Results
Demographics, diagnosis, and treatment :
A convenience sample of 150 patients attending the outpatient psychiatric clinic located in Jerash Hospital was approached. Eligible patients (n= 120, response rate of 80%) who accepted to complete the survey and gave consent were recruited into the study. The mean age of patients was 39.4±9.5 and the mean weight was 78.7± 18.2. More than half of the patients were males (66.7%), most of them (68.3%) reported not to perform any exercise, and 75% of the patients had health insurance (Table 1). Only 32.6% of the patients were employed before their diagnosis, and more than half of these patients (56.5%) reported loss of their job due to their psychological illness.
With regard to the type of diagnosed psychological illness, more than half of the patients (53.3%) reported being diagnosed with depression, followed by schizophrenia (30%), obsessive compulsive disorder (9.2%) and Bipolar (7.5%). No family history of a psychological illness was reported by 70.8% of the patients.
Most of the participants (87.5%) agreed that they have a psychological illness, 2.5% were not sure, and 10.0% were not convinced. They reported that their first psychological symptom started at a much earlier age (27.2±1.2) when compared to their current mean age (39.4±9.5).
Almost all of the patients (98.4%) reported that they started taking a medication to treat their psychiatric disorder. It was the specialist who advised the patients to start taking their medication in most cases (97.5%). The medications used by the patients included antidepressants and antipsychotics (Table 2), comprising mostly Citapram® (citalopram, 21%), Kemadrin® (procyclidine hydrochloride, 14%), and Haldol® (haloperidol Injection, 13.5 %).
Patient perspectives about their psychiatric disorders and their medications :
Following medication use, less than half of the patients (47.5%) reported complete control over their illness. Others reported partial control (43.3%), while few reported poor control (9.2%).
A deeper insight into patient’s perspectives of the causes that led to their physiological illnesses (Figure 1) included family problems (41.0%), death of a beloved person (20%), work problems (15%) and financial problems (10%). Patients reported that they visited the specialist merely due to the advice of a family member (74.2%), others followed the general practitioner’s advice (10.8%), and 8.3% visited the specialist based on their own decision.
Around half of the patients (51.7%) believed that their medications lead to addiction, yet they reported that this did not prevent them from taking it. Some patients (46.7%) believed that their medications do not cause addiction. Two patients said that they do not take their medication because they believed it might cause addiction.
The sources of information about psychiatric illnesses are important for psychiatric patients and are reported in Figure 2. It was the specialist who gave the patients such information in most cases (92.5%), followed by the use of the internet (3.3%), or via a pharmacist consultation (1.7%). When patients were specifically asked about the source of information regarding their medications (Figure 2), the majority reported that it was the specialist (78.3%), followed by the pharmacist (14.2%) then the internet (5.8%).
When asked if they had questions about their psychiatric illnesses which were not answered, most patients responded that this never (46.7%) or only slightly (19.2%) happened. When asked if they had questions about their psychiatric medications that were not answered, most patients responded that this never (58.3%) or only slightly (15.0%) happened. Reasons for not getting answers about medications included neither visiting nor calling the specialist in the first place (29.2% of all patients), the specialist did not give enough time (6.7%) and neither visiting nor calling the pharmacist (5.8%).
Patient awareness and preference of psychotherapy :
Most of the patients (89.2%) did not hear about psychotherapy before, and all of them were never exposed to it prior to study entry. After psychotherapy was explained to the patients, the majority (65.9%) of them strongly agreed/agreed that they would have chosen psychotherapy prior to starting treatment if they had known about it before (9.2% were neutral and 25% strongly disagreed/disagreed).
Adherence to treatment and barriers :
Most of the patients (71.0%) responded that they always/usually adhere to their medications. The most frequent barrier to adherence reported by the patients was suffering from adverse effects (31.9%). Others reported different barriers, such as being unconvinced that they needed a medication (23.3%), believing that their illness symptoms would get resolved without the use of a medication (11.2%), and not being able to afford their medication when it was not provided by the hospital (11.2%).
A high proportion of patients (59.2%) reported that they regard their psychological illness in terms of religious faith as counting for their benefit in the Hereafter and these patients reported a significant better adherence to treatment (Pearson correlation, p=0.046).; others (10%) believed their illness is a sort of divine punishment, while the rest thought it was neither due to the pre-mentioned reasons (30.8%).
In response to questions related to perceived public psychiatric disorder stigma and self-stigma, 52.5% of patients always/usually looked at themselves positively and unaffected by the existence of their psychiatric problem; which correlated significantly (r- 0.394, p<0.001) with better treatment adherence. On the other hand, 41.7% said that the felt embarrassed that their family, friends, or people in their surrounding know that they are taking a medication for a psychological problem.
As for adherence to the advice provided by the specialist, the majority (89.2%) reported that they would not stop taking their medication on their own even if their symptoms faded away. Others (10.8%) reported that they would stop taking their medication gradually once their symptoms disappeared.