The lived experience of psychosis in Nicaragua: a qualitative examination of the views of service users.

Background: The experience of psychosis is individual and influenced by a complex intersection of identity, thought processes, perceptions and culture. Little is known about the lived experience of psychosis in Nicaragua.

Aim: To explore the subjective experience of psychosis in Nicaragua from the perspectives of service users.

Methods: Focus groups with 28 service users with experience of psychosis. A qualitative analysis using both inductive and deductive approaches was used to analyse these data.

Results: Participants mostly attributed the onset of psychosis to external factors such as physical or psychological trauma and highlighted the impact of long-term conflict in the area. Whilst medication was generally viewed positively where this was available participants foregrounded lay and community support networks and engagement in valued activities in their narratives about the management of psychosis. Religious and magical forces were salient in participants' accounts of causal pathways, wider Nicaraguan culture and management practices. Stigma, social exclusion and limited access to formal health services and psychological interventions in particular were the major barriers reported to recovery from psychosis.

Conclusion: Our findings point to the potential utility of culturally adapted psychological interventions in Nicaragua as well as the value of lay and community workforces in delivering such interventions.