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Trust of patients and families in mental healthcare providers and institutions: a cross-cultural study in Chennai, India, and Montreal, Canada

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Abstract

Purpose

Cross-cultural psychosis research has typically focused on a limited number of outcomes (generally symptom-related). It is unknown if the purported superior outcomes for psychosis in some low- and middle-income countries extend to fundamental treatment processes like trust. Addressing this gap, we studied two similar first-episode psychosis programs in Montreal, Canada, and Chennai, India. We hypothesized higher trust in healthcare institutions and providers among patients and families in Chennai at baseline and over follow-up.

Methods

Upon treatment entry and at months 3, 12 and 24, trust in healthcare providers was measured using the Wake Forest Trust scale and trust in the healthcare and mental healthcare systems using two single items. Nonparametric tests were performed to compare trust levels across sites and mixed-effects linear regression models to investigate predictors of trust in healthcare providers.

Results

The study included 333 patients (Montreal = 165, Chennai = 168) and 324 family members (Montreal = 128, Chennai = 168). Across all timepoints, Chennai patients and families had higher trust in healthcare providers and the healthcare and mental healthcare systems. The effect of site on trust in healthcare providers was significant after controlling for sociodemographic characteristics known to impact trust. Patients' trust in doctors increased over follow-up.

Conclusion

This study uniquely focuses on trust as an outcome in psychosis, via a comparative longitudinal analysis of different trust dimensions and predictors, across two geographical settings. The consistent differences in trust levels between sites may be attributable to local cultural values and institutional structures and processes and underpin cross-cultural variations in treatment engagement and outcomes.

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Data availability

Ethics approval for this study and associated consent procedures do not allow us to publish datasets in a publicly accessible repository. However, the data that support the findings of this study are available from the corresponding author, S.N.I., upon reasonable request.

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Acknowledgements

We would like to thank the Montreal and SCARF patients, families and teams. Specifically, we would like to thank Drs Mangala Ramamurthy, Shivaprakash Srinivasan and T.C. Rameshkumar, and Arthy Jayavel, Anjhana Krishnamoorthi, Helen Martin, Sneha Natarajan and Shruthi Rao who contributed to service delivery and data collection at SCARF. From the Montreal team, we would like to thank Aarati Taksal, Emily Schorr, Geraldine Etienne, Heleen Loohuis, Kevin MacDonald, Megan Pope and Nicole Pawliuk for supporting data collection and project coordination.

Funding

This work was supported by an R-01 grant (no. 5R01MH093303-05) and an associated supplemental grant (no. R01MH093303-04) from the National Institutes of Health. The funding source had no further role in study design, data collection and analysis, writing of the report, and in the decision to submit the report for publication. SMX is recipient of a FCT (Fundação para a Ciência e Tecnologia) doctoral fellowship (SFRH/BD/143544/2019). Over the course of the project, SNI received salary awards from CIHR and FRQS, and AM was supported by the Canada Research Chairs Program.

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  1. Norbert Schmitz

    Present address: University of Tübingen, Geschwister-Scholl-Platz 72074, Tübingen, Germany

Authors and Affiliations

  1. Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada

    Salomé M. Xavier, Ashok Malla, Sally Mustafa, Ridha Joober & Srividya N. Iyer

  2. Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada

    Salomé M. Xavier, Ashok Malla, Sally Mustafa, Ridha Joober, Norbert Schmitz, Howard C. Margolese & Srividya N. Iyer

  3. Schizophrenia Research Foundation (SCARF), R-7A North Main Road, Anna Nagar West Extension, Chennai, 600 101, Tamil Nadu, India

    Greeshma Mohan, Ramachandran Padmavati & Thara Rangaswamy

  4. University of Warwick, Coventry, CV4 7AL, UK

    Greeshma Mohan

  5. Prevention and Early Intervention Program for Psychosis, McGill University Health Centre (PEPP-MUHC), 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada

    Howard C. Margolese

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Contributions

SMX contributed to conceptualization and methodology of the present study, formal analysis, writing—original draft, and writing—review and editing. AM contributed to conceptualization, methodology, project administration and supervision of the larger project, resources, funding acquisition and writing—review and editing. GM contributed to investigation, resources and writing—review and editing. SM performed formal analysis, supervision and writing—review and editing. TR contributed to conceptualization, methodology, project administration and supervision of the larger project, resources, funding acquisition and writing—review and editing. RP and RJ contributed to methodology, project administration and supervision of the larger project, resources, funding acquisition and writing—review and editing. NS contributed to methodology and supervision of the larger project, funding acquisition and writing—review and editing. HCM contributed to resources and writing—review and editing. SNI contributed to conceptualization, methodology, project administration and supervision of the larger project and current study, resources, funding acquisition, investigation, writing—original draft, and writing—review and editing.

Corresponding author

Correspondence to Srividya N. Iyer.

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All study participants provided informed consent to participate in the study. In the case of minors, assent from them and consent from their parents/guardians were obtained.

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Xavier, S.M., Malla, A., Mohan, G. et al. Trust of patients and families in mental healthcare providers and institutions: a cross-cultural study in Chennai, India, and Montreal, Canada. Soc Psychiatry Psychiatr Epidemiol 59, 813–825 (2024). https://doi.org/10.1007/s00127-023-02576-z

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