title: Association of treatment delay, migration and urbanicity in psychosis.
abstract: BACKGROUND
  Several factors may contribute to duration of untreated psychosis (DUP): patient-delay, referral-delay and treatment-delay caused by mental health care services (MHS-delay). In order to find the most effective interventions to reduce DUP, it is important to know what factors in these pathways to care contribute to DUP.
  
  
  OBJECTIVE
  To examine the relationship of the constituents of treatment delay, migration status and urbanicity.
  
  
  METHODS
  In first episode psychotic patients (n=182) from rural, urban and highly urbanized areas, DUP, migration status and pathways to care were determined.
  
  
  RESULTS
  Mean DUP was 53.6 weeks (median 8.9, SD=116.8). Patient-delay was significantly longer for patients from highly urbanized areas and for first generation immigrants. MHS-delay was longer for patients who were treated already by MHS for other diagnoses.
  
  
  CONCLUSIONS
  Specific interventions are needed focusing on patients living in highly urbanized areas and first generation immigrants in order to shorten patient delay. MHS should improve early detection of psychosis in patients already in treatment for other diagnosis.
authors.affiliation: Friesland Mental Health Care Service, Department of Education and Research, PO Box 932, 8901 Leeuwarden, The Netherlands. nynke.boonstra@ggzfriesland.nl
authors.forename: N
authors.initials: N
authors.lastname: Boonstra
authors.forename: B
authors.initials: B
authors.lastname: Sterk
authors.forename: L
authors.initials: L
authors.lastname: Wunderink
authors.forename: S
authors.initials: S
authors.lastname: Sytema
authors.forename: L
authors.initials: L
authors.lastname: De Haan
authors.forename: D
authors.initials: D
authors.lastname: Wiersma
mesh_terms: D000293:Adolescent; D000328:Adult; D042241:Early Diagnosis; D054242:Emigrants and Immigrants; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011618:Psychotic Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D014505:Urban Population