Researchers Present Initial Findings on Psychosis in a Global Context at HSPH Webinar

Researchers presented initial findings on the prevalence and treatment of psychosis in India, Nigeria, and Trinidad at a virtual event hosted by the Harvard T.H. Chan School of Public Health on Wednesday.

The principal investigators of the International Research Programme on Psychoses In Diverse Settings — professors at universities in England, Trinidad and Tobago, and Nigeria — spoke at the event.

Psychosis is characterized by loss of contact with reality, such as hallucinations or delusions.

“Psychotic disorders can be devastating, often associated with considerable suffering for individuals and families over long periods of time,” said Craig Morgan, an epidemiology professor at King’s College London.

Mortality rates for individuals with psychosis are three to four times higher than those without, and less than 20 percent of those with psychosis are able to sustain long-term employment, per Morgan.

Psychotic disorders are also more common than often assumed, he said — approximately 3 percent of the population is affected by psychosis, with the average onset of symptoms at age 30.

Due to the belief that psychotic disorders were “genetic neurodevelopmental disorders,” practitioners long assumed that cases of psychosis were consistent across the globe, explained Morgan. Recent studies have shown, however, that rates vary among populations.

Delayed understanding of such variability may be due to disparities in where researchers tend to conduct their studies, he said.

“Over 80 percent of the world's population lives in the Global South but less than 10 percent of research on psychotic disorders has been in these settings,” Morgan explained.

With INTREPID, Morgan and his colleagues seek to rectify that imbalance. The program’s objective is to improve access to care for patients with psychosis who live in the Global South.

Gerard Hutchinson, a psychiatry professor at the University of the West Indies in St. Augustine, shared initial findings on the differential prevalence of untreated psychosis in India, Nigeria, and Trinidad.

The length of time individuals with psychosis are untreated is far greater in India than in both Trinidad and Nigeria, he explained.

“The ability to contact services and seek help — for reasons that we hope to be able to identify — takes a much longer time in India,” Hutchinson said.

Oye Gureje, a psychiatry professor at University of Ibadan in Nigeria, also noted the correlations between physical health conditions and psychosis.

“Groups that report a high frequent use of cannabis are more likely to also be found to have a higher rate of incidents of psychosis,” he said. The rates of anemia and malnutrition were also significantly higher among people with psychosis than people without.

Gureje concluded by posing a question that INTREPID has brought to light: “To what extent can we bring about, or initiate, some changes that would bring these people to care much earlier than the case at the moment?”

Byron J. Good — a medical anthropology professor at Harvard Medical School who attended the webinar — said he hopes data collected by INTREPID will lead to improvements in treatment for people in the Global South.

“It is important because it tries to correct sampling methods to identify a more representative group of people, many of whom are untreated,” he said.