Treatments for people living with schizophrenia in Sub-Saharan Africa: an adapted realist review

Abstract

Aim: To identify the treatments and interventions available and their impact on people living with schizophrenia in Sub-Saharan Africa.

Background: Help-seeking behaviour and the choice of treatment are largely influenced by socio-cultural factors and beliefs about the causes of mental illness. This review addresses the gap in knowledge regarding the treatment options available to people living with schizophrenia in Sub-Saharan Africa.

Design: Adapted realist literature review.

Data sources: Electronic databases searched in June 2016 included PubMed, EMBASE, PsycINFO, ProQuest and CINAHL.

Review methods: The adapted realist review approach used to synthesize the published research involved identifying the review aim, searching and selecting relevant studies, extracting, iteratively analysing and synthesizing relevant data and reporting results.

Results: Forty studies from eight countries were reviewed. Most people were treated by both faith/traditional healers and modern psychiatry. Common treatments included antipsychotics, electroconvulsive therapy and psychosocial interventions. Few treatment options were available outside major centres, there was poor adherence to medication and families reported a high level of burden associated with caring for a relative.

Limitations: Major limitations of this review were the lack of studies, variable quality and low level of evidence available from most countries from Sub-Saharan Africa and lack of generalizability.

Conclusion: People living with schizophrenia in Sub-Saharan Africa were treated by faith, traditional healers and modern psychiatry, if at all. Further research is needed to better understand the local situation and the implications for caring for people from this region.

Implications for nursing and health policy: Mental health services in Sub-Saharan Africa are limited by fiscal shortages, lack of mental health services and qualified mental health professionals. This review provides evidence to inform nursing and healthcare policy, including recruiting and training mental health professionals and ensuring access to evidence-based, person-centred and culturally relevant mental health services within the primary care context.

Keywords: Health Professional Shortages Mental Health Care; Mental Health Care; Mental Health Nursing; Realist Review; Schizophrenia; Sub-Saharan Africa; Treatment Options.