Comparing treatment delays and pathways to early intervention services for psychosis in urban settings in India and Canada

Abstract

IntroductionAlthough extensively studied in high-income countries (HICs) and less so in low-and middle-income countries (LMICs), pathways to care and treatment delays in early psychosis have not been compared across contexts. We compared pathways to early intervention for psychosis in an HIC (Montreal, Canada) and an LMIC (Chennai, India). We hypothesised that the duration of untreated psychosis (DUP) would be longer in Chennai. MethodsThe number of contacts preceding early intervention, referral sources, rst contacts, and DUP and its referral and help-seeking components of rst-episode psychosis patients at both sites were similarly measured and compared using chi-square analyses and t-tests/one-way ANOVAs. ResultsOverall and help-seeking DUPs of Chennai (N = 168) and Montreal (N = 165) participants were not signi cantly different. However, Chennai patients had shorter referral DUPs [mean = 12.0 ± 34.1 weeks vs.Montreal mean = 13.2 ± 28.7 weeks; t(302.57) = 4.40; p < .001] as the early intervention service was the rst contact for 44% of them (vs. 5% in Montreal). Faith healers comprised 25% of rst contacts in Chennai. Those seeing faith healers had signi cantly shorter help-seeking but longer referral DUPs. As predicted, most (93%) Montreal referrals came from medical sources. Those seeing psychologists/counsellors/social workers as their rst contact had longer DUPs. ConclusionDifferences in cultural views about mental illnesses and organizational structures shape pathways to care and their associations with treatment delays across contexts. Both formal and informal sources need to be targeted to reduce delays. Early intervention services being the rst portal where help is sought can reduce DUP especially if accessed early on in the illness course.

Similar and different? A cross-cultural comparison of the prevalence, course of and factors associated with suicidal thoughts and behaviors in first-episode psychosis in Chennai, India and Montreal, Canada

“…Finally, health system context differences may also have played a role. In Montreal, the emergency services within the EIS’ larger premises and the physicians being more oriented toward risk management (MacDonald et al, 2023), as well as the higher uptake of legal means to hospitalize patients against their will (or the family’s) in case of suicidal risk, may have contributed to lower risk of death by suicide. For example, in one suicide death in Chennai, the patient’s husband refused the immediate admission advised by the treating team, and the suicide occurred few hours later.…”