Systematic mapping on availability, extent and distribution of mental health research in Malawi.

Background: Mental health research is essential in the implementation of evidence-based interventions. This can be impeded by unavailability or limited access to local evidence in low- and middle-income countries (LMICs) such as Malawi. Aim: The aim of this systematic mapping was to describe the availability, extent and distribution of mental health research conducted in Malawi. Setting: The study was conducted at Kamuzu University of Health Sciences in Malawi. Methods: A systematic search of four electronic databases from inception to September 2021 was carried out. All published and unpublished mental health studies in all languages were eligible for inclusion. Studies were screened against inclusion and exclusion criteria, and data were extracted, analysed and presented in tables and as a narrative synthesis. Results: Cross-sectional studies (33.6%, n = 76) were found to be the most common study design for mental health research in Malawi. More studies were conducted on women (21.2%, n = 48) compared to men (1.3%, n = 3). Mental health research was concentrated in the southern region of the country (44.8%, n = 120) and in the three cities of Lilongwe (17.9%, n = 48), Blantyre (16.4%, n = 44) and Zomba (9.0%, n = 24). Conclusion: This systematic mapping suggests that there are few studies on mental health in Malawi which are not equally distributed across the country. There is a pressing need to conduct more mental health research using robust designs across disciplines. Contribution: Research on mental health is urgently needed to produce culturally acceptable data in Malawi.

Clinical Predictors of Duration of Untreated Psychosis: Exploring Psychosocial and Clinical Predictors of Duration of Untreated Psychosis in First-Episode Psychotic Patients in Mzuzu, Malawi.

Introduction: The duration of untreated Psychosis (DUP) is a modifiable factor in the management and outcome of patients with psychosis. However, its predictive factors have not been studied much in Malawi. Our study was aimed at determining the psychosocial and clinical predictors of DUP in first episode psychosis in Malawi. Method: A quantitative cross-sectional study, using secondary data from an early intervention study project was done in Mzuzu, Malawi. We analysed 140 adult participants enrolled in early intervention project in 2010. Data was collected using abstraction sheet to target predictive factors. We conducted univariate and multivariate logistic regression at confidence interval of 95%. We described the mean DUP, and looked at relationship of clinical and psychosocial factors with DUP. Results: Most participants were male (60%, n=84) and single (51.4%, n=72). The median age of male participants was 31 years (Range=18 to 60), lower than females 35 years (Range=18 to 65). (what were the numbers of females). The majority of the participants' highest education level was secondary school (63.6%, n=89), and most had DUP of ≥ 6 months (74%, n=103). We found mean DUP of 42 months (SD= ±71). Employment status, diagnosis of schizophrenia (OR=10.93, 95% C.I 3.08-38.89), and negative symptoms of psychosis were associated with DUP of ≥ 6 months. Public self-consciousness and social quality of life were associated with long DUP. Conclusion: Our study shows psychosocial and clinical factors that predict long DUP in Malawi. This highlights the need to target these factors when working on first episode psychosis for a better outcome.

Association between referral source and duration of untreated psychosis in pathways to care among first episode psychosis patients in Northern Malawi.

AIMS: To examine the association between referral source and duration of untreated psychosis (DUP) and explore determinants of referral source; when adjusting for pathways to care, positive and negative symptoms, diagnosis and socio-demographic characteristics. METHODS: A total of 140 subjects with first episode psychosis (FEP) were enrolled from a pilot early intervention service for psychosis in Northern Malawi between June 2009 and September 2012. Logistic regression analyses were used to quantify the associations between variables of interest. RESULTS: Age ranged between 18 and 65 at assessment, with median, 33. Median DUP was 12.5 months. First contact did not independently determine DUP. Long DUP (>6 months) was associated with referral from community based volunteer (CBV) or traditional healer (TH), a unit increase in severity of negative symptoms and having schizophrenia, which was also associated with referral from CBV or TH. Additionally, being unemployed was associated with referral from CBV or TH. However, a unit increase in the number of times religious advice (RA) was sought, GP was contacted and severity of positive symptoms was associated with referral by GP. CONCLUSIONS: Mental health awareness is justified for this population and collaboration with THs in identifying and treating patients with psychosis may help reduce treatment delays. Access to mental health services ought to improve, particularly for the unemployed group. Future studies should consider adjusting for referral source when ascertaining first contact source as a predictor of DUP.

Effects of socio-demographic characteristics, premorbid functioning, and insight on duration of untreated psychosis in first-episode schizophrenia or schizophreniform disorder in Northern Malawi.

AIM: Long duration of untreated psychosis (DUP) is prevalent and has been shown to be associated with poorer prognosis. Thus, knowledge of its determinants may help to target early interventions to reduce DUP on the needed population. Previous studies seeking to understand determinants of DUP have been inconclusive. Therefore, this study aimed to investigate the effects of socio-demographic characteristics, premorbid functioning, and insight on DUP in patients with first-episode schizophrenia or schizophreniform disorder. METHODS: This cross-sectional study recruited 110 subjects (aged 18-65) during a pilot early intervention service for psychosis in Northern Malawi, between June 2009 and September 2012. Short DUP was defined as ≤6 months, whereas long DUP was defined as >6 months. Unadjusted and adjusted analyses were performed to identify determinants of DUP. RESULTS: Of the 110 subjects, 99 (90%) had schizophrenia. Median DUP was 27.5 months, while mean (SD) DUP was 71.24 (92.32) months. In addition, at least 75% had long DUP, which was associated with lower level of education, poor insight, younger age at onset, and at least one parent deceased. CONCLUSIONS: Long DUP is prevalent in Northern Malawi. Thus, early interventions to reduce DUP are warranted in this population. Although having at least one parent deceased predicted long DUP in this study, this remains speculative because factors, such as timing of parents' death and grief reactions of the patients were not assessed. Therefore, further investigations incorporating these factors are needed to ascertain this result.

Rate of and time to symptomatic remission in first-episode psychosis in Northern Malawi: A STROBE-compliant article.

Although longer duration of untreated psychosis (DUP) is associated with poor response to antipsychotic treatment, it remains unclear whether it independently influences time to symptomatic remission in first-episode psychosis (FEP). This study examined rate of symptomatic remission, and explored if DUP, premorbid functioning, global functioning, insight and socio-demographic characteristics were independently associated with time to symptomatic remission in FEP.This prospective study enrolled 126 FEP patients (aged 18-65) between June 2009 and September 2012. Subjects were followed-up monthly over 18 months after they had received antipsychotic medication. Remission in positive and negative symptoms was defined as in the Remission in Schizophrenia Working Group (RSWG) criteria. Subjects were defined as "in symptomatic remission" if they remitted in both negative and positive symptoms. At baseline, the following explanatory variables were measured: socio-demographic characteristics; DUP as short (≤5 months) and long (>5 months); premorbid functioning as deteriorating, stable poor, and stable good according to Cannon-Spoor Premorbid Adjustment Scale; global functioning as "worst (1-10) to serious (41-50)" and "moderate (51-60) to superior (91-100)," according to the Global Assessment of Functioning Scale; and insight as poor (≤8) and good (≥9) according to the Insight Scale (Birchwood). Univariate and multivariable analyses were used to generate results.Out of 126 subjects, 98 (78%) completed follow-up, of which 70 (71.4%) achieved symptomatic remission within mean duration of 8.05 (4.54) months. Besides, having long DUP and separated/divorced/widowed (adjusted hazard ratio [aHR] = 0.07, 95%CI = [0.01, 0.46]), long DUP and poor insight (aHR = 0.18, 95%CI = [0.04, 0.89]), poor insight and separated/divorced/widowed (aHR = 0.09, 95%CI = [0.01, 0.70]), deteriorating premorbid functioning (aHR = 0.47, 95%CI = [0.23, 0.97]), family history of psychiatric disorders (aHR = 0.52, 95%CI = (0.30, 0.93]), and being male (aHR = 0.47, 95%CI = [0.24, 0.92]) delayed symptomatic remission.These results propose that psychological interventions and social support for mental health problems are warranted and may enhance better response to antipsychotic medications among separated/divorced/widowed patients with long DUP or poor insight, and poor insight patients with long DUP. Deteriorating premorbid functioning, family history of psychiatric disorders and being male continue being important risk factors for poor odds of remission.