Belief models in first episode schizophrenia in South India

Abstract

Background: Existing evidence indicates that dissonance between patients' and professionals' explanatory models affects engagement of patients with psychiatric services in Western and non-Western countries.

Aims: To assess qualitatively the explanatory models (EMs) of psychosis and their association with clinical variables in a representative sample of first episode patients with schizophrenia in South India.

Method: One hundred and thirty one patients with schizophrenia presenting consecutively were assessed. Measures included the patient's explanatory models, and clinician ratings of insight, symptoms of psychosis, and functioning on standard scales.

Results: The majority of patients (70%) considered spiritual and mystical factors as the cause of their predicament; 22% held multiple models of illness. Patients who held a biomedical concept of disease had significantly higher scores on the insight scale compared to those who held non-medical beliefs. Multivariate analyses identified three factors associated with holding of spiritual/mystical models (female sex, low education and visits to traditional healers); and a single factor (high level of insight) for the endorsement of biological model.

Conclusions: Patients with schizophrenia in this region of India hold a variety of non-medical belief models, which influence patterns of health seeking. Those holding non-medical explanatory models are likey to be rated as having less insight.