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First help-seeking attempt before and after psychosis onset: measures of delay and aversive pathways to care

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Delay in receiving effective treatment for psychosis adversely impacts outcomes. We investigated the timing of the first help-seeking attempt in individuals with recent onset non-affective psychosis by comparing those who sought help during the prodrome to those who sought help after psychosis onset across sociodemographic and clinical characteristics, overall functioning, and occurrence of aversive events during their pathways to care.


Patients were admitted from February 1st, 2014 to January 31st, 2019 to the Program for Specialized Treatment Early in Psychosis (STEP) in New Haven, CT. Psychosis-onset date was ascertained using the Structured Interview for Psychosis-risk Syndromes. Key dates before and after psychosis onset, along with initiators and aversive events, were collected via semi-structured interview.


Within 168 individuals, 82% had their first help-seeking episode after psychosis onset and did not differ in terms of sociodemographic characteristics from prodrome help seekers. When the first help-seeking episode started before (i.e., during prodrome) vs after psychosis onset it was mostly initiated by patients vs family members (Cramer’s V = 0.23, p = 0.031) and led to a faster prescription of an antipsychotic once full-blown psychosis emerged (time to antipsychotic since psychosis onset = 21 vs 56 days, p = 0.03). No difference in aversive events before STEP enrollment was detected across groups.


Help seeking during the prodrome is associated with faster initiation of antipsychotic treatment and is more likely to be self-initiated, compared to help seeking after psychosis onset. Early detection efforts that target prodromal samples may improve the length and experience of pathways to care.

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The preliminary results of this work have been accepted as poster presentation at SIRS 2020, Florence. Abstract is available as Maria Ferrara*, Sinan Guloksuz, Walter Mathis, Andrea Raballo, Fangyong Li, I-Hsin Lin, Sumaiyah Syed, Keith Gallagher, Scott Woods, Cenk Tek, Vinod Srihari. T242. The timing of first help-seeking attempt in first-episode psychosis can lead to aversive pathways to care. Results from the STEP-ED study. Schizophrenia Bulletin, Volume 46, Issue Supplement_1, April 2020, Page NP,


This work was supported by the National Institutes of Health (R01MH103831 to V.H.S.). The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The work described in this article was funded in part by the State of Connecticut, Department of Mental Health and Addiction Services, but this publication does not express the views of the Department of Mental Health and Addiction Services or the State of Connecticut. The views and opinions expressed are those of the authors.

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Correspondence to Maria Ferrara.

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The study have been approved by the Yale University Institutional Review Board and have, therefore, been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Informed consent was obtained from all participants per procedures of the study protocol approved by the Yale University Institutional Review Board [page 6 of the manuscript].

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Ferrara, M., Guloksuz, S., Mathis, W.S. et al. First help-seeking attempt before and after psychosis onset: measures of delay and aversive pathways to care. Soc Psychiatry Psychiatr Epidemiol 56, 1359–1369 (2021).

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