INTREPID Publications

INTREPID II

Data collection is currently ongoing for INTREPID II and new publications will be added below once they become available.

2021

Cohen, A. & Morgan, C.. 2021. Estimating the incidence of psychosis in diverse settings. Psychol Med. England: pp. 527-528. doi: 10.1017/S0033291719003702.

2020

Roberts, T., Gureje, O., Rangaswamy, T., Hutchinson, G., Cohen, A., Weiss, H., John, S., Lee Pow, J., Donald, C., Olley, B., Miguel Esponda, G., Murray, R., Morgan, C. (2020). INTREPID II: protocol for a multistudy programme of research on untreated psychosis in India, Nigeria and Trinidad. BMJ Open, 10:e039004. doi: 10.1136/bmjopen-2020-039004

Abstract
INTRODUCTION: There are few robust and directly comparable studies of the epidemiology of psychotic disorders in the Global South. INTREPID II is designed to investigate variations in untreated psychotic disorders in the Global South in (1) incidence and presentation (2) 2-year course and outcome, (3) help-seeking and impact, and (4) physical health.
METHODS: INTREPID II is a programme of research incorporating incidence, case–control and cohort studies of psychoses in contiguous urban and rural areas in India, Nigeria and Trinidad. In each country, the target samples are 240 untreated cases with a psychotic disorder, 240 age-matched, sex-matched and neighbourhood-matched controls, and 240 relatives or caregivers. Participants will be followed, in the first instance, for 2 years. In each setting, we have developed and are employing comprehensive case-finding methods to ensure cohorts are representative of the target populations. Using methods developed during pilot work, extensive data are being collected at baseline and 2-year follow-up across several domains: clinical, social, help-seeking and impact, and biological.
ETHICS AND DISSEMINATION: Informed consent is sought, and participants are free to withdraw from the study at any time. Participants are referred to mental health services if not already in contact with these and emergency treatment arranged where necessary. All data collected are confidential, except when a participant presents a serious risk to either themselves or others. This programme has been approved by ethical review boards at all participating centres. Findings will be disseminated through international conferences, publications in international journals, and through local events for key stakeholders.

Roberts, T., Morgan, C., Gureje, O., Hutchinson, G., Rangaswamy, T., John, S., Lee Pow, J., Donald, C., Olley, B. (2020). T241. Incidence and Socio-demographic/Clinical characteristics of Psychotic Disorders in India, Nigeria and Trinidad: preliminary baseline findings from INTREPID II. Schizophrenia Bulletin, Volume 46, Issue Supplement_1, April 2020, Page S324, https://doi.org/10.1093/schbul/sbaa029.801

INTREPID I

These publications are outputs from INTREPID I, a pilot programme funded by the Wellcome Trust, in which we tested the methods for INTREPID II and mapped out a network of key informants, service providers and traditional practitioners in each site. Read more about INTREPID I in the articles below.

2016

Morgan, C., John, S., Esan, O., Hibben, M., Patel, V., Weiss, H., Murray, R. M., Hutchinson, G., Gureje, O., Thara, R., Cohen, A. (2016). The incidence of psychoses in diverse settings, INTREPID (2): A feasibility study in India, Nigeria, and Trinidad. Psychological Medicine, 46(9), 1923-1933. doi:10.1017/S0033291716000441

Abstract
BACKGROUND: There are striking global inequities in our knowledge of the incidence, aetiology, and outcome of psychotic disorders. For example, only around 10% of research on incidence of psychotic disorders originates in low- and middle-income countries. We established INTREPID I to develop, implement, and evaluate, in sites in India (Chengalpet), Nigeria (Ibadan), and Trinidad (Tunapuna-Piarco), methods for identifying and recruiting untreated cases of psychosis, as a basis for investigating incidence and, subsequently, risk factors, phenomenology, and outcome. In this paper, we compare case characteristics and incidence rates across the sites.
METHOD: In each site, to identify untreated cases of psychoses in defined catchment areas, we established case detection systems comprising mental health services, traditional and spiritual healers, and key informants.
RESULTS: Rates of all untreated psychoses were 45.9 (per 1 00 000 person-years) in Chengalpet, 31.2 in Ibadan, and 36.9 in Tunapuna-Piarco. Duration of psychosis prior to detection was substantially longer in Chengalpet (median 232 weeks) than in Ibadan (median 13 weeks) and Tunapuna-Piarco (median 38 weeks). When analyses were restricted to cases with a short duration (i.e. onset within preceding 2 years) only, rates were 15.5 in Chengalpet, 29.1 in Ibadan, and 26.5 in Tunapuna-Piarco. Further, there was evidence of age and sex differences across sites, with an older average age of onset in Chengalpet and higher rates among women in Ibadan.
CONCLUSION: Our findings suggest there may be differences in rates of psychoses and in the clinical and demographic profiles of cases across economically and socially distinct settings.

Cohen, A., Padmavati, R., Hibben, M., Oyewusi, S., John, S., Esan, O., Patel, V., Weiss, H., Murray, R., Hutchinson, G., Gureje, O., Thara, R., Morgan, C. (2016). Concepts of madness in diverse settings: a qualitative study from the INTREPID project. BMC Psychiatry, 16(1). doi:10.1186/s12888-016-1090-4

Abstract
BACKGROUND: In order to facilitate case identification of incident (untreated and recent onset) cases of psychosis and controls in three sites in India, Nigeria and Trinidad, we sought to understand how psychoses (or madness) were conceptualized locally. The evidence we gathered also contributes to a long history of research on concepts of madness in diverse settings.
METHODS: We conducted focus group discussions and individual interviews to collect information about how informants in each site make sense of and respond to madness. A coding framework was developed and analyses of transcripts from the FGDs and interviews were conducted.
RESULTS: Analyses suggest the following: a) disturbed behaviors are the primary sign of madness; b) madness is attributed to a wide range of causes; and, c) responses to madness are dictated by cultural and pragmatic factors. These findings are congruent with similar research that has been conducted over the past 50 years.
CONCLUSIONS: The INTREPID research suggests that concepts about madness share similar features across diverse settings: a) terms for madness are often derived from a common understanding that involves disruptions in mental processes and capacities; b) madness is recognized mostly by disruptive behaviours or marked declines in functioning; c) causal attributions are varied; and, d) help-seeking is a complex process.

2015

Morgan, C., Hibben, M., Esan, O., Sujit, J., Patel, V., Weiss, H., Murray, R. M., Hutchinson, G., Gureje, O., Thara, R., Cohen, A. (2015) Searching for psychosis: INTREPID (1): systems for detecting untreated and first-episode cases of psychosis in diverse settings. Social Psychiatry and Psychiatric Epidemiology 50(6), 879-893. doi:10.1007/s00127-015-1013-6

Abstract
PURPOSE: Our understanding of psychotic disorders is largely based on studies conducted in North America, Europe and Australasia. Few methodologically robust and comparable studies have been carried out in other settings. INTREPID is a programme of research on psychoses in India, Nigeria, and Trinidad. As a platform for INTREPID, we sought to establish comprehensive systems for detecting representative samples of cases of psychosis by mapping and seeking to engage all professional and folk (traditional) providers and potential key informants in defined catchment areas.
METHOD: We used a combination of official sources, local knowledge of principal investigators, and snowballing techniques.
RESULTS: The structure of the mental health systems in each catchment area was similar, but the content (i.e., type, extent, and nature) differed. Tunapuna–Piarco (Trinidad), for example, has the most comprehensive and accessible professional services. By contrast, Ibadan (Nigeria) has the most extensive folk (traditional) sector. We identified and engaged in our detection system—(a) all professional mental health services in each site (in- and outpatient services—Chengalpet, 6; Ibadan, 3; Trinidad, 5); (b) a wide range of folk providers (Chengalpet, 3 major healing sites; Ibadan, 19 healers; Trinidad: 12 healers); and c) a number of key informants, depending on need (Chengalpet, 361; Ibadan, 54; Trinidad, 1).
CONCLUSIONS: Marked differences in mental health systems in each catchment area illustrate the necessity of developing tailored systems for the detection of representative samples of cases with untreated and first-episode psychosis as a basis for robust, comparative epidemiological studies.

A ritual site in Nigeria

University of the West Indies, Trinidad