Boujelben Ines, D'Andrea Giuseppe, Ouellet-Plamondon Clairelaine, Artaud Laurence, Villeneuve Marie, Shah Jai, Iyer Srividya N, Abdel-Baki Amal
Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Québec, Canada; Département de Psychiatrie et Addictologie, Université de Montréal, Québec, Canada.
Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Québec, Canada; Prevention and Early Intervention Program for Psychosis (PEPP)-Montréal, Douglas Mental Health University Institute, Montréal, QC, Canada; ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, QC, Canada; Department of Psychiatry, McGill University, Montréal, QC, Canada.
Schizophr Res. 2025 Jun;280:122-129. doi: 10.1016/j.schres.2025.04.021. Epub 2025 Apr 25.
Early-intervention services (EIS) are the gold standard for first-episode psychosis (FEP). Immigrants and racialized youth with FEP are more likely to access EIS through adverse pathways (police and/or ambulance-mediated) and to disengage from treatment. We aimed to use a comprehensive, intersectional approach to examine inequalities in pathways to care and EIS disengagement, comparing immigrants stratified by generational and racialized minority status, with White majority non-immigrants.
Incident FEP cases from two Canadian EIS were stratified according to immigrant generation and racialized minority status. Pathways to care and disengagement were examined using logistic regression models adjusted for potential confounders.
Of 567 participants, 173 (30.8 %) experienced an adverse pathway. The proportion of adverse pathway was highest among racialized first-generation immigrants (N = 52, 38.2 %), followed by non-racialized (N = 13, 32.5 %) and racialized second-generation immigrants (N = 23, 32.4 %). White non-immigrants (N = 77, 26.9 %) and non-racialized first-generation immigrants (N = 6, 23.1 %) presented lower rates. Odds of adverse pathways were only significantly increased for racialized first-generation immigrants (OR = 1.72, 95 % CI = 1.06-2.80) compared with White non-immigrants. Disengagement was associated with adverse pathways to care (OR = 1.80, 95 % CI = 1.09-2.97), but not with immigrant stratified groups. The relationship between adverse pathways and disengagement was not moderated by immigrant status.
Racialized first-generation immigrants are more likely to encounter adverse pathways. The interplay between systemic, cultural, and individual factors, including perceived need for mental healthcare knowledge and trust towards healthcare institutions can hinder access to services. Racially differing practices in emergency response may play a role. Further research is needed to understand inequities in EIS access.
早期干预服务（EIS）是首发精神病（FEP）的黄金标准。患有FEP的移民和种族化青年更有可能通过不良途径（警方和/或救护车介导）获得EIS，并且更有可能脱离治疗。我们旨在采用一种全面的、交叉性的方法来研究获得护理途径和EIS脱离方面的不平等现象，将按代际和种族化少数群体身份分层的移民与白人多数非移民进行比较。
来自两个加拿大EIS的新发FEP病例根据移民代际和种族化少数群体身份进行分层。使用针对潜在混杂因素进行调整的逻辑回归模型来研究获得护理和脱离治疗的途径。
在567名参与者中，173人（30.8%）经历了不良途径。不良途径的比例在种族化第一代移民中最高（N = 52，38.2%），其次是非种族化移民（N = 13，32.5%）和种族化第二代移民（N = 23，32.4%）。白人非移民（N = 77，26.9%）和非种族化第一代移民（N = 6，23.1%）的比例较低。与白人非移民相比，只有种族化第一代移民出现不良途径的几率显著增加（OR = 1.72，95% CI = 1.06 - 2.80）。脱离治疗与不良的获得护理途径相关（OR = 1.80，95% CI = 1.09 - 2.97），但与移民分层群体无关。不良途径与脱离治疗之间的关系不受移民身份的调节。
种族化第一代移民更有可能遇到不良途径。系统、文化和个体因素之间的相互作用，包括对精神卫生保健知识的感知需求和对医疗机构的信任，可能会阻碍获得服务。应急响应中的种族差异做法可能起到了一定作用。需要进一步研究以了解EIS获得方面的不平等现象。
