PSYchosis MAPping in kwaZulu-Natal (PSYMAP-ZN)

Lead Research Organisation: University of Exeter

Abstract

PSYMAP-ZN is a collaborative 3-year study of psychotic illness in South Africa between the University of KwaZulu-Natal and the University of Exeter. Building on a very successful pilot study in the same region, we aim to produce new evidence that will help to answer some of the following questions:- How common is psychosis in this population?- What individual factors, and especially what socioeconomic and environmental factors, increase a person's risk for psychosis in this context?- How do these individual and environmental risk factors impact the illness itself?- How do people with psychosis and their families and caregivers seek help in this community and what role do informal providers such as traditional health practitioners play in this pathway to care? Importantly, we are asking these questions because there is very little research evidence on psychosis from low- and middle-income countries, especially within Sub-Saharan Africa. Also, we know that formal health and mental health services for people with severe mental disorders such as psychosis are generally inadequate and often inaccessible within this under-resourced region. We also know that people with psychotic symptoms living in especially rural and remote areas, where mental health expertise is often unavailable, very often consult traditional health practitioners seeking help and care.

Technical Summary

PSYMAP-ZN is a 3-year epidemiological study of psychosis in South Africa and a collaboration between the Universities of KwaZulu-Natal and Exeter. Building on our successful INCET pilot study in the same region, we aim to identify all incident cases of psychosis within Msunduzi Municipality in KwaZulu-Natal Province over a 2-year period. In our pilot study we developed an effective strategy to collaborate with traditional health practitioners in case identification and we will further develop this approach. We will recruit 240 cases and 240 age and gender matched controls into a case-control study and evaluate psychopathology, individual and neighbourhood level factors associated with psychosis risk and presentation. We will utilise innovative spatial epidemiological (GIS) methods to characterise the socioeconomic and physical environment and map the distribution of incident cases across varying neighbourhoods within the catchment area (e.g. varying by urban/rural, population density, socioeconomic status, levels of crime, and amount of green space). We will use novel virtual reality experiments in a subsample of 75 cases and 75 controls to evaluate symptom and physiological responses to simulated virtual environments - to determine whether this method can aid diagnosis as well as our understanding of risk factors (such as history of childhood trauma). Finally, we will explore the help-seeking behaviours and pathways to care of people with psychosis and their carers using quantitative, spatial and qualitative methods. Our findings will contribute substantially to the very limited evidence-base on psychosis epidemiology, the impact of the environment on psychosis, and help-seeking behaviours and pathways to care of people with psychosis in LMIC settings. In particular our findings will inform the development of appropriate and effective services for this vulnerable population and produce a model for successful collaboration between formal and informal providers