Abstract
<p><strong>Background.</strong> Socio-environmental factors are associated with an increased incidence of psychosis and may affect the pathway to care in first-episode psychosis (FEP).</p><p><strong>Objective.</strong> To determine the relationship between individual- and neighbourhood-level socio-environmental factors (household income and rated measures of neighbourhood social capital) and duration of untreated psychosis (DUP) in South Africa.</p><p><strong> Methods.</strong> We obtained data regarding sociodemographics, evolution of symptoms and pathway to care from interviews with 54 consecutively admitted FEP patients at Town Hill Hospital. Caregivers and clinical notes were also consulted. A population-based survey of social capital was conducted in the residential neighbourhood of each patient at onset. Cox regression analyses were used to test whether socioeconomic factors and overall neighbourhood social capital scores and sub-scores were associated with DUP.</p><p><strong>Results.</strong> After controlling for age at onset, gender and income, a shorter DUP was independently associated with police involvement in pathways to care, while non-black ethnicity and greater levels of total social capital were associated with a longer DUP. Community participation, neighbourhood connectedness, and trust and safety were specifically associated with a longer DUP.</p><p><strong>Conclusions</strong>. Individual factors including greater age at onset and police involvement in the care pathway were significantly associated with shorter DUP in this middle-income setting. Paradoxically, aspects of social capital pertaining to greater community involvement were associated with delays in pathways to appropriate care. It is possible that community members opted to care for individuals with early psychosis longer before sending them to formal health services. This is especially likely in contexts where mental health services are scarce and inaccessible, which has important implications for mental health education campaigns.</p>
Highlights
Socio-environmental factors are associated with an increased incidence of psychosis and may affect the pathway to care in first-episode psychosis (FEP)
The age-and-gender distribution of subjects was similar to other first-episode samples with age at onset skewed towards younger ages in men (median 21.5 years; interquartile range (IQR) 19 - 26) and a later median age at onset in women (26.5 years; IQR 20.5 - 38.5)
Mean household income was R2 560 ($365) per month, while most participants lived in houses with fewer than 5 rooms (52%) with ≥5 individuals living in the home (59%)
Summary
Socio-environmental factors are associated with an increased incidence of psychosis and may affect the pathway to care in first-episode psychosis (FEP). After controlling for age at onset, gender and income, a shorter DUP was independently associated with police involvement in pathways to care, while non-black ethnicity and greater levels of total social capital were associated with a longer DUP. Individual factors including greater age at onset and police involvement in the care pathway were significantly associated with shorter DUP in this middle-income setting. It is possible that community members opted to care for individuals with early psychosis longer before sending them to formal health services. This is especially likely in contexts where mental health services are scarce and inaccessible, which has important implications for mental health education campaigns.
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