title: Stigma and treatment delay in first-episode psychosis: a grounded theory study.
abstract: OBJECTIVE
  A longer duration of untreated psychosis (DUP) is associated with greater morbidity in the early course of schizophrenia. This formative, hypothesis-generating study explored the effects of stigma, as perceived by family members, on DUP.
  
  
  METHODS
  Qualitative interviews were conducted with 12 African American family members directly involved in treatment initiation for a relative with first-episode psychosis. Data analysis relied on a grounded theory approach. A testable model informed by constructs of Link's modified labelling theory was developed.
  
  
  RESULTS
  Four main themes were identified, including: (i) society's beliefs about mental illnesses; (ii) families' beliefs about mental illnesses; (iii) fear of the label of a mental illness; and (iv) a raised threshold for the initiation of treatment. A grounded theory model was developed as a schematic representation of the themes and subthemes uncovered in the family members' narratives.
  
  
  CONCLUSIONS
  The findings suggest that due to fear of the official label of a mental illness, certain coping mechanisms may be adopted by families, which may result in a raised threshold for treatment initiation, and ultimately treatment delay. If the relationships within the grounded theory model are confirmed by further qualitative and quantitative research, public educational programs could be developed with the aim of reducing this threshold, ultimately decreasing DUP.
authors.affiliation: Department of Behavioral Sciences and Health Education, Rollins School of Public Health of Emory University, Atlanta, Georgia, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Franz
authors.forename: Tandrea
authors.initials: T
authors.lastname: Carter
authors.forename: Amy S
authors.initials: AS
authors.lastname: Leiner
authors.forename: Erin
authors.initials: E
authors.lastname: Bergner
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Thompson
authors.forename: Michael T
authors.initials: MT
authors.lastname: Compton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003469:Culture; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D010342:Patient Acceptance of Health Care; D011618:Psychotic Disorders / Q000523:psychology* / Q000628:therapy; D012559:Schizophrenia / Q000175:diagnosis; D012931:Social Environment; D013240:Stereotyping; D013997:Time Factors