Researchers visited households in the Nyanza Province of Western Kenya where 1,158 adults were assessed for the presence of common mental disorders in the preceding month and psychotic symptoms during the past year. Participants were also given a list of 11 different stressful life events and asked to say which, if any, they had experienced in the last six months. Identical assessments were conducted in 2004 and again in 2013, of adults living in the same area of Nyanza Province.
The study, funded by the UK Department for International Development (DFID) and published in the International Journal of Environmental Research and Public Health, revealed a rise in the prevalence of one or more psychotic symptoms from 8 per cent in 2004 to 13.9 per cent in 2013 and an increase in the presence of two or more symptoms from 0.6 per cent in 2004 to 3.8 per cent in 2013.
This upward trend was accounted for by a striking increase in the prevalence of psychotic symptoms in women – 17.8 per cent in 2013 compared with 6.9 per cent in 2004. There was no significant change in men (10.6 per cent in 2013 and 9.4 per cent in 2004).
A significant relationship was found between increased risk of psychotic symptoms and life events, which included serious illness, injury or assault to a close relative, major financial crisis, bullying, violence in the home and running away from home.
When researchers accounted for gender in examining life events, they found that several individual events were associated with increased risk of having psychotic symptoms in females, including serious illness, injury or assault to self, bullying, violence at home and running away from home. None of the same or other life events were associated with increased risk of having psychotic symptoms in males.
Rachel Jenkins, Emeritus Professor of Epidemiology and International Mental Health Policy at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London, said: ‘The rise in prevalence of psychotic symptoms observed in our study could be at least partly explained by experience of violence in the Nyanza region over the last decade, an area which is known to have suffered some of the worst election violence in Kenya in 2007.
‘Our data suggests that these negative life events have a greater impact on the psychotic symptoms of women than men. This is consistent with a recent national survey of the 2007 election-related violence in Kenya, which found that 60 per cent of households reported at least one episode of physical or sexual violence, with women affected more than men.’
According to Professor Jenkins, Kenya is ill-equipped to deal with these issues due to the scarcity of primary and specialist mental health care in the country. She said: ‘A doctor in the UK – who has five to six years of medical training – looks after a population of around 1,700, whereas a Kenya primary care health worker –who only has three years of training – looks after a population of around 10,000.
‘Similarly in Kenya there is roughly one psychiatric nurse for 250,000 people, whereas in the UK there is one psychiatric nurse per 5-10,000 people.
‘Looking specifically at the Nyanza Province, there was previously one psychiatrist for a population of around five million, although this has recently increased to one in two million.’
Professor Jenkins concluded: ‘Our study highlights that it is necessary to integrate mental health services into general health care services, especially at the local level, and in particularwhere poverty and violence are likely to occur during periods of political unrest.
‘Since women are more at risk for psychotic symptoms in this population, an important step would also be to include mental health screening at antenatal and postnatal visits.’
Previous work by Professor Jenkins, in collaboration with the Kenya Ministry of Health, Kenya Medical Training College and Kenya Psychiatric Association, includes a continuing professional development training programme for primary health care workers in Kenya. This programme was funded by Nuffield Foundation and has reached over 2,000 of the existing 5,000 workforce. A recent randomized controlled trial demonstrating its effectiveness was also funded by DFID.
Notes to editors
Jenkins R et al (2015) ‘Adult Psychotic Symptoms, Their Associated Risk Factors and Changes in Prevalence in Men and Women Over a Decade in a Poor Rural District of Kenya’ International Journal of Environmental Research and Public Health doi:10.3390/ijerph120505310
For further media information please contact Jack Stonebridge, Press Officer, Institute of Psychiatry, Psychology & Neuroscience, King’s College London firstname.lastname@example.org/ (+44) 020 7848 5377.