Determinants of pathways to care among young adults with early psychosis entering a coordinated specialty care program
Determinants of pathways to care among young adults with early psychosis entering a coordinated specialty care program
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DOI：
10.1111/eip.12877
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发表时间：
2019-09-10
影响因子：
2
通讯作者：
Dixon, Lisa
中科院分区：
文献类型：
--
作者：
Marino, Leslie;Scodes, Jennifer;Dixon, Lisa
目的描述美国青少年早期精神病患者获得协调专科护理的途径的特点，考察各种因素与未治疗精神病(DUP)持续时间的关系，并探索与从症状出现到首次精神卫生服务接触(DUP)时间相关的因素。方法样本包括在OnTrackNY登记的779名年龄在16岁到30岁之间的新近发病的非情感性精神病患者。评估的领域包括人口统计学、临床特征、精神卫生服务利用和护理途径的特征。主要结果包括从出现精神病症状到进入OnTrackNY的时间(DUP)和从出现精神症状到第一次精神卫生服务接触(DUP)的时间(DUP)。结果平均DUP为231.2天(SD=87.7，中位数为169)，平均DUP为73.7d(SD=110.8，中位数为27)。在学校、较好的社会功能、较多的急诊室就诊或住院次数与较短的DUP相关。暴力意念或行为、第一次服务接触时有门诊精神健康检查或第一次服务接触时出现幻觉与较长的DUP显著相关。只有第一次服务接触的类型(门诊精神卫生治疗或其他非精神卫生服务提供者)和有幻觉作为第一次服务接触的临床原因与求助DUP相关。结论转诊延迟时间长于求助延迟时间。通过系统层面的干预来减少治疗转诊延迟的战略可能最有可能减少这一人群的总体DUP。
Aim To describe the characteristics of the pathway to coordinated specialty care for young adults with early psychosis in the United States, to examine how various factors correlate with the duration of untreated psychosis (DUP), and to explore factors associated with time from onset of symptoms to first mental health service contact (help-seeking DUP). Methods The sample included 779 individuals ages 16 to 30 with recent-onset non-affective psychosis enrolled in OnTrackNY. Domains assessed included demographics, clinical characteristics, mental health service utilization and characteristics of the pathway to care. Primary outcomes included the time from onset of psychotic symptoms to admission to OnTrackNY (DUP) and time from onset of psychotic symptoms to first mental health service contact (help-seeking DUP). Results The mean DUP was 231.2 days (SD = 87.7, median = 169) and mean help-seeking DUP was 73.7 days (SD = 110.8, median = 27). Being in school, better social functioning, and greater number of ER visits or hospitalizations were associated with shorter DUP. Violent ideation or behaviour and having an outpatient mental health visit as the first service contact or hallucinations as the reason for first service contact were significantly associated with longer DUP. Only the type of first service contact (outpatient mental health treatment or other non-mental health service provider) and having hallucinations as the clinical reason for the first service contact were associated with help-seeking DUP. Conclusions Referral delays were longer than help-seeking delays. Strategies to reduce treatment referral delays through systems-level interventions may be most likely to reduce the overall DUP in this population.