Walter Mathis1,2, Maria Ferrara1,2,3, Shadie Burke1,2, Fangyong Li4, John Cahill1,2, I-Hsin Lin4, Jessica Pollard1,2, Scott Woods1, Vinod Srihari1,2; 1Yale University School of Medicine, 2Program for Specialized Treatment Early in Psychosis (STEP), 3AUSL Modena, 4Yale School of Public Health
Specialized services for first episode psychosis(FES) continue to observe prolonged durations of untreated psychosis(DUP). Extant knowledge about pathways to care(PTC) for FES offers little testable guidance on modifiable factors for reducing DUP. There is an urgent need to quantitatively understand contributors to delay regionally, as well as how treatment site delays are moderated by patient characteristics. A semi-structured scale was used to detail PTC for 50 consecutive enrollees to an FES targeting a defined geographic catchment. All contacts and dates were digitally coded. Sub-units of delay, including marginal delays attributable to healthcare providers, were computed and analyzed across patient demographics. Contact with outpatient psychiatric care had the highest attributable delay(mean=52.35±62.81days, p<0.001) and higher parental income increased time from first antipsychotic prescription to FES enrollment(p=0.04). Delay attributable to treatment sites varied with some patient factors. The mean delay from an inpatient admission was twice as long for the oldest quartile than the youngest three quartiles. In local emergency departments, men experienced over four times the delay as women(mean=9.86±53.80 vs. mean=2.33±5.60), and African-Americans experienced three times the mean delay of other racial categories. For outpatient psychiatric settings, the highest quartile of parental education experienced a little over half the mean delay of the lower three quartiles. These findings show delay varies across treatment site and by patient characteristics. While specific to the regional system of care and sample analyzed, the results validate an approach to measuring factors that influence delay, giving FES actionable ways to test DUP reduction strategies.
