Rosenthal Adi, Meyer Monet S, Bolden-Thompson Khalima, Gobrial Sarah, Shim Ruth, Lesh Tyler A, Ragland J Daniel, Loewy Rachel, Savill Mark, Carter Cameron S, Niendam Tara A
Department of Psychology, University of Denver, Denver (Rosenthal); Department of Psychiatry and Behavioral Sciences, University of California (UC) Davis, Sacramento (Meyer, Bolden-Thompson, Gobrial, Shim, Lesh, Ragland, Savill, Carter, Niendam); Department of Psychology, UC San Francisco, San Francisco (Loewy).
Psychiatr Serv. 2025 May 1;76(5):461-468. doi: 10.1176/appi.ps.20230465. Epub 2025 Mar 19.
Time between the onset of psychosis and the start of treatment significantly influences outcomes. Rapid access to care is essential, yet barriers such as stigma, difficulties with navigating the mental health system, and financial constraints prolong this process. This mixed-methods study aimed to assess how these barriers affect participation in early psychosis services.
A directed content analysis of telephone log data was conducted from intake assessments at an early psychosis clinic. Stepwise logistic regression and analyses of variance were used to evaluate the impact of barriers on assessment completion and time from referral to assessment.
Of 1,048 individuals screened for early psychosis services, 201 completed a telephone assessment. Individuals who dropped out had a higher proportion of barriers overall than did those who completed the assessment (p<0.01). Greater than 50% of interactions included at least one barrier, with logistical issues being the most common. Increased barriers were correlated with longer assessments and lower completion rates. Adults and Hispanic participants reported more barriers, compared with adolescents and non-Hispanic individuals, respectively. Significant contributors to nonengagement included unknown gender, public insurance, and various barriers.
Identifiable barriers to intake assessment were frequently reported by clients and were associated with higher intake noncompletion and a longer assessment process. Efforts to address logistical barriers may represent an essential step in improving the linkage process and reducing the duration of untreated psychosis.
精神病发作与开始治疗之间的时间对治疗结果有显著影响。快速获得治疗至关重要，但诸如耻辱感、心理健康系统导航困难以及经济限制等障碍会延长这一过程。这项混合方法研究旨在评估这些障碍如何影响早期精神病服务的参与情况。
对一家早期精神病诊所 intake 评估的电话记录数据进行定向内容分析。采用逐步逻辑回归和方差分析来评估障碍对评估完成情况以及从转诊到评估的时间的影响。
在 1048 名接受早期精神病服务筛查的个体中，201 人完成了电话评估。退出者总体上遇到的障碍比例高于完成评估者（p<0.01）。超过 50%的互动至少包含一个障碍，后勤问题最为常见。障碍增加与评估时间延长和完成率降低相关。与青少年和非西班牙裔个体相比，成年人和西班牙裔参与者分别报告了更多障碍。导致不参与的重要因素包括性别不明、公共保险和各种障碍。
客户经常报告 intake 评估存在可识别的障碍，这些障碍与 intake 未完成率较高和评估过程较长有关。解决后勤障碍的努力可能是改善联系过程和缩短未治疗精神病持续时间的关键一步。
