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The pathways to mental health care of first-episode psychosis patients: a systematic review

Published online by Cambridge University Press:  18 March 2010

K. K. Anderson ,
R. Fuhrer  and
A. K. Malla
K. K. Anderson*
Affiliation:
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
R. Fuhrer
Affiliation:
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
A. K. Malla
Affiliation:
Department of Psychiatry, McGill University, Douglas Mental Health University Institute, Montreal, Québec, Canada
*
*Address for correspondence: K. K. Anderson, Department of Epidemiology, Biostatistics and Occupational Health, 1020 Pine Avenue West, Montreal, QCH3A 1A2, Canada. (Email: kelly.anderson@mail.mcgill.ca)
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Abstract

Background

Although there is agreement on the association between delay in treatment of psychosis and outcome, less is known regarding the pathways to care of patients suffering from a first psychotic episode. Pathways are complex, involve a diverse range of contacts, and are likely to influence delay in treatment. We conducted a systematic review on the nature and determinants of the pathway to care of patients experiencing a first psychotic episode.

Method

We searched four databases (Medline, HealthStar, EMBASE, PsycINFO) to identify articles published between 1985 and 2009. We manually searched reference lists and relevant journals and used forward citation searching to identify additional articles. Studies were included if they used an observational design to assess the pathways to care of patients with first-episode psychosis (FEP).

Results

Included studies (n=30) explored the first contact in the pathway and/or the referral source that led to treatment. In 13 of 21 studies, the first contact for the largest proportion of patients was a physician. However, in nine of 22 studies, the referral source for the greatest proportion of patients was emergency services. We did not find consistent results across the studies that explored the sex, socio-economic, and/or ethnic determinants of the pathway, or the impact of the pathway to care on treatment delay.

Conclusions

Additional research is needed to understand the help-seeking behavior of patients experiencing a first-episode of psychosis, service response to such contacts, and the determinants of the pathways to mental health care, to inform the provision of mental health services.

Keywords

Early interventionfirst-episode psychosishelp-seekingmental health servicespathways to care
Type
Review Article
Information
Psychological Medicine , Volume 40 , Issue 10 , October 2010 , pp. 1585 - 1597
Copyright
Copyright © Cambridge University Press 2010

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