A comprehensive journal club presentation regarding a research published in pakistan on schizophrenia

1. By
Saad Bin Zafar Mahmood

2. Perceptions about the cause of Schizophrenia
and the subsequent help seeking behaviour
in a Pakistani Population - A Cross-sectional
survey
Zafar SN, Syed R, Tehseen S, Gowani SA, Waqar S, Zubair A, Yousaf W,
Zubairi AJ & Naqvi H
BMC Psychiatry 2008, 8:56

3.  Original Research article
 Published in BioMed Central Psychiatry
 Date of publication : 17th July 2008
 Main corresponding author : Syed Nabeel
Zafar - AKU

4.  Background & Objectives of study
 Methodology
 Results
 Discussion & Conclusion
 References

5.  What is Schizophrenia
Severe mental illness characterized by
fundamental disturbances in thoughts,
emotions and perceptions.
 8th leading cause of DALYS in age group of
15-44 years (Rossler et al., 2005)

6.  Wrong perceptions regarding the cause of
schizophrenia & various stigmata
 Delayed treatment
 Studies show favorable prognosis with good
family and social support, early diagnosis
and management

7.  To determine the perceptions regarding the
etiology of schizophrenia and the
subsequent help seeking behaviour

8.  Questionnaire based cross sectional study
 Conducted at Agha Khan University Hospital
between 18th to 22nd December 2006 (5 days)
 Three areas were chosen
 Community Health Centre (CHC)
 Consulting Clinics (CC)
 Inpatient family waiting areas

9.  Sample
 Total of 404 participants
 Culturally diverse populations
 Inclusion / Exclusion criteria applied
Inclusion Exclusion
• all individuals • No medical staff or medical
above 18 years student was interviewed
• Attendants of psychiatric
patients also excluded
• People unable to read urdu
were excluded
• anyone under the age of 18
years was excluded

10.  Questionnaire
 Developed in Urdu
 Three sections
 Section 1 - Demographic details
 Age,
 sex,
 marital status,
 education level,
 religion,
 religious inclination,
 Profession
 Family System (Joint or Nuclear)

11. Section 2 Questionnaire
 Asking the participant views regarding the possible causes
for a case of schizophrenia
 22 choices were given
 Four point likert scale used ( main reason, possible
reason, not likely a reason and definitely not a reason)
 Lastly asked to state the most important cause

12. Section 3 Questionnaire
 Asking the participant regarding the probable approach they
would employ if they had a relative with a psychotic problem
 15 interventional choices were given
 Three point likert scale useed (definitely do, will
consider doing and will not do at all)
 Lastly asked to state the most important step they would
take

13.  Ethical considerations
 Research was in accordance with the Helsinki
declaration
 Participants were verbally explained the nature
of research, its advantages and disadvantages
 Confidentiality maintained and no such
information was recorded
 Written informed consent was taken

14.  Results of the demographic profile
 Mean age = 31.35 ± 9.93 years
 77 % males and 23 & females
 Majority of participants well educated (62 %
holding bachelor’s degree
 Majority were Muslim (92 %)

15. Before Categorization After Categorization
Cause of Schizophrenia Cause of Schizophrenia
Primary level of
education 8.4
22.3
12.1
54.0 13.6 38.4
Females 13.4
10.1
Nuclear family 15.6
Age greater than 47
Biological Cause
Mental illness Low IQ Religious Cause
God's will Others Personality Issue
Psycho-social Stressor
Other Social Issues and Superstitious beliefs

16. Before Categorization After Categorization
Help seeking behaviour Help seeking behaviour
10.6 3
26.7
Males
14.9
Young (17-26 years) 40.6
Very religious 52.2
6.7Less educated Females
7.4 19.3
8.9 9.7Nuclear family
Joint family system
Moderately religious
Visit Psychiatrist Professional Medical help
Visit Family Physician Religious Remidies
Do nothing No Help seeking behaviour
Pray Social alterations
Offer sadqa / Khirat Magic and Excorcism steps
Others

17.  Well known that the general population of
especially the developing countries
attributes non biological beliefs to the cause
of schizophrenia
 As a result there is an increase in DUP
 DUP is a very important factor of prognosis

18.  This study shows that those who gave
biological causes for the disease were 3
times more likely to seek professional
medical help.
 Relatives of psychiatric patients have
different beliefs than that of general
population (Angermeyer et al., 2003)

19.  Study shows that there is increased
awareness in people living in nuclear family
 Underreporting of the disease due to lack of
help seeking behaviour
 As a result unable to design nationwide
strategies

20.  Limitations / Biasness in this study
 The sample population is not representative
of the Pakistani population
 Sample is highly educated
 Study was conducted in a hospital setting
 Likert scale used always have a tendency of bias

21.  The study gives a good impression
regarding perceptions of pakistanis
 It shows that to decrease the burden of
schizophrenia more awareness have to be
created

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