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Comparing Treatment Delays and Pathways to Early Intervention Services for Psychosis in Urban Settings in India and Canada

Authors

  • Kathleen MacDonald aPrevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 boulevard LaSalle, Montreal, Quebec H4H 1R3, Canada
  • Greeshma Mohan cSchizophrenia Research Foundation (SCARF), R-7A North Main Road, Anna Nagar West Extension, Chennai 600 101, Tamil Nadu, India
  • Nicole Pawliuk aPrevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 boulevard LaSalle, Montreal, Quebec H4H 1R3, Canada
  • Ridha Joober aPrevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 boulevard LaSalle, Montreal, Quebec H4H 1R3, Canada
  • Ramachandran Padmavati cSchizophrenia Research Foundation (SCARF), R-7A North Main Road, Anna Nagar West Extension, Chennai 600 101, Tamil Nadu, India
  • Thara Rangaswamy cSchizophrenia Research Foundation (SCARF), R-7A North Main Road, Anna Nagar West Extension, Chennai 600 101, Tamil Nadu, India
  • Ashok Malla aPrevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 boulevard LaSalle, Montreal, Quebec H4H 1R3, Canada
  • Srividya Iyer aPrevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 boulevard LaSalle, Montreal, Quebec H4H 1R3, Canada

Keywords:

pathways to care, psychosis, cross-cultural, duration of untreated psychosis, early intervention, LMICs

Abstract

Introduction: 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. Methods: 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. Results: 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. Conclusion: 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. Keywords: pathways to care, psychosis, cross-cultural, duration of untreated psychosis, early intervention, LMICs

Author Biographies

Kathleen MacDonald, aPrevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 boulevard LaSalle, Montreal, Quebec H4H 1R3, Canada

bDepartment of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, Quebec H3A 1A1, Canada

Ridha Joober, aPrevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 boulevard LaSalle, Montreal, Quebec H4H 1R3, Canada

bDepartment of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, Quebec H3A 1A1, Canada

Ashok Malla, aPrevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 boulevard LaSalle, Montreal, Quebec H4H 1R3, Canada

bDepartment of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, Quebec H3A 1A1, Canada

Srividya Iyer, aPrevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 boulevard LaSalle, Montreal, Quebec H4H 1R3, Canada

bDepartment of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, Quebec H3A 1A1, Canada

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