Background:
Although some debate exists in the literature, there is a general consensus that patients with a longer duration of untreated psychosis (DUP) have poorer health outcomes than those treated early. Two recent meta-analyses have established this relationship as being of moderate effect size. Recent research has focused on reducing DUP through either a community approach or a ‘at-risk’ individuals approach. However, it is not currently established in the literature the relative contributions of individual vs. community factors predicting DUP.
Methods:
The present study examined an existing research cohort of 456 Early Psychosis (EP) patients, from 19 mental health teams. The DUP of 326 of these patients had been assessed by the clinician. Multilevel modeling was used to establish the relative contribution of service level variables, and patient level variables.
Results:
The initial null model showed that the service level accounted for 0.54% of potentially explainable variance in the total model; this was not significant (P = 0.36). The remaining 99.46% of variance was accounted for by the patient level. An exploratory analysis of individual factors showed that item 7 of the HoNOS (Depressed Mood) had a significant positive relationship to DUP (P = 0.01), while item 10 (problems with ADLs) had a negative relationship approaching significance (P = 0.06).
Conclusions:
While other individual predictive relationships need to be tested, this study identifies depression as a candidate risk factor for prolonged DUP. Importantly, this research also highlights the central importance of individual factors over community factors in producing treatment delays.
