Orygen, Parkville, VIC, Australia.
Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia.
Aust N Z J Psychiatry. 2022 Dec;56(12):1566-1575. doi: 10.1177/00048674221075980. Epub 2022 Feb 7.
Understanding the pathways to care for migrants experiencing a first episode of psychosis is important, as they are more likely to experience longer delays to treatment and negative experiences, such as involuntary treatment. Despite the increased risk of developing a psychotic illness and barriers associated with pathways to care, there are limited studies exploring pathways to care in migrants in Australia. This study seeks to examine pathways to care for young people with a first episode of psychosis to a publicly funded youth mental health service.
This study included all young people aged 15-24 years who presented with a first episode of psychosis to the Early Psychosis Prevention and Intervention Centre (EPPIC) between 1 February 2011 and 31 December 2016. Referral sources and place of birth were recorded at the time of presentation. The severity of psychotic symptoms was rated at baseline.
A total of 1220 young people presented with a first episode of psychosis during the study period, including 293 (24.5%) first-generation migrants. First-generation migrants with a first episode of psychosis were more likely to be admitted to hospital than Australian-born youth (odds ratio = 1.67, 95% confidence interval = [1.27, 2.18], < 0.001) and this remained significant when controlled for demographic (adjusted odds ratio = 1.41, 95% confidence interval = [1.07, 1.88], = 0.016) and clinical factors (adjusted odds ratio = 1.38,95% confidence interval = [1.01, 1.89], = 0.044). First-generation migrants were also more likely to have an involuntary admission (odds ratio = 1.67, 95% confidence interval = [1.26, 2.21], < 0.001) and this remained significant when controlled for demographic (adjusted odds ratio = 1.42, 95% confidence interval = [1.05, 1.91], = 0.022) and clinical factors (adjusted odds ratio = 1.50, 95% confidence interval = [1.08, 2.09], = 0.017). Migrants had more severe delusions ( = 0.005), bizarre behavior ( < 0.001) and positive formal thought disorder ( = 0.003) at the time of presentation. Migrants were also more likely to attend the emergency department during their presentation with first episode of psychosis (odds ratio = 1.76, 95% confidence interval = [1.31, 2.36], < 0.001).
First-generation migrants who develop a psychotic disorder are at greater risk of experiencing negative pathways to care than the Australian-born population. Further research is needed to identify the factors that lead to migrants being involuntarily admitted to hospital for first episode of psychosis.
了解移民首次出现精神病症状的治疗途径非常重要，因为他们更有可能经历更长的治疗延迟和负面体验，如非自愿治疗。尽管移民患精神病的风险增加，并且与治疗途径相关的障碍，但很少有研究探索澳大利亚移民的治疗途径。本研究旨在探讨年轻的首次出现精神病症状的患者到一个公共资助的青年心理健康服务机构的治疗途径。
本研究包括 2011 年 2 月 1 日至 2016 年 12 月 31 日期间首次出现精神病症状的年龄在 15-24 岁的所有年轻人。在出现时记录转诊来源和出生地。在基线时评估精神病症状的严重程度。
在研究期间，共有 1220 名年轻人首次出现精神病症状，其中 293 名（24.5%）是第一代移民。与澳大利亚出生的年轻人相比，首次出现精神病症状的第一代移民更有可能被收治入院（优势比=1.67，95%置信区间=1.27-2.18， < 0.001），并且当控制人口统计学因素（调整后的优势比=1.41，95%置信区间=1.07-1.88， = 0.016）和临床因素（调整后的优势比=1.38，95%置信区间=1.01-1.89， = 0.044）时，这种情况仍然显著。第一代移民也更有可能非自愿入院（优势比=1.67，95%置信区间=1.26-2.21， < 0.001），并且当控制人口统计学因素（调整后的优势比=1.42，95%置信区间=1.05-1.91， = 0.022）和临床因素（调整后的优势比=1.50，95%置信区间=1.08-2.09， = 0.017）时，这种情况仍然显著。移民在出现时的妄想（ = 0.005）、奇特行为（ < 0.001）和阳性形式思维障碍（ = 0.003）更为严重。移民在首次出现精神病症状时也更有可能到急诊科就诊（优势比=1.76，95%置信区间=1.31-2.36， < 0.001）。
与澳大利亚出生的人群相比，首次出现精神病症状的第一代移民经历负面治疗途径的风险更高。需要进一步研究确定导致移民非自愿入院治疗首次精神病发作的因素。
