Epidemiology of Untreated Psychoses in 3 Diverse Settings in the Global South
Authors: 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 ,   INTREPID Group, 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 
Published: November 2022

Importance

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.

Objective

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.

Design, Setting, and Participants

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.

Main Outcomes and Measures

The presence of an untreated psychotic disorder, assessed using the Schedules for Clinical Assessment in Neuropsychiatry, which incorporate the Present State Examination.

Results

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).

Conclusions and Relevance

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.