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Pathways to care among patients with first-episode psychosis in Asia: a systematic review
Y T Li1, C L M Hui1, S K W Chan1
1Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
Objective:
This systematic review aimed to explore the pathways to care among individuals in Asia experiencing first-episode psychosis (FEP), focusing on the initial points of contact and the final referral source to psychiatric care, as well as key determinants that may influence the duration of untreated psychosis.
Methods:
Electronic databases of PsycINFO, PubMed, EMBASE (Ovid), and Scopus were searched for quantitative observational studies involving Asian participants diagnosed with FEP, including both affective and non-affective psychoses, with mentioning of duration of untreated psychosis, first contact, last contact, and/or determinants and barriers to help-seeking.
Results:
In total, 22 studies were included. Traditional healers were the most frequent initial point of contact, while family members were the most common final referral source to psychiatric care. Key determinants of help-seeking behaviours included symptom profiles, knowledge and awareness of psychosis, and the influence of family members. Pathways to care for individuals experiencing FEP in Asia are diverse, reflecting wide variations in social, cultural, and health system factors.
Conclusion:
This review highlights the roles of traditional healers and family members in help-seeking, as well as the challenges posed by limited awareness, stigma, and cultural beliefs. Psychoeducation for traditional healers and family members may facilitate earlier detection and treatment. Asia-specific research may allow development of culturally sensitive approaches for early intervention services.
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