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Outcomes of people with psychotic disorders in a community-based rehabilitation programme in rural India

  • Sudipto Chatterjee (a1), Aravind Pillai (a2), Sumeet Jain (a3), Alex Cohen (a3) and Vikram Patel (a3)...
Abstract
Background

There is little evidence of the feasibility, acceptability and impact of services for the care of people with psychotic disorders in low- and middle-income countries.

Aims

To describe the scaling up and impact of a community-based rehabilitation programme for people with psychotic disorders in a very-low-resource setting.

Methods

Longitudinal study of people with psychotic disorders who had been ill for an average of 8 years in a rural Indian community. All individuals received a community-based intervention package comprising psychotropic medications, psychoeducation, adherence management, psychosocial rehabilitation and support for livelihoods. The primary outcome was change in disability scores.

Results

The cohort consisted of 256 people with psychotic disorders (schizophrenia, bipolar affective disorder and other psychosis) of whom 236 people completed the end-point assessments (92%), with a median follow-up of 46 months. There were significant reductions (P<0.05) in the levels of disability for the cohort, the vast majority (83.5%) of whom engaged with the programme. On multivariate analyses, lower baseline disability scores, family engagement with the programme, medication adherence and being a member of a self-help group were independent determinants of good outcomes. Lack of formal education, a diagnosis of schizophrenia and dropping out of the programme were independent determinants of poor outcomes.

Conclusions

Community-based rehabilitation is a feasible and acceptable intervention with a beneficial impact on disability for the majority of people with psychotic disorders in low-resource settings. The impact on disability is influenced by a combination of clinical, programme and social determinants.

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Copyright
Corresponding author
Professor Vikram Patel, Sangath Centre, Porvorim, Goa, India 403521. Email: vikram.patel@lshtm.ac.uk
Footnotes
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This programme was partly supported by the Sir Dorabji Tata Trust, a registered charity in Mumbai, India. V.P. is supported by a Wellcome Trust Senior Clinical Research Fellowship in Tropical Medicine.

Declaration of interest

S.C. and V.P. are associated with a randomised controlled trial evaluation of the community-based rehabilitation intervention described in this paper, funded by the Wellcome Trust.

Footnotes
References
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Outcomes of people with psychotic disorders in a community-based rehabilitation programme in rural India

  • Sudipto Chatterjee (a1), Aravind Pillai (a2), Sumeet Jain (a3), Alex Cohen (a3) and Vikram Patel (a3)...
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