Service delay in schizophrenia: case–control study of pathways to care among homeless and non-homeless patients
Background Early detection of psychosis is paramount for reducing the duration of untreated psychosis (DUP). One key factor contributing to extended DUP is service delay – the time from initial contact with psychiatric services to diagnosis. Reducing service delay depends on prompt identification...
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Cambridge University Press
2025-03-01
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| Series: | BJPsych Open |
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| Online Access: | https://www.cambridge.org/core/product/identifier/S2056472425000195/type/journal_article |
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| author | Ida-Marie Mølstrøm Rasmus Handest Mads Gram Henriksen Annick Urfer Parnas Julie Nordgaard |
| author_facet | Ida-Marie Mølstrøm Rasmus Handest Mads Gram Henriksen Annick Urfer Parnas Julie Nordgaard |
| author_sort | Ida-Marie Mølstrøm |
| collection | DOAJ |
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Background
Early detection of psychosis is paramount for reducing the duration of untreated psychosis (DUP). One key factor contributing to extended DUP is service delay – the time from initial contact with psychiatric services to diagnosis. Reducing service delay depends on prompt identification of psychosis. Patients with schizophrenia and severe social impairment have been found to have prolonged DUP. Whether service delay significantly contributes to prolonged DUP in this group is unclear.
Aim
To examine and compare the course of illness for patients with schizophrenia who are homeless or domiciled, with a focus on service delay in detecting psychosis.
Method
In this case–control study, we included out-patients with a schizophrenia spectrum diagnosis and who were homeless or domiciled but in need of an outreach team to secure continuous treatment. Interviews included psychosocial history and psychopathological and social functioning scales.
Results
We included 85 patients with schizophrenia spectrum disorder. Mean service delay was significantly longer in the homeless group (5.5 years) compared with the domiciled group (2.5 years, P = 0.001), with a total sample mean of 3.9 years. Similarly, DUP was significantly longer in the homeless group, mean 15.5 years, versus 5.0 years in the domiciled group (P < 0.001). Furthermore, the homeless group had an earlier onset of illness than the domiciled group but were almost the same age at diagnosis.
Conclusions
Our findings point to the concerning circumstance that individuals with considerable risk of developing severe schizophrenia experience a substantial delay in diagnosis and do not receive timely treatment.
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| format | Article |
| id | doaj-art-fdcc2a861a3b4e05bc57c9adbcfc76b8 |
| institution | Kabale University |
| issn | 2056-4724 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | BJPsych Open |
| spelling | doaj-art-fdcc2a861a3b4e05bc57c9adbcfc76b82025-08-20T03:40:23ZengCambridge University PressBJPsych Open2056-47242025-03-011110.1192/bjo.2025.19Service delay in schizophrenia: case–control study of pathways to care among homeless and non-homeless patientsIda-Marie Mølstrøm0https://orcid.org/0000-0003-3790-4989Rasmus Handest1https://orcid.org/0000-0002-3221-1860Mads Gram Henriksen2https://orcid.org/0000-0002-2103-7318Annick Urfer Parnas3https://orcid.org/0000-0001-7398-5830Julie Nordgaard4https://orcid.org/0000-0003-2492-9124Mental Health Center Amager, Capital Region Psychiatry, Copenhagen, Denmark Psychiatry East, Region Zealand, Roskilde, DenmarkMental Health Center Amager, Capital Region Psychiatry, Copenhagen, DenmarkPsychiatry East, Region Zealand, Roskilde, Denmark Centre for Subjectivity Research, Department of Communication, University of Copenhagen, Copenhagen, DenmarkMental Health Center Amager, Capital Region Psychiatry, Copenhagen, Denmark Department of Clinical Medicine, University of Copenhagen, Copenhagen, DenmarkPsychiatry East, Region Zealand, Roskilde, Denmark Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark Background Early detection of psychosis is paramount for reducing the duration of untreated psychosis (DUP). One key factor contributing to extended DUP is service delay – the time from initial contact with psychiatric services to diagnosis. Reducing service delay depends on prompt identification of psychosis. Patients with schizophrenia and severe social impairment have been found to have prolonged DUP. Whether service delay significantly contributes to prolonged DUP in this group is unclear. Aim To examine and compare the course of illness for patients with schizophrenia who are homeless or domiciled, with a focus on service delay in detecting psychosis. Method In this case–control study, we included out-patients with a schizophrenia spectrum diagnosis and who were homeless or domiciled but in need of an outreach team to secure continuous treatment. Interviews included psychosocial history and psychopathological and social functioning scales. Results We included 85 patients with schizophrenia spectrum disorder. Mean service delay was significantly longer in the homeless group (5.5 years) compared with the domiciled group (2.5 years, P = 0.001), with a total sample mean of 3.9 years. Similarly, DUP was significantly longer in the homeless group, mean 15.5 years, versus 5.0 years in the domiciled group (P < 0.001). Furthermore, the homeless group had an earlier onset of illness than the domiciled group but were almost the same age at diagnosis. Conclusions Our findings point to the concerning circumstance that individuals with considerable risk of developing severe schizophrenia experience a substantial delay in diagnosis and do not receive timely treatment. https://www.cambridge.org/core/product/identifier/S2056472425000195/type/journal_articlePsychosisprognosishomelessnesssocial psychiatrycourse of illness |
| spellingShingle | Ida-Marie Mølstrøm Rasmus Handest Mads Gram Henriksen Annick Urfer Parnas Julie Nordgaard Service delay in schizophrenia: case–control study of pathways to care among homeless and non-homeless patients BJPsych Open Psychosis prognosis homelessness social psychiatry course of illness |
| title | Service delay in schizophrenia: case–control study of pathways to care among homeless and non-homeless patients |
| title_full | Service delay in schizophrenia: case–control study of pathways to care among homeless and non-homeless patients |
| title_fullStr | Service delay in schizophrenia: case–control study of pathways to care among homeless and non-homeless patients |
| title_full_unstemmed | Service delay in schizophrenia: case–control study of pathways to care among homeless and non-homeless patients |
| title_short | Service delay in schizophrenia: case–control study of pathways to care among homeless and non-homeless patients |
| title_sort | service delay in schizophrenia case control study of pathways to care among homeless and non homeless patients |
| topic | Psychosis prognosis homelessness social psychiatry course of illness |
| url | https://www.cambridge.org/core/product/identifier/S2056472425000195/type/journal_article |
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