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Proxy consultations for severe mental illnesses: An exploratory cross-sectional study from a tertiary care hospital

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  • Prakyath Ravindranath Hegde
  • Guru S Gowda
  • Bhavika Vajawat
  • Sivakami Sundari Subramaniyan
  • Vinay Basavaraju
  • Narayana Manjunatha
  • Channaveerachari Naveen Kumar
  • Suresh Bada Math

Abstract

Background: Non-adherence to medication leading to a break in continuity of care poses significant challenges in severe mental illness (SMI), leading to poor outcomes. In India, proxy consultation, wherein caregivers consult on behalf of patients, is a commonly adopted but insufficiently researched area to address these challenges. Aims: To explore the extent of proxy consultation in outpatient care of persons with SMI and investigate its sociodemographic and clinical correlates. Methodology: In a tertiary care psychiatry outpatient setting, we conducted a cross-sectional study involving 374 caregivers of persons with SMI (Schizophrenia, Bipolar and related disorders). Descriptive statistics and univariate logistic regression were performed to examine correlates’ relationships with proxy consultation. Results: Proxy consultation prevalence was 43% in the past 1 year. Compared with 18 to 30 years, middle-aged patients aged 31 to 40, 41 to 50 and 51 to 60 years had twofold, threefold and sixfold increased chances of proxy consultation, respectively. Being illiterate had six times higher odds than graduates, three times and two times if they studied till primary and secondary education. Early age of onset was associated with three times higher chances of proxy consultation compared to the onset of illness in adulthood. On the contrary, male gender and upper and middle socioeconomic status decreased the chances of proxy consultation by 40%. Financial difficulties ( n  = 72, 45%) and patients’ unwillingness to visit outpatients ( n  = 44, 27.5%) were the most commonly cited reasons for proxy consultation. Conclusion: Proxy consultations are relatively common, driven by many social, economic, patient-related, pragmatic and practical factors. In formulating community care policies for persons with SMI, the primary imperative should be to conduct additional research, deepening our understanding of proxy consultations. Additionally, it is essential to be mindful of the diverse issues associated with proxy consultations during the formulation process.

Suggested Citation

  • Prakyath Ravindranath Hegde & Guru S Gowda & Bhavika Vajawat & Sivakami Sundari Subramaniyan & Vinay Basavaraju & Narayana Manjunatha & Channaveerachari Naveen Kumar & Suresh Bada Math, 2024. "Proxy consultations for severe mental illnesses: An exploratory cross-sectional study from a tertiary care hospital," International Journal of Social Psychiatry, , vol. 70(6), pages 1108-1117, September.
    • Handle: RePEc:sae:socpsy:v:70:y:2024:i:6:p:1108-1117
    DOI: 10.1177/00207640241255591
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    References listed on IDEAS

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    1. Katrina Witt & Richard van Dorn & Seena Fazel, 2013. "Risk Factors for Violence in Psychosis: Systematic Review and Meta-Regression Analysis of 110 Studies," PLOS ONE, Public Library of Science, vol. 8(2), pages 1-15, February.
    2. Colin D Mathers & Dejan Loncar, 2006. "Projections of Global Mortality and Burden of Disease from 2002 to 2030," PLOS Medicine, Public Library of Science, vol. 3(11), pages 1-20, November.
    3. Prakyath R Hegde & Guru S Gowda & Bhavika Vajawat & Vinay Basavaraju & Sydney Moirangthem & Channaveerachari Naveen Kumar & Suresh Bada Math, 2023. "Study on covert administration of medications practices among persons with severe mental illness: A cross-sectional study," International Journal of Social Psychiatry, , vol. 69(1), pages 28-37, February.
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