An individual’s personal income appears to play a role in the amount of time between the onset of psychosis and receipt of services to treat first-episode psychosis (FEP), suggests a study in Psychiatric Services. FEP programs offer a team-based approach to support people recently diagnosed with schizophrenia spectrum disorders.
“The findings of our study highlight the relevance of individual income level as a determinant of health care access for persons with FEP,” wrote Shruthi Venkataraman, M.D., M.Sc., of McGill University and colleagues. “Early detection efforts should measure and target personal income and other [socioeconomic status] indicators to improve access for all individuals who may benefit from FEP services.”
The researchers analyzed data from patients enrolled in two first-episode treatment programs—the Program for Specialized Treatment Early in Psychosis (STEP) in New Haven, Conn., and the Prevention and Recovery in Early Psychosis (PREP) in Boston. While STEP relies on an early detection awareness campaign (called Mindmap) to connect patients with FEP services, PREP does not have this type of early detection campaign.
The study included a total of 218 people (average age, 22 years; 70% male). About 79% of the participants reported a personal monthly income of less than $1,000, about 13% reported a personal monthly income between $1,000 and $2,000, and 8% reported a personal monthly income more than $2,000. (Personal income, rather than household income, was chosen as a proxy for socioeconomic status because a significant number of participants declined to disclose or did not know household income.)
Three measures of days of untreated psychosis were collected: the interval from the onset of psychosis to enrollment in an FEP service, the interval from the onset of psychosis to first use of an antipsychotic medication, and the interval from the first use of an antipsychotic medication to enrollment in an FEP service.
Lower personal income was significantly associated with longer time between onset of psychosis and enrollment in an FEP service after accounting for age, race, and exposure to an early detection campaign. “Additionally, although Mindmap significantly reduced [the interval from the onset of psychosis to enrollment in an FEP service] across all income groups, the campaign was more effective as personal income increased, thereby amplifying disparity in access delays due to low personal income,” Venkataraman and colleagues wrote.
The researchers noted that lower income may be associated with a longer duration of untreated psychosis in a variety of ways: low income has been associated with more severe psychopathology, poorer general medical health, higher stress, and lower levels of social support (friends and family, health care providers, and public services).
“Lower socioeconomic status has also been associated with lower quality of health care services, less opportunity for social participation, less access to knowledge about social services and how to access them, and self-stigma that can impede help seeking,” they wrote.
For related information, see the Psychiatric News article “New Network Collects Real Time Data to Improve Treatment of Early Psychosis.”
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