Patient-reported outcome measures in early psychosis: A cross-cultural, longitudinal examination of the self-reported health and self-reported mental health measures in Chennai, India and Montreal, Canada

Neha Nair; Salomé Xavier; Daniel Rabouin; Greeshma Mohan; Thara Rangaswamy; Padmavati Ramachandran; Ridha Joober; Norbert Schmitz; Ashok Malla; Srividya N Iyer

doi:10.1016/j.schres.2024.03.006

Patient-reported outcome measures in early psychosis: A cross-cultural, longitudinal examination of the self-reported health and self-reported mental health measures in Chennai, India and Montreal, Canada

Schizophr Res. 2024 Mar 22:267:75-83. doi: 10.1016/j.schres.2024.03.006. Online ahead of print.

Authors

Affiliations

¹ Department of Psychiatry, McGill University, Montreal, Canada; Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Canada. Electronic address: neha.nair@mail.mcgill.ca.
² Department of Psychiatry, McGill University, Montreal, Canada; Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Canada. Electronic address: salome.xavier@mail.mcgill.ca.
³ Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Canada. Electronic address: daniel.rabouin.chum@ssss.gouv.qc.ca.
⁴ Schizophrenia Research Foundation, Chennai, India. Electronic address: greeshma@scarfindia.org.
⁵ Schizophrenia Research Foundation, Chennai, India. Electronic address: thara@scarfindia.org.
⁶ Schizophrenia Research Foundation, Chennai, India. Electronic address: padmavati@scarfindia.org.
⁷ Department of Psychiatry, McGill University, Montreal, Canada; Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Canada. Electronic address: ridha.joober@douglas.mcgill.ca.
⁸ Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Canada; Department of Population-Based Medicine, University Hospital Tübingen, Tübingen, Germany. Electronic address: norbert.schmitz@med.uni-tuebingen.de.
⁹ Department of Psychiatry, McGill University, Montreal, Canada; Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Canada. Electronic address: ashok.malla@mcgill.ca.
¹⁰ Department of Psychiatry, McGill University, Montreal, Canada; Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Canada. Electronic address: srividya.iyer@mcgill.ca.

PMID: 38520813
DOI: 10.1016/j.schres.2024.03.006

Abstract

Objective: Despite their acknowledged value, patient-reported outcome measures (PROMs) are infrequently used in psychosis, particularly in low-and middle-income countries. We compared ratings on two single-item PROMs, Self-Rated Health (SRH) and Self-Rated Mental Health (SRMH), of persons receiving similar early psychosis services in Chennai, India and Montreal, Canada. We hypothesized greater improvements in SRH and SRMH in the Chennai (compared to the Montreal) sample.

Methods: Participants (Chennai N = 159/168 who participated in the larger study; Montreal N = 74/165 who participated in the larger study) completed the SRH and SRMH during at least two out of three timepoints (entry, months 12 and 24). Repeated measures proportional odds logistic regressions examined the effects of time (baseline to month 24), site, and relevant baseline (e.g., gender) and time-varying covariates (i.e., symptoms) on SRH and SRMH scores.

Results: SRH (but not SRMH) scores significantly differed between the sites at baseline, with Chennai patients reporting poorer health (OR: 0.33; CI: 0.18, 0.63). While Chennai patients reported similar significant improvements in their SRH (OR: 7.03; CI: 3.13; 15.78) and SRMH (OR: 2.29, CI: 1.03, 5.11) over time, Montreal patients only reported significant improvements in their SRMH. Women in Chennai (but not Montreal) reported lower mental health than men. Higher anxiety and longer durations of untreated psychosis were associated with poorer SRH and SRMH, while negative symptoms were associated with SRH.

Conclusions: As hypothesized, Chennai patients reported greater improvements in health and mental health. The marked differences between health and mental health in Montreal, in contrast to the overlap between the two in Chennai, aligns with previous findings of clearer distinctions between mind and body in Western societies. Cross-context (e.g., anxiety) and context-specific (e.g., gender) factors influence patients' health perceptions. Our results highlight the value of integrating simple PROMs in early psychosis.

Keywords: Cross-cultural; First-episode psychosis; Patient-reported outcomes; Self-rated health; Self-rated mental health.