title: Pathways to care in subjects at high risk for psychotic disorders - a European perspective.
abstract: Evidence-based decisions on indicated prevention in early psychosis require large-scale studies on the pathways to care in high-risk subjects. EPOS (The European Prediction of Psychosis Study), a prospective multi-center, naturalistic field study in four European countries (Finland, Germany, The Netherlands and England), was designed to acquire accurate knowledge about pathways to care and delay in obtaining specialized high risk care. Our high risk sample (n=233) reported on average 2.9 help-seeking contacts, with an average delay between onset of relevant problems to initial help-seeking contact of 72.6 weeks, and between initial help-seeking contact and reaching specialized high risk care of 110.9 weeks. This resulted in a total estimated duration of an unrecognized risk for psychosis of 3 ½ years. Across EPOS EU regions, about 90% of care pathway contacts were within professional health care sectors. Between EPOS regions, differences in the pathways parameters including early detection and health-care systems were often very pronounced. High-risk participants who later made transition to a full psychotic disorder had significantly longer delays between initial help-seeking and receiving appropriate interventions. Our study underlines the need for regionally adapted implementation of early detection and intervention programs within respective mental health and health care networks, including enhancing public awareness of early psychosis.
authors.affiliation: Department of Psychiatry, Ruhr-University Bochum, LWL University Hospital Bochum, Alexandrinenstr. 1, 44801 Bochum, Germany.
authors.forename: Heinrich Graf
authors.initials: HG
authors.lastname: von Reventlow
authors.affiliation: Department of Psychiatry, Ruhr-University Bochum, LWL University Hospital Bochum, Alexandrinenstr. 1, 44801 Bochum, Germany.
authors.forename: Seza
authors.initials: S
authors.lastname: Krüger-Özgürdal
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Cologne, 50924 Cologne, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Ruhrmann
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Cologne, 50924 Cologne, Germany; University Hospital of Child and Adolescent Psychiatry, University of Bern, Bolligenstr. 111, 3000 Bern 60, Switzerland.
authors.forename: Frauke
authors.initials: F
authors.lastname: Schultze-Lutter
authors.affiliation: Department of Psychiatry and Psychotherapy, Charité, Charitéplatz 1, 10117 Berlin, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Heinz
authors.affiliation: Early Intervention Service, School of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom; Youthspace, Birmingham & Solihull Mental Health Foundation Trust, 66-68 Hagley Road, B16 8PF Birmingham, United Kingdom.
authors.forename: Paul
authors.initials: P
authors.lastname: Patterson
authors.affiliation: Department of Psychiatry, University of Turku, Psychiatric Clinic, 20520 Turku, Finland.
authors.forename: Markus
authors.initials: M
authors.lastname: Heinimaa
authors.affiliation: Academic Medical Centre, University of Amsterdam, Tafelbergweg 25, 1105 BC Amsterdam Zuidoost, The Netherlands; Mediant, Broekheurne-Ring 1050, 7546 TA Enschedé, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Dingemans
authors.affiliation: School of Psychology, University of Manchester, Oxford Road, M13 9PL, United Kingdom.
authors.forename: Paul
authors.initials: P
authors.lastname: French
authors.affiliation: Early Intervention Service, School of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom.
authors.forename: Max
authors.initials: M
authors.lastname: Birchwood
authors.affiliation: Department of Psychiatry, University of Turku, Psychiatric Clinic, 20520 Turku, Finland.
authors.forename: Raimo K R
authors.initials: RK
authors.lastname: Salokangas
authors.affiliation: Academic Medical Centre, University of Amsterdam, Tafelbergweg 25, 1105 BC Amsterdam Zuidoost, The Netherlands; Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, PO Box 16, University of Maastricht, 6200 MD Maastricht, The Netherlands.
authors.forename: Don
authors.initials: D
authors.lastname: Linszen
authors.affiliation: School of Psychology, University of Manchester, Oxford Road, M13 9PL, United Kingdom.
authors.forename: Anthony
authors.initials: A
authors.lastname: Morrison
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Cologne, 50924 Cologne, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Klosterkötter
authors.affiliation: Department of Psychiatry, Ruhr-University Bochum, LWL University Hospital Bochum, Alexandrinenstr. 1, 44801 Bochum, Germany. Electronic address: georg.juckel@wkp-lwl.org.
authors.forename: Georg
authors.initials: G
authors.lastname: Juckel
mesh_terms: D000293:Adolescent; D000328:Adult; D042241:Early Diagnosis; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D012307:Risk Factors; D055815:Young Adult
keywords: Early psychosis; High-risk; Mental health care services; Pathways to care