Abstract: Background and Objective: There has been a reported increase in the use of complementary and alternative medicine among patients generally, a potential risk of non-compliance and interaction which may affect outcome when concomitantly used with orthodox medicine. Mental disorders are highly prevalent in both the developed and the developing world with hundreds of millions of people suffering from psychiatric morbidity. The objective of this study was to describe the prevalence and determinants of complementary and alternative medicines (CAM) use among psychiatric patients. Materials and Methods: The study was a descriptive cross-sectional study carried out among psychiatric outpatients in two tertiary hospitals in Sokoto state north-western Nigeria (the Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto and Federal Neuropsychiatric Hospital (FNPH) Kware), between February and May 2014. An interviewer-administered structured questionnaire was used to collect the data on socio-demographic, clinical and CAM use variables. Data was extracted and analysis was done using the statistical package for social sciences (SPSS) version 18.0. Results: A lifetime CAM use and for psychiatric disorders of 64.8 and 53.8% with only about a third current users and majority of the respondents found to have used herbal drinks and prayers in UDUTH and FNPH, respectively. Although a small proportion of the respondents preferred CAM to orthodox medications in both hospitals, however about one third of the respondents spent only 1,000 Nigerian Naira on CAM in UDUTH and FNPH. Majority of the study population in both hospitals were within the age bracket of 21-40 years. Age, gender, duration of onset of illness and cost were some of the socio-demographic determinants that influence the use of CAM in this study. Conclusion: In this study, prevalence of CAM use was high among psychiatric patients. Age, gender, disease duration and cost are part of the determinants of CAM use.
INTRODUCTION
Several studies have been carried out with regards to complementary and alternative medicine in different demographics and diverse patient population, but there is dearth of information with regards to use of complementary and alternative medicine among psychiatric patients especially the prevalence and determinants associated with the use. Available literatures have not described lifetime and current CAM users among psychiatric patient population especially in this geopolitical zone. Such information when provided gives an idea of the magnitude of CAM use among such patient population and reasons for such use; this will in turn help predict whether CAM use can affect psychiatric patient management and outcome. Complementary and alternative medicine (CAM) can be explained as a term commonly used for all forms of therapy that is not in line and not considered part of modern day orthodox medicine1. There is an increasing acceptance of CAM among Nigerians as is obtained in other parts of the world2 and this may not be unconnected to the significant side effects associated with conventional therapy3. The World Health Organization opines that over 75% of world population have used CAM to treat medical conditions suggesting that CAM is popular across board among patients4. Broadly conceptualized, the term “complementary and alternative medicine” (CAM) refers to treatments not considered to be standard to the current practice of western medicine. “Complementary” refers to the use of these techniques in combination with conventional approaches, whereas “alternative” refers to their use in lieu of conventional practices5. Potential risks associated with CAM use could be non adherence to orthodox medications, drug interactions and adverse drug reactions6, delay in effective treatment for serious condition, interference with vital treatment, exploitation of vulnerable groups such as children and the seriously ill, overloading patient with multiple medications, toxicity, side effects, interactions and adulteration with pharmaceutical substances7.
Psychiatric disorders and related complications are a cause of significant morbidity and inflict a substantial strain on a nation’s economy8. Results from the WHO World Mental Health Consortium demonstrate that common mental disorders are highly prevalent in both the developed and the developing world9. The majority of the world’s 450 million people who suffer from psychiatric morbidity live in developing countries and less than 10% have access to mental health care10.
The concurrent use of Complementary and Alternative Medicine (CAM) with orthodox medicine may be part of causes of drug interactions, noncompliance, adverse drug reactions and poly-pharmacy in patients. Nigeria is part of countries in the world where the uses of Complementary and Alternative Medicine (CAM) is common, but there is dearth of information on the prevalence of their use and factors influencing the use among psychiatric patients. This study therefore was aimed at determining the prevalence and determinants of complementary and alternative medicines use among psychiatric outpatients.
MATERIALS AND METHODS
The study was conducted among psychiatric outpatients in two tertiary health facilities in Sokoto state (Usmanu Danfodiyo University Teaching Hospital Sokoto and Federal Neuropsychiatric Hospital Kware, both in north western Nigeria). A cross sectional descriptive study was carried out between February and May 2014. A total of 211 psychiatric outpatients were recruited. An interviewer-administered structured questionnaire was used and data was obtained in a face-to-face interview. Data on socio-demographic, clinical and CAM use variables were extracted. Data analysis was performed using descriptive statistics of the Statistical Package for Social Sciences for windows version 18.0. Ethical clearance was obtained from the ethics and research committee of the Usmanu Danfodiyo University Teaching Hospital, Sokoto (UDUTH/HREC/2014/No. 244).
RESULTS
The data in Table 1 described the demographic variables of the study populations from Usmanu Danfodiyo University Teaching Hospital Sokoto (UDUTH) and Federal Neuropsychiatry Hospital Kware (FNPH). Majority of the respondents were within the age group of 21-40 years with more males than females and predominantly from the Hausa ethnic group and Islamic religion in both facilities. Majority of the respondents in UDUTH are married while majority in FNPH are not. Majority of the study population in UDUTH had at least a child while majority in FNPH had no child. About one third of the respondent had up to tertiary education in UDUTH with overall majority having at least up to secondary school education and residing in urban or semi urban settlements in both hospitals. Over one half of the study population either earns less than 10,000 NGN per month or nothing at all.
| Table 1: | Socio-demographic variables of respondents |
N = 211, UDUTH: Usmanu Danfodiyo University Teaching Hospital and FNPH: Sokoto and Federal Neuropsychiatric Hospital |
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| Table 2: | Clinical variables of respondents |
N = 211, UDUTH: Usmanu Danfodiyo University Teaching Hospital and FNPH: Sokoto and Federal Neuropsychiatric Hospital |
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Results in Table 2 depicted the clinical variables of the study populations from UDUTH and FNPH. Duration from onset of psychiatric condition was 1-5 years while age at onset was 21-40 years and the absence of co-morbidities in most of the respondents in both hospitals. Only a small fraction of respondents from UDUTH has substance abuse problems. Significant proportions of the study population had no problem with Hospital/ orthodox medication and admit to improvement in their condition with use of Hospital medications in both facilities. Monthly expenditure on Hospital medications by the study population in both facilities varies as displayed.
Data in Table 3 showed the complementary and alternative medicines use variables of the respondents in UDUTH and FNPH.
| Table 3: | Complementary and Alternative Medicine (CAM) Use Variables of Respondents |
N = 211, UDUTH: Usmanu Danfodiyo University Teaching Hospital and FNPH: Sokoto and Federal Neuropsychiatric Hospital |
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The study population demonstrated an average degree of knowledge on CAM evidenced by the demonstration of knowledge of CAM used locally citing examples. Lifetime CAM use and for psychiatric illnesses was higher while only about a third are current CAM users and use CAM concurrently with Hospital (orthodox) medications among the respondents in both facilities. More of the study population from UDUTH reported no improvement in their conditions with CAM use while FNPH admitted otherwise. The duration of CAM use among respondents varies as shown with a higher percentage of respondents not informing their physician that they use CAM. Very few respondents across board reported side effects with CAM use and believed CAM is better for mental disorders but majority have never been advised to by their physician to stop CAM use. Expenditures ever on CAM among respondents varies and suggested that concomitant use of CAM and Hospital medications be allowed by doctors despite the fact that they seldom recommend CAM use for other psychiatric cases. Herbal drinks and prayers are the most frequently used CAM among the study population.
DISCUSSION
The result of this study showed that lifetime CAM use and for psychiatric illnesses was high with about one third of respondents being current CAM users. This is similar to a study among diabetic11 and lung cancer12 patients in Beirut Lebanon, cancer patients in northwest13, southwest14 and southeast15 Nigeria, also among people with anxiety/depression in the US16 and Troms Norway17 which reported a lower prevalence. However the previous studies on the prevalence of CAM used for mental disorders reported that 26% of patients suffering from a mental illness visited a traditional healer prior to presenting themselves to a mental health services18, a sizeable portion of the respondents report use of CAM to address emotional and mental problems19, 45% of adults who reported seeing a medical doctor in the past year had also used CAM therapy20, also previous studies10,21 which reported 80 and 60-90%, respectively, with a study from Jamaica22 which reported a prevalence of concomitant herb-drug use in this population of home users as 26.7%.
Reports from this study revealed that about a third of the respondents are current CAM users and use CAM concurrently with Hospital medications with a higher percentage of respondents not informing their physician that they use CAM and reported no improvement in their conditions with CAM use and that herbal drinks and prayers are the most frequently used CAM among the study population. This is contrary to findings in a study of CAM use among cancer patients in south-western Nigeria which reported 64% current CAM users with about 60% of respondents discussing their CAM use with the attending physician and 65% are satisfied with CAM treatment, where as vegetables and supplements were the most frequently used CAM14, but similar to the finding in a study of CAM use in cancer patients in north-western and south eastern Nigeria which reported prayer and herbal therapy as the most common CAM methods with majority of the CAM users not deriving any benefit from CAM use and physicians are unaware of the CAM use in most case15,23, which highlight in previous report24, where it was reported that patients reported a wide range of CAM use, including prayer/spiritual healing (54%). Very few respondents across board reported side effects with CAM use and believed CAM is better for mental disorders this is in contrast to findings in previous studies which reported various unwanted effects14,15. Findings in this study opined that majority have never been advised by their physician to stop CAM use and suggested that concomitant use of CAM and Hospital medication be allowed by doctors despite the fact that they seldom recommend CAM use for other psychiatric cases, similar to findings in previous studies where most respondents will not recommend CAM use but will use the two together for synergy15.
More of the study population were within the age group of 21-40 years with more males than females, with more male and within this age bracket associated with the use of CAM for their condition. Majority of the respondents in UDUTH are married, which is partly similar to a study in Lebanon which reported majority of the sample population being males and predominantly married12. Over one half of the study population either earns less than 10,000 NGN per month or nothing at all and admits that their monthly income affects their ability to pay Hospital medications and hence the necessity to seek for alternative. More of the respondents with duration from onset of psychiatric condition between 1-5 years and age at onset of 21-40 years were more likely to use CAM for their condition. Significant proportions of the study population are satisfied with Hospital medicine use and admit to improvement in their condition with use of Hospital medicines but admitted that the monthly expenditure on Hospital medications is part of the consideration that warrants CAM use.
CONCLUSION
The prevalence of CAM use among psychiatric patients in this study was relatively high. Herbal drinks and prayers were found to be the most commonly used type of CAM. Age, gender, disease duration and cost have been identified as some of the socio-demographic determinants influencing the use of CAM in the study population. Hence the need for psychiatrists to pay more attention to CAM use and related factors among their psychiatric patients as a factor that could affect patient management and outcome.