Schizophrenia Bulletin Advance Access published online on November 5, 2008
Schizophrenia Bulletin, doi:10.1093/schbul/sbn137
Ethnic Diversity and Pathways to Care for a First Episode of Psychosis in Ontario
2 McMaster University, Hamilton, Ontario
3 St. Joseph's Healthcare Hamilton
4 University of Western Ontario, London, Ontario
5 London Health Sciences Centre, Ontario
6 McGill University, Montreal, Quebec
7 Douglas Hospital, Montreal, Quebec
8 University of Ottawa, Ontario
9 The Ottawa Hospital
1 To whom correspondence should be addressed; 25 Charlton Ave E, Ste 703, Hamilton, ON L8N 1Y2, Canada; tel: 1 905 540 6586; fax: 1 905 525 2805; e-mail: archies{at}mcmaster.ca.
Objective: To examine ethnic variations in the pathways to care for persons accessing early intervention (EI) services in Ontario. Method: The pathways to care and the duration of untreated psychosis were assessed for first-episode psychosis patients who entered specialized EI services in Ontario. The sample was assigned to the following ethnic classifications: the White (Caucasian), Black (African descent), and Asian (ancestry from the continent) groups, plus all the "other ethnicities" group. Results: There were 200 participants: 78% were male; 61% from the White, 15% Black, 13% Asian, and 11% were from the other ethnicities group. At the first point of contact, more participants used nonmedical contacts (12%), such as clergy and naturopathic healers, than psychologists (8%) or psychiatrists (7%). There were no ethnic differences for duration of untreated psychosis (median 22 weeks) or for initiation of help seeking by family/friends (53%), police (15%), or self (33%). After adjusting for relevant clinical and demographic factors, the Asian and other ethnicities groups were 4 and 3 times (respectively) more likely than the White or Black groups (P = .017) to use emergency room services as the first point of contact in the pathways to care. Participants from the Asian group experienced less involuntary hospitalizations (P = .023) than all the other groups. Yet overall, there were many more similarities than significant differences in the pathways to care. Conclusion: EI services should monitor the pathways to care for young people of diverse ethnic backgrounds to address any disparities in accessing care.
Keywords: first-episode psychosis / pathways to care / schizophrenia / schizophreniform / DUP / early intervention in psychosis / help seeking