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Cited by 91Mental Health Treatment and AccessMigration, Health and TraumaPosttraumatic Stress Disorder Research

Estimating clinically relevant mental disorders in a rural and an urban setting in postconflict Timor Leste

Silove, Derrick, Bateman, Catherine Robina, Brooks, Robert T., Fonseca, C. Amaral Zulmira, Steel, Zachary, Rodger, James, Soosay, Ian, Fox, Greg +2 more·2008·Archives of General Psychiatry
DOI 10.1001/archpsyc.65.10.1205
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Abstract

CONTEXT: Epidemiologic studies undertaken in postconflict countries have focused primarily on trauma-related disorders. There is a need to include disabling psychotic disorders in order to plan clinical services in these settings. OBJECTIVES: To estimate the prevalence of key clinical disorders in Timor Leste (East Timor), and to assess cultural factors that may influence help-seeking patterns. DESIGN, SETTING, PARTICIPANTS: A 2-phase total population survey of 1544 adults in an urban and a rural area of Timor Leste. Phase 1 involved a household informant survey using indigenous terms to detect psychosis and a screen of all adults for posttraumatic stress disorder (PTSD) and symptoms of psychologic distress, including depression and anxiety. In phase 2, clinicians interviewed all those identified by household informants and half of those who screened positive in order to assign DSM-IV diagnoses. Disability, explanatory models, and perceived needs were also assessed. MAIN OUTCOME MEASURES: Phase 1: Demographic characteristics; trauma events and PTSD (Harvard Trauma Questionnaire); psychologic distress (Kessler-10 scale). Phase 2: Structured Clinical Interview for relevant DSM-IV diagnoses; the Global Assessment of Functioning Scale and the World Health Organization Disability Assessment Scales; and the modified Short Explanatory Model Interview. RESULTS: The household informant method in phase 1 detected mainly psychotic disorders, and the screen method detected PTSD and depression. Phase 2 yielded a DSM-IV point prevalence estimate of 5.1% (including psychosis, 1.35%; and PTSD, 1.47%). Psychotic disorders were most disabling, primarily attributed to supernatural causes and treated mainly by traditional healers. Those with depression and PTSD experienced substantial disability but had received little treatment. They attributed their mental problems to social and traumatic causes. CONCLUSIONS: Our 2-phase method proved effective for identifying the range of disorders relevant to planning clinical services in postconflict developing countries. The unmet needs of the mentally ill in countries such as Timor Leste pose a major challenge to psychiatry.

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Authors
Silove, D., Bateman, C. R., Brooks, R. T., Fonseca, C. A. Z., Steel, Z., Rodger, J., Soosay, I., Fox, G., Patel, V., & Bauman, A.
Affiliations
  • Sydney South West Area Health Service (AU)
  • The University of Sydney (AU)
ORCID
Venue
Archives of General Psychiatry
Publisher
American Medical Association (AMA)
Published
2008-10-06
Volume
65
Issue
10
Pages
1205
ISSN
0003-990X (ISSN-L)
DOI
10.1001/archpsyc.65.10.1205
OpenAlex
W2129676301
Cited by
91
References
59
Citations by year
2026: 2 · 2025: 1 · 2024: 1 · 2023: 1 · 2022: 3 · 2020: 1 · 2019: 6 · 2018: 2 · 2017: 6 · 2016: 16 · 2015: 5 · 2014: 9 · 2013: 7 · 2012: 4
FWCI
12.04
Type
journal article
Language
en
Open access
closed
Locations
  • Archives of General Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Keywords
prevalence of mental disorders, psychosis, post-traumatic stress disorder, depression, anxiety, psychological distress, Timor-Leste, urban-rural differences, traditional healers, help-seeking, disability, unmet mental health needs
MeSH terms
Adult, Civil Disorders, Conflict, Psychological, Cross-Sectional Studies, Cross-Cultural Comparison, Culture, Depressive Disorder, Disability Evaluation, Female, Health Surveys, Humans, Indonesia, Magic, Male, Mass Screening, Medicine, Traditional, Middle Aged, Personality Assessment, Pilot Projects, Psychotic Disorders, Rural Population, Stress Disorders, Post-Traumatic, Urban Population, Witchcraft, Diagnostic and Statistical Manual of Mental Disorders

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