First help-seeking attempt before and after psychosis onset: measures of delay and aversive pathways to care

Soc Psychiatry Psychiatr Epidemiol. 2021 Aug;56(8):1359-1369. doi: 10.1007/s00127-021-02090-0. Epub 2021 May 4.


Purpose: Delay in receiving effective treatment for psychosis adversely impacts outcomes. We investigated the timing of the first help-seeking attempt in individuals with recent onset non-affective psychosis by comparing those who sought help during the prodrome to those who sought help after psychosis onset across sociodemographic and clinical characteristics, overall functioning, and occurrence of aversive events during their pathways to care.

Methods: Patients were admitted from February 1st, 2014 to January 31st, 2019 to the Program for Specialized Treatment Early in Psychosis (STEP) in New Haven, CT. Psychosis-onset date was ascertained using the Structured Interview for Psychosis-risk Syndromes. Key dates before and after psychosis onset, along with initiators and aversive events, were collected via semi-structured interview.

Results: Within 168 individuals, 82% had their first help-seeking episode after psychosis onset and did not differ in terms of sociodemographic characteristics from prodrome help seekers. When the first help-seeking episode started before (i.e., during prodrome) vs after psychosis onset it was mostly initiated by patients vs family members (Cramer's V = 0.23, p = 0.031) and led to a faster prescription of an antipsychotic once full-blown psychosis emerged (time to antipsychotic since psychosis onset = 21 vs 56 days, p = 0.03). No difference in aversive events before STEP enrollment was detected across groups.

Conclusion: Help seeking during the prodrome is associated with faster initiation of antipsychotic treatment and is more likely to be self-initiated, compared to help seeking after psychosis onset. Early detection efforts that target prodromal samples may improve the length and experience of pathways to care.

Keywords: Duration of untreated psychosis; Early detection; Early intervention; First-episode psychosis; Help-seeking behavior; Pathways to care.

MeSH terms

  • Early Diagnosis
  • Family
  • Hospitalization
  • Humans
  • Psychotic Disorders* / diagnosis
  • Psychotic Disorders* / drug therapy
  • Time Factors