Mental illness such as schizophrenia, depression, dementia, and other mental, and substance-use disorders constitute 13% of the global burden of disease. Schizophrenia in particular is a major public health problem, affecting almost 1% of the world's population. Although relatively rare, it is one of the most severe mental disorders. There are about 25 million people living with schizophrenia in low and middle income countries. Butajira, Ethiopia has found the prevalence of schizophrenia to be 5:1 where males have a higher risk of schizophrenia compared to women. The reason behind this high gender differential in this setting still remains unclear. My overall career goal is to become an independent investigator in global mental health research with expertise in women's mental health. My career goals include the ability to bring my public health training into the field of psychiatry to better understand th complexities of psychotic disorder in resource-limited settings. This training award will enable me to accomplish my scientific objective of understanding both individual, family and community factors relevant to the detection and incidence of schizophrenia. My 3 specific aims are 1: To conduct a 20-year systematic review of the incidence and prevalence of schizophrenia; 2: To understand community members' cultural explanatory models of schizophrenia in Butajira, Ethiopia to improve cultural and gender sensitivity to aid in identifying new patients with schizophrenia; 3: To conduct a one-year incident study in schizophrenia in Butajira, Ethiopia using trained community members and to examine the family and other social contacts' attitudes towards new onset cases of schizophrenia. I am well-positioned to accomplish these aims given my previous doctoral training in behavioral sciences and mixed methodological research focusing on women with a severe mental illness. A high level of institutional commitment is evidenced by the history of the two institutions (Massachusetts General Hospital and Addis Ababa University - AAU) collaborating together from both a clinical and research collaboration. I will draw on the expertise of an internationally-renowned mentoring committee of experts in community based participatory research (CPBR) including community intervention development, psychiatric epidemiology, behavioral sciences, qualitative research, and schizophrenia research across both the Harvard wide campus and AAU, while creating my own research trajectory that is distinct from that of my mentors. The approach is innovative in that it utilizes a conceptual framework that accounts for the individual, family, and community factors that are relevant to the detection of schizophrenia in a resource-limited setting using CBPR methods. This represents a substantive departure from the status quo in several ways such as the conceptual framework and methodological design. The proposed research is significant because it will have broad implications for the understanding of protective and risk factors in the development of schizophrenia and will have major implications for gender-specific interventions and policy given the role of rural women in sub-Saharan Africa.
Mental illness such as schizophrenia, depression, dementia, and other mental, and substance-use disorders constitute 13% of the global burden of disease and schizophrenia, although relatively rare, is one of the most severe mental disorders. The proposed study will focus on women with schizophrenia in Butajira, Ethiopia examining individual, family, and community factors relevant to the detection and incidence of schizophrenia. The focus on rural Ethiopia will have broad implications for the understanding of protective and risk factors in the development of schizophrenia and for gender-specific services and policy given the role of rural women in sub-Saharan Africa.
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