Ashok K. Malla - US grants

[unreadable] DESCRIPTION (provided by applicant): One of the most consistent findings in both cultural psychiatry and outcome research in schizophrenia is that outcomes of schizophrenia are better in developing countries than in developed ones. Yet, little is known about why this is the case. The proposed project is a first step towards building a sustained research program that will reveal the mechanisms underlying the cross-cultural variation in psychosis outcomes. Specifically, the project involves collaboration between leading schizophrenia research teams, with complementary strengths in culturally relevant schizophrenia research in India and pioneering first-episode psychosis research in Canada. Previous investigations of cross-cultural variation in outcomes of psychosis have often been limited by confounding factors such as differences in duration of untreated psychosis and treatments received. The proposed study avoids this pitfall by focusing on first-episode patients who have not been treated before. Over the proposed two-year funding period, a well characterized sample of patients with previously untreated first- episode psychosis will be followed in India and Canada and treatment interventions will be clearly defined. The premise of the pilot studies to be undertaken is that family factors positively impact the course of schizophrenia in India, buffering the toxic effects of untreated psychosis prior to detection and reinforcing the effects of treatment after detection. The specific hypotheses to be tested are (1) Duration of untreated psychosis will have a less detrimental effect on clinical outcomes in India than in Canada. Differences between family support available to patients in India and Canada will account for the less pernicious effect of delay in treatment. (2) Duration of untreated psychosis in India itself will be predicted by family factors such as previous family experience with mental illness and the type of family structure (nuclear versus extended). Individuals in extended families and in families with lower levels of prior experience with mental illness will have longer duration of untreated psychosis. (3) Family factors will significantly predict six-month and one-year clinical and occupational outcomes in India. Results will increase our understanding of what it is that families do that contributes to better outcomes in India. Such an understanding will lead to the development of culturally appropriate family interventions and strategies to reduce treatment delay in India. In the course of collaborating to conduct these pilot studies, the Indian site will also build its capacity to conduct long-term research in early psychosis. Such research can inform the development of policies and clinical services that can address the severe burden of schizophrenia on people in developing countries who face acute shortage of resources. PUBLIC HEALTH RELEVANCE: This study seeks to strengthen the research collaboration between a developed country, Canada and a developing country, India for the purpose of understanding why schizophrenia has different outcomes in different cultural settings. This project will increase the understanding of the role of families in seeking and facilitating treatment, and thus help the development of early intervention and family services. An important outcome of this project will be the building of culturally appropriate and sustainable research capacity in a developing country and thereby the improvement of services for people with schizophrenia across the world. [unreadable] [unreadable] [unreadable]

DESCRIPTION (provided by applicant): In cultural psychiatry and schizophrenia outcome research, it is consistently found that the outcomes of treated schizophrenia are better in developing countries than in developed ones. Yet, little is known about why this is so. It is not known whether this difference extends to all outcome domains or is limited to the select and narrowly defined clinical and functional outcomes that existing research has focused on. Given these significant knowledge gaps, the long-term goal of the proposed project is a sustained research program that will reveal the nature of and the mechanisms underlying cross-cultural variation in psychosis outcomes. Specifically, the project involves collaboration between two teams with complementary strengths in culturally relevant schizophrenia research in India and pioneering first-episode psychosis research in Canada. Previous investigations of cross-culturally varied psychosis outcomes have often been limited by confounding factors such as differences in the duration of untreated psychosis and treatments received. To avoid this pitfall, the proposed study will focus on patients with previously untreated first-episode psychosis in Chennai, India and Montreal, Canada who will receive clearly defined and similar treatment for two years. Key objectives are to investigate inter-site differences in a range of outcome domains and family factors and whether the differences in family factors contribute to variation in outcomes. Our premise is that the better outcomes of psychosis in India can be largely explained by the comparatively higher levels of family support available to persons with psychosis in India as compared to in developed countries such as Canada. The specific hypotheses of this study are: (1) Two years after treatment, the Indian patients will have better functional, subjective, and clinical outcomes than the Canadian ones. They will be likelier to be working or in school, report a better quality of life, and have higher and more sustained improvement in symptoms. They will also be likelier to stay engaged in and not drop out from treatment. (2) The Indian patients will be more likely to have family members involved in their treatment and enjoy higher levels of specific types of family support and involvement, both general psychological support and support specific to promoting treatment adherence and recovery. Further, family factors will mediate the inter-site variation in clinical outcomes. A combination of quantitative and qualitative research methods will be deployed. At both sites, qualitative methods will especially help understand how patients regard recovery and how family members and patients perceive the family's role in the lives of young people with psychosis. The project's findings will advance our understanding of the course of early psychosis in India; of cross-cultural variation in schizophrenia outcomes; and of how families contribute to better outcomes in India. This understanding will shape the development of culturally appropriate family and early intervention services in India and suggest strategies for improving schizophrenia outcomes in the West, thus alleviating (even if partially) the severe burden that schizophrenia imposes irrespective of cultural setting. PUBLIC HEALTH RELEVANCE: This study involves research collaboration between a developed country, Canada and a developing country, India for the purpose of understanding whether and why schizophrenia has different outcomes in different cultural settings. This project will increase our knowledge of the role of families in facilitating treatment, and thus help the development of early intervention and family services. Our findings will also shed light on how young persons with schizophrenia view and understand recovery and how families view their role in the treatment of schizophrenia.