The impact of mode of onset of psychosis on pathways to care in a hospitalized, predominantly African-American, first-episode sample.

Aim: Given recent findings that mode of onset is a determinant of duration of untreated psychosis (DUP), along with a dearth of research coupling the mode of onset and pathways to care constructs, this study explored the possible effects of mode of onset on pathways to care.

Methods: The study included 76 patients hospitalized for first-episode, nonaffective psychosis in two urban, public-sector psychiatric units. Consensus-based best estimates were derived for mode of onset, pathways to care variables and DUP. Associations between mode of onset and several types of pathways to care variables were examined: (i) two key duration variables during the pathway; (ii) four variables pertaining to services contacted, sources of help and reasons for psychiatric contact; and (iii) the number of help-seeking contacts during the pathway.

Results: None of the sociodemographic or clinical variables examined (except DUP) were associated with mode of onset. In further assessing the association between mode of onset and DUP, mode of onset was related to the first component of DUP - delay in initiating any help contact - but not with the duration from initiating the first help contact until hospitalization. Mode of onset was not significantly associated with a number of other key pathways to care variables (e.g. type of first help-seeking contact, number of help-seeking contacts).

Conclusion: The present findings suggest that both community-wide informational campaigns and early intervention programmes may benefit from focusing on gradually developing psychosis, which confers a longer delay to initiating care.