The Female Experience of Early Phase Psychosis and Perceived Barriers to Accessing Early Intervention Services: A Qualitative Analysis

The Female Experience of Early Phase Psychosis and Perceived Barriers to Accessing Early Intervention Services: A Qualitative Analysis | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 12 November 2025 V1 Latest version Share on The Female Experience of Early Phase Psychosis and Perceived Barriers to Accessing Early Intervention Services: A Qualitative Analysis Authors : Ella Hodgson-Pageau 0009-0008-0340-9449 [email protected] , Esther Puiras , and Kara Dempster Authors Info & Affiliations https://doi.org/10.22541/au.176293448.89457884/v1 251 views 111 downloads Contents Abstract Abstract 1. Introduction 2. Methods 4. Discussion 5. Conclusion References Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Introduction: Early intervention services (EIS) are crucial for improving outcomes in psychotic spectrum disorders but are less accessible for females. The disparity has been attributed to a sex and gender-specific presentations of psychosis as well as social factors. The aim of this study was to conduct an exploratory qualitative analysis of female-specific barriers to accessing EIS for psychosis. Methods: Semi-structured interviews were conducted with 14 cisgender female participants enrolled in the Nova Scotia Early Psychosis Program (NSEPP) in Halifax, Nova Scotia. Retrospective chart reviews were also conducted for each participant to gather information about their referral pathways and clinical history. The interview data was analyzed using reflexive inductive thematic analysis methodology. Results: The analysis revealed four superordinate themes and ten subordinate themes of female experiences accessing EIS. (1) Clinician preconceptions or dismissal : descriptions of multiple interactions with the healthcare system, clinician preconceptions of presentation and feeling dismissed. (2) Interpersonal relationships : male romantic partners delayed access to care and support of family and friends accelerated access to care. (3) Masking symptoms : participants hid symptoms out of fear of external perceptions and apparent high functioning at onset affected care (4) Trust and communication with the medical team : reports of a lack of understanding, distrust and unclear communication from clinicians. Conclusions: These themes underscore the importance of improving clinical awareness of sex and gender-specific characteristics of the presentation of early psychosis. The Female Experience of Early Phase Psychosis and Perceived Barriers to Accessing Early Intervention Services: A Qualitative Analysis Ella Hodgson-Pageau 1 , Esther Puiras 2 , Kara Dempster 3 1. Department of Psychology & Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada. [email protected] (Corresponding author) 2. Nova Scotia Health Authority – Research and Innovation, Halifax, Nova Scotia, Canada. [email protected] 3. Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada. [email protected] Data collection was funded by the Dalhousie Department of Psychiatry. This project was approved by the Nova Scotia Health Research Ethics Board (file #1030961). All participants provided written, informed consent to this research and its publication. Generated and analyzed data is available within the paper and supplementary material. Transcripts of interviews are available upon request from the authors. There are no relevant conflicts of interest. Abstract Introduction: Early intervention services (EIS) are crucial for improving outcomes in psychotic spectrum disorders but are less accessible for females. The disparity has been attributed to a sex and gender-specific presentations of psychosis as well as social factors. The aim of this study was to conduct an exploratory qualitative analysis of female-specific barriers to accessing EIS for psychosis. Methods: Semi-structured interviews were conducted with 14 cisgender female participants enrolled in the Nova Scotia Early Psychosis Program (NSEPP) in Halifax, Nova Scotia. Retrospective chart reviews were also conducted for each participant to gather information about their referral pathways and clinical history. The interview data was analyzed using reflexive inductive thematic analysis methodology. Results: The analysis revealed four superordinate themes and ten subordinate themes of female experiences accessing EIS. (1) Clinician preconceptions or dismissal : descriptions of multiple interactions with the healthcare system, clinician preconceptions of presentation and feeling dismissed. (2) Interpersonal relationships : male romantic partners delayed access to care and support of family and friends accelerated access to care. (3) Masking symptoms : participants hid symptoms out of fear of external perceptions and apparent high functioning at onset affected care (4) Trust and communication with the medical team : reports of a lack of understanding, distrust and unclear communication from clinicians. Conclusions: These themes underscore the importance of improving clinical awareness of sex and gender-specific characteristics of the presentation of early psychosis. Keywords: First Episode Psychosis, Psychotic Disorders, Early intervention, Sex factors, Gender equity 1. Introduction Proactive measures are crucial in optimizing outcomes for psychotic spectrum disorders (PSDs). Early intervention services (EIS) provide phase-specific, developmentally tailored care aimed at maximizing functional recovery during this vulnerable period (O’Connell et al., 2021). A recent meta-analysis found that EIS were associated with better outcomes than standard treatment in terms of symptom severity, hospitalizations, global functioning and remission (Correll et al., 2018). Similarly, mortality rates of first episode psychosis (FEP) patients who accessed EIS were four times lower than FEP patients who did not (Anderson et al., 2018a). Given the potentially life-saving impact of EIS, it is alarming that females experiencing psychosis may be systemically excluded. Meta analyses found slightly higher rates of schizophrenia (Solmi et al., 2023; van Der Werf et al., 2014) and all PSDs (Jongsma et al., 2019) in males. This difference may be partially attributed to clinician bias. Case descriptions of individuals with psychotic symptoms are 1.8 times more likely to receive a schizophrenia diagnosis from psychiatrists when described with ”he/him” pronouns compared to identical descriptions using ”she/her” (Hoye et al., 2006). For females who are diagnosed, males are still 50% more likely to be in the group that accesses EIS (Anderson et al., 2018b). Additionally, the m/f incidence ratio of 1.44:1 (Jongsma et al., 2019) does not align with the EIS patient ratio of 3:1 (Polillo et al., 2023). Some have argued that the lower proportion of females in EIS reflects program eligibility criteria (Brand et al., 2022), as females tend to experience a later onset of symptoms and many services restrict enrollment to individuals under 35 years (Nolin et al., 2016). However, epidemiological evidence shows that the average age of psychosis onset for females falls between 25 and 35 (Ochoa et al, 2012), meaning that most females with FEP should still qualify for EIS care. Therefore, the significant underrepresentation of females in EIS is unlikely to be solely attributable to age differences. Sex-specific characteristics of PSDs may contribute to the disparity (Carter et al., 2023; Moukas et al., 2010). There is a preponderance of affective symptoms in women: 62% of women diagnosed with schizophrenia spectrum disorders (SSD) had a mood disorder as their last diagnosis prior to SSD, compared to 39% of men (Sommer et al., 2020). This may be due, in part, to gender stereotypes impacting psychiatric emergency room diagnoses (Muroff et al., 2017). Given that 4 out of 11 surveyed Canadian EISs did not accept patients with affective psychoses (Nolin et al., 2016), the prominence of affective symptoms may contribute to women not being connected to EIS. Furthermore, women experiencing psychosis are less likely to present with prominent negative symptoms (Irving et al., 2021) which, in combination with mood related symptoms, may not match clinicians’ preconceptions of PSDs thereby resulting in a failure to recognize psychosis and refer to EIS. In a focus group study on gender differences in pathways to care for psychosis, women reported feeling ignored and told they were too functional (Ferrari et al., 2018). Although females tend to present with superior baseline social functioning compared to males (Dama et al., 2019b), longitudinal studies find that recovery and functionality are approximately equal across sexes (Sommer et al., 2020; Ayessa-Arriola et al., 2020; Seeman, 2019). However, one study found that men had improved clinical symptoms relative to women after 6 months of engagement with EIS (Domenicano et al., 2025). Societal and cultural expectations may contribute to gender differences in social functioning, as women are socialized to be pleasant and altruistic (Carter, 2014). Additionally, PSDs are highly stigmatized (Lee et al., 2016). Therefore, women may hide psychotic symptoms for the sake of others or for appearances. There is a paucity of literature examining how social factors and a sex-specific initial presentation of psychosis may impact the way symptoms are addressed in the healthcare system. This gap can be attributed to the historical exclusion of females from clinical research and an ongoing lack of sex and gender-based analysis (Reichlin et al., 2022; Heidari et al., 2016). Although existing research often uses the terms interchangeably, female (sex) and woman (gender) are not synonymous (Christiansen et al., 2022). The current study recognized the distinction. This study aimed to qualitatively examine the barriers female, woman-identifying patients face when seeking help during their first episode of psychosis. 2. Methods 2.1 Participants A convenience sample of 14 females receiving care at the Nova Scotia Early Psychosis Program (NSEPP) in Halifax, Nova Scotia, Canada was recruited. NSEPP accepts individuals between the ages of 19 and 35 with PSDs and <6 months of antipsychotic treatment. NSEPP does not accept patients experiencing psychosis due to a medical condition, substance-induced psychosis, or mood disorders with psychotic features. All participants provided written consent, and this project was approved by the Nova Scotia Health Research Ethics Board (file #1030961). 2.2 Semi-structured interviews The semi-structured interview on patient experiences accessing care included two topics of exploration: initial presentation and social factors. Given the semi-structured nature of the interview, questions were not necessarily asked in order, and participants were prompted to elaborate if they provided insufficient detail. Interviews were conducted by an undergraduate student who had received training in qualitative research methods. The 1-hour interviews were audio-recorded and occurred either in person at NSEPP or virtually on Zoom for Healthcare. Transcripts were auto generated in Microsoft Word, then checked against recordings to ensure accuracy. During this process, identifying information was removed. After 10 interviews, transcripts were assessed for data saturation after each additional interview (Francis et al., 2010). Saturation is the point where no new themes are emerging (Vasileiou et al., 2018), and it was achieved after 14 interviews. 2.3 Demographics and medical chart review Ethnicity, gender, employment, academics, current medications and substance use were recorded at the start of the interview. Source of referral to NSEPP, available psychiatric diagnoses, number/date of mental health-related presentations to Nova Scotia Healthcare services, and number/date of inpatient admissions were obtained through a retrospective medical chart review. 2.4 Data analysis There is limited research on how sex-specific experiences impact pathways to EIS, so we employed an inductive approach. Following the procedure for inductive thematic analysis, we did not have a hypothesis tied to any topic (Naeem et al., 2023). Coders did not search for predetermined themes within the data, but rather recorded themes that arose from it, consistent with Braun & Clarke’s recommendations for thematic analysis (2006). Once transcribed, reports were uploaded to NVivo for data management (Lumivero, 2020). Qualitative analyses were conducted by two researchers: an undergraduate student and an NSEPP research coordinator. Table 1 describes the analysis process in alignment with Braun & Clarke’s steps for thematic analysis (2006). These include (1) familiarization with transcripts, (2) initial coding of excerpts relating to the research question, (3) searching for themes in the codes, (4) reviewing themes to ensure they are consistent and distinct, (5) defining and naming themes, and (6) writing the report. Reflexive thematic analysis is inherently subjective, and generated themes are not only a reflection of the raw transcripts, but also the researcher’s positionality (Braun & Clarke, 2024). Prior to beginning analysis, the research team met to discuss the role of their personal biases in coding data and generating themes (Braun & Clarke, 2019). Previous experiences working in early phase psychosis and gender identity were highlighted as informing the analysis. Throughout the study, researchers maintained informal reflexive journals to continuously reflect on the role of their positionality in coding (Braun & Clarke, 2019). 3. Analysis A total of 14 female individuals from the NSEPP participated. The mean age was 27 (SD = 3.7). The mean number of mental health-related contacts prior to NSEPP referral was 4.9 (SD=3.5). An overview of sample characteristics can be found in tables 2 and 3. The key superordinate themes revealed in this study were (1) Clinician preconceptions or dismissal, (2) Interpersonal relationships, (3) Masking symptoms, (4) Trust and communication with medical team. Together, they provide an account of the experience of seeking care for psychosis as a woman. 3.1 Clinician preconceptions or dismissal Participants described not being adequately heard by clinicians. Some reported that their cries for help were dismissed, while others felt that clinicians were asking the wrong questions or focusing on the wrong things. This took the form of three subordinate themes: (1) Multiple interactions with the healthcare system (2) Clinician preconceptions of presentation (3) Feeling dismissed. Prior to accessing EIS, participants reported repeated emergency department presentations and/or interactions with police. The need to persistently seek help before being referred to EIS was emphasized across multiple interviews. Even when admitted to hospital, women reported leaving the hospital in highly vulnerable states without having received adequate care. P2: “And that was like that was in between two suicide attempts. So, I’d have a suicide attempt and end up at the hospital for, like, a couple days, and they’d just let me out. And a week later, I’d do it again” Others also commented on how clinicians seemed to limit their attention to certain symptoms or diagnoses. P12: “It was kind of like you would just hit this wall of like, oh, you’re just having a panic attack. And I’m like, no, this is worse. This is like significantly worse.” P6: “They were just like, ready to give out that diagnosis to anyone, I guess so, if anything was wrong, they were just like, oh, yeah, it’s BPD (borderline personality disorder)” Many participants indicated clinicians did not appreciate the severity of their symptoms and therefore, did not respond appropriately. Some got the impression that clinicians thought they were just seeking help for attention. 3.2 Interpersonal relationships The role of interpersonal relationships in access to EIS arose as a theme throughout the interviews. This manifested in different forms, with both positive and negative effects on the help seeking process. The subordinate themes that arose were (1) Male romantic partners delaying access to care and (2) Support of family and friends accelerating access to care. Women described their male romantic partners invalidating their symptoms and either playing a neutral role in their access to care or actively isolating them and discouraging help-seeking. Several participants described emotional abuse and their partner intentionally worsening their delusions. P10: “I feel like he was kind of playing into it a little bit because I would be like, I think there’s people following me for these reasons and he’s just like, oh, yeah, there probably is and he would be like, oh, like look at that person they’re looking at us weird” Participants also described positive effects of interpersonal relationships in accessing care. When participants were experiencing psychosis with minimal insight, the advocacy and care from close relationships proved extremely helpful. P14: “Luckily, my mom kind of figured out, like, yo, there’s something kind of going on here. She contacted our family Doctor” 3.3 Masking symptoms Women described actively hiding their symptoms, even when they were uncertain what was happening. This manifested into subordinate themes of (1) hiding symptoms out of fear of external perceptions and (2) apparent high functioning at onset affecting care. Even when unaware of what they were experiencing, participants described putting enormous effort into maintaining a socially acceptable external appearance. They frequently worried about how they were being perceived. They described an internal conflict between wanting help and not wanting to be perceived as deviating from societal expectations. P1: “I also just didn’t necessarily like sharing all the time because it’s, uh. Sort of like, how do you even say some of these things out loud?” P5: “I was just acting as normal as I could” Participants expressed that when seeking help, their external appearance did not match their internal distress. P4: “I felt like I had a lot of more internal conflict and internal symptoms than I did outside symptoms.” Some explicitly stated that their ability to calmly communicate with clinicians was a barrier to care and encouraged others in similar positions to do the opposite. P10: “Hype it up as much as you can. Yeah, because if you don’t hype it up, you’re not going to get the help” 3.4 Communication and trust in medical team Throughout the interviews there was a recurring theme of distrust and confusion over mental health status, medications and next steps. These feelings could be attributed to three subordinate themes: (1) Lack of understanding (2) Distrust (3) Unclear communication from clinicians. Participants attributed a lack of education and understanding of psychosis in health care workers as a barrier to EIS. Compounded by lack of insight, this led to extreme confusion over their health. P3: “I wish they had been like, this is what psychosis is, this is what you’re like, they told me I had psychosis, but I just don’t remember anyone explaining what it was to me.” Participants repeatedly described lack of insight and minimal awareness of psychosis prior to being referred to EIS. P7: “I also didn’t really know what psychosis was until my first episode.” Women also described a lack of trust in healthcare providers that prevented them from openly communicating their symptoms. This lack of trust sometimes extended into paranoid delusions surrounding their medical team. P6: “I’m not exactly sure why I didn’t like feel like I could be open with them (clinicians) but I just really, I just didn’t trust people, I guess.” Confusing communication from clinicians led to further difficulties accessing appropriate care. Participants described feeling that they received generally unclear, and at times condescending, messages on how to manage their mental health. 4. Discussion 4.1 Key findings This study implemented semi-structured interviews and an inductive thematic analysis to generate common themes in relation to female perspectives of accessing care for psychosis. A descriptive chart review was also conducted. Females in this study had an average of 4.9 healthcare contacts prior to referral to EIS which is more than double rates described in the literature of the average number of healthcare contacts prior to EIS referral (Platz et al., 2006). This supports delayed recognition of psychotic symptoms in this sample. The qualitative component, and the focus of this study, revealed four main themes: (1) Clinician preconceptions and dismissal, (2) Interpersonal relationships, (3) Masking symptoms and (4) Trust and communication. Throughout the interviews, dismissal was the most salient theme, which may reflect a broader pattern of women’s psychotic symptoms being overlooked or attributed to alternative diagnoses. Descriptions of clinicians dismissing symptoms of psychosis, at times due to the patient’s ability to communicate calmly, align with other findings of care-seeking women being told they are “too functional” (Ferrari et al., 2018). Although females appear high-functioning at onset, long term outcomes are similar to males (Ayesa-Arriola et al., 2020; Mazza et al., 2021). Participants also felt that clinicians were fixated on alternative diagnoses including generalized anxiety disorder, borderline personality disorder and bipolar disorder, instead of focusing on psychotic symptoms. This was reflected in the chart review. Women are significantly more likely than men to be diagnosed with a personality or mood disorder in the year prior to the diagnosis of a PSD (Carter et al., 2023; Sommer et al., 2020). The emotional distress caused by psychotic symptoms may be the focus of diagnosis rather than the psychotic symptoms themselves (Roberts & Parry, 2022). Alternative diagnoses can delay appropriate assessment and intervention for psychosis (Jorgensen et al., 2025). Although psychosis is often associated with social withdrawal (American Psychiatric Association, 2013), interpersonal relationships were central to participants’ access to care. Recent studies show that social withdrawal is more prevalent in male patients (Irving et al., 2021), whereas females score higher on assessments of theory of mind (Abu-Akel & Bo, 2013). The ability to maintain close relationships at the onset of psychosis could accelerate access to care (Tiller et al., 2023). Conversely, several participants expressed that their male romantic partner negatively impacted access to EIS by invalidating symptoms and fostering delusional beliefs. Other women experiencing psychosis have reported partners using their illness to manipulate them (Firmin et al., 2021). Interpersonal relationships may be either protective or contribute to barriers in accessing evidence-based care for women experiencing early psychosis symptoms. Participants also reported hiding symptoms to assimilate with others, which has previously been described as masking (McKinney et al., 2024). Self-stigma is a well-documented barrier to accessing care for psychosis (Kular et al., 2019). It may be accentuated for women, who are socialized to be pleasant and non-disruptive (Carter, 2014). Women’s comparatively stronger social functioning (Brand et al., 2022), less severe negative symptoms (Irving et al., 2021) and increased awareness of others’ perceptions (Abu-Akel & Bo, 2013) likely facilitate masking. These differences in presentation and functioning may permit women to effectively convince others that they are healthy despite actively experiencing psychosis. Participants also reported that poor understanding of psychosis and inadequate communication from clinicians delayed access to care. This aligns with another qualitative study, in which participants felt the definition of psychosis was not adequately communicated to them (Huurman et al., 2023). Unclear communication may contribute to distrust in clinicians (Senger et al., 2024; Prasannakumar et al., 2023). Literature on communication and trust is from mixed-sex samples, indicating that the theme may reflect general difficulties in seeking care for early psychosis as opposed to a sex-specific experience. Nonetheless, these challenges may amplify other barriers faced by women. 4.2 Strengths and limitations The primary limitation is that the sample included women actively engaged with NSEPP. Consequently, we did not hear from women who faced barriers that prevented referral to EIS. Future research should focus on females diagnosed with PSDs who were not appropriately referred to EIS. Another limitation is the lack of male control group from the same population, which makes it difficult to conclude with certainty that these barriers are sex specific. Further research is warranted on sex-specific presentations of early psychosis and barriers to care. 4.3 Clinical implications The results of this study highlight opportunities for clinical education and support the need for further research exploring the underrepresentation of females in EIS. Women may initially be assumed to have mood instability or personality pathology despite psychosis ultimately being their primary diagnosis (Ferrara & Sirhari, 2021; Sommer et al., 2020; Brand, 2022). Clinicians may have fixed stereotypes surrounding the typical presentation of an individual experiencing psychosis, more closely corresponding with characteristics that are more prominent in males. Therefore, education programs should disseminate research on the female-specific presentation of early psychosis and highlight biases contributing to females failing to receive evidence-based EIS care. 5. Conclusion This research highlights significant barriers women face in accessing EIS for psychosis. Clinician preconceptions and dismissal was a primary theme, as many participants felt ignored or misunderstood. Their apparent high functioning may have led to an underestimation of illness severity. Similarly, participants reported alternative diagnoses that may have delayed appropriate care for psychosis. Interpersonal relationships emerged as another major theme, as supportive close relationships facilitated access to care, while negative dynamics with male partners hindered it. Participants described masking symptoms due to fears of how they were being perceived by others. Finally, communication issues with participants’ medical teams and a lack of trust further compounded barriers to care. This study indicates the need for a sex and gender-specific approach to psychosis to ensure equality in referral to EIS. 6. Appendix Figure 1 Summary of superordinate and subordinate themes Figure 1. Four superordinate themes of clinician preconceptions and dismissal, interpersonal relationships, communication and trust in medical team and masking are further subdivided into ten subordinate themes. Table 1 Process of thematic analysis (Braun & Clarke, 2006) Phase Procedure Familiarization Transcripts were independently read and initial impressions were recorded Initial coding Transcripts were uploaded to NVivo and all quotes relevant to the research question were independently coded by the first and second author Meetings and reflection Authors met to compare initial codes and check inter-rater reliability. Occasional conflicts were resolved through full research team consensus Searching for themes Codes were grouped into subordinate themes, and aggregated to form superordinate themes Reviewing themes Themes were reviewed to ensure they were consistent and distinctive Defining and naming themes Themes were named and further refined in relation to the research question Writing the report Themes, quotations and analytic commentary were presented in a narrative report Table 2 Self-report demographics of participants Variable M(SD) Age 27(3.7) Years of education 14.5(2.9) N(%) Gender Woman 13(93) Non-binary 1(7) Ethnicity White North American 10(71) White European 1(7) Indigenous and White 1(7) Middle Eastern and White 1(7) South Asian 1(7) Employment status Unemployed 7(50) Part-time 3(21) Full-time 4(28) Substance use (>1x/week) None 6(42) Alcohol 2(14) Cannabis 6(42) Other 0(0) Table 3 Chart review demographics of participants Number of contacts with mental health services prior to NSEPP referral 4.9(3.5) Number of inpatient admissions prior to NSEPP referral 1(0.9) N(%) Source of referral to NSEPP Inpatient 6(43) Mental Health Urgent Care Services 2(14) Emergency Department (ED) or Psychiatry Emergency Services 2(14) Central Intake 1(7) Community Mental Health Services 1(7) Early Intervention Service for Psychosis (from another province) 1(7) General Practitioner 1(7) Discharge diagnosis at first recorded mental health-related ED presentation Unspecified psychosis 4(29) Substance-induced psychosis 1(7) Brief psychotic disorder 1(7) Bizarre/paranoid behaviour 1(7) Substance abuse multi 1(7) Cluster B personality traits 1(7) Depression 1(7) Suicide attempt 1(7) Gastritis 1(7) Strep throat 1(7) Unknown 1(7) Psychiatric diagnoses in 5 years prior to acceptance to NSEPP Attention deficit hyperactivity disorder 5 Borderline personality disorder/Cluster B personality traits 6 Antisocial personality traits 1 Eating disorder 1 Polysubstance abuse disorder 2 Cannabis use disorder 3 Generalized anxiety disorder 4 Social anxiety disorder 2 Depression 2 Mania 1 Intellectual disability 1 Substance induced psychosis 2 Unspecified psychosis 4 Brief psychotic disorder 1 Current primary diagnosis Schizophrenia 6(43) Schizoaffective 3(21) Substance-induced psychosis 2(14) Bipolar disorder 1(7) Unknown 2(14) References 1. 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Keywords early intervention first episode psychosis gender equity psychotic disorders sex factors Authors Affiliations Ella Hodgson-Pageau 0009-0008-0340-9449 [email protected] Dalhousie University Department of Psychology and Neuroscience View all articles by this author Esther Puiras Nova Scotia Health Research Foundation View all articles by this author Kara Dempster Dalhousie University Department of Psychiatry View all articles by this author Metrics & Citations Metrics Article Usage 251 views 111 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Ella Hodgson-Pageau, Esther Puiras, Kara Dempster. The Female Experience of Early Phase Psychosis and Perceived Barriers to Accessing Early Intervention Services: A Qualitative Analysis. Authorea . 12 November 2025. DOI: https://doi.org/10.22541/au.176293448.89457884/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. 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