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. 2021 Aug;56(8):1359-1369.
doi: 10.1007/s00127-021-02090-0. Epub 2021 May 4.

First help-seeking attempt before and after psychosis onset: measures of delay and aversive pathways to care

Maria Ferrara  1   2 , Sinan Guloksuz  3   4 , Walter S Mathis  3   5 , Fangyong Li  6 , I-Hsin Lin  6 , Sumaiyah Syed  3   5 , Keith Gallagher  3   5 , Jai Shah  7   8 , Emily Kline  9 , Cenk Tek  3 , Matcheri Keshavan  9 , Vinod H Srihari  3   5
Affiliations

First help-seeking attempt before and after psychosis onset: measures of delay and aversive pathways to care

Maria Ferrara et al. Soc Psychiatry Psychiatr Epidemiol. 2021 Aug.

Abstract

Purpose: Delay in receiving effective treatment for psychosis adversely impacts outcomes. We investigated the timing of the first help-seeking attempt in individuals with recent onset non-affective psychosis by comparing those who sought help during the prodrome to those who sought help after psychosis onset across sociodemographic and clinical characteristics, overall functioning, and occurrence of aversive events during their pathways to care.

Methods: Patients were admitted from February 1st, 2014 to January 31st, 2019 to the Program for Specialized Treatment Early in Psychosis (STEP) in New Haven, CT. Psychosis-onset date was ascertained using the Structured Interview for Psychosis-risk Syndromes. Key dates before and after psychosis onset, along with initiators and aversive events, were collected via semi-structured interview.

Results: Within 168 individuals, 82% had their first help-seeking episode after psychosis onset and did not differ in terms of sociodemographic characteristics from prodrome help seekers. When the first help-seeking episode started before (i.e., during prodrome) vs after psychosis onset it was mostly initiated by patients vs family members (Cramer's V = 0.23, p = 0.031) and led to a faster prescription of an antipsychotic once full-blown psychosis emerged (time to antipsychotic since psychosis onset = 21 vs 56 days, p = 0.03). No difference in aversive events before STEP enrollment was detected across groups.

Conclusion: Help seeking during the prodrome is associated with faster initiation of antipsychotic treatment and is more likely to be self-initiated, compared to help seeking after psychosis onset. Early detection efforts that target prodromal samples may improve the length and experience of pathways to care.

Keywords: Duration of untreated psychosis; Early detection; Early intervention; First-episode psychosis; Help-seeking behavior; Pathways to care.

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Conflict of interest statement

Conflicts of interest/Competing interests The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Pathways to care in first episode psychosis. Definitions of measures of delay. PTC Pathway to care. APS = Attenuated Positive Symptoms Syndrome DUI = Duration of untreated illness. APD = antipsychotic drug. STEP = Program for Specialized Treatment Early in Psychosis. DHSp* = Delay initiating Help-Seeking (patient); DHSf* = Delay initiating Help-Seeking (Family). DHF = Delay in Help-finding. *can be prior to, or after, Psychosis onset defined as the date on which Presence of Psychotic Syndrome (POPS) criteria within the Structured Interview for Psychosis-Risk Syndromes (SIPS) were first met.
Fig. 2
Fig. 2
Initiators of the first help-seeking attempt during prodromal (pre-POPS) vs psychotic (post-POPS) phase.
See this image and copyright information in PMC

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