Reducing the Duration of Untreated Psychosis through Community Education

描述（由申请人提供）：大多数信息活动，以减少未经治疗的精神病（DUP）的持续时间已不成功。此外，对高风险、文化多样性群体的关注很少。这一应用的总体目标是加强宣传运动的有效性，使其发展更加科学严谨，并通过针对各种高风险社区的可持续运动扩大其影响范围。居住在洛杉矶县拉丁裔（主要是墨西哥裔）高密度（>80%）社区的讲西班牙语的青少年和成年人（15-64岁）将作为目标群体。这组是在DUP的高风险，因为其精神卫生服务的使用率低，其移民的比例大，因为移民有精神障碍的发病率升高。为实现总体目标，将开展多层次和多平台的西班牙语交流运动（CC），以（a）提高讲西班牙语的青少年和成年人对精神病的认识;（B）减少拉丁美洲精神病首次发作患者的DUP;（c）探索DUP与精神病首次发作患者及其照顾者的精神病认识之间的关系。嵌入在多种媒体格式中的是中心信息：“使用La CLAve（线索）来检测你所爱的人的严重精神疾病”，这一信息已在初步研究中显示，以提高精神病素养。La CLAve既是一个首字母缩略词，也是一种帮助人们记住精神病关键症状的记忆手段。为了增强CC的可持续性，社区的多个层面（个人、护理促进者、社区资源和心理健康机构）将管理该计划，信息活动的母版将分发给关键社区人员，社区人员将接受培训以管理CC的关键方面。为了评估IC的渗透和可持续性，将在三个时间点（基线，18个月和36个月）对代表性家庭（每波N = 500）进行调查。预计在3年期间，精神病知识的普及率将提高并保持不变。为了评估DUP是否减少，圣费尔南多精神健康诊所的工作人员将在4年内为所有患有FEP的拉丁裔患者确定DUP。 根据精神障碍的发病率和目标社区的人群，预计每年有60例拉丁裔FEP患者（N = 240）。与1年基线相比，预计DUP将在未来3年内显著下降。为了探讨个人的DUP和精神病素养的关系，精神病素养和转诊来源的所有新的FEP患者和他们的照顾者将在相关变量进行检查。拟议的研究计划有可能领导第二代DUP减少计划，该计划具有强大的证据基础，并达到许多有需要的人，包括那些长期DUP风险高的服务不足的群体。

DESCRIPTION (provided by applicant): Most informational campaigns to reduce the duration of untreated psychosis (DUP) have been unsuccessful. Moreover, there has been little attention given to high-risk, culturally diverse groups. The overall objective of this application is to strengthen the effectiveness of informational campaigns by bringing more scientific rigor to their development and by extending their reach through sustainable campaigns for diverse, high-risk communities. Spanish-speaking adolescents and adults (ages 15-64) residing in a high density (>80%) Latino (largely Mexican origin) community within Los Angeles County will serve as the target group. This group is at high risk for DUP given its low rates of mental health service use and its large proportion of immigrants because immigrants have elevated incidence rates of psychotic disorders. To achieve the overall objective, a multi-level and multi-platform Spanish language Communication Campaign (CC) will be carried out (a) to increase the psychosis literacy of Spanish-speaking adolescents and adults; (b) to reduce the DUP for Latinos with first-episode psychosis (FEP), and (c) to explore the relationship between DUP and the psychosis literacy of individuals with FEP and their caregivers. Embedded in the multiple media formats is the central message: "Use La CLAve (the clue) to detect serious mental illness in your loved ones", a message that has been shown in preliminary studies to increase psychosis literacy. La CLAve is both an acronym and mnemonic device to help people remember the key symptoms of psychosis. To enhance the sustainability of the CC, multiple levels of the community (individuals, care facilitators, community resources, and the mental health institution) will be administered the program, master copies of the informational campaign will be distributed to key community personnel, and community personnel will be trained to administer key aspects of the CC. To assess the penetration and sustainability of the IC, surveys will be conducted of representative households (N = 500 for each wave) at three time points: baseline, 18 months and 36 months. An increase and maintenance of psychosis literacy is expected over the 3-year period. To assess whether there is a reduction of DUP, intake workers at San Fernando Mental Health Clinic will identify the DUP for all incoming Latino patients with FEP over a 4-year period. Based on incidence rates of psychotic disorders and the population of the targeted community, 60 Latino patients with FEP are expected each year (N = 240). Compared to a 1-year baseline, the DUP is expected to decrease significantly over the next 3 years. To explore the relationship of individual's DUP and psychosis literacy, the psychosis literacy and referral sources of all new FEP patients and their caregivers will be among the relevant variables that are examined. The proposed research program has the potential to lead a second generation of DUP reduction programs, one that has a strong evidence base and that reaches many in need, including those underserved groups with high risk for prolonged DUP.