Understanding Components of Duration of Untreated Psychosis and Relevance for Early Intervention Services in the Canadian Context: Comprendre les Composantes de la Durée de la Psychose Non Traitée et la Pertinence de Services D’intervention Précoce Dans le Contexte Canadien

Abstract

Background: Clinical, functional, and cost-effectiveness outcomes from early intervention services (EIS) for psychosis are significantly associated with the duration of untreated psychosis (DUP) for the patients they serve. However, most EIS patients continue to report long DUP, while a reduction of DUP may improve outcomes. An understanding of different components of DUP and the factors associated with them may assist in targeting interventions toward specific sources of DUP. Objectives: To examine the components of DUP and their respective determinants in order to inform strategies for reducing delay in treatment in the context of an EIS. Methods: Help-seeking (DUP-H), Referral (DUP-R), and Administrative (DUP-A) components of DUP, pathways to care, and patient characteristics were assessed in first episode psychosis ( N = 532) patients entering an EIS that focuses on systemic interventions to promote rapid access. Determinants of each component were identified in the present sample using multivariate analyses. Results: DUP-H (mean 25.64 ± 59.00) was longer than DUP-R (mean = 14.95 ± 45.67) and DUP-A (mean 1.48 ± 2.55). Multivariate analyses showed that DUP-H is modestly influenced by patient characteristics (diagnosis and premorbid adjustment; R 2 = 0.12) and DUP-R by a combination of personal characteristics (age of onset and education) and systemic factors (first health services contact and final source of referral; R 2 = 0.21). Comorbid substance abuse and referral from hospital emergency services have a modest influence on DUP-A ( R 2 = 0.08). Patients with health care contact prior to onset of psychosis had a shorter DUP-H and DUP-R than those whose first contact was after psychosis onset (F(1, 498) = 4.85, P < 0.03 and F(1, 492) = 3.34, P < 0.07). Conclusions: Although much of the variance in DUP is unexplained, especially for help-seeking component, the systemic portion of DUP may be partially determined by relatively malleable factors. Interventions directed at altering pathways to care and promote rapid access may be important targets for reducing DUP. Simplifying administrative procedures may further assist in reducing DUP.

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

“…Echoing a previous report [12], our current ndings underline a need in Montreal for capacity building among psychologists/counsellors/social workers, who were shown to delay nal referral to early intervention for psychosis and to increase the number of contacts along the way. Disconcertingly, this suggests that even mental healthcare professionals need additional training to identify the presentations of psychosis; value early intervention services as appropriate care settings for rst-episode psychosis; and know how to refer to such services (e.g., through direct access to intake clinicians at well-publicised early psychosis services) [12].…”

“…Based on previous literature on longer DUPs and the postulated role of healers in increasing treatment delays in LMICs [8]; and the predominance of medical contacts in the Canadian setting [12], we hypothesised that DUP would be longer in Chennai than in Montreal. For a ner-grained analysis, we also compared patients' rst contacts after psychosis, referral sources, and the numbers of total contacts prior to initiating services at both sites.…”

Inflammatory markers of symptomatic remission at 6 months in patients with first-episode schizophrenia

“…Longer DUP is associated with lower remission rates, poor premorbid functioning, insidious onset of disease, higher severity and persistence of psychotic symptoms (negative symptoms, in particular), and delayed treatment 51 , 52 . DUP is influenced by patient and guardian factors related to help-seeking (e.g., stigmatization or misunderstanding of psychotic illnesses) and factors related to the care providers (e.g., physicians, counselors, teachers, religious personnel, mental health service specialists) in the institutions where the first contact is made (e.g., ability of case managers to identify psychosis or access to early intervention services) 53 – 56 . Therefore, it is crucial that government authorities and health providers deliver evidence-based interventions that reduce the DUP and improve clinical outcomes in first-episode psychosis.…”

The Impact of Policy Changes, Dedicated Funding and Implementation Support on Early Intervention Programs for Psychosis

“…Most programs conducted educational activities targeted at referral sources to promote early detection, a practice known to shorten DUP, 46,47 improving clinical and functional outcomes. 48,49 However, fewer programs held any public education activities compared to 2016, 7 which may be seen as time-consuming and resource-intensive. These could possibly be best developed and deployed by provincewide organisations (e.g., AQPPEP 50 ) and the government for wider reach, uniformity of messaging and cost-effectiveness.…”