Pathways to care and determinants of first help-seeking among patients with psychotic disorders in Northwestern Madagascar: a multicenter cross-sectional study

Psychotic disorders represent a major public health concern worldwide. In low- and middle-income countries, pathways to mental health care are often complex and strongly influenced by sociocultural beliefs, leading to delayed access to psychiatric services. In Madagascar, limited data are available regarding the care pathways of patients with psychotic disorders. The objective of the study is to analyse the pathways to care of patients with psychotic disorders and to identify factors influencing the choice of first help-seeking source. A multicenter cross-sectional analytical study was conducted from July 2020 to April 2021 in one university neuropsychiatric hospital and three faith-based healing centers (Toby Fifohezana) affiliated with the Church of Jesus Christ in Madagascar (FJKM) and the Malagasy Lutheran Church (FLM) in Northwestern Madagascar. Patients presenting psychotic symptoms and their accompanying decision-makers were included. Sociodemographic, clinical, and pathway-related data were collected using a structured questionnaire. Data were analysed using SPSS version 25. Chi-square tests were applied, with p < 0.05 considered statistically significant. A total of 108 patients were included. The mean age was 29.9 ± 9.7 years, and 72.8% were male. First help-seeking was mainly from traditional healers (56.5%) and religious practices (22.2%), whereas only 12.0% consulted psychiatric services and 9.3% consulted general practitioners as a first resort. Higher educational level of decision-makers was significantly associated with initial use of medical services (p < 0.001). Belief in supernatural causation, rural residence, and employment in the primary sector were significantly associated with first consultation with traditional or religious healers. Pathways to care for psychotic disorders in Northwestern Madagascar are predominantly non-medical at onset, leading to delays in appropriate psychiatric treatment. Strengthening mental health literacy, improving accessibility of psychiatric services, and promoting collaboration between traditional, religious, and medical sectors are essential to optimize early care.