications: Magico-religious healers constitute an important health-care contact point for patients who develop mental health symptoms. This study did not identify any specific socio-demographic profile of patients who consult magico-religious healers in the first instance. They were however, less educated than patients who seek health-care from alternative sources. We also could not identify any specific diagnostic characteristics of patients who consult magico-religious healers. Although these patients do have more health-care contacts before they seek psychiatric care and treatment, this did not delay their eventual psychiatric treatment (as compared to patients who did not seek magico-religious treatments). This study has implications for the development of mental health services. Training and awareness creation amongst patients as well as locally identified magico-religious healers may help to shorten the duration of untreated illness. Maintenance of a registry of locally practicing magico-religious healers, regular training/ exchange of information, and active liaison with local psychiatric services may help in improving mental health care. This is probably especially relevant in the current context of scarce governmental resources. Introduction Epidemiological studies suggest that the prevalence of mental illnesses in India ranges from 9.5 to 370 per 1000 population. Despite the enormity of psychiatric morbidity, a substantial treatment gap exists between available resources and the illness burden. In a recent WHO study, nearly 76-85% of seriously mentally ill patients had not received any treatment in the preceding 12 months. A patient’s decision to seek help for mental health symptoms (and from who) depends on a number of socio-demographic & illness related factors, beliefsystems, as well as accessibility & affordability of care. Mental illnesses are understood, in India, as being intricately related to spiritual and religious factors, and this belief often influences patients’ recognition of illness and their care-seeking behaviours. As a result, traditional magico-religious healers are an important source of health-care for a significant proportion of mentally ill patients in India. Their therapeutic interventions for mental illnesses take several forms and include prayers, rituals, exorcism, counter magic, talismans, enchanted rings, sacred ash, and offerings to temples etcall related to subscription to a core set of spiritual or religious beliefs about the nature of mental illnesses. A number of factors are suggested to influence the patient’s decision to seek treatment from a magico-religious healerthese include the patient’s socio-economic status, literacy, gender, nature of symptoms, affordability and access to care, Aparna B et al. Patients who seek traditional magico-religious treatments Telangana Journal of Psychiatry, July-December 2016:2(2):86-89 87 previous/ vicarious experiences of care for similar problems, etc. In scientific literature however, concerns have been raised about patients seeking/ consulting with a magicoreligious healer for their psychiatric symptoms. These revolve around the view that magico-religious consultations may not be effective, and may delay patients en route their pathway to psychiatric carethus potentially contributing to the duration of untreated illness and treatment outcomes. Aims The present study aimed to examine sociodemographic and illness-related characteristics of patients who seek traditional magico-religious treatments as compared to those who seek other medical care for their mental health symptoms. The study also examined whether patients who seek magico-religious treatments have longer durations of untreated illness and more health-care contacts as compared to the control group. Methodology Setting: The study was conducted in the Outpatient and Emergency departments of the Institute of Medical Psychology, Asha hospital, Hyderabad, India. This is a 100-bedded privately run psychiatric unit which provides Outpatient and Inpatient services for patients with a wide range of psychiatric conditions. It is one of the oldest and well-established private academic psychiatric units in Hyderabad and caters to patients from the states of Telangana and Andhra Pradesh. The Study sample: Ninety one patients were recruited from the OP and emergency departments of the Institute of Medical Psychology, Asha Hospital in Hyderabad, Telangana, over a period of 6-months. Key informants for these patients were interviewed to enquire about the patient’s first and subsequent care contacts, as well as for a number of background socio-demographic and illness details. Subjects whose first contact was with a traditional magic-religious healer were compared with subjects who sought medical or mental health professional (psychiatrist/ physician/ registered or unregistered medical practitioner/ medical specialist/ community nurse) help for their symptoms. Inclusion criteria: Key Informants/ Carers of all new registrations were eligible to participate in the study irrespective of the psychiatric diagnosis, provided that they were consenting and were able to give information about the patient’s illness & care prior to the index presentation. Exclusion criteria: Patients not accompanied by any family members, and those whose carers who were unable to give a clear account of the patient’s illness and treatment pathway were excluded. Study design: This was a cross-sectional study involving a guided interview of index-patients’ carers to ascertain the patients’ first and subsequent healthcare contacts before seeking help from a psychiatrist. Instruments: All recruited subjects were administered a semi-structured interview to elicit background social, demographic, residential, occupational and illnessrelated information. The WHO Pathways encounter form was adapted and completed for each of the previous health care contacts. This tool was originally developed by the WHO to rather systematic information about the sources of care used by patients before seeing mental health professional. It is a standard tool which has been used in many Indian studies previously. Statistical Analysis: Data was analysed using the SPSS statistical software (version 23). Subjects who consulted a magico-religious healer in the first instance for their symptoms were compared with those who did not, with respect to their socio-demographic characteristics, diagnosis, time delay to 1 healthcare contact, duration of untreated (by a psychiatrist) illness and number of healthcare contacts until they saw a psychiatrist. The data was analysed using descriptive statistics, group comparisons were done using the t-test and chi-squared test where appropriate. Results Thirty three (36.3%) of the subjects had sought care from magico-religious healers in the first instance. The rest (63.7%) consulted various other healthcare providers like medical practitioners, psychiatrists, medical specialists like neurologists, community nurses/ social workers, etc, and served as the controls for the study. Subjects who sought care from magico-religious healers were similar to the controls with respect to their age, sex-distribution, residence, social status and incomes, but the latter group was more educated than the former (p<0.05). The groups did not differ with respect to their diagnostic distribution or the duration of untreated psychosis. However, the magico-religious treatment subjects sought care (f