Treatment Seeking Behavior of Mentally ill Patients in a Rural Area: A Cross-sectional Study
Author(s): Pragya Sharma, AK Vohra, H Khurana
Vol. 32, No. 4 (2007-10 - 2007-12)
ISSN No. 0970-0218
Pragya Sharma, AK Vohra1, H Khurana1
The World Bank report (1993) revealed that the disability
adjusted life years (DALY) loss due to neuropsychiatric
disorders is much higher than diarrhea, malaria, worm
infestations and tuberculosis if taken individually.
Constant efforts are being put in by the government
to develop health programmes and services for the
people to attain highest possible levels of health and this
applies to mental health also. The mental health facilities
are nearly non-existent in rural areas with the prevalence
being almost same in rural and urban areas.1 Despite
decentralization of Mental Health Programme, when
there is no availability of specialist services in urban
areas, then to expect these services in rural areas is
only a dream. Even at places where these services are
available, these are often underutilized due to several
constraints like being distantly located or attached with
stigma.2
Thus it becomes important to understand the preferences
people make for treatment of mental disorders to ensure
proper utilization of the services.
This study was conducted to find out the treatment
seeking behavior of patients suffering from mental
illnesses in a rural area.
Materials and Methods
The present study is a cross-sectional study which was
carried out in Beri block which is attached as a field
practice area to department of Community Medicine,
PGIMS, Rohtak.
Sampled population in the area selected was 20,534.
The sample population spread over ten randomly
selected villages in the block. The sample was selected
by stratified random sampling METHOD selecting every
third house in the area. A key informant was identified
in each house and was subjected to a screening test
for presence of mental illness in any of the family
members. The purpose of interview was explained
and the confidentiality of information was also ensured
before commencing the interview. The diagnoses for
mental illness was further confirmed using a WHOaccredited
tool; SCAN (Schedule for Clinical Assessment
on Neuropsychiatry) and later the response regarding
treatment seeking behavior was studied on a pre-tested
semi structured schedule. The data were collected and
analyzed using appropriate statistical tests.
Results and Discussion
A prevalence rate of 30.1 per thousand was calculated.
Of the total 188 cases identified, only 136 resorted to
treatment of one or the other kind.
Majority (36.2%) of patients accounted their illness to
physical reasons followed by supernatural (16.5%) and
mental (13.3%) reasons. The reason for selecting a
particular modality depends on the concept and attitude
related to the cause of illness as has been observed by
others also.3,4 The patients who attributed their illness to
supernatural or physical causes did not seek help from
health care professionals. On the contrary, attributing the
illness to a rational cause only brought the patient to the
rational treatment.2 Perception of illness and attributing it
to a particular cause was a significant factor in selecting
the modality of treatment on applying statistical tests.
(P < 0.05)
Magico-religious system (MRS) was opted by 52 (38.2%)
of patients followed by 42 (30.9%) who opted for alternative
medicine, 39 (28.6%) selected general practitioner/PHC
facility for treatment whereas only 40 (29.4%) availed
specialist services from a psychiatrist. Most common
reason for selecting MRS was faith in the system (28.9%).
Specialist services were selected by most (30%) only after
referral from other facilities [Table 1]. Similar findings have
been observed by others also.4
Sources of information for treatment
Most (47.8%) of the patients contacting a psychiatrist
for treatment were referred by an old patient or relative
benefited from the system followed by a doctor or
faith healer (37.1%) and media (14.7%) [Table 2]. The
observations were found to be statistically significant
implying the direct role of social networking in the
decision making regarding the selection of modality of treatment. The degree of interconnectedness of social
networks influences the treatment seeking behavior has
been observed by others also.5
Table 1: Reasons for seeking treatment from various modalities
Reasons
Magico-religious
system (n=52)
Alternative
medicine (n=42)
Physician/PHC
facility (n=39)
Psychiatrist
(n=40)
Faith in the system/ modality
15 (28.9)
2 (4.8)
3 (7.7)
8 (20)
Effective treatment
9 (17.3)
4 (9.5)
10 (25.6)
7 (17.5)
Less expensive
3 (5.77)
4 (9.5)
10 (25.6)
0
Reputation of healer
0
8 (19)
0
0
Easy accessibility
0
14 (33.3)
2 (5.13)
0
Recommendation/decision maker’s choice
6 (11.5)
5 (11.9)
3 (7.69)
12 (30)
Referral
7 (13.5)
5 (11.9)
5 (12.8)
13 (32.5)
Belief in aetiology
12 (23.1)
0
6 (15.4)
0
Total
52
42
39
40
Table 2: Sources of information for treatment
Source
No. of patients (n = 136)
Old patient*
34 (25)
Relative*
31 (22.8)
Printed matter**
12 (8.8)
Electronic media**
08 (5.9)
Doctor***
26 (19.1)
Faith healers***
18 (13.2)
Others (health workers,
Aanganwadi workers etc.)***
07 (5.1)
Total
136 (100)
*Category 1 (P<0.01, highly significant), **Category 2, ***Category 3
References
- Aggarwal ML. Mental health care of rural population in India.
J Mental Health Hum Behav 1998:5-10.
- Banerjee G. Help Seeking behavior and belief system.
Indian J Soc Psychiatry 1997;13:61-4.
- Kessler RC, Olfson M, Berglund PA. Patterns and predictors
of treatment contact after first onset of psychiatric disorders.
Am J Psychiatry 1998;155:62-9.
- Tiwari SC, Sitholey P, Sethi BB. Mental health Care:
Perception and experiences of rural population I Uttar
Pradesh- a brief report. Indian J Psychiatry 1999;41:37-41.
- Chadda RK, Aggarwal V, Chandra M. Help seeking behavior
of the psychiatric patients before seeking care at a mental
hospital. Intern J Soc Psychol 2001;47:71-8.
Department of Community Medicine, Maulana Azad Medical
College, New Delhi – 110 002, (1)Department of Psychiatry,
Pt BD Sharma, PGIMS, Rohtak, India
Correspondence to:
Dr. Pragya Sharma,
C-704, Vikas Puri, New Delhi – 110 018, India.
E-mail: pragyarun308(at)yahoo.com
Received: 14.08.06
Accepted: 05.02.07
ISSN No. 0970-0218
Pragya Sharma, AK Vohra1, H Khurana1
The World Bank report (1993) revealed that the disability adjusted life years (DALY) loss due to neuropsychiatric disorders is much higher than diarrhea, malaria, worm infestations and tuberculosis if taken individually. Constant efforts are being put in by the government to develop health programmes and services for the people to attain highest possible levels of health and this applies to mental health also. The mental health facilities are nearly non-existent in rural areas with the prevalence being almost same in rural and urban areas.1 Despite decentralization of Mental Health Programme, when there is no availability of specialist services in urban areas, then to expect these services in rural areas is only a dream. Even at places where these services are available, these are often underutilized due to several constraints like being distantly located or attached with stigma.2
Thus it becomes important to understand the preferences people make for treatment of mental disorders to ensure proper utilization of the services.
This study was conducted to find out the treatment seeking behavior of patients suffering from mental illnesses in a rural area.
Materials and Methods
The present study is a cross-sectional study which was carried out in Beri block which is attached as a field practice area to department of Community Medicine, PGIMS, Rohtak.
Sampled population in the area selected was 20,534. The sample population spread over ten randomly selected villages in the block. The sample was selected by stratified random sampling METHOD selecting every third house in the area. A key informant was identified in each house and was subjected to a screening test for presence of mental illness in any of the family members. The purpose of interview was explained and the confidentiality of information was also ensured before commencing the interview. The diagnoses for mental illness was further confirmed using a WHOaccredited tool; SCAN (Schedule for Clinical Assessment on Neuropsychiatry) and later the response regarding treatment seeking behavior was studied on a pre-tested semi structured schedule. The data were collected and analyzed using appropriate statistical tests.
Results and Discussion
A prevalence rate of 30.1 per thousand was calculated. Of the total 188 cases identified, only 136 resorted to treatment of one or the other kind.
Majority (36.2%) of patients accounted their illness to physical reasons followed by supernatural (16.5%) and mental (13.3%) reasons. The reason for selecting a particular modality depends on the concept and attitude related to the cause of illness as has been observed by others also.3,4 The patients who attributed their illness to supernatural or physical causes did not seek help from health care professionals. On the contrary, attributing the illness to a rational cause only brought the patient to the rational treatment.2 Perception of illness and attributing it to a particular cause was a significant factor in selecting the modality of treatment on applying statistical tests. (P < 0.05)
Magico-religious system (MRS) was opted by 52 (38.2%) of patients followed by 42 (30.9%) who opted for alternative medicine, 39 (28.6%) selected general practitioner/PHC facility for treatment whereas only 40 (29.4%) availed specialist services from a psychiatrist. Most common reason for selecting MRS was faith in the system (28.9%). Specialist services were selected by most (30%) only after referral from other facilities [Table 1]. Similar findings have been observed by others also.4
Sources of information for treatment
Most (47.8%) of the patients contacting a psychiatrist for treatment were referred by an old patient or relative benefited from the system followed by a doctor or faith healer (37.1%) and media (14.7%) [Table 2]. The observations were found to be statistically significant implying the direct role of social networking in the decision making regarding the selection of modality of treatment. The degree of interconnectedness of social networks influences the treatment seeking behavior has been observed by others also.5
Table 1: Reasons for seeking treatment from various modalities
| Reasons | Magico-religious system (n=52) |
Alternative medicine (n=42) |
Physician/PHC facility (n=39) |
Psychiatrist (n=40) |
|---|---|---|---|---|
| Faith in the system/ modality | 15 (28.9) | 2 (4.8) | 3 (7.7) | 8 (20) |
| Effective treatment | 9 (17.3) | 4 (9.5) | 10 (25.6) | 7 (17.5) |
| Less expensive | 3 (5.77) | 4 (9.5) | 10 (25.6) | 0 |
| Reputation of healer | 0 | 8 (19) | 0 | 0 |
| Easy accessibility | 0 | 14 (33.3) | 2 (5.13) | 0 |
| Recommendation/decision maker’s choice | 6 (11.5) | 5 (11.9) | 3 (7.69) | 12 (30) |
| Referral | 7 (13.5) | 5 (11.9) | 5 (12.8) | 13 (32.5) |
| Belief in aetiology | 12 (23.1) | 0 | 6 (15.4) | 0 |
| Total | 52 | 42 | 39 | 40 |
Table 2: Sources of information for treatment
| Source | No. of patients (n = 136) |
|---|---|
Old patient* |
34 (25) |
Relative* |
31 (22.8) |
Printed matter** |
12 (8.8) |
Electronic media** |
08 (5.9) |
Doctor*** |
26 (19.1) |
Faith healers*** |
18 (13.2) |
| Others (health workers, Aanganwadi workers etc.) *** |
07 (5.1) |
| Total | 136 (100) |
*Category 1 (P<0.01, highly significant), **Category 2, ***Category 3
References
- Aggarwal ML. Mental health care of rural population in India. J Mental Health Hum Behav 1998:5-10.
- Banerjee G. Help Seeking behavior and belief system. Indian J Soc Psychiatry 1997;13:61-4.
- Kessler RC, Olfson M, Berglund PA. Patterns and predictors of treatment contact after first onset of psychiatric disorders. Am J Psychiatry 1998;155:62-9.
- Tiwari SC, Sitholey P, Sethi BB. Mental health Care: Perception and experiences of rural population I Uttar Pradesh- a brief report. Indian J Psychiatry 1999;41:37-41.
- Chadda RK, Aggarwal V, Chandra M. Help seeking behavior of the psychiatric patients before seeking care at a mental hospital. Intern J Soc Psychol 2001;47:71-8.
Department of Community Medicine, Maulana Azad Medical College, New Delhi – 110 002, (1)Department of Psychiatry, Pt BD Sharma, PGIMS, Rohtak, India
Correspondence to:
Dr. Pragya Sharma,
C-704, Vikas Puri, New Delhi – 110 018, India.
E-mail: pragyarun308(at)yahoo.com
Received: 14.08.06
Accepted: 05.02.07