Research That Matters (January 17 - 20, 2008)

Purpose: Pathways to care has been defined as “the sequence of contacts with individuals and organizations prompted by the distressed person's efforts, and those of his or her significant others, to seek help as well as the help that is supplied in response of these efforts.” Pathways to care in first-episode psychosis (FEP) is an important area of psychiatric research as treatment soon after the onset of psychotic symptoms, during the duration of untreated psychosis (DUP), is theorized to be a critical period during which intervention may be especially effective in reducing future disability and chronicity. Recent evidence indicates that individuals with FEP already have significant deficits in social and occupational functioning by the time they do present for services. To date, the international FEP research has reported limited findings on pathways to care; but it is questionable how applicable these findings are to the US. In the US, only one study has reported on pathways to care for FEP (Compton et al. who described a sample of 25 of African Americans who were hospitalized in one urban public hospital). This poster presents pathways to care information for 594 individuals with FEP of various ethnicities who were hospitalized at any one of 12 hospitals within a large suburban and rural county.

Methods: This secondary analysis draws from data from the Suffolk County Mental Health Project, an NIMH-funded prospective epidemiological study of the natural course of psychotic illness in Suffolk County, New York. A sample of 594 individuals who experienced their first hospitalization ever due to psychosis (27%, schizophrenia or schizoaffective disorder; 31%, bipolar or major depressive disorder with psychotic features; 42%, other) was identified and their (1) demographic and clinical characteristics (2) duration of untreated psychosis and utilization of health services before first hospitalization; and (3) circumstances surrounding their first hospitalization are reported.

Results: Participants in the SCMHP sample were generally young, were more often male, white, unmarried, and were approximately evenly distributed across high, medium, and low SES. Despite the even spread across SES, a little less than half did not have any health insurance. They had significant mental health needs with elevated positive, negative, and depressive symptoms, and more than half met criteria for lifetime diagnosis of alcohol and/or substance abuse. DUP ranged from 0 to 8509 days with a median of 35 and mean of 600, and almost two thirds reported accessing some type of outpatient services before first hospitalization. Participants were more often accompanied to the hospital by family and friends than police or EMS; were more often hospitalized involuntarily; and were more often hospitalized due to bizarre or disturbing behavior than self-injurious or aggressive/violent behavior.

Implications: This poster provides a first look at pathways to care for FEP across different ethnicities in the US. Beginning with this descriptive information, FEP researchers may develop theoretical frameworks in order to test hypotheses regarding FEP pathways to care in the US.