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Determinants of negative pathways to care and their impact on service disengagement in first-episode psychosis

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Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

Although there have been numerous studies on pathways to care in first-episode psychosis (FEP), few have examined the determinants of the pathway to care and its impact on subsequent engagement with mental health services.

Methods

Using a sample of 324 FEP patients from a catchment area-based early intervention (EI) program in Montréal, we estimated the association of several socio-demographic, clinical, and service-level factors with negative pathways to care and treatment delay. We also assessed the impact of the pathway to care on time to disengagement from EI services.

Results

Few socio-demographic or clinical factors were predictive of negative pathways to care. Rather, service-level factors, such as contact with primary care providers, have a stronger impact on patterns of health service use across multiple indicators. Patients who were in contact with primary care had a reduced likelihood of negative pathways to care, but also had longer referral delays to EI services. Socio-demographic and clinical factors were more relevant for predicting subsequent engagement with EI services, and indicators of negative pathways to care were not associated with service disengagement.

Conclusions

Primary care providers may be an efficacious target for interventions aimed at reducing overall treatment delay. Increasing the uptake of primary care services may also reduce the likelihood of negative pathways to care. Our findings draw attention to the need for further investigations of the role that the primary care system plays in early intervention for FEP, and strategies for supporting service providers in this role.

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Acknowledgments

We gratefully acknowledge the research and clinical staff of the Prevention and Early Intervention Program for Psychoses (PEPP) in Montréal for their involvement in carrying out the study. This study was funded by a Canadian Institutes of Health Research (CIHR) Interdisciplinary Capacity Enhancement Grant in Health Inequalities (Project # HOA-80072). Kelly Anderson is supported by a Frederick Banting and Charles Best Canada Graduate Scholarship from the Canadian Institutes of Health Research (CIHR). Dr. Fuhrer holds a CIHR Canada Research Chair in Psychosocial Epidemiology, and Dr. Malla holds a CIHR Canada Research Chair in Early Psychosis. The authors have no conflicts of interest with respect to the publication of this manuscript.

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Authors and Affiliations

  1. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada

    Kelly K. Anderson, Rebecca Fuhrer, Norbert Schmitz & Ashok K. Malla

  2. Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada

    Norbert Schmitz & Ashok K. Malla

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  1. Kelly K. Anderson
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  2. Rebecca Fuhrer
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  3. Norbert Schmitz
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  4. Ashok K. Malla
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Correspondence to Kelly K. Anderson.

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Anderson, K.K., Fuhrer, R., Schmitz, N. et al. Determinants of negative pathways to care and their impact on service disengagement in first-episode psychosis. Soc Psychiatry Psychiatr Epidemiol 48, 125–136 (2013). https://doi.org/10.1007/s00127-012-0571-0

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