Original Article
 
Study of risk factors in patients hospitalized for psychotic disorders in the Dalal Xel mental health center in Fatick (Senegal)
Ibrahima Seck1, Jean Augustin Diegane Tine2, Abou SY3, Matar BA3, Khadim Niang2, François Ngor Faye4, Anta Tal-Dia5
1Professor, Director of studies, Public Health and Preventive Medicine, ISED, Dakar, Senegal
2Assistant, Public Health and Preventive Medicine, ISED, Dakar, Senegal
3Physician, Hospital Fann, Psychiatry, Dakar, Senegal
4Director, Dalal Xel Mental Health Center, Dakar, Senegal
5Professor, Director of ISED, Public Health and Preventive Medicine, ISED, Dakar, Senegal

Article ID: 100011P16IS2017
doi:10.5348/P16-2017-11-OA-3

Address correspondence to:
Ibrahima Seck
Institut de Santé et Développement (ISED)
Dakar-Fann, Senegal

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Seck I, Tine Jad, SY A, Matar BA, Niang K, Faye FN, Tal-Dia A. Study of risk factors in patients hospitalized for psychotic disorders in the Dalal Xel mental health center in Fatick (Senegal). Edorium J Public Health 2017;4:20–26.


ABSTRACT
Aims: Psychiatric disorders are characterized by the complexity of their psychodynamic mechanisms and the inadequacy of therapeutic means. This study aims to study the risk factors of psychotic pathologies hospitalized in Dalal Xel of Factick.
Methods: This is a cross-sectional, retrospective, registrable, descriptive and analytical study carried out between 02 June and 21 July 2014 in the Dalal Xel mental health center in Fatick. All patients hospitalized in this facility were included between November 2003 and April 2014 and their medical records were retrieved. Simple logistic regression was used.
Results: Of the 7274 patient's record collected, the average age was 34.32 years (± 20.32), men were the majority at 61.2% and 57.6% were from rural areas. Serer represented 39.6% of cases. The 34.9% were out of school. Psychotic forms were mostly represented (56.8%). The main factors related to psychosis after adjustment are age between 16 and 40 years (OR = 8.2 [6.6-10.3]), marriage (OR = 0.7 [0.6–0.9]), the death of the father (OR = 1.3 [1.1–1.5]), the death of the mother (OR = 1.4 [1.1–1.9]).
Conclusion: Psychotic disorders are influenced by the socio-family experience of the individual. Marriage, orphan status and family support have been identified as risk factors in psychosis, hence the importance of involving the family in patient follow-up and in the development of mental health policies.

Keywords: Dalal Xel, Fatick, Psychiatric pathologies, Risk factors, Senegal


INTRODUCTION

Psychotic pathologies have the particularity of being often chronic and costly. According to Charrier, the direct costs associated with schizophrenia range from US $16 billion in the United States to US $204 billion in the United Kingdom and $79 billion in Canada [1]. Developing countries, particularly those in Africa, are no exception. Those who are already struggling with their inadequate health systems and on a small budget do not have the means to cope with the growing mental health problems [2].

Since 1956, Senegal has setup psychiatric structures to provide a sanitary environment for the mentally ill with the creation of the neuropsychiatry department of the Fann hospital. In 1994, the first private non-profit psychiatric structure was created as the mental health center “Dalal Xel” in Thiès. Then in 2003, another health center “Dalal Xel” was opened in Fatick. This partnership between the Order of “Saint-Jean de Dieu” and the State of Senegal has increased the coverage and quality of mental health services. Dalal Xel´s mental health care providers offer a range of preventive and curative services to the population.[3]

This study investigated the risk factors of patients hospitalized for psychotic disorders in the Dalal Xel mental health center in Fatick, Senegal. The specific objectives were:

  • describe the socio-demographic characteristics (individual and family) of patients hospitalized in the Dalal Xel mental health center in Fatick
  • describe the occupational characteristics of patients hospitalized at Dalal Xel mental health center in Fatick
  • determine the frequencies of the various pathologies hospitalized in Dalal Xel mental health center in Fatick
  • analyze socio-demographic factors related to psychotic illnesses hospitalized in Dalal Xel mental health center in Fatick
  • analyze the occupational factors related to the psychotic pathologies hospitalized in the Dalal Xel mental health center of Fatick


MATERIALS AND METHODS

Presentation of Dalal Xel health center

Dalal Xel health center is a health structure of the Catholic Church owned by the Hospitaller Order of the brothers of Saint John of God located in the region of Thiès. The Hospitaller Order of the brothers of Saint John of God was founded in 1550 by Juan Ciudad who became John of God (1495–1550).

In Senegal, the brothers of Saint John of God created the hospital of Saint Jean de Dieu in Thiès in 1984. In view of the impact of mental illness on the Senegalese population, they decided to create the mental health center of Senegal. Dalal Xel of Thiès in 2000.

The study included mothers/caregivers who had children aged less than five years and permanent residents of selected kebeles (small villages). Mothers who come to visit their parents were not included. The survey included questions concerning sociodemographic, children and maternal characteristics, environmental health conditions, child feeding practices, water source and hand washing practice.

The mental health center of Fatick is located at the entrance of the town of Fatick on National No. 1 150 km from Dakar and 65 km from Mbour.

The Dalal Xel system is under the guidance of the Consultative Council (CAC).

Each Dalal Xel is managed by a steering committee composed of the head of the health center, the chief medical officer and an administrative and financial manager.

The Dalal Xel health center in Fatick is subdivided into four departments: management, outpatient ward, hospital wards and occupational therapy.

The Dalal Xel mental health center in Fatick has a small staff. By September 2014, there were 10 caregivers including two psychiatrists, one psychopathology nurse and seven nursing assistants.

The activities of the psychiatric center are general psychiatric consultation, adult hospitalization and occupational therapy and occupational therapies such as gardening, weaving, games of mind (card game, lady´s play), etc.


Type of study

This was a cross-sectional, retrospective, descriptive and analytical study.


Study period

The quantitative study covered the period from 02 June to 21 July 2014.


Study population and sampling

This study was exhaustive, on the basis of the hospitalization register and patient records. It was included all patients who were recorded in the hospitalization records of the structure between November 2003 and April 2014. It was excluded those registries that did not have a diagnosis clearly identified by the psychiatrist.


Procedure for collecting and entering data

In each hospitalization unit, there is a register at the nurses´ room and a file at the doctor´s office.

All the patient files, found in the hospitalization units of the structure and belonging to the study period, were collated in a seizure mask made on Microsoft Access 2007 by two seizure operators trained and taken care of by the structure.


Data analysis

The analysis of the data was done with Epi-info 3.5.3 and with software R 3.1.1. The qualitative variables were described with the frequency and 95% confidence interval and the quantitative variables by mean, standard deviation and quantiles. Tables and charts were built on Microsoft Excel 2007.

Variables have been crossed to meet the expectations of the determinants objectives. This was done using the tests of KHI2 (comparison of two proportions) or Student (comparison of two averages) according to their applicability conditions with a significance threshold of p = 0.05. The odds ratio, surrounded by its confidence interval, quantified the strength of the link.

A multivariate analysis was performed with a simple logistic regression for the determination of factors related to psychosis, with an adjustment to the variables related to the individual, family and occupational characteristics while ensuring the conditions of applicability with a threshold of significance set at 5%. Variables with p values ??less than 0.25 in bivariate analysis were used for modeling [4].

The lrtest (likelihood ratio) and AIC allowed the choice of the last one with the step-by-step descending method. Finally, the Hosmer Lemeshow test made it possible to test the suitability of the final model. [5]

In the models, the associations were measured by the odds ratio with their confidence intervals.


Ethical considerations

This study was initiated as part of an evaluation of the activities of the Dalal Xel mental health center in collaboration with the head of the health center. The data is collected anonymously. No judgment of subjective, personified or group value that may taint the personality of the individuals and the institution will be published in this study. No remuneration or financial or material compensation was offered to the patients.


RESULTS

Clinical features

Between November 2003 and April 2014, there were 7274 patients who were hospitalized at the Dalal Xel psychiatric center in Fatick. By filing the records, it was found that 91.55% (6660 patients) of the cases had a diagnosis of discharge. Of these patients with a diagnosis, 72.8% (4848 cases) had psychiatric illnesses, 2.5% (1766 cases) had neurological diseases as a cause of hospitalization, and the rest had general medicines such as gastric disturbances, infectious syndromes, etc.

In the psychiatric illness group, 77.6% (3763 cases) had psychoses, 15% (728 cases) had mood disorders (depression, mania, bipolar disorder) and 7.4% (357 cases) were neurotic according to the psychiatric classification of the French school.

In the psychotic group, using ICD10, we found that 34.3% (1291 cases) had schizophrenic disorders, 32.1% (1207 cases) had acute delusional disorders, 15% (566 cases) had mental disorders related to psychoactive substances. Chronic hallucinatory psychotic disorders and non-dissociative psychotic disorders accounted for 8.9% (336 cases) and 6.9% (225 cases, respectively). The mental disorders associated with puerperality were minority at 2.8% (108 cases). Table 1 summarizes the distribution of cases according to ICD 10.


Socio-demographic characteristics

The mean age of hospitalized patients was 34.3 years with a standard deviation of 20.3 years. Men were in the majority with a sex ratio (M / F) of 1.5. The unmarried, the childless, the uneducated were more frequent. Most of the patients were orphans. Table 2 summarizes the socio-demographic characteristics of the patients.


Professional features

The majority of patients reported having a vocational qualification. The 93.2% had a job in the private sector. The 36.3% had a domestic job. It had 1.4% of learners and 2.9% of unemployed. Table 3 summarizes the occupational characteristics of the patients.


Professional featuresAnalytical section

Multivariate analysis has shown that age, educational level, orphan status, family support, geographic origin are risk factors for psychosis. Table 4 gives the results of the multivariate analysis made by a simple logistic regression.

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Table 1: Distribution of cases of psychotic disorders according to ICD 10


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Table 2: Distribution of hospitalized patients by socio-demographic


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Table 3: Distribution of hospitalized patients by occupational characteristics



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Table 4: Psychotic risk factors by logistic regression



DISCUSSION

This retrospective study was confronted with missing values in the exploration of hospitalization records. Consultation activities were not explored because of the incompleteness of socio-demographic information and especially clinical diagnosis. But we had a statistically representative number of records to do the logistic regression.

A psychosis is a mental disorder characterized by the loss of contact with reality, a disorganization of the personality, and the delirious transformation of experience. Psychoses are thus distinguished from neuroses, in which the patient retains the notion of the real, even if sometimes he does not understand the interpretation. In a neurosis, the subject retains a critical mind towards his illness. Chronic psychoses include chronic delusions, schizophrenia, paranoia, chronic hallucinatory psychosis (psychiatric hallucinations). Psychotic disorders, opening on a delusional experience, occur in several circumstances [6] .

Psychoses are very serious disease because of their physical, economic and social consequences. This study estimated the extent of these psychotic pathologies to be 3763 inpatients between November 2003 and April 2014 in this small 23-bed mental health center. On an average we found one case of psychotic hospitalization per day for more than 10 years.

The proportional morbidity of psychoses in hospitalization in this structure is 77.6%. It is thus the leading cause of hospitalization, which is explained by its seriousness. The Kirkbride meta-analysis showed a lower prevalence of psychotic disorders (4‰) but was in the general population [7] . Schizophrenic disorders accounted for 34.3% of cases of psychosis.

A rural geographic origin protected against psychosis (OR = 0.8 [0.7–0.88]) [8] [9][10]. Urbanization would be a factor in aggravating or decompensating psychosis with a very high risk [8][10][11][12][13]. Lifestyle and education different from the city to the countryside. In Senegal, rural life is very communal with broad social support that differs from the urban organization that is becoming more and more nuclear. With the difficulties of life in the countryside, education is based on traditional, religious and resilience bases called in wolof mougn.

Exposure to psychosis is higher among people aged 16 to 40 years. This result agrees with the age of schizophrenia [9][14][15][16][17][18]. This age group represents a large part of the working population, hence the importance of the impact of psychiatric pathologies on the development of a country [16][20] [21].

The married couple are less exposed to psychosis (OR = 0.7 [0.6–0.8] or psychosis which is a chronic disease, usually dyssocial does not allow the patient to be able to marry. The orphan is exposed to psychosis through the lack of a solid social fabric and a parental framework in the psychological development of the person, in medical assistance and therapeutic follow-up.

This lack of follow-up of certain orphans may trigger predisposing factors or the complication of a psychotic state that may associate it with mood disorders. This result agrees with the usefulness of family support in the medical follow-up of the psychotic (OR = 0.2 [0.1–0.3]). Therapists often involve the family in the follow of the sick at home. They understood the importance of the family in the follow-up of psychotics [10][11][19][20]. To facilitate the involvement of families, the accessibility of mental health services should be improved through decentralization of mental health care to different levels of the health pyramid by identifying the appropriate service packages [12][22][23][24].

The risk of psychosis is higher in patients without qualifications (OR = 1.5 [1.3–1.8]). Student status would protect against psychosis with OR = 0.3 [0.1 - 0.6]. This result would also be related to the mental handicap of the disease, which means that patients do not have the opportunity to follow the normal educational cycle, which leads to an early termination of studies and a lack of qualification [13][25].


CONCLUSION

Fatick´s Dalal Xel Mental Health Center is a small, 23-bed facility that receives an average of 700 patients per year. It hosts all psychiatric pathologies, neurological pathologies and even medical emergencies.

The risk factors for psychotic disorders are age, marital status, orphan status and inadequate family support.


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Acknowledgements
We acknowledge al Dal Xel center and Fann Hospital Psychiatric Staff who help us in the work.

Author Contributions
Ibrahima Seck – Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Jean Augustin Diegane Tine – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Final approval of the version to be published
Abou SY – Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be published
Matar BA – Acquisition of data, Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Khadim Niang – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Final approval of the version to be published
François Ngor Faye – Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be published
Anta Tal-Dia – Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2017 Ibrahima Seck et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.