A Cultural Paradox: Understanding the Experience of Living with Schizophrenia in Sub-Saharan Africa

BACKGROUND: Although improvements have been made in understanding schizophrenia, the influence of culture on its course and outcome is still unclear. Scholars agree that cultural factors play a role in the diagnosis, treatment and lived experience of people with schizophrenia. Studies concluded that people in developing settings had ‘better outcomes’ compared with their counterparts from developed countries. This poster will discuss findings from a realist review on the links between social context and treatment availability for people experiencing schizophrenia in SSA.

METHODS: Search strategy used the PICO approach and MeSH terms. Traditional databases revealed a paucity of literature. Specialist databases like WHO HINARI, African Index Medicus (AIM), and African Journals Online revealed more studies.

RESULTS: Total papers selected for this realist review by all 3 reviewers (n = 85). Results revealed four themes namely, the role of traditional healers; role of families; treatment access; and perceived source of psychosis. Examples of articles included clinical outcome of schizophrenia in Ethiopia, popular conceptions of schizophrenia in Cape Verde, social outcome among Nigerian outpatients, and the prevalence of Schneider’s first-rank symptoms in Zulu patients.

DISCUSSION: Explanatory models on help-seeking behaviour revealed that understanding cultural factors can lead to better outcomes in the treatment for schizophrenia in SSA. Integrating traditional medicine could improve choice and treatment access. Literature revealed a need for research from other health professionals (e.g. mental health nurses).

CONCLUSION: This study revealed that treatment pathways best suited to the cultural setting of the patient need to be integrated into care planning.