Reducing the Duration of Untreated Psychosis through Community Education

描述(由申请人提供)：大多数旨在减少未治疗精神病(DUP)持续时间的宣传活动都未获成功。此外，很少有人关注高风险、文化多样性的群体。这一应用程序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，并通过面向各种高风险社区的可持续运动扩大其影响范围。居住在洛杉矶县内高密度(80%)拉丁裔(主要是墨西哥裔)社区的讲西班牙语的青少年和成年人(15-)将成为目标群体。这一群体患DUP的风险很高，因为他们的精神卫生服务使用率很低，而且移民的比例很大，因为移民的精神障碍发病率较高。为实现这一总体目标，将开展一项多层次、多平台的西班牙语沟通运动(CC)：(A)提高讲西班牙语的青少年和成年人的精神病素养；(B)减少首发精神病(FEP)拉美裔人的DUP；(C)探讨DUP与FEP患者及其照顾者的精神病素养之间的关系。在多种媒体格式中嵌入了一条中心信息：“使用La clave(线索)来检测你所爱的人中严重的精神疾病”，这一信息已经在提高精神病识别率的初步研究中显示出来。La clave既是一个缩写，也是一种助记符，可以帮助人们记住精神病的关键症状。为了增强CC的可持续性，将对社区的多个层面(个人、护理促进者、社区资源和精神卫生机构)进行管理，将向关键社区人员分发宣传活动的主副本，并对社区人员进行培训，以管理CC的关键方面。为了评估社区的渗透率和可持续性，将在三个时间点对具有代表性的家庭(每波N=500户)进行调查：基线、18个月和36个月。预计在这三年期间，精神病识字率将增加并保持不变。为了评估DUP是否减少，圣费尔南多精神卫生诊所的收容工作人员将在4年内为所有来访的患有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口，预计每年将有60名拉丁裔FEP患者(N=240)。与1年基线相比，预计DUP在未来3年将大幅下降。为了探索个体的DUP与精神病素养的关系，所有新的FEP患者及其照顾者的精神病素养和转诊来源将是考察的相关变量之一。拟议的研究计划有可能领导第二代DUP减少计划，该计划拥有强大的证据基础，并惠及许多有需要的人，包括那些长期DUP风险高、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.