INTREPID II: protocol for a multistudy programme of research on untreated psychosis in India, Nigeria and Trinidad

Abstract

IntroductionThere are few robust and directly comparable studies of the epidemiology of psychotic disorders in the Global South. INTREPID II is designed to investigate variations in untreated psychotic disorders in the Global South in (1) incidence and presentation (2) 2-year course and outcome, (3) help-seeking and impact, and (4) physical health.MethodsINTREPID II is a programme of research incorporating incidence, case–control and cohort studies of psychoses in contiguous urban and rural areas in India, Nigeria and Trinidad. In each country, the target samples are 240 untreated cases with a psychotic disorder, 240 age-matched, sex-matched and neighbourhood-matched controls, and 240 relatives or caregivers. Participants will be followed, in the first instance, for 2 years. In each setting, we have developed and are employing comprehensive case-finding methods to ensure cohorts are representative of the target populations. Using methods developed during pilot work, extensive data are being collected at baseline and 2-year follow-up across several domains: clinical, social, help-seeking and impact, and biological.Ethics and disseminationInformed consent is sought, and participants are free to withdraw from the study at any time. Participants are referred to mental health services if not already in contact with these and emergency treatment arranged where necessary. All data collected are confidential, except when a participant presents a serious risk to either themselves or others. This programme has been approved by ethical review boards at all participating centres. Findings will be disseminated through international conferences, publications in international journals, and through local events for key stakeholders.

The Impact of Coronavirus Disease 2019 on People with and without Severe Mental Illness in Tamil Nadu, India

“…A detailed research protocol for INTREPID II has been published elsewhere. [4] Out of 225 recruited participants, 158 cases and their respective controls completed the COVID-19 survey between July 26 and December 11. These were the total number of participants that we were able to contact during this period.…”

Course of psychotic experiences and disorders among apprentice traditional health practitioners in rural South Africa: 3-year follow-up study

“…The lack of diversity of study populations and research settings means that many relevant contextual variations remain undetected. Therefore, in order to improve our understanding of psychosis, it is essential to examine a wider array of social and cultural contexts ( 4 ). In addition, when sociocultural settings are not taken into full account, this may limit the effectiveness of interventions, undermine indigenous knowledge and support systems, and advance the medicalization of social suffering ( 9 – 12 ).…”

“…The influence of culture is inevitably linked with the experience, interpretation and course of what the biomedical model understands to be psychotic symptoms. Theories on psychosis, however, are biased toward Western, urban, high-income countries, as only a small fraction of research on psychosis has been conducted in low-and middle-income countries (LMICs, see list of abbreviations) (3,4). Research done in LMICs has been based mainly on persons who visit formal mental health services, while many individuals with mental health problems in LMICs would seek help from traditional health practitioners (THPs) (5)(6)(7)(8).…”

“…of psychosis, it is essential to examine a wider array of social and cultural contexts (4). In addition, when sociocultural settings are not taken into full account, this may limit the effectiveness of interventions, undermine indigenous knowledge and support systems, and advance the medicalization of social suffering (9)(10)(11)(12).…”

The Africa Ethics Working Group (AEWG): a model of collaboration for psychiatric genomic research in Africa

“…Over the last decade, research collaborations in mental health between the Global North and South have proliferated both between (North-South) and within (South-South) groups leading to rapid growth in the understanding of health and illness across diverse settings ( Breuer et al ., 2019 ; Lasalvia et al ., 2015 ; Ramsay et al ., 2016 ; Ramsay, 2015 ; Roberts et al ., 2020 ; Thornicroft & Semrau, 2019 ; University of Cape Town, 2014 ). This has seen increased inclusion of the Global South in rapidly evolving fields such as psychiatric genomics and neuroscience with a promise to improve health outcomes.…”