Causal attributions, pathway to care and clinical features of first-episode psychosis: a South African perspective

Int J Soc Psychiatry. 2011 Sep;57(5):538-45. doi: 10.1177/0020764010390199. Epub 2010 Nov 15.


Background: Causal belief systems and help-seeking practices may impact on pathway to care and features of first-episode psychosis (FEP) that have prognostic value. This is particularly relevant in South Africa where many people subscribe to traditional belief systems and consult traditional healers.

Aim: To evaluate the relationship between causal attributions and pathway to care and features of FEP that have prognostic value.

Method: We tested associations between causal attributions and pathway to care and duration of untreated psychosis (DUP), age of onset, PANSS-rated positive, negative and general symptoms and depressive symptoms (Calgary Depression Scale) in a sample of 54 FEP patients.

Results: Spiritual attribution of cause (49% of patients) was associated with long DUP, while consultation with a traditional healer (39% of patients) was associated with long DUP and high negative symptoms. Only 19% had consulted a psychiatrist. Seventy nine per cent (79%) were referred to hospital by family, police were involved in 44% of admissions, and 81% were admitted involuntarily.

Conclusions: Spiritual attributions of cause and previous consultation with traditional healers may delay entry to psychiatric care and thereby negatively impact on prognosis of FEP. This highlights the importance of mental health education and developing a positive collaborative relationship with traditional healers, especially in low- and middle-income countries.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Female
  • Humans
  • Interviews as Topic
  • Male
  • Medicine, African Traditional / statistics & numerical data
  • Middle Aged
  • Patient Acceptance of Health Care / psychology*
  • Psychotic Disorders / etiology*
  • Psychotic Disorders / physiopathology
  • Psychotic Disorders / therapy*
  • South Africa
  • Young Adult