Saturday, 15 January 2005 - 12:00 PM

This presentation is part of: Poster Session II

A Tri-Ethnic Study of the Duration of Untreated Psychosis

Background: Schizophrenia is a chronic illness that results in impaired quality of life from the time of onset throughout much of the life course. The delay between symptom onset and initiation of treatment is referred to as the duration of untreated psychosis (DUP). Research has documented a tendency for ethnic minority patients to delay seeking psychiatric treatment until the illness has progressed to an unmanageable degree. However, there are no published studies on the DUP that focus on ethnic minorities. Purpose: The aim of this study was to use a mixed-method design to investigate the DUP among ethnically diverse patients with schizophrenia. Using the quantitative data we hypothesized that: (1) a smaller proportion of ethnic minority patients will have a DUP of less than one year, and (2) among patients with a DUP of one year or more, ethnic minority patients will have a longer DUP. Methods: The sample came from the initial phase of the San Diego site-Schizophrenia Care and Assessment Program, a longitudinal naturalistic study on the course of schizophrenia treatment. Analyses were based on semi-structured interviews conducted with 100 persons diagnosed with a schizophrenia spectrum disorder. Data for 42 males and 58 females, ages 18 to 71 years (M = 42, SD=11) were analyzed. There were 23 African Americans, 54 Euro-Americans, and 23 Latinos. DUP was constructed as the difference between age of first prescription and age of first persistent symptoms. Qualitative analyses of the illness narratives for each patient were conducted to further corroborate the quantitative findings. Results: Nearly 50% of the patients (n=49) reported a DUP of less than one year. The data did not support our first hypothesis in that there were no ethnic differences in the proportion of patients reporting a DUP of less than one year. Subsequent analyses were conducted to examine the DUP among those patients with a wider gap (n=50). Due to a non-normal distribution of DUP scores we compared the median scores for each group. The overall median DUP was 4 years. Latinos had the largest median gap (8 yrs), followed by African Americans (5 yrs), and Euro-Americans (3 yrs). We regressed the log of DUP onto dummy-coded ethnicity variables (Euro-American as reference group) while controlling for age of onset and education (as a proxy for socioeconomic status). The model was significant, R²= .40, Adjusted R²= .30 (F {5, 44} = 5.21, p =.001). Our second hypothesis was partially supported as the relationships between DUP and African American ethnicity (.87, t {37} =2.48, p =.02) and age of onset (-.42, t {44} =-2.51, p =.02) were significant. Among the cultural themes abstracted from the narratives were: difficulty accessing services due to limited financial resources; reliance on spirituality in response to symptoms; close-knit family networks; and stigma. Implications for Practice or Policy: The much longer median DUP among African Americans compared to that of Euro-Americans suggests a need for practice guidelines that raise awareness of the disparity in access to early pharmacological interventions.

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