1 Research Division, Institute of Mental Health, Singapore.
2 Early Psychosis Intervention Programme (EPIP) & General Psychiatry (GP1), Institute of Mental Health, Singapore.
Int J Soc Psychiatry. 2018 Sep;64(6):554-562. doi: 10.1177/0020764018784632. Epub 2018 Jun 27.
Pathways to care studies in Singapore are of high interest given the cultural diversity and various sources of help available for those with mental illnesses, ranging from the more traditional to tertiary-level mental health care services.
The current study aimed to explore the associations of patients' socio-demographic characteristics with pathways to first contact and duration of untreated mental illness.
A total of 402 participants were recruited through convenience sampling. A pathway to care form was used to gather systematic information about the sources of care utilized by participants before approaching a mental health professional. Data were analysed using multinomial logistic regression and multiple linear regression models to assess the associations.
Majority of participants reported primary care (36.0%) as their first point of contact, followed by non-formal sources of help (33.8%), specialist care (21.8%), police/court (4.0%), websites/media (3.3%) and religious/traditional treatment (1.3%). Those belonging to Malay and Indian ethnicity (vs Chinese) were more likely to make first contact with non-formal sources of help than primary care. Those who received a diagnosis of any mood or anxiety disorder (vs schizophrenia and related psychoses) were less likely to make first contact with specialist care or non-formal sources of help than primary care. Those who were separated/divorced/widowed were significantly associated with higher duration of untreated illness compared to those who were single. Participants whose family/relative initiated the first contact were significantly associated with a shorter duration of untreated illness compared to those who initiated first contact on their own.
Findings suggest the determinants of the pathways to first contact and duration of untreated illness included diagnosis, ethnicity, marital status and family initiating the first contact. The pathways adopted by these participants need to be kept in mind for planning mental health programmes.
鉴于新加坡的文化多样性以及为精神疾病患者提供的各种帮助来源，包括从传统到三级精神卫生保健服务，对其就医途径进行研究具有很高的意义。
本研究旨在探讨患者的社会人口学特征与首次接触和未治疗精神疾病持续时间之间的关联。
通过便利抽样共招募了 402 名参与者。使用就医途径表收集参与者在接触精神卫生专业人员之前利用的各种治疗来源的系统信息。使用多项逻辑回归和多元线性回归模型分析数据，以评估关联。
大多数参与者（36.0%）首先选择初级保健作为其首次就诊点，其次是非正规来源的帮助（33.8%）、专科护理（21.8%）、警察/法庭（4.0%）、网站/媒体（3.3%）和宗教/传统治疗（1.3%）。属于马来族和印度族（与华族相比）的患者更有可能首先选择非正规来源的帮助，而不是初级保健。与初级保健相比，被诊断为任何心境或焦虑障碍（而非精神分裂症和相关精神病）的患者更不可能首先选择专科护理或非正规来源的帮助。与单身者相比，离异/分居/丧偶者的未治疗疾病持续时间明显更长。与患者自行首次就诊相比，其家人/亲属发起首次就诊的患者未治疗疾病持续时间明显更短。
研究结果表明，首次接触和未治疗疾病持续时间的决定因素包括诊断、种族、婚姻状况和家人发起首次接触。需要牢记这些参与者采用的途径，为精神卫生规划做准备。
