Psychotic disorders in an African setting: Incidence, early course, and treatment pathways. We propose to pilot and build capacity for a study that will investigate the incidence rate, early course, and treatment pathways (INCET) of first episode psychotic disorders (FEP) in Vulindlela, Kwazulu-Natal, South Africa: henceforth referred to as the FEP-INCET study. Whereas most previous studies in Africa have relied upon hospital admissions, the FEP-INCET will encompass those who seek help from informal and formal community practitioners. It will be the first study in an African setting to derive incidence rates for FEP;prospectively investigate the range of early manifestations and early course of FEP;trace the pathways into and out of informal as well as formal health care;and identify factors that influence help-seeking at each point in the pathway. It will establish a platform for future studies, including early intervention studies, biological studies, and genetic studies. We believe that it will be transformative for global mental health, by bringing Africa squarely into the purview of investigators who focus on psychotic disorders. The Principal Investigators are Ezra Susser at Columbia University and Jonathan Burns at the University of KwaZulu-Natal. Vulindlela is a poor rural community of population 450,000, mainly Zulu. It is one of the few sites in Africa where such a study is feasible. One reason is that our colleagues in HIV research have studied the population demography, the sociocultural environment, and the health care resources of Vulindlela. The community has a strong traditional council with five traditional wards, each headed by a tribal chief. The tribal chiefs play a key role in community life in parallel with formal government authorities. The unemployment rate is about 45%. More than one third of the population age 15-34 years is HIV positive. Traditional healers predominate in health care, and are usually the first (and often the only) port of call for patients with FEP. A challenging- and novel- feature of FEP-INCET will be the identification of patients at the traditional healer practices. This preparatory study for FEP-INCET will be done in one of the five wards of Vulindlela. In this ward there are 5 traditional healers, two health clinics, no general practitioners, and no hospitals. We will pilot screening for FEP at the five traditional healer and two clinic practices;translate and adapt assessments for use in the isiZulu language and the local culture;and build the capacity at the University of KwaZulu-Natal needed to implement the study. After completing this work, we will prepare an R01 application for the FEP-INCET study.
This study will do the preparatory work required to launch the first ever study of the incidence, course and treatment of first-episode psychoses in an African setting. Whereas most previous studies in Africa have relied upon hospital admissions, this study will include those who seek help from informal and formal community practitioners. We believe that it will be transformative for global mental health, by opening pathways to research and treatment in Africa, and broadening our understanding of the range and frequency of psychotic disorders across the globe.
