title: Pathways to First-Episode Care for Psychosis in African-, Caribbean-, and European-Origin Groups in Ontario.
abstract: OBJECTIVE
  To compare the pathways to care and duration of untreated psychosis (DUP) for people of Black-African, Black-Caribbean, or White-European origin with first-episode psychosis (FEP).
  
  
  METHODS
  We recruited a sample of 171 patients with FEP of Black-African, Black-Caribbean, and White-European origin from hospital- and community-based early intervention services (EIS) in the cities of Toronto and Hamilton. We compared the 3 groups on DUP and key indicators of the pathway to care.
  
  
  RESULTS
  We observed differences in pathways to care across the 3 groups. Black-Caribbean participants had an increased odds of referral from an inpatient unit to EIS (OR 3.33; 95% CI 1.46 to 7.60) and a decreased odds of general practitioner involvement on the pathway to care (OR 0.17; 95% CI 0.07 to 0.46), as well as fewer total contacts (exp[β] 0.77; 95% CI 0.60 to 0.99) when compared with White-European participants. Black-African participants had an increased odds of contact with the emergency department at first contact (OR 3.78; 95% CI 1.31 to 10.92). The differences in the DUP between groups were not statistically significant.
  
  
  CONCLUSIONS
  Our findings suggest that there are significant differences in the pathways to EIS for psychosis for people of African and Caribbean origin in our Canadian context. It is essential to gain a comprehensive understanding of the pathways that different population groups take to mental health services, and the reasons behind observed differences, to inform the development of equitable services, targeting patients in the critical early stages of psychotic disorder.
authors.affiliation: Post-doctoral Fellow, Centre for Addiction and Mental Health, Toronto, Ontario.
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Anderson
authors.affiliation: Research Analyst, Centre for Addiction and Mental Health, Toronto, Ontario.
authors.forename: Nina
authors.initials: N
authors.lastname: Flora
authors.affiliation: Post-doctoral Fellow, Centre for Addiction and Mental Health, Toronto, Ontario.
authors.forename: Manuela
authors.initials: M
authors.lastname: Ferrari
authors.affiliation: Project Coordinator, Centre for Addiction and Mental Health, Toronto, Ontario.
authors.forename: Andrew
authors.initials: A
authors.lastname: Tuck
authors.affiliation: Associate Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Archie
authors.affiliation: Independent Scientist, Centre for Addiction and Mental Health; Assistant Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario.
authors.forename: Sean
authors.initials: S
authors.lastname: Kidd
authors.affiliation: Manager of Research, Schizophrenia Society of Ontario; Assistant Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario.
authors.forename: Taryn
authors.initials: T
authors.lastname: Tang
authors.affiliation: Professor, Division of Social and Transcultural Psychiatry, Department of Psychiatry, McGill University; Director, Culture and Mental Health Research Unit, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec.
authors.forename: Laurence J
authors.initials: LJ
authors.lastname: Kirmayer
authors.forename: Kwame
authors.initials: K
authors.lastname: McKenzie
mesh_terms: D000328:Adult; D044383:Black People / Q000208:ethnology / Q000706:statistics & numerical data*; D017691:Caribbean Region / Q000208:ethnology; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D009864:Ontario / Q000208:ethnology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011618:Psychotic Disorders / Q000208:ethnology / Q000628:therapy*; D044465:White People / Q000208:ethnology / Q000706:statistics & numerical data*; D055815:Young Adult