Document Type : Original article
Authors
Mental Health and Research Center, Community Mental Health Research Group, Iran University of Medical Science, Tehran, Iran
Abstract
Keywords
Abstract
Background: This study was conducted to determine the frequency of unconventional treatment use by psychiatric patients in Tehran.
Methods: In this cross-sectional study, 404 patients diagnosed with psychiatric disorders were studied. The participants responded to a checklist and filled a questionnaire about their demographic characteristics.
Results: Simultaneous use of conventional and unconventional treatment was seen in 39.4% of patients, and among them, herbal therapy was the most common type (20.5%). No relationship was observed between patient satisfaction and the use of such treatment (p=0.347).
Conclusion: There is a high frequency of unconventional treatment use in psychiatric patients. However, the exact reasons for patients’ tendency towards such approach and also advantages and disadvantages of its application need more investigation.
Keywords: Demography, Humans, Mental disorders
Introduction
The World Health Organization (WHO) estimates at least one family per four families around the world suffers from psychiatric disorders (1). Epidemiological studies of mental disorders in different parts of Iran have shown that the prevalence of psychiatric disorders varies between 11 to 23% (2). These statistics show the importance of diagnosis and treatment of mental disorders. To treat psychiatric diseases, medication, psychotherapy, or electroconvulsive therapy are available options (3). Some schizophrenic patients do not comply with proper therapies due to treatment side effects (4). There are many causes for a psychiatric patient to use complementary medicines; as an example, such medicines can reduce the side effects of specific medications and prevent weight gain as a common problem. In addition, unlike psychiatric drugs and the skepticism toward such treatments, complementary medicine has an excellent ‘natural’ reputation, and people prefer to use them (5-7). Effective advertisemnets and financial gain, unsuccssful heterodox approaches in psychiatry and other specialties, and the desire of health professionals for complementary medicine are other critical factors for popularity of such medication (8).
The term Complementary and Alternative Medicine (CAM) means the various treatment and prevention practices in which the strategies and efficacy differ from traditional or conventional biomedical therapies (9). Practices of complementary and alternative medicine are not part of conventional medicine because there is not sufficient evidence for their safety and effectiveness. Complementary interventions are used along with conventional treatment, while alternative interventions are used instead of conventional medicine (10).
On the other hand, in some studies, most people believe that complementary and alternative medicine is safe (11).
Herbal medicine, acupuncture, energy therapy, and meta medicine are the typical alternative and complementary medicine techniques. Age, gender, ethnicity, marital status, level of education, physical condition, and personality characteristics are the common factors that may be associated with the use of complementary and alternative treatments (12). Furthermore, culture, beliefs, spirituality, and religion are other important factors that affect the use of complementary medicine (13).
In Sadighi’s study in Tehran, 83.2% of the respondents were educated about complementary medicine. Herbal medication (75.6%), acupuncture (43.6%), hypnosis (39.2%), energy therapy (28.1%), yoga (22.1%), meditation (5.3%) and homeopathy (4.1%) are the most popular modalities (14). Also, Iranian patients have access to Iranian traditional medicine in addition to other modalities (15).
Shahmohammadi’s study showed that 14% of patients with psychiatric disorders were referred to traditional healers at their first visit, and 36% of them during the treatment (16). Derakhshanpoor et al stated that 42% of patients with psychiatric problems were referred to traditional healers at the first attempt to treat their current condition. Moreover, 51% of the patients were referred to traditional healers during their disease (17).
The use of alternative and complementary treatments has been prevalent all over the world, and knowing about them can help clinicians to have better judgment and prepare a better treatment plan (18). Based on available information, complementary medicine is also popular in our country, but the data about psychiatric patients is scarce. By understanding the frequency of complementary treatment use in psychiatric patients, optimal treatment plans and future relevant studies can be designed and implemented (5). The purpose of the current study was to investigate the frequency of the use of non-traditional treatment among patients with psychiatric disorders.
Materials and Methods
This cross-sectional study was performed on 404 patients with psychiatric disorders who were referred to Tehran Psychiatric Institute and Iran Psychiatric Hospital in 2015. Both non-traditional and convential medical treatments were used in this study. Before initiation of the study, informed consent was obtained from the patients and the participants responded to the questionnaire afterwards. The sampling was done using a non-random sampling, and the samples were collected from patients of Tehran Psychiatry Institute and Iran Psychiatric Hospital who were available and willing to participate (Convenience sampling). The main instruments of the study were a checklist and a questionnaire. The questionnaire was filled out in the presence of the researcher. It consisted of demographic information (Age, gender, level of education, employment) and a checklist about the use of alternative treatments (Acupuncture, energy therapy, herbal therapy, hydrotherapy, meta medicine, homeopathy, fortune telling, mindfulness techniques, touch therapy, praying, vegetarianism, movement therapy, etc) and patients’ satisfaction about the modality.
Inclusion criteria were the age range of 18 to 64 years, Iranian nationality, lack of having a severe psychotic disorder diagnosed by a psychiatrist (Schizophrenia spectrum), lack of addiction to drugs, and at least six month duration of illness. Also, the exclusion criterion was the lack of response to more than 10% of the questionnaire items. The data were analyzed using SPSS V21 (IBM Corp., New York, USA). In descriptive statistics, frequency distribution, central tendency, the mean, standard deviation, and scatter index were reported. Differences were considered significant when the p-value was less than 0.05.
Results
A total of 404 patients with psychiatric disorders participated in this study. The mean age of participants was 36.6, and 55% of them were female. Moreover, 33% were housewives, and 66% of participants had diploma. The number of patients who were only prescribed drugs was 245 (60.6%), and the number of patients who used alternative treatments in addition to medical treatment was 159 (39.4%). Complete details are provided in table 1.
Affective disorder was the most frequent diagnosis among participants. Obsessive-compulsive disorder, anxiety disorder, somatic symptom disorder and personality disorder were other diagnoses of the participants.Herbal therapy was the most popular modality among non-traditional treatments and 50% of people who used it suffered from somatic symptom disorder. The frequency of diagnosis among 159 people who had used non-traditional methods and other ones are summarized in table 2.
The mean patient satisfaction with treatment in the medical treatment group was 57.04%, and in the non-traditional treatment group was 32.37%. Meanwhile, using the Mann-Whitney test, no relationship was observed between patient satisfaction and the use of such treatment (p=0.347).
Table 1. Demographic characteristics of the participants
|
Demographic features |
Frequency |
|
|
Age (Mean±SD) |
36.6±10.3 |
|
|
Sex Number (%) |
Female |
225 (55.8%) |
|
Male |
179 (44.2%) |
|
|
Educational level Number (%) |
Under diploma |
114 (28.5%) |
|
diploma |
147 (36.4%) |
|
|
Associate’s degree |
43 (10.9%) |
|
|
BA |
72 (17.8%) |
|
|
MD |
19 (4.7%) |
|
|
PhD |
7 (1.7%) |
|
|
Marital status Number (%) |
Single |
170 (42.3%) |
|
Married |
197 (49%) |
|
|
Divorced |
31 (7.7%) |
|
|
Widow/widower |
4 (1.0%) |
|
|
Occupational status Number (%) |
Unemployed |
71 (17.6%) |
|
Retired |
22 (5.4%) |
|
|
Housewife |
133 (33.2%) |
|
|
Worker |
12 (3.0%) |
|
|
Self-employed |
87 (21.5%) |
|
|
Employee |
47 (11.9%) |
|
|
Other |
30 (7.4%) |
|
|
Sampling location Number (%) |
Institute |
195 (48.3%) |
|
Iran Hospital |
209 (51.7%) |
|
|
Using alternative treatment Number (%) |
159 (39.4%) |
|
Table 2. Frequency of diagnosis in the nontraditional treatment group
|
|
Depressive Disorders (n=11) |
Bipolar Disorders (n=252) |
Obsessive-Compulsive Disorders N=51 |
Anxiety Disorders (n=45) |
Somatic Disorders (n=8) |
Personality Disorders (n=40) |
Other Disorders (n=32) |
Total Number N=404 |
||||||||
|
Acupuncture |
0 |
0% |
10 |
4.0% |
2 |
3.9% |
3 |
6.7% |
1 |
12.5% |
1 |
2.5% |
2 |
6.3% |
17 |
4.2% |
|
Energy therapy |
1 |
9.1% |
18 |
7.1% |
4 |
7.8% |
5 |
11.1% |
1 |
0% |
7 |
17.5% |
3 |
9.4% |
17 |
7.2% |
|
Metamedicine |
0 |
0% |
8 |
3.2% |
0 |
0% |
2 |
4.4% |
0 |
0% |
2 |
5.0% |
1 |
3.1% |
29 |
2.7% |
|
Hydrotherapy |
0 |
0% |
11 |
4.4% |
1 |
2.0% |
0 |
0% |
0 |
0% |
3 |
7.5% |
2 |
6.3% |
11 |
4.0% |
|
Fortune telling |
1 |
9.1% |
32 |
12.7% |
5 |
9.8% |
2 |
4.4% |
0 |
37.5% |
7 |
17.5% |
3 |
9.4% |
16 |
11.9% |
|
Homeopathy |
0 |
0% |
2 |
0.8% |
0 |
0% |
1 |
2.2% |
3 |
0% |
0 |
0% |
0 |
0% |
48 |
0.7% |
|
Touch therapy |
0 |
0% |
4 |
1.6% |
3 |
5.9% |
1 |
2.2% |
0 |
0% |
0 |
0% |
2 |
6.3% |
3 |
2.2% |
|
Praying |
1 |
9.1% |
42 |
16.7% |
7 |
13.7% |
2 |
4.4% |
0 |
37.5% |
7 |
17.5% |
3 |
9.4% |
9 |
15.1% |
|
Mindfulness based therapy |
0 |
0% |
15 |
6.0% |
3 |
5.9% |
7 |
15.6% |
3 |
0% |
3 |
7.5% |
3 |
9.4% |
61 |
15.1% |
|
Vegetarianism |
0 |
0% |
6 |
2.4% |
0 |
0% |
0 |
0 |
0 |
0% |
1 |
2.5% |
0 |
0% |
61 |
1.5% |
|
Movement therapy |
0 |
0% |
13 |
5.2% |
1 |
2.0% |
6 |
13.3% |
0 |
12.5% |
5 |
12.5% |
4 |
12.5% |
6 |
6.7% |
|
Any other therapy |
2 |
18.2% |
81 |
32.1% |
15 |
29.4% |
14 |
31.1% |
1 |
50.0% |
16 |
40.0% |
10 |
31.3% |
27 |
31.4% |
|
Herbal Medicine |
3 |
27.3% |
57 |
22.6% |
11 |
21.6% |
6 |
13.3% |
4 |
50.0% |
8 |
20.0% |
5 |
15.6% |
127 |
20.5% |
*Some people used more than one method and are located in more than one group.
Discussion
This cross-sectional study was performed to evaluate the prevalence of complementary medicine use in patients with psychiatric disorders in Iran eleven years after the last survey in 2003. The results of this study indicated that 39.4% of patients with psychiatric disorders used alternative medicine. The results of other studies suggest that in America, 34%, in Australia, 52%, and in Canada, 68% of those who have psychiatric problems use alternative medicine (19-21). In England, lifetime and 12‐month prevalence of CAM use were 44.0% and 26.3%, respectively. Those suffering from anxiety or depression or people with poorer mental health were significantly more likely to use CAM (22) . The results of this study and those obtained in several countries show that the frequency of non-traditional methods in comparison to some developed countries is less studied (15-18). The reasons for infrequent use of non-traditional treatment in this study may be related to the fact that 58.5% of our sample was collcted from Iran Psychiatric Hospital, and the place of treatment and type of services can affect the results. Second, our subjects were psychiatric patients, and the subjects studied in those countries were taken from the general population; in fact, in this study, those who sought formal treatment were assessed. Most patients demanding complementary medicine are those with major depressive disorder and bipolar disorder, respectively.
It should be noted that these results are consistent with the results obtained by Elkins et al. They recognized that most of the participants in their study suffered from major depression and 63% of the people had used at least one of the methods of complementary medicine within the last 12 months (23). Unützer et al reported that 21.3% of the users of alternative medicine were patients with major depressive disorders (24). In a review article of Thirthalli et al scrutinizing Indian studies, most individuals who used CAM had psychosis manifesting as trance or possession disorders. Still, the most prevalent diagnosis among outpatients who use traditional Chinese medicine is mood and anxiety disorders (25).
However, in the study conducted by Davidson et al, patients with anxiety disorders and depression were the group who mostly used complementary medical treatments (26).
Given that the highest frequency in the use of non-traditional methods has been observed in patients with major depression, the reasons such as long-term treatment and the lack of adequate response to treatment had been the causes for the tendency of the patients toward the use of such therapies. However, in the studies done in other countries, age, sex, race, education, and social issues have been the determining factors (27-30).
In this study, herbal treatment was an option being used by the patients. The long tradition of using herbal medicine to treat a variety of diseases among Iranian people is probably the reason for people’s frequent use (31). Also, plant diversity, the number of shops offering herbal plant products and easy access to herbal medicine for consumption contribute to frequent use of such treatment. In the research on the use of herbal treatment conducted by Bahceci et al, similar results were achieved (32).
The large sample size and the wide range of patients referring to psychiatric clinics were some strengths of the study.
One of the limitations was that the non-traditional treatments could be classified in more general categories in the checklist; for example, the treatment for which there is scientific evidence and treatment for which there is no evidence could be sepretatley included in the checklist.
Conclusion
Our findings showed that almost 40% of the patients with psychiatric disorders used non-traditional treatments, whereas half of them preferred herbal treatment. Most patients demanding complementary medicine were those with major depressive disorder and bipolar disorder, respectively. Given the popularity of these modalities among psychiatric patients, further studies on their efficacy and interactions with traditional treatments are suggested to be conducted in future.
Acknowledgements
Hereby, we thank all patients and staff for their cooperation in conducting this research.
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