Comparing treatment delays and pathways to early intervention services for psychosis in urban settings in India and Canada.
Comparing treatment delays and pathways to early intervention services for psychosis in urban settings in India and Canada.
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将治疗延迟和途径与印度和加拿大城市环境中精神病的早期干预服务进行比较。
DOI：
10.1007/s00127-022-02414-8
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发表时间：
2023-04
影响因子：
4.4
通讯作者：
Iyer, Srividya N.
中科院分区：
文献类型：
--
作者：
MacDonald, Kathleen;Mohan, Greeshma;Pawliuk, Nicole;Joober, Ridha;Padmavati, Ramachandran;Rangaswamy, Thara;Malla, Ashok;Iyer, Srividya N.
尽管在高收入国家（HIC）进行了广泛研究，而在低收入和中等收入国家（LMICs）则较少，但尚未在不同背景下比较早期精神病的护理和治疗延迟途径。我们比较了HIC（加拿大蒙特利尔）和LMIC（印度钦奈）精神病早期干预的途径。我们假设，未经治疗的精神病（DUP）的持续时间在钦奈会更长。早期干预前的接触，转诊来源，第一次接触，DUP及其转诊和寻求帮助的组成部分，首发精神病患者在这两个网站进行了类似的测量和比较，使用卡方分析和t检验/单因素方差分析。金奈（N=168）和蒙特利尔（N=165）参与者的总体和寻求帮助的DUP没有显着差异。然而，钦奈患者的转诊DUP较短[平均值=12.0±34.1周，蒙特利尔平均值=13.2±28.7周; t（302.57）=4.40; p<.001]，因为44%的患者（蒙特利尔为5%）首次接触早期干预服务。信仰治疗师占金奈首次接触者的25%。那些看信仰治疗师的人寻求帮助的时间明显较短，但转介DUP较长。正如预测的那样，大多数（93%）蒙特利尔转诊来自医疗来源。那些第一次接触心理学家/辅导员/社会工作者的人有更长的DUP。关于精神疾病和组织结构的文化观点的差异塑造了护理途径及其与治疗延误的关联。必须针对正式和非正式来源，以减少延误。早期干预服务是寻求帮助的第一个门户，可以减少DUP，特别是如果在疾病过程的早期获得。
Although extensively studied in high-income countries (HICs) and less so in low- and middle-income countries (LMICs), pathways to care and treatment delays in early psychosis have not been compared across contexts. We compared pathways to early intervention for psychosis in an HIC (Montreal, Canada) and an LMIC (Chennai, India). We hypothesised that the duration of untreated psychosis (DUP) would be longer in Chennai. The number of contacts preceding early intervention, referral sources, first contacts, and DUP and its referral and help-seeking components of first-episode psychosis patients at both sites were similarly measured and compared using chi-square analyses and t-tests/one-way ANOVAs. Overall and help-seeking DUPs of Chennai (N=168) and Montreal (N=165) participants were not significantly different. However, Chennai patients had shorter referral DUPs [mean=12.0±34.1 weeks vs. Montreal mean=13.2±28.7 weeks; t(302.57)=4.40; p<.001] as the early intervention service was the first contact for 44% of them (vs. 5% in Montreal). Faith healers comprised 25% of first contacts in Chennai. Those seeing faith healers had significantly shorter help-seeking but longer referral DUPs. As predicted, most (93%) Montreal referrals came from medical sources. Those seeing psychologists/counsellors/social workers as their first contact had longer DUPs. Differences in cultural views about mental illnesses and organizational structures shape pathways to care and their associations with treatment delays across contexts. Both formal and informal sources need to be targeted to reduce delays. Early intervention services being the first portal where help is sought can reduce DUP especially if accessed early on in the illness course.
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DOI：
10.1007/s11126-020-09736-3
发表时间：
2020-09
期刊：
The Psychiatric quarterly
影响因子：
--
作者：
Fresan A;Apiquian R;Robles-García R;Zarate CT;Balducci PM;Broussard B;Wan CR;Compton MT
通讯作者：
Compton MT
影响因子：
3.5
作者：
Moe AM;Rubinstein EB;Gallagher CJ;Weiss DM;Stewart A;Breitborde NJ
通讯作者：
Breitborde NJ
影响因子：
2.8
作者：
Akol, Angela;Moland, Karen Marie;Engebretsen, Ingunn Marie S.
通讯作者：
Engebretsen, Ingunn Marie S.
影响因子：
4.5
作者：
Iyer, Srividya N.;Mangala, Ramamurti;Malla, Ashok K.
通讯作者：
Malla, Ashok K.
影响因子：
10.5
作者：
Malla, Ashok;Iyer, Srividya N.;Joober, Ridha
通讯作者：
Joober, Ridha