title: Determinants of negative pathways to care and their impact on service disengagement in first-episode psychosis.
abstract: OBJECTIVE
  Although there have been numerous studies on pathways to care in first-episode psychosis (FEP), few have examined the determinants of the pathway to care and its impact on subsequent engagement with mental health services.
  
  
  METHODS
  Using a sample of 324 FEP patients from a catchment area-based early intervention (EI) program in Montréal, we estimated the association of several socio-demographic, clinical, and service-level factors with negative pathways to care and treatment delay. We also assessed the impact of the pathway to care on time to disengagement from EI services.
  
  
  RESULTS
  Few socio-demographic or clinical factors were predictive of negative pathways to care. Rather, service-level factors, such as contact with primary care providers, have a stronger impact on patterns of health service use across multiple indicators. Patients who were in contact with primary care had a reduced likelihood of negative pathways to care, but also had longer referral delays to EI services. Socio-demographic and clinical factors were more relevant for predicting subsequent engagement with EI services, and indicators of negative pathways to care were not associated with service disengagement.
  
  
  CONCLUSIONS
  Primary care providers may be an efficacious target for interventions aimed at reducing overall treatment delay. Increasing the uptake of primary care services may also reduce the likelihood of negative pathways to care. Our findings draw attention to the need for further investigations of the role that the primary care system plays in early intervention for FEP, and strategies for supporting service providers in this role.
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada. kelly.anderson@mail.mcgill.ca
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Anderson
authors.forename: Rebecca
authors.initials: R
authors.lastname: Fuhrer
authors.forename: Norbert
authors.initials: N
authors.lastname: Schmitz
authors.forename: Ashok K
authors.initials: AK
authors.lastname: Malla
mesh_terms: D000293:Adolescent; D000328:Adult; D002170:Canada; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D017063:Outcome Assessment, Health Care; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D013997:Time Factors; D055815:Young Adult