Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-17T21:23:19.137Z Has data issue: false hasContentIssue false
  • English
  • Français

The pathways to mental health care of first-episode psychosis patients: a systematic review

Published online by Cambridge University Press:  18 March 2010

K. K. Anderson ,
R. Fuhrer  and
A. K. Malla
K. K. Anderson*
Affiliation:
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
R. Fuhrer
Affiliation:
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
A. K. Malla
Affiliation:
Department of Psychiatry, McGill University, Douglas Mental Health University Institute, Montreal, Québec, Canada
*
*Address for correspondence: K. K. Anderson, Department of Epidemiology, Biostatistics and Occupational Health, 1020 Pine Avenue West, Montreal, QC H3A 1A2, Canada. (Email: kelly.anderson@mail.mcgill.ca)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Although there is agreement on the association between delay in treatment of psychosis and outcome, less is known regarding the pathways to care of patients suffering from a first psychotic episode. Pathways are complex, involve a diverse range of contacts, and are likely to influence delay in treatment. We conducted a systematic review on the nature and determinants of the pathway to care of patients experiencing a first psychotic episode.

Method

We searched four databases (Medline, HealthStar, EMBASE, PsycINFO) to identify articles published between 1985 and 2009. We manually searched reference lists and relevant journals and used forward citation searching to identify additional articles. Studies were included if they used an observational design to assess the pathways to care of patients with first-episode psychosis (FEP).

Results

Included studies (n=30) explored the first contact in the pathway and/or the referral source that led to treatment. In 13 of 21 studies, the first contact for the largest proportion of patients was a physician. However, in nine of 22 studies, the referral source for the greatest proportion of patients was emergency services. We did not find consistent results across the studies that explored the sex, socio-economic, and/or ethnic determinants of the pathway, or the impact of the pathway to care on treatment delay.

Conclusions

Additional research is needed to understand the help-seeking behavior of patients experiencing a first-episode of psychosis, service response to such contacts, and the determinants of the pathways to mental health care, to inform the provision of mental health services.

Keywords

Early interventionfirst-episode psychosishelp-seekingmental health servicespathways to care
Type
Review Article
Information
Psychological Medicine , Volume 40 , Issue 10 , October 2010 , pp. 1585 - 1597
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Addington, J, Addington, D (2006). Early intervention for psychosis: who refers? Schizophrenia Research 84, 176–177.CrossRefGoogle ScholarPubMed
Addington, J, Van Mastrigt, S, Hutchinson, J, Addington, D (2002). Pathways to care: help seeking behaviour in first episode psychosis. Acta Psychiatrica Scandinavica 106, 358–364.CrossRefGoogle ScholarPubMed
Archie, S, Akhtar-Danesh, N, Norman, R, Malla, A, Roy, P, Zipursky, RB (2009). Ethnic diversity and pathways to care for a first episode of psychosis in Ontario. Schizophrenia Bulletin. Published online: 5 November 2008. doi:10.1093/schbul/sbn137.Google Scholar
Bechard-Evans, L, Schmitz, N, Abadi, S, Joober, R, King, S, Malla, A (2007). Determinants of help-seeking and system related components of delay in the treatment of first-episode psychosis. Schizophrenia Research 96, 206–214.CrossRefGoogle ScholarPubMed
Bergner, E, Leiner, AS, Carter, T, Franz, L, Thompson, NJ, Compton, MT (2008). The period of untreated psychosis before treatment initiation: a qualitative study of family members' perspectives. Comprehensive Psychiatry 49, 530–536.CrossRefGoogle ScholarPubMed
Bhugra, D, Corridan, B, Rudge, S, Leff, J, Mallett, R (1999). Early manifestations, personality traits and pathways into care for Asian and white first-onset cases of schizophrenia. Social Psychiatry and Psychiatric Epidemiology 34, 595–599.CrossRefGoogle ScholarPubMed
Bhugra, D, Harding, C, Lippett, R (2004). Pathways into care and satisfaction with primary care for black patients in South London. Journal of Mental Health 13, 171–183.CrossRefGoogle Scholar
Bhugra, D, Hilwig, M, Mallett, R, Corridan, B, Leff, J, Neehall, J, Rudge, S (2000). Factors in the onset of schizophrenia: a comparison between London and Trinidad samples. Acta Psychiatrica Scandinavica 101, 135–141.CrossRefGoogle ScholarPubMed
Burnett, R, Mallett, R, Bhugra, D, Hutchinson, G, Der, G, Leff, J (1999). The first contact of patients with schizophrenia with psychiatric services: social factors and pathways to care in a multi-ethnic population. Psychological Medicine 29, 475–483.CrossRefGoogle Scholar
Chiang, JCS, Chow, ASY, Chan, RCK, Law, CW, Chen, EYH (2005). Pathway to care for patients with first-episode psychosis in Hong Kong. Hong Kong Journal of Psychiatry 15, 18–22.Google Scholar
Chien, VH, Compton, MT (2008). The impact of mode of onset of psychosis on pathways to care in a hospitalized, predominantly African-American, first-episode sample. Early Intervention in Psychiatry 2, 73–79.CrossRefGoogle Scholar
Chong, SA, Mythily, S, Lum, A, Chan, YH, McGorry, P (2005). Determinants of duration of untreated psychosis and the pathway to care in Singapore. International Journal of Social Psychiatry 51, 55–62.CrossRefGoogle ScholarPubMed
Cole, E, Leavey, G, King, M, Johnson-Sabine, E, Hoar, A (1995). Pathways to care for patients with a first episode of psychosis: a comparison of ethnic groups. British Journal of Psychiatry 167, 770–776.CrossRefGoogle ScholarPubMed
Compton, MT (2005). Barriers to initial outpatient treatment engagement following first hospitalization for a first episode of nonaffective psychosis: a descriptive case series. Journal of Psychiatric Practice 11, 62–69.CrossRefGoogle ScholarPubMed
Compton, MT, Carter, T, Bergner, E, Franz, L, Stewart, T, Trotman, H, McGlashan, TH, McGorry, PD (2007). Defining, operationalizing and measuring the duration of untreated psychosis: advances, limitations and future directions. Early Intervention in Psychiatry 1, 236–250.CrossRefGoogle Scholar
Compton, MT, Esterberg, ML, Druss, BG, Walker, EF, Kaslow, NJ (2006). A descriptive study of pathways to care among hospitalized urban African American first-episode schizophrenia-spectrum patients. Social Psychiatry and Psychiatric Epidemiology 41, 566–573.CrossRefGoogle ScholarPubMed
Cougnard, A, Kalmi, E, Desage, A, Misdrahi, D, Abalan, F, Brun-Rousseau, H, Salmi, LR, Verdoux, H (2004 a). Factors influencing compulsory admission in first-admitted subjects with psychosis. Social Psychiatry and Psychiatric Epidemiology 39, 804–809.CrossRefGoogle ScholarPubMed
Cougnard, A, Kalmi, E, Desage, A, Misdrahi, D, Abalan, F, Brun-Rousseau, H, Salmi, LR, Verdoux, H (2004 b). Pathways to care of first-admitted subjects with psychosis in South-Western France. Psychological Medicine 34, 267–276.CrossRefGoogle ScholarPubMed
Cratsley, K, Regan, J, McAllister, V, Simic, M, Aitchison, KJ (2008). Duration of untreated psychosis, referral route, and age of onset in an early intervention in psychosis service and a local CAMHS. Child and Adolescent Mental Health 13, 130–133.CrossRefGoogle Scholar
Fuchs, J, Steinert, T (2002). Pathways to psychiatric care and duration of untreated psychosis in first-episode psychosis patients [in German]. Fortschritte der Neurologie-Psychiatrie 70, 40–45.CrossRefGoogle ScholarPubMed
Fuchs, J, Steinert, T (2004). Patients with a first episode of schizophrenia spectrum psychosis and their pathways to psychiatric hospital care in South Germany. Social Psychiatry and Psychiatric Epidemiology 39, 375–380.CrossRefGoogle ScholarPubMed
Garety, PA, Rigg, A (2001). Early psychosis in the inner city: a survey to inform service planning. Social Psychiatry and Psychiatric Epidemiology 36, 537–544.CrossRefGoogle ScholarPubMed
Goldberg, D, Huxley, P (1980). Mental Illness in the Community: The Pathway to Psychiatric Care. Tavistock Publications: London, UK.Google Scholar
Harrison, G, Holton, A, Neilson, D, Owens, D (1989). Severe mental disorder in Afro-Caribbean patients: some social, demographic and service factors. Psychological Medicine 19, 683–696.CrossRefGoogle ScholarPubMed
Kohn, D, Pukrop, R, Niedersteberg, A, Schultze-Lutter, F, Ruhrmann, S, Bechdolf, A, Berning, J, Maier, W, Klosterkotter, J (2004). Pathways to care: help-seeking behavior in first-episode psychosis [in German]. Fortschritte der Neurologie-Psychiatrie 72, 635–642.Google ScholarPubMed
Lincoln, C, Harrigan, S, McGorry, PD (1998). Understanding the topography of the early psychosis pathways. An opportunity to reduce delays in treatment. British Journal of Psychiatry. Supplement 172, 21–25.CrossRefGoogle ScholarPubMed
Lincoln, CV, McGorry, P (1995). Who cares? Pathways to psychiatric care for young people experiencing a first episode of psychosis. Psychiatric Services 46, 1166–1171.Google ScholarPubMed
Marshall, M, Lewis, S, Lockwood, A, Drake, R, Jones, P, Croudace, T (2005). Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Archives of General Psychiatry 62, 975–983.CrossRefGoogle ScholarPubMed
McGorry, PD, Killackey, E, Yung, AR (2007). Early intervention in psychotic disorders: detection and treatment of the first episode and the critical early stages. Medical Journal of Australia 187, S8–S10.CrossRefGoogle ScholarPubMed
Melle, I, Larsen, TK, Haahr, U, Friis, S, Johannessen, JO, Opjordsmoen, S, Simonsen, E, Rund, BR, Vaglum, P, McGlashen, T (2004). Reducing the duration of untreated first-episode psychosis: effects on clinical presentation. Archives of General Psychiatry 61, 143–150.CrossRefGoogle ScholarPubMed
Monteiro, VBM, Dos Santos, JQ, Martin, D (2006). Patients' relatives delayed help seeking after a first psychotic episode. Revista Brasileira de Psiquiatria 28, 104–110.CrossRefGoogle ScholarPubMed
Morgan, C, Mallett, R, Hutchinson, G, Bagalkote, H, Morgan, K, Fearon, P, Dazzan, P, Boydell, J, McKenzie, K, Harrison, G, Murray, R, Jones, P, Craig, T, Leff, J (2005 a). Pathways to care and ethnicity. 2: Source of referral and help-seeking. Report from the AESOP study. British Journal of Psychiatry 186, 290–296.CrossRefGoogle ScholarPubMed
Morgan, C, Mallett, R, Hutchinson, G, Bagalkote, H, Morgan, K, Fearon, P, Dazzan, P, Boydell, J, McKenzie, K, Harrison, G, Murray, R, Jones, P, Craig, T, Leff, J (2005 b). Pathways to care and ethnicity. 1: Sample characteristics and compulsory admission. Report from the AESOP study. British Journal of Psychiatry 186, 281–289.CrossRefGoogle ScholarPubMed
Norman, RM, Malla, AK (2001). Duration of untreated psychosis: a critical examination of the concept and its importance. Psychological Medicine 31, 381–400.CrossRefGoogle ScholarPubMed
Norman, RMG, Malla, AK, Verdi, MB, Hassall, LD, Fazekas, C (2004). Understanding delay in treatment for first-episode psychosis. Psychological Medicine 34, 255–266.CrossRefGoogle ScholarPubMed
O'Callaghan, E, Turner, N, Renwick, L, Jackson, D, Sutton, M, Foley, SD, McWilliams, S, Behan, C, Fetherstone, A, Kinsella, A (2010). First episode psychosis and the trail to secondary care: help-seeking and health-system delays. Social Psychiatry and Psychiatric Epidemiology 45, 381–391.CrossRefGoogle ScholarPubMed
Perkins, DO, Gu, H, Boteva, K, Lieberman, JA (2005). Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. American Journal of Psychiatry 162, 1785–1804.CrossRefGoogle ScholarPubMed
Platz, C, Umbricht, DS, Cattapan-Ludewig, K, Dvorsky, D, Arbach, D, Brenner, HD, Simon, AE (2006). Help-seeking pathways in early psychosis. Social Psychiatry and Psychiatric Epidemiology 41, 967–974.CrossRefGoogle ScholarPubMed
Rogler, LH, Cortes, DE (1993). Help-seeking pathways: a unifying concept in mental health care. American Journal of Psychiatry 150, 554–561.Google ScholarPubMed
Scholten, DJ, Malla, AK, Norman, RM, McLean, TS, McIntosh, EM, McDonald, CL, Eliasziw, M, Speechley, KN (2003). Removing barriers to treatment of first-episode psychotic disorders. Canadian Journal of Psychiatry 48, 561–565.CrossRefGoogle ScholarPubMed
Sharifi, V, Kermani-Ranjbar, T, Amini, H, Alaghband-rad, J, Salesian, N, Seddigh, A (2009). Duration of untreated psychosis and pathways to care in patients with first-episode psychosis in Iran. Early Intervention in Psychiatry 3, 131–136.CrossRefGoogle ScholarPubMed
Singh, SP, Grange, T (2006). Measuring pathways to care in first-episode psychosis: a systematic review. Schizophrenia Research 81, 75–82.CrossRefGoogle ScholarPubMed
Temmingh, HS, Oosthuizen, PP (2008). Pathways to care and treatment delays in first and multi episode psychosis: findings from a developing country. Social Psychiatry and Psychiatric Epidemiology 43, 727–735.CrossRefGoogle ScholarPubMed
Turner, M, Smith-Hamel, C, Mulder, R (2006). Pathways to care in a New Zealand first-episode of psychosis cohort. Australian and New Zealand Journal of Psychiatry 40, 421–428.Google Scholar
Wong, DFK (2007 a). Crucial individuals in the help-seeking pathway of Chinese caregivers of relatives with early psychosis in Hong Kong. Social Work 52, 127–135.CrossRefGoogle ScholarPubMed
Wong, DFK (2007 b). Uncovering sociocultural factors influencing the pathway to care of Chinese caregivers with relatives suffering from early psychosis in Hong Kong. Culture, Medicine and Psychiatry 31, 51–71.CrossRefGoogle ScholarPubMed