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Swisher VS, Ricketts EJ, Rogers SA. The Impact of Family Functioning on Help-Seeking Behavior and Symptom Severity in Obsessive-Compulsive Disorder. J Nerv Ment Dis 2023; 211:670-678. [PMID: 37381146 DOI: 10.1097/nmd.0000000000001683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
ABSTRACT Poor family functioning is associated with higher symptom severity in pediatric obsessive-compulsive disorder (OCD) and delayed help-seeking behavior in other forms of psychopathology. However, little is known about the impact of family functioning on help-seeking behavior and symptom severity in adults with OCD. The present study investigated the association between family functioning and both treatment delay and symptom severity in adults with obsessive-compulsive symptoms. Participants were 194 adults who self-identified as having OCD and completed an internet survey, including measures assessing family functioning, obsessive-compulsive symptom severity, help-seeking behavior, and depression symptom severity. Poorer family functioning was associated with higher obsessive-compulsive and depression symptom severity, after controlling for significant demographic variables. With respect to domains of family functioning, poorer general functioning, problem solving, communication skills, role functioning, affective involvement, and affective responsiveness were associated with higher obsessive-compulsive and depression symptom severity, after controlling for demographics. Poorer problem solving and communication were not significantly associated with treatment delay after controlling for demographics. Findings highlight the need for family intervention within the treatment framework for adult OCD and suggest targets ( e.g. , communication) to be addressed.
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Affiliation(s)
- Valerie S Swisher
- Department of Psychology, Westmont College, Santa Barbara, California
| | - Emily J Ricketts
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California
| | - Steven A Rogers
- Department of Psychology, Westmont College, Santa Barbara, California
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Santos MM, Kratzer M, Zavala J, Lopez D, Ullman J, Kopelowicz A, Lopez SR. The duration of untreated psychosis among U.S. Latinxs and social and clinical correlates. Front Psychiatry 2023; 14:1052454. [PMID: 37181867 PMCID: PMC10167038 DOI: 10.3389/fpsyt.2023.1052454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 03/31/2023] [Indexed: 05/16/2023] Open
Abstract
Purpose This study (a) documents the duration of untreated psychosis (DUP) and (b) examines both social and clinical correlates of DUP in a sample of U.S. Latinxs with first-episode psychosis (FEP). Methods Data were collected for a longitudinal study evaluating a community education campaign to help primarily Spanish-speaking Latinxs recognize psychotic symptoms and reduce the DUP, or the delay to first prescribed antipsychotic medication after the onset of psychotic symptoms. Social and clinical variables were assessed at first treatment presentation. A sequential hierarchical regression was conducted using √DUP to identify independent predictors of the DUP. A structural equation model was used to explore the association between DUP predictors, DUP, and clinical and social correlates. Results In a sample of 122 Latinxs with FEP, the median DUP was 39 weeks (M = 137.78, SD = 220.31; IQR = 160.39-5.57). For the full sample, being an immigrant and having self-reported relatively poor English-speaking proficiency and self-reported strong Spanish-speaking proficiency were related to a longer delay to first prescribed medication after psychosis onset. For the immigrant subgroup, being older at the time of migration was related to a longer delay. Self-reported English-speaking proficiency emerged as an independent predictor of the DUP. Although the DUP was not related to symptomatology, it was associated with poorer social functioning. Low self-reported English-speaking ability is associated with poorer social functioning via the DUP. Conclusion Latinxs with limited English language skills are especially at high risk for experiencing prolonged delays to care and poor social functioning. Intervention efforts to reduce the delay in Latinx communities should pay particular attention to this subgroup.
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Affiliation(s)
- Maria M. Santos
- Department of Psychology, California State University, San Bernardino, San Bernardino, CA, United States
| | - Maya Kratzer
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, United States
| | - Jaqueline Zavala
- School of Social Welfare, University of California, Berkeley, Berkeley, CA, United States
| | - Daisy Lopez
- Department of Psychology, University of Miami, Miami, FL, United States
| | - Jodie Ullman
- Department of Psychology, California State University, San Bernardino, San Bernardino, CA, United States
| | - Alex Kopelowicz
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Steven Regeser Lopez
- Department of Psychology, University of Southern California, Los Angeles, CA, United States
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Systematic review of pathways to care in the U.S. for Black individuals with early psychosis. NPJ SCHIZOPHRENIA 2021; 7:58. [PMID: 34857754 PMCID: PMC8639758 DOI: 10.1038/s41537-021-00185-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/03/2021] [Indexed: 11/09/2022]
Abstract
The pathway to receiving specialty care for first episode psychosis (FEP) among Black youth in the US has received little attention despite documented challenges that negatively impact engagement in care and clinical outcomes. We conducted a systematic review of US-based research, reporting findings related to the pathway experiences of Black individuals with FEP and their family members. A systematic search of PubMed, PsycInfo, and Embase/Medline was performed with no date restrictions up to April 2021. Included studies had samples with at least 75% Black individuals and/or their family members or explicitly examined racial differences. Of the 80 abstracts screened, 28 peer-reviewed articles met the inclusion criteria. Studies were categorized into three categories: premordid and prodromal phase, help-seeking experiences, and the duration of untreated psychosis (DUP). Compounding factors such as trauma, substance use, and structural barriers that occur during the premorbid and prodromal contribute to delays in treatment initiation and highlight the limited use of services for traumatic childhood experiences (e.g., sexual abuse). Studies focused on help-seeking experiences demonstrated the limited use of mental health services and the potentially traumatic entry to services (e.g., law enforcement), which is associated with a longer DUP. Although the majority of studies focused on help-seeking experiences and predictors of DUP, findings suggests that for Black populations, there is a link between trauma and substance use in the pathway to care that impacts the severity of symptoms, initiation of treatment, and DUP. The present review also identifies the need for more representative studies of Black individuals with FEP.
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Tsibidaki A. Children with cerebral palsy: Family and parent demographic characteristics and family strengths in Greece and Italy. J Health Psychol 2020; 26:2071-2083. [PMID: 31918571 DOI: 10.1177/1359105319900276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The study focuses on families raising a child with cerebral palsy to investigate family strengths and their association with family and parent demographic characteristics in Greece and Italy. Participants were 120 parents raising a biological child with cerebral palsy. Data collection used a self-report questionnaire and the Family Strengths Inventory. According to the findings, families share a high sense of family strengths, which is mainly represented in the high sense of 'pride' and 'accord'. In addition, demographic characteristics seem to be important predictors of well-being and strengthen parents and families raising a child with cerebral palsy.
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Kaminga AC, Dai W, Liu A, Myaba J, Banda R, Wen SW. Effects of socio-demographic characteristics, premorbid functioning, and insight on duration of untreated psychosis in first-episode schizophrenia or schizophreniform disorder in Northern Malawi. Early Interv Psychiatry 2019; 13:1455-1464. [PMID: 30706661 PMCID: PMC6900171 DOI: 10.1111/eip.12794] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 12/24/2018] [Accepted: 01/13/2019] [Indexed: 11/27/2022]
Abstract
AIM Long duration of untreated psychosis (DUP) is prevalent and has been shown to be associated with poorer prognosis. Thus, knowledge of its determinants may help to target early interventions to reduce DUP on the needed population. Previous studies seeking to understand determinants of DUP have been inconclusive. Therefore, this study aimed to investigate the effects of socio-demographic characteristics, premorbid functioning, and insight on DUP in patients with first-episode schizophrenia or schizophreniform disorder. METHODS This cross-sectional study recruited 110 subjects (aged 18-65) during a pilot early intervention service for psychosis in Northern Malawi, between June 2009 and September 2012. Short DUP was defined as ≤6 months, whereas long DUP was defined as >6 months. Unadjusted and adjusted analyses were performed to identify determinants of DUP. RESULTS Of the 110 subjects, 99 (90%) had schizophrenia. Median DUP was 27.5 months, while mean (SD) DUP was 71.24 (92.32) months. In addition, at least 75% had long DUP, which was associated with lower level of education, poor insight, younger age at onset, and at least one parent deceased. CONCLUSIONS Long DUP is prevalent in Northern Malawi. Thus, early interventions to reduce DUP are warranted in this population. Although having at least one parent deceased predicted long DUP in this study, this remains speculative because factors, such as timing of parents' death and grief reactions of the patients were not assessed. Therefore, further investigations incorporating these factors are needed to ascertain this result.
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Affiliation(s)
- Atipatsa C. Kaminga
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaHunanChina
- Department of Mathematics and StatisticsMzuzu UniversityMzuzuMalawi
| | - Wenjie Dai
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaHunanChina
| | - Aizhong Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaHunanChina
| | - Japhet Myaba
- Department of Clinical Medicine, Mental Health Research SectionSaint John of God Community ServicesMzuzuMalawi
| | - Richard Banda
- Department of Clinical Medicine, Mental Health Research SectionSaint John of God Community ServicesMzuzuMalawi
| | - Shi W. Wen
- Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaHunanChina
- OMNI Research Group, Department of Obstetrics and Gynecology, Faculty of MedicineUniversity of OttawaOttawaOntarioCanada
- Ottawa Hospital Research InstituteClinical Epidemiology ProgramOttawaOntarioCanada
- School of Epidemiology, Public Health, and Preventive Medicine, Faculty of MedicineUniversity of OttawaOttawaOntarioCanada
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Hernandez M, Hernandez MY, Lopez D, Barrio C, Gamez D, López SR. Family processes and duration of untreated psychosis among US Latinos. Early Interv Psychiatry 2019; 13:1389-1395. [PMID: 30644163 PMCID: PMC6629522 DOI: 10.1111/eip.12779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 11/27/2018] [Accepted: 12/26/2018] [Indexed: 11/28/2022]
Abstract
AIM Little is known about family processes and treatment seeking among Latinos with first-episode psychosis (FEP) living in the United States. This study examined family processes prior to treatment and their relation to duration of untreated psychosis (DUP) among Latinos with FEP and their family caregivers. METHODS Thirty-three Latinos with FEP and their low-acculturated family caregivers (n = 33) participated in qualitative semi-structured interviews focused on treatment-seeking experience and family relationships. Transcripts were analysed using thematic analysis and themes were grouped based on short (n = 18) or long (n = 15) DUP. RESULTS Findings revealed differences based on DUP length. Patients with short DUP had stronger family relationships characterized by open communication and disclosure of symptoms that facilitated awareness and direct action by family caregivers. However, patients with long DUP had more troubled family relationships that often challenged early treatment seeking. CONCLUSIONS Findings highlight the relevance of family context in the provision of early treatment for Latinos with FEP. Family-based services are needed that increase awareness of symptoms and provide families with support that can facilitate ongoing patient treatment during this critical period.
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Affiliation(s)
- Mercedes Hernandez
- Department of Psychology, University of Southern California, Los Angeles, California
| | - Maria Y Hernandez
- Department of Psychology, University of Southern California, Los Angeles, California
| | - Daisy Lopez
- Department of Psychology, University of Southern California, Los Angeles, California
| | - Concepción Barrio
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
| | - Diana Gamez
- Department of Psychology, University of Southern California, Los Angeles, California
| | - Steven R López
- Department of Psychology, University of Southern California, Los Angeles, California
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Abd Alhadi H. Determinant of treatment delay in the first episode of psychosis: a qualitative study. ACTA ACUST UNITED AC 2018. [DOI: 10.15406/jpcpy.2018.09.00532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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8
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Family assessment among patients with various mental disorders. MIDDLE EAST CURRENT PSYCHIATRY 2018. [DOI: 10.1097/01.xme.0000530437.44931.b5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Hasan AA, Musleh M. Barriers to Seeking Early Psychiatric Treatment amongst First-episode Psychosis Patients: A Qualitative Study. Issues Ment Health Nurs 2017; 38:669-677. [PMID: 28485998 DOI: 10.1080/01612840.2017.1317307] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIMS The aim of this study was to explore the family members' determinant of the delay in seeking psychiatric care to patients diagnosed with psychosis. METHODS Qualitative semi-structured interviews were carried out with twenty-seven family members of patients with psychosis at psychiatric outpatient clinics in Amman, Jordan. RESULTS The findings revealed that perceived stigma and fears about being labelled are the main barriers to requesting early psychiatric health care. The participants cited many different reasons linked to finding help led to delay in seeking help in the early stages of the illness including misattribution of the cause and symptoms of mental illness, family and financial factors. CONCLUSIONS The study highlights the importance of enhancing knowledge about the schizophrenia-related spectrum to ensure patients seek treatment in a more timely manner.
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Affiliation(s)
- Abd Alhadi Hasan
- a Nursing Department , Dr Soliman Fakeeh College of Nursing and Medical Sciences , Jeddah , Saudi Arabia
| | - Mahmoud Musleh
- b Nursing Department , Fakeeh College for Medical Sciences , Jeddah , Saudi Arabia
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Marthoenis M, Aichberger MC, Schouler-Ocak M. Patterns and Determinants of Treatment Seeking among Previously Untreated Psychotic Patients in Aceh Province, Indonesia: A Qualitative Study. SCIENTIFICA 2016; 2016:9136079. [PMID: 27382501 PMCID: PMC4921139 DOI: 10.1155/2016/9136079] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 05/07/2016] [Accepted: 05/12/2016] [Indexed: 06/01/2023]
Abstract
Immediate treatment of first-episode psychosis is essential in order to achieve a positive outcome. However, Indonesian psychiatric patients often delay accessing health services, the reason for which is not yet fully understood. The current study aimed to understand patterns of treatment seeking and to reveal determinants of the delay in accessing psychiatric care among first-time user psychotic patients. Qualitative interviews were conducted with sixteen family members who accompanied the patients to a psychiatric hospital. Many families expressed beliefs that mental illness appertains to village sickness and not hospital sickness; therefore, they usually take the patients to traditional or religious healers before taking them to a health professional. They also identified various factors that potentially delay accessing psychiatric treatment: low literacy and beliefs about the cause of the illness, stigmatisation, the role of extended family, financial problems, and long distance to the psychiatric hospital. On the other hand, the family mentioned various factors related to timely help seeking, including being a well-educated family, living closer to health facilities, previous experience of successful psychotic therapy, and having more positive symptoms of psychosis. The findings call for mental health awareness campaigns in the community.
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Affiliation(s)
- Marthoenis Marthoenis
- University Psychiatric Clinic of Charité at St. Hedwig's Hospital, Große Hamburger Strasse 5-11, 10115 Berlin, Germany
| | - Marion C. Aichberger
- Departments of Psychiatry and Psychotherapy, Charite Universitätsmedizin, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Meryam Schouler-Ocak
- University Psychiatric Clinic of Charité at St. Hedwig's Hospital, Große Hamburger Strasse 5-11, 10115 Berlin, Germany
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11
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Skubby D, Bonfine N, Tracy H, Knepp K, Munetz MR. The Help-Seeking Experiences of Parents of Children with a First-Episode of Psychosis. Community Ment Health J 2015; 51:888-96. [PMID: 25876766 DOI: 10.1007/s10597-015-9877-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 04/09/2015] [Indexed: 10/23/2022]
Abstract
The objective was to understand the experiences of parents as they sought psychological and specialized medical services for a loved one having a first episode of psychosis. The research method was qualitative and the data gathering was done through semi-structured interviews. Eleven parents of eight adolescent or young adult children consented to be interviewed. Data from these interviews were coded and sorted. Parents reported that many of their encounters resulted in delays in accessing treatment. These encounters were characterized by misattributions of the child's behavior, poor advice, misdiagnosis, disbelief in the seriousness of the child's condition, and an unwillingness to share information. But parents also reported that encounters with other individuals were characterized by helpful advice, emotional support, and suggestions as to how to access early intervention services. Encounters with many professionals were generally not helpful to parents. These encounters served as roadblocks to accessing proper treatment for their child. More publicity, outreach, and education are recommended in the professional community.
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Affiliation(s)
- David Skubby
- Department of Sociology and Anthropology, Hendrix College, 1600 Washington Ave., Conway, AR, 72032, USA.
| | - Natalie Bonfine
- Department of Psychiatry, Northeast Ohio Medical University, State Route 44, Rootstown, OH, 44272, USA
| | - Hattie Tracy
- Child Guidance and Family Solutions, 18 North Forge St., Akron, OH, 44304, USA
| | - Kristen Knepp
- Department of Psychiatry, Northeast Ohio Medical University, State Route 44, Rootstown, OH, 44272, USA
| | - Mark R Munetz
- Department of Psychiatry, Northeast Ohio Medical University, State Route 44, Rootstown, OH, 44272, USA
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Nerhus M, Berg AO, Haram M, Kvitland LR, Andreassen OA, Melle I. Migrant background and ethnic minority status as predictors for duration of untreated psychosis. Early Interv Psychiatry 2015; 9:61-5. [PMID: 24225002 DOI: 10.1111/eip.12106] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 10/10/2013] [Indexed: 11/30/2022]
Abstract
AIM The aim of the study was to explore if patients with migration and/or ethnic minority background have longer duration of untreated psychosis (DUP) than patients from the reference population, and in case to what extent this was best explained by ethnic minority status or migration background, including age at migration. METHODS Four hundred sixty-two first-episode patients were included. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I Disorders was used for diagnostic purposes. Patients were interviewed about migration history and ethnicity using structured questionnaires. RESULTS Being part of an ethnic minority group had a trend-level significance, and migration after the age of 6 had a statistically significant association with prolonged DUP. CONCLUSIONS Age at migration has a moderate, but statistically significant effect on DUP. The findings indicate migrating after school start is associated with a longer DUP in immigrant populations.
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Affiliation(s)
- Mari Nerhus
- Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, KG Jebsen Centre for Psychosis Research, Oslo, Norway
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Mo'tamedi H, Rezaiemaram P, Aguilar-Vafaie ME, Tavallaie A, Azimian M, Shemshadi H. The relationship between family resiliency factors and caregiver-perceived duration of untreated psychosis in persons with first-episode psychosis. Psychiatry Res 2014; 219:497-505. [PMID: 25017617 DOI: 10.1016/j.psychres.2014.06.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 06/08/2014] [Accepted: 06/10/2014] [Indexed: 11/16/2022]
Abstract
Although the family has an important role in the early detection and intervention of first-episode psychosis (FEP), there are few findings reporting associations between family strengths and early treatment-seeking experiences. This study aimed to investigate, within the framework of the resiliency model of family stress, adjustment, and adaptation, the association between family coping strategies, resource management factors and duration of untreated psychosis (DUP) in Iranian families with one adult child with FEP. Hundred and seven individuals referred to three medical centers in Tehran and diagnosed with FEP participated in this study. Caregiver-perceived DUP was measured via semi-structured interviews administered to primary caregivers. They also completed two questionnaires regarding family resources of stress management and family coping strategies. Data analysis indicated that the Family Inventory of Resources of Management (FIRM) total scale score did not significantly explain the variance of caregiver-perceived DUP, but one of the FIRM subscales, the Extended Family Social Support, and the Family Crisis-Oriented Personal Evaluation scale (F-COPES) total score and one its subscales, the Acquiring Social Support, explained a significant amount of the variance of caregiver-perceived DUP. The results suggest that higher family resiliency, especially social support, facilitates the family's appropriate adaptive reaction (i.e., treatment-seeking), with the consequent decrease of DUP.
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Affiliation(s)
- Hadi Mo'tamedi
- Department of Clinical Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Peyman Rezaiemaram
- Department of Psychology, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran.
| | - Maria E Aguilar-Vafaie
- Department of Psychology, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran
| | - Abaas Tavallaie
- Behavioral Sciences Research Center, Baqiyatallah Medical University, Tehran, Iran
| | - Mojtaba Azimian
- Department of Clinical Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hashem Shemshadi
- Department of Clinical Sciences and Speech Reconstructive Surgery, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Compton MT, Goulding SM, Gordon TL, Weiss PS, Kaslow NJ. Family-level predictors and correlates of the duration of untreated psychosis in African American first-episode patients. Schizophr Res 2009; 115:338-45. [PMID: 19833482 PMCID: PMC2783750 DOI: 10.1016/j.schres.2009.09.029] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Revised: 09/18/2009] [Accepted: 09/22/2009] [Indexed: 11/15/2022]
Abstract
BACKGROUND Little is known about how family-level factors are associated with duration of untreated psychosis (DUP), especially in ethnic/racial minority groups, such as African Americans. This study involved African American first-episode patients and their family members who initiated evaluation and treatment for them. It was hypothesized that a longer DUP would be predicted by family members' endorsement of: (1) less knowledge about schizophrenia, (2) greater perceptions of stigma, (3) lower levels of insight, (4) fewer family strengths, (5) more limited family coping capacity, and (6) lower levels of caregiver strain. METHODS From a sample of 109 patients, 42 African American patients with family-level data were included. Cox proportional hazard models quantified associations between family-level predictors and DUP, and analyses controlled for effects of three previously determined patient-level predictors of DUP - mode of onset of psychosis, living with family members versus alone or with others, and living above versus below the federal poverty level. RESULTS The median DUP was 24.5 weeks. Greater family strengths and a better family coping capacity were associated with a shorter DUP, whereas higher insight among informants and greater level of perceived caregiver strain were associated with a longer DUP. CONCLUSIONS Whereas family strengths and coping likely account for a significant portion of variability in DUP, both insight and caregiver strain probably evolve as a consequence of DUP. Efforts to strengthen families and tap into existing strengths of families in specific cultural groups would likely enhance early treatment-seeking for psychotic disorders.
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Affiliation(s)
- Michael T Compton
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia 30303, USA.
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Mode of onset of psychosis and family involvement in help-seeking as determinants of duration of untreated psychosis. Soc Psychiatry Psychiatr Epidemiol 2008; 43:975-82. [PMID: 18604616 DOI: 10.1007/s00127-008-0397-y] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Accepted: 06/09/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND The duration of untreated psychosis (DUP) is a potentially modifiable determinant of the early course of nonaffective psychotic disorders, though a paucity of research has addressed determinants of DUP. Recent data from London and Nottingham, UK indicated that a shorter DUP was predicted by: (1) an acute mode of onset, (2) employment, and (3) active involvement of at least one family member in seeking evaluation (Morgan et al. Br J Psychiatry 189:446-452, 2006). The present analysis was conducted in an effort to replicate those findings in a predominantly low-income, urban, African American sample. METHOD DUP and the three key predictors of interest were assessed using standardized procedures. All analytic plans replicated those of Morgan and colleagues (Morgan et al. Br J Psychiatry 189:446-452, 2006) to the largest extent possible. Sufficient information was available to rate DUP for 73 patients. RESULTS The median DUP was 23.4 weeks. Bivariate tests, survival analysis, and Cox regression revealed that an insidious mode of onset was associated with a substantially longer DUP compared with an acute onset, and that family involvement in help-seeking was independently associated with a longer duration. CONCLUSIONS While mode of onset is a reliable illness-related determinant of DUP, further research is needed on the complex ways in which family-related variables influence DUP.
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