Determinants of negative pathways to care and their impact on service disengagement in first-episode psychosis

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.

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.

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.

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.