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Health Services Determinants of the Duration of Untreated Psychosis Among African-American First-Episode Patients

Dr. Compton, Ms. Ramsay, Ms. Goulding, and Dr. Gordon are affiliated with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Grady Memorial Hospital, Box 26238, 80 Jesse Hill Jr. Dr., Atlanta, GA 30303 (e-mail: mcompto{at}emory.edu). Dr. Shim is with the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta. Mr. Weiss is with the Department of Biostatistics and Dr. Druss is with the Department of Health Policy and Management, both at the Rollins School of Public Health, Emory University, Atlanta.

OBJECTIVE: The duration of untreated psychosis is associated with poor outcomes in multiple domains in the early course of nonaffective psychotic disorders, although relatively little is known about determinants of this critical period, particularly health services-level determinants. This study examined three hypothesized predictors of duration of untreated psychosis (lack of insurance, financial problems, and broader barriers) among urban, socioeconomically disadvantaged African Americans, while controlling for the effects of three patient-level predictors (mode of onset of psychosis, living with family versus alone or with others before hospitalization, and living above versus below the federally defined poverty level). METHODS: Analyses included data from 42 patient-family member dyads from a larger sample of 109 patients with a first episode of nonaffective psychosis. The duration of untreated psychosis and all other variables were measured in a rigorous, standardized fashion in a study designed specifically to examine determinants of treatment delay. Survival analyses and Cox regression assessed the effects of the independent predictors on time from onset of psychosis to hospital admission for initial evaluation and treatment. RESULTS: The median duration of untreated psychosis was 24.5 weeks. When the analyses controlled for the three patient-level covariates, patients without health insurance, with financial problems, or with barriers to seeking help had a significantly longer duration of untreated psychosis. CONCLUSIONS: Health services-related factors, such as lack of insurance, are predictive of longer treatment delay. Efforts to eliminate uninsurance and underinsurance, as well as minimize barriers to treatment, would be beneficial for improving the prognosis of young patients with emerging nonaffective psychotic disorders.

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