Table 1.
Study characteristics
| Study | Study objectives | Country | Population | Setting | N | Mean age (range) | (% male) | Instrument | Source of data |
|---|---|---|---|---|---|---|---|---|---|
| Addington et al. [22] | To determine the number of attempts it took before patients with FEP received adequate help, the signs or symptoms that led them to seek help and the people from whom they attempted to seek help | Calgary, Canada | First-episode psychosis | Early intervention for psychosis program | 86 | 24 (15–51) | 66.3% | Interview developed for the study | II + FI |
| Anderson et al. [12] | To estimate the extent to which sociodemographic, clinical, and service-level factors were associated with negative pathways to care and referral delay | Montreal, Canada | First-episode psychosis | Early intervention for psychosis program | 324 | Median 22.6 (14–30) | 69.8% | CORS | II + FI + CR |
| Anderson et al. [23] | To compare the pathways to care and duration of untreated psychosis for people of Black African, Black Caribbean, or White European origin with FEP | Toronto and Hamilton, Canada | First-episode psychosis | Early intervention for psychosis program | 171 | 21 (19–27) | 66.7% | WHO Encounter Form | II + FI + CR |
| Archie et al. [24] | To examine ethnic variations in the pathways to care for persons accessing early intervention services in Ontario | Ontario, Canada | First-episode psychosis | Early intervention for psychosis program | 200 | 24.5 (16–50) | 78% | CORS | II + FI + CR |
| Bakare [25] | To assess first points of contact and referral sources for a group of patients seen in a neuropsychiatric facility in South-Eastern Nigeria | Enugu, Nigeria | Any mental illness | Child and adolescent inpatient unit | 393 | 15.7 (3–18) | 55.7% | Interview developed for study | II + FI |
| Bekele et al. [26] | To describe the routes taken by patients to reach psychiatric care, evaluate the time delay before seeking psychiatric care, and investigate the relationship between delays in the pathway to care and sociodemographic and clinical factors | Addis Ababa, Ethiopia | Any mental illness | Mental health hospital (inpatient and outpatient) | 1044 | 29 (2–85) | 62.2% | WHO Encounter Form | II + CR |
| Bhui et al. [27] | To assess (1) which services or agencies are encountered by patients in their pathways to specialist psychiatric care; (2) which services or agencies and individual characteristics of patients were independently associated with the shortest DUP | East London, UK | First-episode psychosis | Specialist psychiatric service | 480 | 67.7% under 30, (18–64) | 61.3% | WHO Encounter Form | II |
| Chadda et al. [28] | To study the help-seeking behaviour of patients visiting a mental hospital | Delhi, India | Any mental illness | Outpatient clinic | 78 | 50%+ under 30, (18–49) | 61.5% | Questionnaire developed for study | II + FI + CR |
| Chesney et al. [29] | To describe the pathways to care for patients with FEP in Singapore | Singapore | First-episode psychosis | Early intervention for psychosis program | 900 | 27.1, (16–40) | 49.7% | Interview developed for study | II + CR |
| Cheung et al. [30] | To estimate the public health costs of specific help-seeking pathways into an early intervention psychosis clinic | Edmonton, Canada | First-episode psychosis | Early intervention for psychosis program | 50 | 22.2 | 82.0% | Semi-structured interview (PCI) | II |
| Chiang et al. [31] | To review the help-seeking pathways and reasons for delay for patients with FEP | Hong Kong | First-episode psychosis | Early intervention for psychosis program | 55 | 22.2 (16–30) | 60.0% | Interview developed for study | II + FI |
| Chien and Compton [32] | To explore the possible effects of mode of onset on pathways to care | Atlanta, United States | First-episode psychosis | Hospital for FEP psychiatric units | 76 | Mean 23.2 | 77.6% | Interview developed for study | II |
| Commander et al. [33] | To compare the experiences of people with non-affective psychoses from three broad ethnic groups, with respect to (a) pathways to care (b) the treatment received while in hospital (c) the delivery of care post-discharge | Birmingham, UK | First-episode psychosis | 4 hospital inpatient units | 120 | 65% under 35 (16–60) | 59.1% | WHO Encounter Form | II |
| Compton et al. [34] | To examine the pathways to care and number of help-seeking contacts prior to hospitalization in first-episode patients of African–American background, and to ascertain the frequency of contact with primary care providers and police | Atlanta, United States | First-episode psychosis | Public sector hospital or crisis centre (inpatient) | 25 | 22.8 (18–32) | 76.0% | Symptom onset in schizophrenia inventory, CORS | II |
| Cougnard et al. [35] | To describe the pathways to care between onset of psychosis and first admission | Bordeaux, France | First-episode psychosis | Acute wards of two psychiatric hospitals | 85 | 27.8 (17–45) | 63.9% | Questionnaire developed for study | II + FI + CR |
| Del Vecchio et al. [36] | To explore the role of relatives in pathways to care of patients with a recent onset of psychosis | Naples, Italy | First-episode psychosis | Outpatient unit | 34 | 26 (18–35) | 64.7% | Pathways to care Form | II |
| Ehmann et al. [37] | To examine the treatment delay associated with community and inpatient pathways into care for persons experiencing FEP | Vancouver, Canada | First-episode psychosis | Early intervention for psychosis service | 104 | 20.9 (15–37) | 67.3% | WHO Encounter Form | II + FI |
| Etheridge et al. [38] | To assess whether duration of untreated psychosis in Rotherham reflected that reported nationally and internationally, and to identify potential obstacles to early identification and treatment | Rotherham, UK | First-episode psychosis | Early intervention for psychosis services (inpatient and outpatient) | 18 | 29.4 (15–50) | 61.1% | Questionnaire developed for study | II + FI |
| Fridgen et al. [39] | To examine the help-seeking behaviour of individuals at risk for psychosis or with FEP in a low-threshold system with easy access to mental health care facilities, in which a specialized early detection clinic was newly established | Basel, Switzerland | First-episode psychosis | Early intervention for psychosis outpatient clinic | 61 UHR + 37 FEP | 28.4 (18+) | 59.0% | Basel interview for psychosis | II |
| Fuchs and Steinert [40] | To examine patients’ help-seeking contacts and the delays on their pathways to psychiatric care in Germany | Ravensburg, Germany | First-episode psychosis | Admission in hospital for first-episode psychosis | 66 | Median 26 (14–51) | 59.0% | IRAOS + interview, adapted | II |
| Giasuddin et al. [41] | To find out the referral patterns, delays to reach mental health professionals, and diagnoses and treatment received before reaching psychiatric care | Dhaka, Bangladesh | Any mental illness | Outpatient clinic | 50 | 25.8 (12–45) | 58.0% | WHO Encounter Form | II |
| Hastrup et al. [42] | To document DUPs in Denmark and investigate associations of DUP with demographic characteristics, premorbid and illness-related factors and health-service factors | Denmark | First-episode psychosis | General population with FEP diagnosis | 1266 | 21 (15–25) | 55.5% | Danish Psychiatric Register | CR |
| Hodgekins et al. [43] | To examine care pathways experienced by young people accessing a pilot specialist youth mental health service for those with non-psychotic, severe, and complex mental health conditions | Norfolk, UK | Any mental illness | Specialist mental health service | 94 | 18.3 (14–25) | 28.7% | Interview developed for study | II or FI + CR |
| Jain et al. [44] | To evaluate the pathway to care of mentally ill patients attending a tertiary mental health facility in Jaipur, to highlight the difficulties of the mentally ill and their relatives in accessing appropriate care | Jaipur, India | Any mental illness | Tertiary mental health facility | 76 | 59% under 30 | 71.5% | WHO Encounter Form | II + FI |
| Judge et al. [45] | To examine the duration of untreated psychosis in an FEP population, to describe precipitants of help-seeking attempts, and to identify barriers to obtaining appropriate treatment | North Carolina, USA | First-episode psychosis | Early intervention for psychosis clinic | 20 | 19.8 | 75.0% | Pathways to care interview (Perkins) | II |
| Kurihara et al. [46] | To trace the help-seeking pathway of mental patients and to elucidate the role of traditional healing | Bali, Indonesia | Any mental illness | Admission to Mental Hospital | 54 | 30.6 | 48.0% | Interview developed for study | II + FI + CR |
| Lahariya et al. [47] | To study the sociodemographic profile of psychiatric patients; to understand the pathways to care of the patients attending the facility, and to explore the interrelationships between pathways to care and sociodemographic variables | Gwalior, India | Any mental illness | Outpatient department of a psychiatric hospital | 295 | 16–45 | 68.8% | WHO Encounter Form + interview | II |
| Lincoln et al. [48] | To gain an understanding of treatment delays in light of an initial episode of psychosis through examination of pathways to care | Melbourne, Australia | First-episode psychosis | Early intervention for psychosis program | 62 | 22.8 (16–30) | 64.5% | WHO Encounter Form | II |
| McMiller and Weisz [49] | To determine whether African–American and Latino families were less likely than Caucasian families to seek help from agencies and professionals prior to contacting clinics for their child | California, USA | Any mental illness | Community mental health clinic | 192 | 11.4 (7–17) | 64.0% | Referral sequence and problems interview | II + FI |
| Mkize and Uys [50] | To determine the pathways of care that clients with mental illness take, the effects of socio-cultural and economic factors on the pathways to mental health care and the satisfaction with different service providers consulted | Natal, South Africa | Any mental illness | Admission to a mental health institution | 15 | 67% below 29 (15–59) | 46.7% | Interview developed for study | II |
| Naqvi et al. [51] | To systematically study the care and referral pathways taken by patients before they present to a psychiatrist at a university teaching hospital | Karachi, Pakistan | Any mental illness | Outpatient psychiatry clinic | 94 | 53% under age 30 | 55.3% | Interview developed for the study | II |
| Neubauer et al. [52] | To investigate the duration of untreated illness and paths to first treatment in early vs intermediate vs late age of onset anorexia nervosa | Varied institutions, Germany | Anorexia | Specialized services for anorexia (inpatient and outpatient) | 140 | 22.3 | All female | Multiple choice questionnaire developed for study | II |
| Norman et al. [53] | To examine and compare the extent of delay in individuals contacting health professionals and the delay in receiving treatment once such contact is made | London, Canada | First-episode psychosis | Early intervention for psychosis program | 110 | 26.2 (16–51) | 80.0% | CORS | II + CR + FI |
| O’Callaghan et al. [54] | To establish if, when and where people seek help in the early phase of psychosis in a representative sample | Dublin, Ireland | First-episode psychosis | Community-based psychiatric services | 142 | 30.5 (16–64) | 62.0% | Beiser scale for DUP; interview for pathways | II |
| Phillips et al. [55] | To summarize patterns of referral to one service providing clinical care for young people known to be at high risk of developing a psychotic illness | Melbourne, Australia | Ultra-high risk for psychosis | Specialized clinical service | 162 | 18.8 (14–30) | 61.0% | Interview developed for study | II + FI |
| Platz et al. [56] | To obtain information about type of health professionals contacted by patients on their help-seeking pathways; number of contacts; type of symptoms leading to contacts; interval between initial contact and referral to a specialized service | Switzerland | First-episode psychosis, ultra-high risk for psychosis, help-seeking but not UHR or FEP | Specialized outpatient service for UHR | 104 | 22 (14–40) | 73.0% | Interview developed for the study | II |
| Reeler [57] | To investigate pathways to care | Harare, Zimbabwe | Any mental illness | Psychiatric inpatient unit | 48 | 28.2 | 31.1% | WHO Encounter Form | II |
| Reynolds et al. [58] | To explore the impact of a general practitioner training programme on referrals and pathways to care for people at high clinical risk of psychosis or with a first-episode psychosis | Southwark, UK | First-episode psychosis | Early intervention for psychosis program | 102 | 21.9(UHR) 24 (FEP) | 59%, (UHR), 75% (FEP) | Chart review methodology | CR |
| Sharifi et al. [59] | To conduct a first study on the duration of untreated psychosis and pathways to care among patients with first-episode psychosis in Iran as a developing country | Tehran, Iran | First-episode psychosis | Admission to psychiatric hospital | 91 | 27.4 | 58.2% | Interview developed for the study | II + FRI + CR |
| Shin et al. [60] | To examine patients’ help-seeking contacts in a context (Korea) where pathways to care had not been examined before | South Korea | Ultra-high risk for psychosis | Early intervention for psychosis programs | 18 | 15.8 (15–18) | 72.2% | Interview developed for the study | II + FI |
| Stowkowy et al. [61] | To prospectively investigate the pathways to care of those at clinical high risk of developing psychosis | Toronto, Canada | Ultra-high risk for psychosis | Clinic for ultra-high risk of psychosis | 35 | 21 (14–30) | 71.4% | Pathways to care interview (Perkins) | II + FI |
| Subramaniam et al. [62] | To create a typology of patients with first-episode psychosis based on sociodemographic and clinical characteristics, service use and outcomes using cluster analysis | Singapore | First-episode psychosis | Early intervention for psychosis program | 900 | 27.1 (15–41) | 49.6% | Chart review | CR |
| Turner et al. [63] | To present the clinical and sociodemographic characteristics of patients referred to an early intervention for psychosis service and to describe their pathways to care | Christchurch, New Zealand | First-episode psychosis | Early intervention for psychosis program | 182 | 22.4 (16–30) | 72.5% | Interview developed for the study | II |
| Graf von Reventlow et al. [64] | To acquire accurate knowledge about pathways to care and delay in obtaining specialized high risk care | Finland, Germany, Netherlands, UK | Ultra-high risk for psychosis | Early intervention for psychosis program | 233 | 23 | 54.9% | WHO Encounter Form, EPOS Form | II |
| Wiltink et al. [65] | To investigate if the drop in rates of transition from ultra-high risk to FEP may be due to potential changes in patterns of referral to a large ultra-high risk clinic | Melbourne, Australia | Ultra-high risk for psychosis | Early intervention for psychosis program | 150 | 18.3 | 44.0% | Interview developed for the study | II + CR |
DUP, duration of untreated psychosis; CORS, Circumstance of Onset and Relapse Schedule; CR, chart review; FEP, first-episode psychosis; FI, family interviews; II, individual interviews; IRAOS, Instrument for the Retrospective Assessment of the Onset of Schizophrenia; PCI, Pathways to Care Interview; UHR, ultra-high risk