Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia 30303, USA.
Schizophr Res. 2009 Dec;115(2-3):338-45. doi: 10.1016/j.schres.2009.09.029. Epub 2009 Oct 14.
Little is known about how family-level factors are associated with duration of untreated psychosis (DUP), especially in ethnic/racial minority groups, such as African Americans. This study involved African American first-episode patients and their family members who initiated evaluation and treatment for them. It was hypothesized that a longer DUP would be predicted by family members' endorsement of: (1) less knowledge about schizophrenia, (2) greater perceptions of stigma, (3) lower levels of insight, (4) fewer family strengths, (5) more limited family coping capacity, and (6) lower levels of caregiver strain.
From a sample of 109 patients, 42 African American patients with family-level data were included. Cox proportional hazard models quantified associations between family-level predictors and DUP, and analyses controlled for effects of three previously determined patient-level predictors of DUP - mode of onset of psychosis, living with family members versus alone or with others, and living above versus below the federal poverty level.
The median DUP was 24.5 weeks. Greater family strengths and a better family coping capacity were associated with a shorter DUP, whereas higher insight among informants and greater level of perceived caregiver strain were associated with a longer DUP.
Whereas family strengths and coping likely account for a significant portion of variability in DUP, both insight and caregiver strain probably evolve as a consequence of DUP. Efforts to strengthen families and tap into existing strengths of families in specific cultural groups would likely enhance early treatment-seeking for psychotic disorders.
关于家庭因素与未治疗精神病持续时间（DUP）之间的关系，我们知之甚少，尤其是在非裔美国人等族裔/种族少数群体中。本研究涉及首次发作的非裔美国患者及其家庭成员，他们为患者提供评估和治疗。研究假设，家庭成员对以下方面的认可程度越高，DUP 持续时间可能会越长：（1）对精神分裂症的了解较少，（2）对污名的感知度越高，（3）洞察力越低，（4）家庭力量越弱，（5）家庭应对能力越有限，以及（6）照顾者压力越低。
在 109 名患者中，纳入了 42 名具有家庭层面数据的非裔美国患者。Cox 比例风险模型量化了家庭层面预测因素与 DUP 之间的关联，并且分析控制了先前确定的三个与 DUP 相关的患者层面预测因素的影响——精神病发病模式、与家人同住还是独自或与他人同住，以及生活水平是否低于联邦贫困线。
DUP 的中位数为 24.5 周。家庭力量越强，家庭应对能力越好，DUP 持续时间越短，而知情者的洞察力越高，感知到的照顾者压力越大，DUP 持续时间越长。
尽管家庭力量和应对能力可能在 DUP 的变异性中占很大一部分，但洞察力和照顾者压力可能是 DUP 的结果。努力增强家庭并利用特定文化群体中家庭现有的优势，可能会增强对精神病的早期治疗寻求。
