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Pathways to Care: How Help-Seeking Behaviors Relate to Duration of Untreated Psychosis and Treatment Engagement

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Abstract

While much research has focused on the relationship between duration of untreated psychosis (DUP) and clinical outcomes in the first episode psychosis (FEP) patient population, little is known about the individual help-seeking episodes (HSE) that patients undergo before receiving appropriate care. The purpose of this project is to better understand how early referral to FEP-specific care and support system differences affect patients’ DUP and engagement with treatment. Data from 50 patients was analyzed at the Early Psychosis Intervention Clinic of New Orleans (EPIC-NOLA) using a modified version of the Pathways to Care Assessments and data captured during clinical care. Patients with their first HSE leading to a referral to EPIC-NOLA (M = 13.3, SD = 11.17) had shorter DUP compared to patients referred after two or more HSEs (M = 29.7, SD = 36. 7), t (38.6) = 2.31, p = .026, 95%CI = 2.0–30.7. One chi-square test revealed a significantly greater proportion of patients referred after one HSE stayed in treatment for 12 months or more. Cluster analysis and independent t-test analyses revealed that patients with hospital pathways (M = 35.00, SD = 39.36) had significantly longer DUP compared to those with self, other and hospital (M = 15.21, SD = 19.07) care pathways. This study supports existing literature that suggest early FEP treatment leads to shortened DUP and longer treatment engagement. Additionally, patients with support systems (people or services) assisting them with help-seeking reach EPIC-NOLA faster, have shorter DUP, and have better treatment engagement.

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Acknowledgements

We thank Dr. Vinod Srihari of Yale University School of Medicine for contributions in establishing the EPIC-NOLA clinic and the inspiration for the CALM community outreach program in addition to guiding this research project. We thank Dr. Patrick Bordnick of Tulane University School of Social Work for input on statistical analysis. We thank Dr. Marvin Swartz of Duke University School of Medicine for guidance on manuscript organization and data interpretation.

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Author notes

  1. Ashley Weiss and Spencer Steadman contributed equally as co-first authors.

Authors and Affiliations

  1. Department of Psychiatry and Behavioral Services, Tulane University School of Medicine, New Orleans, LA, USA

    Ashley Weiss, Spencer Steadman, Hannah D. Mercier, Serena Chaudhry & Isabel Clark

  2. School of Social Work, Tulane University, New Orleans, LA, USA

    Tonya Cross Hansel

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  1. Ashley Weiss
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  2. Spencer Steadman
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  3. Hannah D. Mercier
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  4. Tonya Cross Hansel
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Contributions

Dr. Ashley Weiss—Substantial contributions to the conception and design of the work, revising it critically for important intellectual content, final approval of the version to be published, agreement to be accountable for all aspects of the work in ensuring that questions related. Spencer Steadman—Substantial contributions to the conception and design of the work, drafting and revising it critically for important intellectual content, final approval of the version to be published, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Hannah Mercier, MS – Substantial contributions to the conception and design of the work, drafting and revising it critically for important intellectual content, final approval of the version to be published, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Dr. Tonya Cross Hansel—Substantial contributions to the design of the work, analysis and interpretation of data, drafting the work or revising it critically for important intellectual content, final approval of the version to be published, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Dr. Serena Chaudhry—Substantial contributions to the design of the work, drafting and revising it critically for important intellectual content, final approval of the version to be published, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Dr. Isabel Clark– Substantial contributions to the conception of the work, drafting important intellectual content, final approval of the version to be published, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Ashley Weiss.

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Ethics Approval

The Tulane University Institutional Review Board approved all research protocols.

Consent to Participate

All patients who completed the Pathways to Care assessments received and signed research-specific informed consent paperwork.

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All patients who completed the Pathways to Care assessments received and signed research-specific informed consent paperwork.

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Weiss, A., Steadman, S., Mercier, H.D. et al. Pathways to Care: How Help-Seeking Behaviors Relate to Duration of Untreated Psychosis and Treatment Engagement. Psychiatr Q 93, 473–482 (2022). https://doi.org/10.1007/s11126-021-09960-5

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