Disparities in access to care for those experiencing the first episode of psychosis may be better understood by looking at overlapping socioeconomic and racial characteristics. An ethno-racially diverse multisite early-intervention service program for first-episode psychosis examines disparities in paths to care by ethnoracial groups and empirically derived clusters incorporating numerous elements of the social and clinical context. Data from a network of 21 coordinated specialty care (CSC) programs in New York State that offer recovery-oriented, evidence-based psychosocial interventions and medications to young people experiencing early psychosis were used to conduct this cohort study. The study included individuals with recent-onset psychosis (<2 years). Intersections between first-contact experiences and demographic characteristics such as race, socioeconomic class, and language proficiency (i.e., type of the first service, referral source, and symptoms at referral). Time to first contact, time from first contact to CSC, and time from onset to CSC were used as efficacy metrics. There were a total of 1,726 participants in the network of CSC programs; 452 were female (26%), 1,263 were male (73%), and 11 (1%) were of another gender. Around 153 Asians (9%), 599 Blacks (35%), 454 Latinx (26%), and 417 Whites (24%). Compared to Asians (median [IQR], 34 [7-94] days) and Blacks (median [IQR], 30 [1-108] days), Whites had the shortest time from onset to first contact (median [IQR], 17 [0-80] days), but the greatest duration from first contact to CSC (median [IQR], 102.5 [45-258] days). There were 5 groupings of people arose, and they cut across ethnicities. The time from onset to first contact was the longest for the most disadvantaged clusters, both socially and in terms of first contact experiences, and the shortest for the most advantaged. Time to treatment outcomes in this cohort study of people with recent-onset psychosis varied by ethnoracial group and by empirically determined clusters incorporating numerous aspects of the social and clinical context. Disparities in time to treatment may be better understood if viewed through an intersectional, ethnoracial lens that accounts for the multiple factors that can contribute to delays in treatment.
Source: jamanetwork.com/journals/jamapsychiatry/article-abstract/2793905
