Pathways to psychiatric care and factors associated with delayed help seeking behavior among psychiatric patients at Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia.

Abstract

Abstract Background: Neuropsychiatric disorders account for about 14%of the global burden of disease. Many people living with mental disorders delay seeking psychiatric care from formal health facilities. Various factors contribute to delayed health seeking behavior including lack of knowledge about psychiatric disorders remains a major barrier to mental health care. An understanding of the process to seek care by patients who experience episodes of mental disorders may determine how and where they received the needed treatment. This study aimed to understand the pathways that put people with mental disorders traversed for psychiatric services, particularly where these individuals will first seek treatment and the factors that influence such pathways. Method: A cross-sectional study was carried out with a total of 344 psychiatric patients visiting Saint Paul’s Hospital Millennium Medical College’s psychiatry outpatient department were enrolled in the study. Delayed health seeking behavior was assessed with WHO encounter form. The median duration used for delay of modern psychiatric services was 52.0 weeks. SPSSv.26 (SPSS for windows) was used for analysis and a multivariable logistic regression model was carried out. P value <0.05 was carried out for statistically significant for the final model. Results: The study revealed that (51.2%, n=171) of the study participants contacted psychiatric hospital directly while the rest (48.8%, n=163) pass through different caregivers to reach a psychiatric hospital. Among those who came indirectly, 28.4% of them initially contacted religious/traditional healers, 12.9% contacted nurses/health officers, and 7.4%other doctors. The median over all delay was 40.0 weeks (IQR=88 weeks).The prevalence of delayed health seeking behavior above 52 weeks was 110(32.9%). Multivariable logistic regression Models showed that respondents with the diagnosis of addiction (AOR=6.37, 95% CI 2.28 to 17.79) and homelessness (AOR=2.37, 95%CI 1.04 to 5.40) were significantly associated with delayed health seeking behavior for psychiatric services with p value less than 0.05. Conclusion: A significant proportion of patients were seeking care for their mental illness through different caregivers before coming to modern psychiatric care services. There is a need of early interventions should be done to help people seek care before different complications occur. viii This study magnified the need to expand mental health services to the community and also the collaborative work that has to be done with religious healers and other traditional healers. Further studies are needed to explore the pathways to psychiatric care.