Skip to main content
×
×
Home

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

  • K. K. Anderson (a1), R. Fuhrer (a1) and A. K. Malla (a2)
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.

Copyright
Corresponding author
*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)
References
Hide All
Addington, J, Addington, D (2006). Early intervention for psychosis: who refers? Schizophrenia Research 84, 176177.
Addington, J, Van Mastrigt, S, Hutchinson, J, Addington, D (2002). Pathways to care: help seeking behaviour in first episode psychosis. Acta Psychiatrica Scandinavica 106, 358364.
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.
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, 206214.
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, 530536.
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, 595599.
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, 171183.
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, 135141.
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, 475483.
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, 1822.
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, 7379.
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, 5562.
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, 770776.
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, 6269.
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, 236250.
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, 566573.
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, 804809.
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, 267276.
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, 130133.
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, 4045.
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, 375380.
Garety, PA, Rigg, A (2001). Early psychosis in the inner city: a survey to inform service planning. Social Psychiatry and Psychiatric Epidemiology 36, 537544.
Goldberg, D, Huxley, P (1980). Mental Illness in the Community: The Pathway to Psychiatric Care. Tavistock Publications: London, UK.
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, 683696.
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, 635642.
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, 2125.
Lincoln, CV, McGorry, P (1995). Who cares? Pathways to psychiatric care for young people experiencing a first episode of psychosis. Psychiatric Services 46, 11661171.
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, 975983.
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, S8S10.
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, 143150.
Monteiro, VBM, Dos Santos, JQ, Martin, D (2006). Patients' relatives delayed help seeking after a first psychotic episode. Revista Brasileira de Psiquiatria 28, 104110.
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, 290296.
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, 281289.
Norman, RM, Malla, AK (2001). Duration of untreated psychosis: a critical examination of the concept and its importance. Psychological Medicine 31, 381400.
Norman, RMG, Malla, AK, Verdi, MB, Hassall, LD, Fazekas, C (2004). Understanding delay in treatment for first-episode psychosis. Psychological Medicine 34, 255266.
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, 381391.
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, 17851804.
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, 967974.
Rogler, LH, Cortes, DE (1993). Help-seeking pathways: a unifying concept in mental health care. American Journal of Psychiatry 150, 554561.
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, 561565.
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, 131136.
Singh, SP, Grange, T (2006). Measuring pathways to care in first-episode psychosis: a systematic review. Schizophrenia Research 81, 7582.
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, 727735.
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, 421428.
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, 127135.
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, 5171.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed