Kvig Erling Inge, Brinchmann Beate, Moe Cathrine, Nilssen Steinar, Larsen Tor Ketil, Sørgaard Knut
Nordland hospital Trust, Bodø, Norway.
UIT The Arctic University of Norway, Tromsø, Norway.
BMC Psychiatry. 2017 May 10;17(1):176. doi: 10.1186/s12888-017-1345-8.
The duration of untreated psychosis is determined by both patient and service related factors. Few studies have considered the geographical accessibility of services in relation to treatment delay in early psychosis. To address this, we investigated whether treatment delay is co-determined by straight-line distance to hospital based specialist services in a mainly rural mental health context.
A naturalistic cross-sectional study was conducted among a sample of recent onset psychosis patients in northern Norway (n = 62). Data on patient and service related determinants were analysed.
Half of the cohort had a treatment delay longer than 4.5 months. In a binary logistic regression model, straight-line distance was found to make an independent contribution to delay in which we controlled for other known risk factors.
The determinants of treatment delay are complex. This study adds to previous studies on treatment delay by showing that the spatial location of services also makes an independent contribution. In addition, it may be that insidious onset is a more important factor in treatment delay in remote areas, as the logistical implications of specialist referral are much greater than for urban dwellers. The threshold for making a diagnosis in a remote location may therefore be higher. Strategies to reduce the duration of untreated psychosis in rural areas would benefit from improving appropriate referral by crisis services, and the detection of insidious onset of psychosis in community based specialist services.
未治疗精神病的持续时间由患者和服务相关因素共同决定。很少有研究考虑到服务的地理可达性与早期精神病治疗延迟之间的关系。为了解决这个问题，我们调查了在主要为农村地区的心理健康环境中，治疗延迟是否由到医院专科服务的直线距离共同决定。
对挪威北部近期发病的精神病患者样本（n = 62）进行了一项自然主义横断面研究。分析了患者和服务相关决定因素的数据。
该队列中有一半患者的治疗延迟超过4.5个月。在二元逻辑回归模型中，发现直线距离对延迟有独立影响，我们对其他已知风险因素进行了控制。
治疗延迟的决定因素很复杂。本研究通过表明服务的空间位置也有独立影响，为先前关于治疗延迟的研究增添了内容。此外，在偏远地区，隐匿性起病可能是治疗延迟中一个更重要的因素，因为专科转诊的后勤影响对城市居民来说要大得多。因此，在偏远地区做出诊断的阈值可能更高。减少农村地区未治疗精神病持续时间的策略将受益于改善危机服务的适当转诊，以及在社区专科服务中检测精神病的隐匿性起病。
