The Role of Help-Seeking Motivation in Diagnostic Delay Among Patients with Schizophrenia: A Mixed-Methods Study

The Role of Help-Seeking Motivation in Diagnostic Delay Among Patients with Schizophrenia: A Mixed-Methods Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Role of Help-Seeking Motivation in Diagnostic Delay Among Patients with Schizophrenia: A Mixed-Methods Study Chong-wen Wu, Min Chen, Yu-xin Zhang, Jing-jing Dai, Qin-xue Zhou, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7518536/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background: Schizophrenia exhibits the most prolonged diagnostic delay among mental disorders. Deficits or misalignment in help-seeking motivation contributes to delayed help-seeking behaviors and missed critical intervention windows. Nevertheless, research gaps persist regarding the systematic investigation of diagnostic delay, and the mechanistic role of help-seeking motivation within the diagnostic process. Study design : This study adopted a convergent mixed study design. During the quantitative phase, 520 clinically stable individuals with schizophrenia were consecutively recruited from outpatient and inpatient psychiatric settings across three specialized psychiatric hospitals in China. Standardized instruments assessed help-seeking motivation, perceived social support, stigma, diagnostic delay. Data analysis utilized SPSS26.0 and Mplus8.0 for measurement modeling and path validation. Concurrently, in-depth interviews explored help-seeking experiences during diagnostic processes with 12 patients and 11 caregivers. Final integration applied methodological triangulation to converge findings. Study results: Quantitative and qualitative analyses identified distinct correlates of diagnostic delay, with quantitative findings revealing mode of initial onset ( OR = 0.311, P < 0.001), perceived social support ( OR = 0.979, P < 0.001), stigma ( OR = 1.054, P < 0.001), and help-seeking motivation ( OR = 0.945, P < 0.001) as core predictors of diagnostic delay, while qualitative thematic analysis identified three barriers in the process of seeking diagnosis: deficient illness insight, inadequate medical information, and inaccessible psychiatric services. Path modeling confirmed that perceived social support could negatively affect diagnostic delay through stigma and help-seeking motivation, accounting for 15.71% and 45.98% of the total effect. Perceived social support could also affect diagnostic delay through the chain-mediated effect of stigma and help-seeking motivation, accounting for 9.96%. Qualitative evidence synergistically showed that multifaceted collaboration (family emotional support and community informational support) jointly elevated perceived support levels while concurrently diminishing stigma and fortifying help-seeking motivation, thereby mitigating diagnostic delay. Integration revealed that multifaceted barriers compromise patients' help-seeking motivation, and the relationship between help-seeking motivation and diagnostic delay is not a singular linear, but follows a core pathway: perceived social support→ stigma→ help-seeking motivation→ diagnostic delay. These factors require multifaceted collaboration to primarily reduce diagnostic delay. Conclusion: Diminishing stigma and fortifying help-seeking motivation are essential for enhancing perceived social support and reducing diagnostic delay in schizophrenia. Moreover, this study highlights the critical need to focusing on providing patients with schizophrenia with family emotional support and community informational support, thereby increasing their help-seeking motivation to effectively address delay in diagnosis. Schizophrenia Perceived social support Stigma Help-seeking motivation Diagnostic delay Mixed-methods Figures Figure 1 Figure 2 Figure 3 Figure 4 1. Introduction Schizophrenia is a chronic disabling psychiatric disorder characterized by disruptions in cognition, thought, affect, and behavior alongside incoherent mental activities, impeding educational and occupational functioning and affecting approximately 24 million individuals globally[ 1 , 2 ]. Birchwood propose that mental disorders exert peak adverse impacts on long-term outcomes within the first two years of illness onset, underscoring the importance of early diagnosis for prognosis optimization. Nevertheless, timely diagnosis remains unattained in over 67% of patients with schizophrenia[ 3 ]. In China specifically, patients with schizophrenia endure a median diagnostic delay of 34 years—the longest among mental disorders[ 1 ]. A longer untreated period will lead to more severe psychotic symptoms and a poorer prognosis in terms of functional level, aggravating the decline in social function and disability level, while also significantly increasing the burden on the country's prevention, treatment and management of mental disorders[ 4 ]. The prevailing academic consensus defines diagnostic delay in schizophrenia as the time interval between first emergence of definitive positive psychotic symptoms and initial contact with psychiatric specialists culminating in definitive diagnosis. Multisystem factors drive this delay with untimely help-seeking representing the primary barrier[ 5 , 6 ]. However, engaging in help-seeking behaviors amidst psychopathological manifestations constitutes a complex cognitive-behavioral process[ 7 ]. Self-determination Theory (SDT) establishes motivation as the intrinsic driver of behavior, with surveys indicating motivation deficits in 76.5% of schizophrenia cases directly compromising behavioral execution[ 8 ]. Notably, a demonstrable discrepancy exists between help-seeking motivation and actual help-seeking behaviors, justifying proactive pre-action interventions. Substantial evidence indicates that interventions solely targeting illness recognition during help-seeking yield limited improvements when neglecting the intrinsic driver of such behaviors[ 9 – 11 ]. Consequently, enhancing help-seeking motivation in schizophrenia not only optimizes help-seeking behaviors but also reduces diagnostic delay. Deci and Ryan developed the SDT that incorporates the determinants of motivation, suggesting that external regulation and introjected regulation are important forms of regulating help-seeking motivation[ 8 ]. Perceived social support, defined as an individual's cognitive appraisal of emotional fulfillment and social integration, provides essential belongingness, informational guidance, and material assistance that enable adaptive coping strategies in mental disorders within robust support systems[ 12 ]. Crucially, social support networks encompassing familial, peer, and community components exert differential influences. Among them, family support emerges as particularly pivotal for schizophrenia help-seeking behaviors by shielding patients from societal stigmatization and actively facilitating treatment engagement, while high-quality social participation during early illness stages fosters societal acceptance, enhances self-worth, and accelerates diagnostic progression[ 13 ]. Stigma refers to the negative emotional experience where individuals face widespread rejection and non-acceptance from others due to their illness[ 14 ]. According to relevant surveys, over 33% of patients with schizophrenia report substantial stigma upon diagnosis, exacerbating disease symptoms and inducing unhealthy psychological and social states, even causing adverse outcomes like suicide[ 15 ]. When pursuing medical care, stigmatized individuals frequently encounter discrimination and prejudice, fostering treatment-avoidance behaviors due to internalized stereotypes[ 16 ]. Empirical studies utilizing the Information-Motivation-Behavioral Skills model confirm that lower stigma levels lead to more common medical-seeking behaviors[ 17 ]. Social support serves as a key protective buffer against stigma-related distress, with robust evidence indicating that patients with low social support levels often have narrow social networks, and discrimination experiences from social rejection increase stigma[ 18 ]. Feeling ashamed and fearing discrimination, patients then adopt measures like concealing illness information and avoiding medical care, frequently causing diagnostic delay[ 19 ]. According to SDT, stigma-bound behaviors compel compliance with external rules to avoid guilt/shame, undermining autonomous motivation[ 20 ].Critically, SDT further posits that robust social support (external regulation) provides essential resources, mitigating negative affect from stigma (introjected regulation), thereby promoting enhanced autonomous help-seeking motivation. In this study, we define help-seeking motivation as an intrinsic psychological process through which individuals initiate and sustain professional help-seeking behaviors aimed at resolving mental health issues or alleviating distress[ 21 ]. In healthcare-seeking contexts, help-seeking motivation serves as the direct cause and driving force for an individual's medical-seeking behavior, playing a role in stimulating such behavior and maintaining its intensity[ 22 ]. Deficiency or distortion in motivation frequently prevents timely professional diagnosis, resulting in varying degrees of diagnostic delay [23] . Consequently, enhancing patients' help-seeking motivation effectively improves their diagnostic delay issues. Empirical studies indicate that individuals with high perceived social support experience stronger feelings of being respected, understood, and emotionally fulfilled, which exerts protective effects on motivation. Belinda et al. demonstrate that patients perceiving high-level social support exhibit elevated help-seeking motivation, promoting proactive healthcare engagement and correspondingly lower incidence of diagnostic delay[ 13 ]. Based on the conceptual model, our study proposes the following hypothesis, and Fig. 1 shows our hypothetical model. H1. Perceived social support has a negative impact predicts diagnostic delay. H2. Perceived social support negatively predicts stigma. H3. Stigma act as a mediator in the relationship between perceived social support and diagnostic delay. H4. Perceived social support has a positive effect on help-seeking motivation. H5. Help-seeking motivation act as a mediator in the relationship between perceived social support and diagnostic delay. H6. Stigma and help-seeking motivation play a chain mediating between perceived social support and diagnostic delay. Prior research has emphasized the rationality behind the prevalence of diagnostic delay in schizophrenia, yet its underlying mechanisms remain insufficiently explored, with the role of help-seeking motivation being particularly understudied. Moreover, existing quantitative approaches fail to capture the dynamic complexity of patients’ lived help-seeking experiences, leaving psychological realities during diagnostic pathways unexamined. Therefore, this study employs a concurrent mixed-methods design: the quantitative component will systematically identify predictors of diagnostic delay and elucidate the mediating pathways of help-seeking motivation, while simultaneously, the qualitative component investigates patients’ lived psychological experiences during help-seeking. Integration through methodological triangulation will delineate the role of help-seeking motivation in diagnostic delay among patients with schizophrenia, generating actionable insights for targeted interventions. 2. Materials and methods 2.1. Study Design This study employed a convergent mixed-methods design, cross-sectional quantitative data were collected via questionnaires concurrently with one-on-one semi-structured qualitative interviews. Methodological triangulation was applied during integration to comparatively analyze datasets, ascertain their mutual confirmation status, and thereby enhance the validity of evidence. The interpretation and presentation of findings will utilize descriptive sequential reporting. The study strictly adhered to the COREQ checklist for qualitative components and STROBE statement for quantitative components[ 24 , 25 ] (Document S1 and S2). 2.2. Participants For the quantitative component, a convenience sampling strategy was utilized. Based on a previously reported diagnostic delay prevalence of 58.6% in schizophrenia, we have calculated that a sample size of 448 individuals is required. We ultimately recruited 520 outpatients and inpatients with schizophrenia from three psychiatric hospitals in Inner Mongolia Autonomous region of China. Qualitative participants were selected through purposeful sampling to capture diverse perspectives, with continued recruitment until no novel insights emerging in three consecutive interviews. The final qualitative sample comprised 12 patients and 11 family caregivers, all purposively selected from patients currently participating in or scheduled for the quantitative phase. The inclusion and exclusion criteria for participants are presented in Table 1 . Table 1 Inclusion and exclusion criteria of the participants Inclusion criteria: 1.Aged between 18 and 60 years. 2.Diagnosed by a psychiatrist based on the International Classification of Diseases-11/Diagnostic and Statistical Manual of Mental Disorders-5 criteria. 3.Clinically stable: Minimal or partial psychotic symptoms, with Brief Psychiatric Rating Scale score 11. 4. Demonstrated adequate cognitive and communication capacity for effective researcher interaction (patients and caregivers). 5.Provided signed informed consent. Exclusion criteria 1.Diagnosed with a mental illness other than schizophrenia, such as depression, dementia, or epilepsy. 2. Significant comorbid physical illnesses or substance abuse disorders (including alcohol). 2.3. Data collection Quantitative data were gathered through structured questionnaires. Prior to formal collection, a pre-survey with 30 patients (excluded from final analysis) assessed comprehension and completion time. Trained researchers delivered standardized instructions prior to supervised on-site completion, conducting immediate completeness checks with clarification support upon request. Qualitative data were collected through semi-structured interview methodology in a quiet clinic or ward within the hospital. After explaining research goals and obtaining audio-recording consent, the interviews were conducted in the participants' language (Chinese), and they were interviewed once for 20 to 40 min.. Researchers active listening techniques, documented non-verbal behaviors, and posed contextual follow-up questions. The interview guide(Document S3) was developed through literature review and expert consultation, with minor wording refinements after pilot testing with the first three participants based on pretest feedback. 2.4. Instruments 2.4.1. Participant Demographic Information Questionnaire The questionnaire was drafted following discussions among research team members and primarily comprises the following questions: demographic characteristics (age at first onset, education/income level at first onset), clinical history (family psychiatric history, initial presentation pattern) and diagnostic delay status (operationally defined). 2.4.2. Perceived Social Support Scale (PSSS) The study employed the Perceived Social Support Scale developed by Zimet to assess the level of perceived social support[ 25 ]. The scale consists of 12 items with three dimensions scored with the Likert 7 scale. The total score ranges from 12 to 84, with higher scores indicating greater perceived social support. The scale's Cronbach's α coefficient was 0.84. The Cronbach's α coefficient for the scale in this study was determined to be 0.93. 2.4.3 Perceived Devaluation-Discrimination (PDD) The study employed the Perceived Devaluation-Discrimination to assess perceived stigma by patients with schizophrenia. The scale consists of 12 items and is a unidimensional scale. Items 1–4, 8, and 10 are reverse-scored, total scores range 12–48 (higher scores = stronger stigma). The scale's Cronbach's α coefficient was 0.98. The Cronbach's α coefficient for the scale in our study was 0.85. 2.4.4. Help-Seeking Motivation Scale for patients with schizophrenia(HSMS) The Help-Seeking Motivation Scale for patients with schizophrenia developed by Song et al was employed in this study to assess the level of help-seeking motivation in schizophrenia[ 26 ]. The scale comprises 21 items organised into three dimensions: Autonomous Motivation (Items 1–8), Controlled Motivation (Items 9–16) and Amotivation (Items 16–21). The scale utilises a 5-point Likert scale, where higher scores indicate a stronger help-seeking motivation among patients with schizophrenia. The scale's Cronbach's α coefficient was 0.90. In this study, the Cronbach's α coefficient of the scale was found to be 0.95. 2.5. Ethical Consideration This study was approved by the Ethics Committee of Harbin Medical University (HMUDQ20230502001), and it conformed to the ethical guidelines of the Helsinki Declaration. Information related to the study was provided to all participants and written informed consent was obtained from all participants. All participants were told that the study was voluntary and could be dropped out at any time without any consequences. 2.6. Statistical Analysis Quantitative data analysis proceeded as follows: survey data underwent double-entry verification using EpiData3.1. All analyses were performed with SPSS26.0 and Mplus8.0 software. Descriptive statistics summarized demographic variables and four key measures: perceived social support, stigma, help-seeking motivation, and diagnostic delay. Chi-square tests compared demographic variables differences between delayed and non-delayed groups, while independent samples t-tests compared psychological variables between delayed and non-delayed groups. Hierarchical binary logistic regression identified factors influencing diagnostic delay. Chain mediation modeling was constructed in Mplus8.0, with the Bootstrap method utilised for 5000 resamples to calculate a 95% confidence interval (CI). If the CI does not contain 0, the mediating effect is considered significant. Differences were deemed statistically significant at p < 0.05. Qualitative data analysis proceeded as follows: interview recordings were verbatim transcribed and translated into English by two research team members, with translation accuracy verified by the other two bilingual team members. Transcripts were managed in NVivo12 and analyzed for seven months. After reading the text repeatedly, two researchers extracted text segments relevant to study objectives, applying descriptive coding. Highlighted texts were independently coded by the two team members, systematically grouped into thematic codes or new categories. The team held multiple online discussions to reach coding consensus. Before analyzing based on the research objective, a preliminary coding framework was developed to reach the consistency of emerging themes and subthemes in the data. Final themes/subthemes were defined through collaborative review, with member checking (participant feedback) enhancing the credibility of the content. 3. Results 3.1. Quantitative research 3.1.1. General characteristics of participants The study included 520 patients with schizophrenia (59.6% male, 40.4% female). Key initial onset characteristics comprised: age distribution (45.8% aged 18–30 years), education (37.5% junior high school), marital status (56.5% single), and month income (30.4% with monthly income < 1000 RMB). Diagnostic delay prevalence reached 75.6% (n = 393). These findings were detailed in Table 2 . Table 2 Demographic and clinical characteristics of patients with schizophrenia(N = 520) Variables N (%) Gender Male 310(59.6%) Female 210(40.4%) Age of first onset 30 155(29.8%) Education level at first onset Primary school and below 126(24.2%) Junior high school 195(37.5%) Senior high school 107(20.6%) College and above 92(17.7%) Marital status at first onset Single 294(56.5%) Married 104(20.0%) Divorce 122(23.5%) Work situation at first onset On the job 227(43.7%) Peasants 69(13.3%) Unemployed 224(43.1%) Month income at first onset 3000 RMB 195(37.5%) Family type at first onset Single family 99(19.0%) Nuclear family 122(23.5%) Stem family 247(47.5%) Joint family 52(10.0%) Religious belief at first onset No 407(78.3%) Yes 113(21.7%) Residence at first onset Rural 308(59.2%) Urban 212(40.8%) Family psychiatric history No 404(77.7%) Yes 116(22.3%) Mode of initial onset Slow 395(76.0%) Acute 125(24.0%) Diagnostic delay No 127(24.4%) Yes 393(75.6%) 3.1.2. Descriptive statistics of perceived social support, stigma and help-seeking motivation in patients with schizophrenia Table 3 presented the descriptive statistics of perceived social support, stigma and help-seeking motivation in patients with schizophrenia. The mean perceived social support score among participants was 37.39 ± 18.30 (out of a total score of 84), indicating a moderately low level of perceived social support in this cohort. The average stigma score was 40.42 ± 9.46 (out of a total score of 48), suggesting a high level of stigma in patients with schizophrenia. For help-seeking motivation levels, the average score was 45.69 ± 19.92 (out of 105), denoting a relatively low level of hope among these patients. Table 3 Descriptive statistics of perceived social support, stigma and help-seeking motivation in patients with schizophrenia Variables Mean Standard error Perceived social support 37.39 18.30 Stigma 40.42 9.46 Help-seeking motivation 45.69 19.92 3.1.3. Univariate analysis of diagnostic delay in patients with schizophrenia The univariate analysis indicated that a statistically significant difference was observed across multiple variables: age of first onset, education level at first onset, marital status at first onset, month income at first onset, family type at first onset and mode of initial onset. Complete statistical results are detailed in Table 4 and Table 5 . Table 4 Chi-square test analysis of diagnostic delay in patients with schizophrenia Variables Diagnostic delay(%) X² P Yes No Gender Male 157(39.9) 53(41.7) 0.127 0.399 Female 236(60.1) 74(58.3) Age of first onset 30 128(32.6) 27(21.3) Education level at first onset Primary school and below 103(26.2) 23(18.1) 14.499 0.002 Junior high school 155(39.4) 38(29.9) Senior high school 76(19.3) 31(24.4) College and above 59(15.0) 35(27.6) Marital status at first onset Single 216(55.0) 78(61.4) 12.825 0.005 Married 92(23.4) 12(9.4) Divorce 85(21.6) 37(29.1) Work situation at first onset On the job 172(43.8) 0(0) 0.401 0.818 Peasants 54(13.7) 55(43.3) Unemployed 167(42.5) 15(11.8) Month income at first onset 3000 RMB 129(32.8) 66(52.0) Family type at first onset Single family 86(21.9) 13(10.2) 16.455 <0.001 Nuclear family 83(21.1) 39(30.7) Stem family 181(46.1) 66(52.0) Joint family 43(10.9) 9(7.1) Religious belief at first onset No 303(77.1) 104(81.9) 1.295 0.225 Yes 90(22.9) 23(18.1) Residence at first onset Rural 237(60.3) 71(55.9) 0.769 0.38 Urban 156(39.7) 56(44.1) Family psychiatric history No 310(78.9) 94(74.0) 1.311 0.252 Yes 83(21.1) 33(26.0) Mode of initial onset Slow 325(82.7) 70(55.1) 39.981 <0.001 Acute 68(17.3) 57(44.9) Table 5 T-test analysis of diagnostic delay in patients with schizophrenia Variables Perceived social support Stigma Help-seeking motivation Diagnostic delay Yes 32.85 ± 16.228 42.43 ± 8.830 39.28 ± 16.538 No 51.45 ± 17.235 34.22 ± 8.631 65.63 ± 16.064 t 11.056 -9.156 15.658 P <0.001 <0.001 <0.001 3.1.4. Hierarchical binary logistic regression of diagnostic delay in patients with schizophrenia Using diagnostic delay as the dependent variable and variables with significant univariate differences as independent variables (categorical coding detailed in Document S4), hierarchical binary logistic regression was performed. Block 1 incorporated demographic variables selected based on univariate results and clinical expertise. This model explained 21.1% of variance in diagnostic delay. Block 2 added perceived social support, stigma, and help-seeking motivation, significantly increasing variance explanation(△ R ²=0.31). These psychological constructs emerged as core predictors of diagnostic delay. Complete regression results are presented in Table 6 . Table 6 Hierarchical binary logistic regression of diagnostic delay in patients with schizophrenia Variables β SE Wald X² P OR 95% CI R ² △ R ² Block 1 (Constant) 1.811 0.445 16.544 <0.001 6.115 0.211 — Mode of initial onset Slow — — — — 1 Acute -1.405 0.238 34.787 <0.001 0.245 0.154–0.391 Block 2 (Constant) 3.408 0.913 13.928 <0.001 30.198 0.521 0.310 Mode of initial onset Slow — — — — 1 Acute -1.167 0.290 16.178 <0.001 0.311 0.176–0.550 Perceived social support -0.022 0.009 6.252 0.012 0.979 0.962–0.995 Stigma 0.052 0.017 9.690 <0.001 1.054 1.020–1.089 Help-seeking motivation -0.057 0.008 47.738 <0.001 0.945 0.929–0.960 3.1.5. The mediating effect of stigma and help-seeking motivation on perceived social support and diagnostic delay Structural equation modeling was employed to examine the mediating roles of stigma and help-seeking motivation. Perceived social support significantly predicted diagnostic delay ( β =-0.522, P < 0.001), stigma ( β =-0.484, P < 0.001) and help-seeking motivation ( β = 0.487, P < 0.001), while stigma directly influenced help-seeking motivation ( β =-0.217, P < 0.001) and diagnostic delay ( β = 0.169, P < 0.001), and help-seeking motivation exerted significant effects on diagnostic delay ( β =-0.493, P < 0.001). Complete regression statistics are presented in Table 7 and visualized path coefficients in Fig. 2 . The results of the mediation analysis indicated that the 95% confidence intervals for all paths excluded zero, establishing mediation effects. Perceived social support's indirect influence on diagnostic delay can be through three paths: (1) Perceived social support→ Stigma→ Diagnostic delay; (2) Perceived social support→ Help-seeking motivation→ Diagnostic delay; (3) Perceived social support→ Stigma→ Help-seeking motivation→ Diagnostic delay. The total indirect effect accounts for 71.65%, including 15.71% for mediation path 1, 45.98% for mediation path 2, and 9.96% for mediation path 3. Table 8 for details. Consequently, Hypothesis 1–6 were validated through these findings. Table 7 Regression analysis of the variables Dependent variable Independent variable β SE t P R 2 F Stigma Perceived social support -0.484 0.035 -13.965 <0.001 0.234 158.240*** Help-seeking motivation Perceived social support 0.487 0.039 12.478 <0.001 0.387 163.197*** Stigma -0.217 0.043 -5.020 <0.001 Diagnostic delay Perceived social support -0.148 0.061 -2.419 0.016 0.479 158.134*** Stigma 0.169 0.062 2.736 0.006 Help-seeking motivation -0.493 0.050 -9.898 <0.001 ***P<0.001 Table 8 Chain mediating effect on perceived social support, stigma, help-seeking motivation and diagnostic delay Model pathways Effect SE Bootstrap95%CI Relative effect LLCI ULCI Direct effect -0.374 0.039 -0.451 -0.298 71.65% Perceived social support→ Stigma→ Diagnostic delay -0.082 0.030 -0.141 -0.022 15.71% Perceived social support→ Help-seeking motivation→ Diagnostic delay -0.240 0.030 -0.302 -0.185 45.98% Perceived social support→ Stigma→ Help-seeking motivation→ Diagnostic delay -0.052 0.013 -0.081 -0.03 9.96% Total indirect effect -0.148 0.061 -0.264 -0.026 28.35% Total effect -0.522 0.043 -0.601 -0.431 100% **P<0.001 3.2. Qualitative research Participants included 12 patients and 11 family caregivers. The total interview duration was 644 min, averaging about 28 min per interview. (Demographic characteristics of participants detailed in Document S5). Thematic analysis identified patients and caregivers as a collaborative unit during diagnostic-seeking, demonstrating shared experiential patterns across multiple dimensions. Two themes with five subthemes emerged, revealing near-identical help-seeking experiences except for divergence within the “Family emotional support” subtheme, as shown in Table 9 . Table 9 Theme, subtheme and encode Theme Subtheme Encode Multifaceted barriers in the process of seeking diagnosis Deficient illness insight Lack of knowledge about the concept of diseases, Misunderstanding of disease symptoms Inadequate medical information Misconceptions about the choice of medical treatment locations, Lack of control over the timing of seeking medical treatment Inaccessible psychiatric services Negative experiences due to insufficient services Multifaceted collaboration to mitigate diagnostic delay Family emotional support(patients) Desire for family tolerance and understanding, Family support reduces the sense of stigma Community informational support Desire for the popularization of knowledge in society to change the public's stereotypical impression of mental illness. Notes: Parentheses are marked as only the help-seeking experience of patients, and the rest are the common help-seeking experience of patients and caregivers. Thematic analysis revealed that patients with schizophrenia encountered multifaceted barriers in the process of seeking diagnosis, severely diminishing motivation levels and contributing to varying degrees of diagnostic delay. Crucially, family emotional support and community informational support counterbalanced these effects, elevating help-seeking motivation and ultimately mitigating diagnostic delay occurrence. Figure 3 shows the frame diagram. 3.2.1. Multifaceted Barriers in the process of seeking diagnosis Patients will face multiple barriers in the process of seeking diagnosis, including deficient illness insight, inadequate medical information, inaccessible psychiatric services, which weakens patients' help-seeking motivation and causes diagnostic delay. Deficient illness insight Patients demonstrated limited mental health literacy, with one-third unaware of schizophrenia concepts and consequences of untreated psychosis, directly undermining help-seeking motivation: P4: "I'd never heard of schizophrenia before diagnosis—only searched online afterward." Although most patients described experiencing various psychological symptoms, they often denied any connection to schizophrenia. Early, subtle symptoms were frequently misinterpreted by patients and caregivers as supernatural phenomena rather than signs of mental illness requiring professional attention: P1: "I thought it was depression after losing my child, never considered schizophrenia." C11: "We believed she was possessed, constantly muttering (incoherent speech)—never considered hospitalization." Abnormal emotions or behaviors in the early stage of the disease are usually ignored by patients and their caregivers, and only when the illness gets worse and affects their daily work and life will they try to seek professional help: P1: " At first, I thought it would get better on its own. After half a year without improvement, I couldn't bear it anymore and went to the hospital." C6: " My brother didn't think it was serious, and I didn't understand. We delayed... only seeking help when it became very severe. We never imagined it was this illness." Inadequate medical information Geographic and economic constraints restricted access to treatment information sources, causing confusion about care pathways: P8: " I didn't know how to treat my illness or where to find effective treatment." C10: " We were completely lost at the time, unsure what medication he needed or where to get treatment. So, he just stayed home." Consequently, many relied on non-specialized interventions through social networks, despite questionable efficacy: P6: " I used traditional Chinese medicine from a local healer in my town for almost half a year. I felt it worked well, so I stopped considering the hospital." C2: " I heard many people with my wife's condition were cured by witch doctors, so I took her to them." Furthermore, determining when to seek professional help proved challenging for most participants. This uncertainty eroded confidence in initiating contact with specialized psychiatric services: P9: " I never knew when to go to the hospital. I only realized when things got bad, but by then it was often too late. This made me reluctant to seek help proactively; I just waited until it worsened." C3: " Neither my husband nor I understood the illness. After each visit, the doctor said it wasn't serious, so we stopped going... we didn't anticipate it worsening so much later." Inaccessible psychiatric services Poor accessibility to mental healthcare was the most frequently cited barrier. Participants identified the substantial time and financial burdens associated with accessing care as major deterrents: P11:" The hospital is 30 kilometers away. Each trip is incredibly time-consuming and draining. I simply couldn't manage it regularly, leading to delay. " C1: "Beyond the hospitalization and treatment costs, just the travel and accommodation expenses placed a huge strain on our family." Additionally, services at local primary care levels often failed to meet treatment expectations. Some families reported losing confidence in the available care and developing skepticism towards local healthcare quality, further reducing help-seeking motivation and causing delay: P10:"Our town hospital lacks equipment like ECT machines and has limited medication. I wanted proper treatment but couldn't get it there, so I eventually gave up going." C8:"We went to the county hospital, but it felt pointless. The level of care wasn't reassuring at all." 3.2.2. Multifaceted collaboration to mitigate diagnostic delay Low levels of help-seeking motivation among schizophrenia patients were linked to insufficient emotional support and unmet informational needs. Addressing diagnostic delay requires collaborative efforts involving family emotional support, and community informational support to strengthen help-seeking motivation. Family emotional support. Upon suspecting illness, patients reported experiencing significant psychological burdens, including denial, anger, and depression. Adequate emotional support from family members was identified as crucial for alleviating this distress, boosting help-seeking motivation, and reducing delay. Participants expressed a desire for comfort and encouragement from family to facilitate seeking help: P1:"I was hesitant about going to the hospital. I wished my husband would discuss it with me and offer reassurance. That would have given me more motivation to seek help earlier, preventing this delay." P7:"People outside have negative views about this illness, but my father constantly encouraged me. This helped me gradually ignore the stigma. Feeling motivated to seek help allowed me to get treatment early." Discussions with family members also enhanced patients' understanding of their illness and fostered positive beliefs about recovery. This process encouraged proactive consideration of sustained treatment and more adaptive coping strategies: P12:"My family and I frequently discussed the illness, which increased my understanding. This gave me confidence and the desire to continue treatment consistently." Community informational support The level of disease knowledge among patients and their caregivers significantly influenced adherence to standardized treatment. Most interviewees reported very limited understanding of schizophrenia and expressed a strong need for accessible disease-related information. They indicated that receiving such information through community/social channels would promote accurate illness perception, restore confidence in recovery: P9:"I wish healthcare providers would explain the illness more. Better understanding that it's manageable would motivate me to keep taking medication." C7:"Ordinary people like us previously knew nothing about schizophrenia, let alone whether lifelong medication is needed. If someone had informed us, we certainly wouldn't have stopped the medication.” Several participants emphasized that broader societal dissemination of mental health knowledge could effectively reduce public stigma. An environment perceived as free from discrimination and prejudice would foster stronger motivation to seek professional care and decrease diagnostic delay: P7: "Public awareness campaigns are essential. Even we patients sometimes view mental illness as abnormal. This stigma makes us afraid to acknowledge our illness or go to the hospital." C5: "People instantly distance themselves upon hearing 'mental illness.' Who dares to let others know there's someone with mental illness in their family?... Once public education improves and people are less afraid of discrimination and isolation, families will be more willing to seek hospital care." 3.3. Integration of Quantitative and Qualitative Findings This study collected and analyzed quantitative and qualitative data independently, subsequently integrating findings through methodological triangulation. The analysis revealed complementarity and expansion between quantitative results and qualitative interview data. The specific analytical procedures are detailed below. 3.3.1. Analysis of factors influencing diagnostic delay in patients with schizophrenia Quantitative and qualitative analyses demonstrated complementarity in identifying diagnostic delay influencing factors: hierarchical binary logistic regression confirmed perceived social support, stigma, and help-seeking motivation as core psychological predictors, while qualitative findings revealed multifaceted barriers in the process of seeking diagnosis - specifically deficient illness insight, inadequate medical information, and inaccessible psychiatric services. Methodological triangulation established that the mode of initial onset, perceived social support, stigma, help-seeking motivation, illness insight, medical information accessibility, and psychiatric service availability collectively constitute primary determinants of diagnostic delay. 3.3.2. Analysis of the role of help-seeking motivation in diagnostic delay Quantitative analysis mapped the pathways through which help-seeking motivation functions within diagnostic delay, while qualitative inquiry illuminated its contextual processes. The overlapping components between quantitative and qualitative findings expanded the scope of research outcomes, demonstrating the property of expansion: Mediation analysis confirmed that perceived social support directly affects diagnostic delay and operates indirectly through the chain mediation of stigma and help-seeking motivation. Qualitative findings demonstrated that seeking help during the diagnostic process involves encountering multifaceted barriers which compromise patients' help-seeking motivation and contribute to diagnostic delay. In this context, family emotional support and community informational support synergistically elevate perceived social support and mitigate stigma, thereby fortifying help-seeking motivation and ultimately reducing diagnostic delay. Integration revealed that multifaceted barriers compromise patients' help-seeking motivation, and the relationship between help-seeking motivation and diagnostic delay is not a singular linear relationship, but follows a core pathway: perceived social support→ stigma→ help-seeking motivation→ diagnostic delay. These factors require multifaceted collaboration to primarily reduce diagnostic delay. The conceptual framework is presented in Fig. 4 . 4. Discussion Qualitative analysis revealed that deficient illness insight was a primary contributor to diagnostic delay in schizophrenia. Insight forms the basis of behavior, low levels of illness insight prevent accurate self-assessment of symptoms, leading to diagnostic delay[ 27 ]. This can be attributed, in part, to mental illness's sensitivity in China, patients often refrain from consulting clinicians despite having disease-related questions[ 14 ]. Our study further revealed inadequate medical information among patients and caregivers, causing confusion regarding whether, when, and where to seek treatment. Prior studies indicate that without scientific medical information guidance, initial symptom management typically involves folk remedies or informal consultations rather than psychiatric care[ 28 ]. Significantly, we observed psychiatric service availability inversely correlates with delay occurrence. Currently, China's mental health system faces insufficient service provision and uneven quality, significantly diminishing treatment engagement among patients with schizophrenia[ 29 ]. These challenges may stem from two primary causes: First, inadequate compensation and challenging work environments for community mental health workers, coupled with limited specialized training access, result in suboptimal identification and management of mental disorders at the primary care level[ 29 ]. Second, disproportionate allocation of governmental resources toward large psychiatric institutions and research academies, rather than grassroots mental health services, further constrains community capacity[ 30 ]. Interviews highlighted that patients strongly desired family emotional support, recognizing family members as primary sources for problem-solving guidance and decision-making assistance, making families their consistent first choice for help-seeking[ 31 ]. Furthermore, patients expressed needs for community informational support, specifically advocating intensified public mental health education to foster social acceptance and alleviate their psychological distress and self-stigma. In light of these findings, healthcare authorities and clinicians should implement enhanced public education campaigns and psychological support services to mitigate barriers' negative impact on help-seeking motivation and treatment initiation, thereby facilitating timely diagnosis. In quantitative analysis, our study indicated that acute initial onset reduced diagnostic delay likelihood compared to insidious presentations. The mode of initial onset critically influences help-seeking decisions, acute manifestations facilitate prompt recognition and treatment initiation, whereas negative symptoms (e.g., apathy, social withdrawal) are frequently misattributed to laziness or low mood by families, consequently delaying diagnosis[ 32 ]. Low perceived social support independently predicted diagnostic delay. Individuals with heightened support perception employ proactive coping strategies. Consequently, reinforcing positive reinforcement of perceived social support is essential to help patients effectively mobilize internal and external resources, thereby reducing diagnostic delay[ 33 ]. This study additionally identified elevated stigma as a significant risk factor for diagnostic delay, aligning with findings from Vally et al[ 33 ]. The rationale behind this is rooted in the public labeling of mental disorders as "pathological" or "neurotic", driving patients to conceal conditions to avoid mockery and discrimination. Furthermore, since initial onset often coincides with critical phases of career establishment and romantic relationship formation, intense shame compels prioritization of occupational/familial stability over treatment, resulting in deliberate care avoidance[ 33 ]. Notably, stronger help-seeking motivation predicted more proactive treatment-seeking behaviors and significantly lower delay likelihood. Motivation uniquely activates care-engagement behaviors, serving as a catalyst distinct from other psychological variables[ 26 ]. Thus, interventions targeting motivation enhancement represent a pivotal strategy, clinicians can guide patients toward timely psychiatric consultation by elevating help-seeking motivation. Our findings robustly confirm stigma's partial mediating role in the relationship between perceived social support and diagnostic delay among patients with schizophrenia. Specifically, perceived social support directly influences diagnostic delay while also exerting indirect effects through stigma, corroborating previous research[ 34 ]. Stigma, conceptualized as a negative emotional response to public discrimination and exclusion, drives treatment avoidance through concealment behaviors when patients anticipate isolation and marginalization due to mental illness stereotypes[ 35 ]. In contrast, perceived social support positively modulates behavioral responses. Patients with stronger perceived support demonstrate greater resilience against prejudice and more adaptive coping during adverse events, exhibiting reduced stigma levels and consequently reducing delays[ 36 ]. Furthermore, perceived social support also indirectly influences delay through help-seeking motivation. Help-seeking motivation, an internal psychological process activating professional help-seeking, interacts bidirectionally with external support resources. Robust external support strengthens patients' propensity for professional help-seeking, enhancing psychiatric service utilization. Consequently, heightened perceived support correlates with increased motivation during health crises. This occurs because feeling supported profoundly reinforces problem-solving resolve and provides actionable information pathways, collectively intensifying their drive to seek help[ 33 ]. This validates our hypothesis that accessible support systems promote timely engagement with professional healthcare, mitigating diagnostic delay. In the chain mediation model, stigma and help-seeking motivation partially mediated the relationship between perceived social support and diagnostic delay, accounting for 9.96% of the total effect. Patients with higher perceived social support cognitively reframe negative public attitudes toward mental illness, thereby reducing self-stigma and its demotivating effects on help-seeking. Additionally, stigma serves as a key psychological factor impeding help-seeking motivation, as evidenced by multiple studies and confirmed here, patients experiencing heightened stigma demonstrate reduced motivation to seek professional help, substantially increasing delay risk when confronting psychiatric symptoms[ 17 , 20 ]. In summary, stigma and help-seeking motivation constitute pivotal mediating factors linking perceived social support to diagnostic delay, establishing them as essential intervention targets for future delay-reduction strategies. Through qualitative interviews, this study explored influencing factors from patient/caregiver perspectives and elucidated help-seeking motivation's functional process in diagnostic delay. Quantitative analysis validated our hypotheses, revealing motivation's pathway effects. Methodological triangulation integrated these findings, enriching evidence from multiple angles and effectively clarifying the role of help-seeking motivation in diagnostic delay among patients with schizophrenia. This convergence strengthens result generalizability. Diagnostic delay fundamentally stems from the interplay between external barriers and internal psychological conflicts. Consequently, enhancing help-seeking motivation to reduce diagnostic delay requires tripartite collaboration: mobilizing family emotional support to build robust networks, enhancing clinician-patient communication to increase disease knowledge access, and implementing stigma-reduction strategies to counter negative emotions. These approaches will establish standardized delay-mitigation protocols, ultimately improving prognostic outcomes. 5. Strengths and limitations This study, like any other, encompasses both strengths and limitations. Notably, our research adopted a mixed-method approach, analyzing risk factors for diagnostic delay among patients with schizophrenia and examining the role of help-seeking motivation in diagnostic delay. The integration of these diverse analytical methods stands as a clear strength of this study, and provides new directions for future family, hospital and community intervention. Nevertheless, the survey has several limitations. Primarily, retrospective assessment of help-seeking motivation during initial onset carries recall bias risks. This necessitates extending future research to validate these findings in first-episode cohorts. Moreover, potential selection bias may exist as participants were exclusively recruited from three psychiatric hospitals, expand recruitment to diverse healthcare settings in future studies could enhance applicability. Finally, help-seeking motivation and other psychological variables may exhibit dynamic fluctuations over time. Future studies should implement longitudinal designs to examine changing patterns of these variables and analyze causal relationships between time-specific influencing factors and diagnostic delay. 6. Conclusions This study enriched the existing theoretical literature on risk factors for diagnostic delay among patients with schizophrenia. And building upon this, we confirmed that diagnostic delay originates from complex interactions between multifaceted barriers and psychological mechanisms, broadening understanding of the role of help-seeking motivation in diagnostic delay. Finally, we propose a tripartite intervention strategy, namely, mobilizing family emotional networks, enhancing clinician-patient knowledge dissemination, and implementing community anti-stigma programs, hereby effectively elevates help-seeking motivation levels to reduce diagnostic delay. Declarations Footnote Jin Songand Chong-Wen Wu contributed equally to this work and should be considered co-first authors. Ethics approval and consent to participate. Author’s contributions Chong-Wen Wu: Writing – original draft, Visualization, Supervision, Methodology, Investigation, Formal analysis, Conceptualization, Data curation, Funding acquisition. Min Chen: Writing – original draft, Funding acquisition, Conceptualization. Yu-Xin Zhang: Writing – original draft, Conceptualization. Jing-Jing Dai: Writing – review & editing, Project administration, Investigation, Data curation. Qin-Xue Zhou: Writing – review & editing, Project administration, Investigation, Data curation. Quan-hui Guo: Writing – review & editing, Supervision, Conceptualization. Yu-Qiu Zhou: Writing – review & editing. Jin Song: Writing – review & editing, Supervision, Project administration, Methodology, Conceptualization. Funding This research was partially supported by the National Natural Science Foundation of China (72074063) and Huzhou natural science foundation(2022YZ42). Availability of data and materials The datasets generated and analysed during the current study are not publicly available due to concerns about the privacy of people diagnosed with schizophrenia, but are available from the corresponding author on reasonable request. The study conformed to the ethical guidelines of the Helsinki Declaration. The study received ethical approval from the Ethics Review Committee of Harbin Medical University (Institutional Review Board: HMUDQ20230726003). After explaining the study purpose, data confidentiality, and data processing to the participants, we obtained written consent for voluntary participation. Participants were enrolled in the study during stable disease and signed an informed consent form. Consent for publication Not Applicable. Declaration of informed consent Participants were enrolled in the study during stable disease and signed an informed consent form. Competing interests The authors declared that they have no competing interests. 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Yarborough BJ, Yarborough MT, Cavese JC. Factors that hindered care seeking among people with a first diagnosis of psychosis. Early Interv Psychiatry. 2019;13(5):1220–6. Additional Declarations No competing interests reported. Supplementary Files DocumentS1COREQchecklist.docx Document S1. COREQ checklist. DocumentS2STROBEStatement.docx Document S2. The STROBE Statement. DocumentS3Theinterviewguide.docx Document S3. The interview guide. DocumentS4Categoricalcoding.docx Document S4. Categorical code. DocumentS5Demographiccharacteristicsofparticipants.docx Document S5. Demographic characteristics of participants. 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01:07:07","extension":"html","order_by":17,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":175797,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7518536/v1/75f15b08ac785677ee6dec37.html"},{"id":92680799,"identity":"06302c90-0ac9-4f18-9dae-140ac79dfdd2","added_by":"auto","created_at":"2025-10-03 01:07:06","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":23190,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7518536/v1/5c1fa5b5e0492091945c427d.png"},{"id":92682704,"identity":"8c24cbae-569d-4714-86f3-5c78539e7d3b","added_by":"auto","created_at":"2025-10-03 01:23:06","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":25848,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7518536/v1/fd5b7afa583e71e8ad4f1b2e.png"},{"id":92680803,"identity":"7e579d05-0928-4c72-889b-391bc0d9f3c0","added_by":"auto","created_at":"2025-10-03 01:07:06","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":49458,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7518536/v1/beadb6913bcfd722afcf06d9.png"},{"id":92680809,"identity":"df6bdcde-9b93-4d4b-a714-695581820b60","added_by":"auto","created_at":"2025-10-03 01:07:06","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":49194,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-7518536/v1/0d0fc68d704295fe68452c07.png"},{"id":92683064,"identity":"530bb2e3-8fa8-44d4-b417-880594ebfd2e","added_by":"auto","created_at":"2025-10-03 01:31:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1861839,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7518536/v1/c4ce582d-f960-416b-b23f-ad0daf84b0fe.pdf"},{"id":92680800,"identity":"c84e5ccc-d488-4d8d-bb70-1a42e471272f","added_by":"auto","created_at":"2025-10-03 01:07:06","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":21272,"visible":true,"origin":"","legend":"\u003cp\u003eDocument S1. COREQ checklist.\u003c/p\u003e","description":"","filename":"DocumentS1COREQchecklist.docx","url":"https://assets-eu.researchsquare.com/files/rs-7518536/v1/1d5c9ae9e7e7efed86d6213c.docx"},{"id":92680806,"identity":"50499f61-6087-487f-aa15-4fc2903681c7","added_by":"auto","created_at":"2025-10-03 01:07:06","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":23861,"visible":true,"origin":"","legend":"\u003cp\u003eDocument S2. The STROBE Statement.\u003c/p\u003e","description":"","filename":"DocumentS2STROBEStatement.docx","url":"https://assets-eu.researchsquare.com/files/rs-7518536/v1/56368d2947ba52df5e097e45.docx"},{"id":92682410,"identity":"69af7482-449b-4ed0-ac33-e5bdd547bb24","added_by":"auto","created_at":"2025-10-03 01:15:07","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":18393,"visible":true,"origin":"","legend":"\u003cp\u003eDocument S3. The interview guide.\u003c/p\u003e","description":"","filename":"DocumentS3Theinterviewguide.docx","url":"https://assets-eu.researchsquare.com/files/rs-7518536/v1/afcc0208e0f754ef436dcf66.docx"},{"id":92680816,"identity":"589867f1-f97a-4757-962f-6bb03f695669","added_by":"auto","created_at":"2025-10-03 01:07:07","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":24184,"visible":true,"origin":"","legend":"\u003cp\u003eDocument S4. Categorical code.\u003c/p\u003e","description":"","filename":"DocumentS4Categoricalcoding.docx","url":"https://assets-eu.researchsquare.com/files/rs-7518536/v1/9f699960ad898b3011bf4dd8.docx"},{"id":92682705,"identity":"449d28b7-ad17-4d34-8ff8-aef126cb6146","added_by":"auto","created_at":"2025-10-03 01:23:06","extension":"docx","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":27609,"visible":true,"origin":"","legend":"\u003cp\u003eDocument S5. Demographic characteristics of participants.\u003c/p\u003e","description":"","filename":"DocumentS5Demographiccharacteristicsofparticipants.docx","url":"https://assets-eu.researchsquare.com/files/rs-7518536/v1/c15baf6710a98f519a146cbb.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Role of Help-Seeking Motivation in Diagnostic Delay Among Patients with Schizophrenia: A Mixed-Methods Study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eSchizophrenia is a chronic disabling psychiatric disorder characterized by disruptions in cognition, thought, affect, and behavior alongside incoherent mental activities, impeding educational and occupational functioning and affecting approximately 24\u0026nbsp;million individuals globally[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Birchwood propose that mental disorders exert peak adverse impacts on long-term outcomes within the first two years of illness onset, underscoring the importance of early diagnosis for prognosis optimization. Nevertheless, timely diagnosis remains unattained in over 67% of patients with schizophrenia[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In China specifically, patients with schizophrenia endure a median diagnostic delay of 34 years\u0026mdash;the longest among mental disorders[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. A longer untreated period will lead to more severe psychotic symptoms and a poorer prognosis in terms of functional level, aggravating the decline in social function and disability level, while also significantly increasing the burden on the country's prevention, treatment and management of mental disorders[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The prevailing academic consensus defines diagnostic delay in schizophrenia as the time interval between first emergence of definitive positive psychotic symptoms and initial contact with psychiatric specialists culminating in definitive diagnosis. Multisystem factors drive this delay with untimely help-seeking representing the primary barrier[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHowever, engaging in help-seeking behaviors amidst psychopathological manifestations constitutes a complex cognitive-behavioral process[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Self-determination Theory (SDT) establishes motivation as the intrinsic driver of behavior, with surveys indicating motivation deficits in 76.5% of schizophrenia cases directly compromising behavioral execution[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Notably, a demonstrable discrepancy exists between help-seeking motivation and actual help-seeking behaviors, justifying proactive pre-action interventions. Substantial evidence indicates that interventions solely targeting illness recognition during help-seeking yield limited improvements when neglecting the intrinsic driver of such behaviors[\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Consequently, enhancing help-seeking motivation in schizophrenia not only optimizes help-seeking behaviors but also reduces diagnostic delay.\u003c/p\u003e\u003cp\u003eDeci and Ryan developed the SDT that incorporates the determinants of motivation, suggesting that external regulation and introjected regulation are important forms of regulating help-seeking motivation[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Perceived social support, defined as an individual's cognitive appraisal of emotional fulfillment and social integration, provides essential belongingness, informational guidance, and material assistance that enable adaptive coping strategies in mental disorders within robust support systems[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Crucially, social support networks encompassing familial, peer, and community components exert differential influences. Among them, family support emerges as particularly pivotal for schizophrenia help-seeking behaviors by shielding patients from societal stigmatization and actively facilitating treatment engagement, while high-quality social participation during early illness stages fosters societal acceptance, enhances self-worth, and accelerates diagnostic progression[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eStigma refers to the negative emotional experience where individuals face widespread rejection and non-acceptance from others due to their illness[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. According to relevant surveys, over 33% of patients with schizophrenia report substantial stigma upon diagnosis, exacerbating disease symptoms and inducing unhealthy psychological and social states, even causing adverse outcomes like suicide[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. When pursuing medical care, stigmatized individuals frequently encounter discrimination and prejudice, fostering treatment-avoidance behaviors due to internalized stereotypes[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Empirical studies utilizing the Information-Motivation-Behavioral Skills model confirm that lower stigma levels lead to more common medical-seeking behaviors[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Social support serves as a key protective buffer against stigma-related distress, with robust evidence indicating that patients with low social support levels often have narrow social networks, and discrimination experiences from social rejection increase stigma[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Feeling ashamed and fearing discrimination, patients then adopt measures like concealing illness information and avoiding medical care, frequently causing diagnostic delay[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. According to SDT, stigma-bound behaviors compel compliance with external rules to avoid guilt/shame, undermining autonomous motivation[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].Critically, SDT further posits that robust social support (external regulation) provides essential resources, mitigating negative affect from stigma (introjected regulation), thereby promoting enhanced autonomous help-seeking motivation.\u003c/p\u003e\u003cp\u003eIn this study, we define help-seeking motivation as an intrinsic psychological process through which individuals initiate and sustain professional help-seeking behaviors aimed at resolving mental health issues or alleviating distress[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In healthcare-seeking contexts, help-seeking motivation serves as the direct cause and driving force for an individual's medical-seeking behavior, playing a role in stimulating such behavior and maintaining its intensity[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Deficiency or distortion in motivation frequently prevents timely professional diagnosis, resulting in varying degrees of diagnostic delay\u003csup\u003e[23]\u003c/sup\u003e. Consequently, enhancing patients' help-seeking motivation effectively improves their diagnostic delay issues. Empirical studies indicate that individuals with high perceived social support experience stronger feelings of being respected, understood, and emotionally fulfilled, which exerts protective effects on motivation. Belinda et al. demonstrate that patients perceiving high-level social support exhibit elevated help-seeking motivation, promoting proactive healthcare engagement and correspondingly lower incidence of diagnostic delay[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Based on the conceptual model, our study proposes the following hypothesis, and Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows our hypothetical model.\u003c/p\u003e\u003cp\u003e\u003cb\u003eH1.\u003c/b\u003e Perceived social support has a negative impact predicts diagnostic delay.\u003c/p\u003e\u003cp\u003e\u003cb\u003eH2.\u003c/b\u003e Perceived social support negatively predicts stigma.\u003c/p\u003e\u003cp\u003e\u003cb\u003eH3.\u003c/b\u003e Stigma act as a mediator in the relationship between perceived social support and diagnostic delay.\u003c/p\u003e\u003cp\u003e\u003cb\u003eH4.\u003c/b\u003e Perceived social support has a positive effect on help-seeking motivation.\u003c/p\u003e\u003cp\u003e\u003cb\u003eH5.\u003c/b\u003e Help-seeking motivation act as a mediator in the relationship between perceived social support and diagnostic delay.\u003c/p\u003e\u003cp\u003e\u003cb\u003eH6.\u003c/b\u003e Stigma and help-seeking motivation play a chain mediating between perceived social support and diagnostic delay.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003ePrior research has emphasized the rationality behind the prevalence of diagnostic delay in schizophrenia, yet its underlying mechanisms remain insufficiently explored, with the role of help-seeking motivation being particularly understudied. Moreover, existing quantitative approaches fail to capture the dynamic complexity of patients\u0026rsquo; lived help-seeking experiences, leaving psychological realities during diagnostic pathways unexamined. Therefore, this study employs a concurrent mixed-methods design: the quantitative component will systematically identify predictors of diagnostic delay and elucidate the mediating pathways of help-seeking motivation, while simultaneously, the qualitative component investigates patients\u0026rsquo; lived psychological experiences during help-seeking. Integration through methodological triangulation will delineate the role of help-seeking motivation in diagnostic delay among patients with schizophrenia, generating actionable insights for targeted interventions.\u003c/p\u003e"},{"header":"2. Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1. Study Design\u003c/h2\u003e\u003cp\u003eThis study employed a convergent mixed-methods design, cross-sectional quantitative data were collected via questionnaires concurrently with one-on-one semi-structured qualitative interviews. Methodological triangulation was applied during integration to comparatively analyze datasets, ascertain their mutual confirmation status, and thereby enhance the validity of evidence. The interpretation and presentation of findings will utilize descriptive sequential reporting. The study strictly adhered to the COREQ checklist for qualitative components and STROBE statement for quantitative components[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] (Document S1 and S2).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2. Participants\u003c/h2\u003e\u003cp\u003eFor the quantitative component, a convenience sampling strategy was utilized. Based on a previously reported diagnostic delay prevalence of 58.6% in schizophrenia, we have calculated that a sample size of 448 individuals is required. We ultimately recruited 520 outpatients and inpatients with schizophrenia from three psychiatric hospitals in Inner Mongolia Autonomous region of China. Qualitative participants were selected through purposeful sampling to capture diverse perspectives, with continued recruitment until no novel insights emerging in three consecutive interviews. The final qualitative sample comprised 12 patients and 11 family caregivers, all purposively selected from patients currently participating in or scheduled for the quantitative phase. The inclusion and exclusion criteria for participants are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eInclusion and exclusion criteria of the participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"1\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInclusion criteria:\u003c/p\u003e\u003cp\u003e1.Aged between 18 and 60 years.\u003c/p\u003e\u003cp\u003e2.Diagnosed by a psychiatrist based on the International Classification of Diseases-11/Diagnostic and Statistical Manual of Mental Disorders-5 criteria.\u003c/p\u003e\u003cp\u003e3.Clinically stable: Minimal or partial psychotic symptoms, with\u0026nbsp;Brief Psychiatric Rating Scale score\u0026thinsp;\u0026lt;\u0026thinsp;30\u0026nbsp;and\u0026nbsp;Insight and Treatment Attitude Questionnaire score\u0026thinsp;\u0026gt;\u0026thinsp;11.\u003c/p\u003e\u003cp\u003e4. Demonstrated\u0026nbsp;adequate cognitive and communication capacity\u0026nbsp;for effective researcher interaction (patients and caregivers).\u003c/p\u003e\u003cp\u003e5.Provided signed informed consent.\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExclusion criteria\u003c/p\u003e\u003cp\u003e1.Diagnosed with a mental illness other than schizophrenia, such as depression, dementia, or epilepsy.\u003c/p\u003e\u003cp\u003e2. Significant comorbid physical illnesses or substance abuse disorders (including alcohol).\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3. Data collection\u003c/h2\u003e\u003cp\u003eQuantitative data were gathered through structured questionnaires. Prior to formal collection, a pre-survey with 30 patients (excluded from final analysis) assessed comprehension and completion time. Trained researchers delivered standardized instructions prior to supervised on-site completion, conducting immediate completeness checks with clarification support upon request. Qualitative data were collected through semi-structured interview methodology in a quiet clinic or ward within the hospital. After explaining research goals and obtaining audio-recording consent, the interviews were conducted in the participants' language (Chinese), and they were interviewed once for 20 to 40 min.. Researchers active listening techniques, documented non-verbal behaviors, and posed contextual follow-up questions. The interview guide(Document S3) was developed through literature review and expert consultation, with minor wording refinements after pilot testing with the first three participants based on pretest feedback.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.4. Instruments\u003c/h2\u003e\u003cdiv id=\"Sec7\" class=\"Section3\"\u003e\u003ch2\u003e2.4.1. Participant Demographic Information Questionnaire\u003c/h2\u003e\u003cp\u003eThe questionnaire was drafted following discussions among research team members and primarily comprises the following questions: demographic characteristics (age at first onset, education/income level at first onset), clinical history (family psychiatric history, initial presentation pattern) and diagnostic delay status (operationally defined).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section3\"\u003e\u003ch2\u003e2.4.2. Perceived Social Support Scale (PSSS)\u003c/h2\u003e\u003cp\u003eThe study employed the Perceived Social Support Scale developed by Zimet to assess the level of perceived social support[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The scale consists of 12 items with three dimensions scored with the Likert 7 scale. The total score ranges from 12 to 84, with higher scores indicating greater perceived social support. The scale's Cronbach's α coefficient was 0.84. The Cronbach's α coefficient for the scale in this study was determined to be 0.93.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\u003ch2\u003e2.4.3 Perceived Devaluation-Discrimination (PDD)\u003c/h2\u003e\u003cp\u003eThe study employed the Perceived Devaluation-Discrimination to assess perceived stigma by patients with schizophrenia. The scale consists of 12 items and is a unidimensional scale. Items 1\u0026ndash;4, 8, and 10 are reverse-scored, total scores range 12\u0026ndash;48 (higher scores\u0026thinsp;=\u0026thinsp;stronger stigma). The scale's Cronbach's α coefficient was 0.98. The Cronbach's α coefficient for the scale in our study was 0.85.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section3\"\u003e\u003ch2\u003e2.4.4. Help-Seeking Motivation Scale for patients with schizophrenia(HSMS)\u003c/h2\u003e\u003cp\u003eThe Help-Seeking Motivation Scale for patients with schizophrenia developed by Song et al was employed in this study to assess the level of help-seeking motivation in schizophrenia[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The scale comprises 21 items organised into three dimensions: Autonomous Motivation (Items 1\u0026ndash;8), Controlled Motivation (Items 9\u0026ndash;16) and Amotivation (Items 16\u0026ndash;21). The scale utilises a 5-point Likert scale, where higher scores indicate a stronger help-seeking motivation among patients with schizophrenia. The scale's Cronbach's α coefficient was 0.90. In this study, the Cronbach's α coefficient of the scale was found to be 0.95.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e2.5. Ethical Consideration\u003c/h2\u003e\u003cp\u003e This study was approved by the Ethics Committee of Harbin Medical University (HMUDQ20230502001), and it conformed to the ethical guidelines of the Helsinki Declaration. Information related to the study was provided to all participants and written informed consent was obtained from all participants. All participants were told that the study was voluntary and could be dropped out at any time without any consequences.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e2.6. Statistical Analysis\u003c/h2\u003e\u003cp\u003eQuantitative data analysis proceeded as follows: survey data underwent double-entry verification using EpiData3.1. All analyses were performed with SPSS26.0 and Mplus8.0 software. Descriptive statistics summarized demographic variables and four key measures: perceived social support, stigma, help-seeking motivation, and diagnostic delay. Chi-square tests compared demographic variables differences between delayed and non-delayed groups, while independent samples t-tests compared psychological variables between delayed and non-delayed groups. Hierarchical binary logistic regression identified factors influencing diagnostic delay. Chain mediation modeling was constructed in Mplus8.0, with the Bootstrap method utilised for 5000 resamples to calculate a 95% confidence interval (CI). If the CI does not contain 0, the mediating effect is considered significant. Differences were deemed statistically significant at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003cp\u003eQualitative data analysis proceeded as follows: interview recordings were verbatim transcribed and translated into English by two research team members, with translation accuracy verified by the other two bilingual team members. Transcripts were managed in NVivo12 and analyzed for seven months. After reading the text repeatedly, two researchers extracted text segments relevant to study objectives, applying descriptive coding. Highlighted texts were independently coded by the two team members, systematically grouped into thematic codes or new categories. The team held multiple online discussions to reach coding consensus. Before analyzing based on the research objective, a preliminary coding framework was developed to reach the consistency of emerging themes and subthemes in the data. Final themes/subthemes were defined through collaborative review, with member checking (participant feedback) enhancing the credibility of the content.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e3.1. Quantitative research\u003c/h2\u003e\u003cdiv id=\"Sec15\" class=\"Section3\"\u003e\u003ch2\u003e3.1.1. General characteristics of participants\u003c/h2\u003e\u003cp\u003eThe study included 520 patients with schizophrenia (59.6% male, 40.4% female). Key initial onset characteristics comprised: age distribution (45.8% aged 18\u0026ndash;30 years), education (37.5% junior high school), marital status (56.5% single), and month income (30.4% with monthly income\u0026thinsp;\u0026lt;\u0026thinsp;1000 RMB). Diagnostic delay prevalence reached 75.6% (n\u0026thinsp;=\u0026thinsp;393). These findings were detailed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic and clinical characteristics of patients with schizophrenia(N\u0026thinsp;=\u0026thinsp;520)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eN\u003c/em\u003e(%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e310(59.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e210(40.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge of first onset\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e127(24.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u0026ndash;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e238(45.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e155(29.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducation level at first onset\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrimary school and below\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e126(24.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJunior high school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e195(37.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSenior high school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e107(20.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCollege and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e92(17.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital status at first onset\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e294(56.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e104(20.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDivorce\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e122(23.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWork situation at first onset\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOn the job\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e227(43.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePeasants\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e69(13.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e224(43.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMonth income at first onset\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;1000RMB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e158(30.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1000\u0026ndash;3000 RMB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e167(32.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;3000 RMB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e195(37.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFamily type at first onset\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSingle family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e99(19.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNuclear family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e122(23.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStem family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e247(47.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJoint family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e52(10.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReligious belief at first onset\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e407(78.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e113(21.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResidence at first onset\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e308(59.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e212(40.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFamily psychiatric history\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e404(77.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e116(22.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMode of initial onset\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSlow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e395(76.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAcute\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e125(24.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiagnostic delay\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e127(24.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e393(75.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section3\"\u003e\u003ch2\u003e3.1.2. Descriptive statistics of perceived social support, stigma and help-seeking motivation in patients with schizophrenia\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presented the descriptive statistics of perceived social support, stigma and help-seeking motivation in patients with schizophrenia. The mean perceived social support score among participants was 37.39\u0026thinsp;\u0026plusmn;\u0026thinsp;18.30 (out of a total score of 84), indicating a moderately low level of perceived social support in this cohort. The average stigma score was 40.42\u0026thinsp;\u0026plusmn;\u0026thinsp;9.46 (out of a total score of 48), suggesting a high level of stigma in patients with schizophrenia. For help-seeking motivation levels, the average score was 45.69\u0026thinsp;\u0026plusmn;\u0026thinsp;19.92 (out of 105), denoting a relatively low level of hope among these patients.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescriptive statistics of perceived social support, stigma and help-seeking motivation in patients with schizophrenia\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStandard error\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerceived social support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e37.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18.30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStigma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e40.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9.46\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHelp-seeking motivation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e45.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19.92\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section3\"\u003e\u003ch2\u003e3.1.3. Univariate analysis of diagnostic delay in patients with schizophrenia\u003c/h2\u003e\u003cp\u003eThe univariate analysis indicated that a statistically significant difference was observed across multiple variables: age of first onset, education level at first onset, marital status at first onset, month income at first onset, family type at first onset and mode of initial onset. Complete statistical results are detailed in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eChi-square test analysis of diagnostic delay in patients with schizophrenia\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eDiagnostic delay(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003eX\u0026sup2;\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e157(39.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e53(41.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.127\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.399\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e236(60.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e74(58.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge of first onset\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e83(21.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44(34.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e11.412\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u0026ndash;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e182(46.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e56(44.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e128(32.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27(21.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducation level at first onset\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrimary school and below\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e103(26.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23(18.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e14.499\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJunior high school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e155(39.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38(29.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSenior high school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e76(19.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31(24.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCollege and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e59(15.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35(27.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital status at first onset\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e216(55.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e78(61.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e12.825\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e92(23.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12(9.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDivorce\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e85(21.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37(29.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWork situation at first onset\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOn the job\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e172(43.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.401\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.818\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePeasants\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e54(13.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e55(43.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e167(42.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15(11.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMonth income at first onset\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;1000RMB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e133(33.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25(19.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e12.733\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1000\u0026ndash;3000 RMB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e131(33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36(28.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;3000 RMB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e129(32.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e66(52.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFamily type at first onset\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSingle family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e86(21.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13(10.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e16.455\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNuclear family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e83(21.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e39(30.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStem family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e181(46.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e66(52.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJoint family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e43(10.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9(7.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReligious belief at first onset\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e303(77.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e104(81.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.295\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.225\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e90(22.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23(18.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResidence at first onset\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e237(60.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e71(55.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.769\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.38\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e156(39.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e56(44.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFamily psychiatric history\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e310(78.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e94(74.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.311\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.252\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e83(21.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33(26.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMode of initial onset\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSlow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e325(82.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e70(55.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e39.981\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAcute\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e68(17.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e57(44.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eT-test analysis of diagnostic delay in patients with schizophrenia\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePerceived social support\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eStigma\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eHelp-seeking motivation\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiagnostic delay\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32.85\u0026thinsp;\u0026plusmn;\u0026thinsp;16.228\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e42.43\u0026thinsp;\u0026plusmn;\u0026thinsp;8.830\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e39.28\u0026thinsp;\u0026plusmn;\u0026thinsp;16.538\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51.45\u0026thinsp;\u0026plusmn;\u0026thinsp;17.235\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34.22\u0026thinsp;\u0026plusmn;\u0026thinsp;8.631\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e65.63\u0026thinsp;\u0026plusmn;\u0026thinsp;16.064\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.056\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-9.156\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15.658\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section3\"\u003e\u003ch2\u003e3.1.4. Hierarchical binary logistic regression of diagnostic delay in patients with schizophrenia\u003c/h2\u003e\u003cp\u003eUsing diagnostic delay as the dependent variable and variables with significant univariate differences as independent variables (categorical coding detailed in Document S4), hierarchical binary logistic regression was performed. Block 1 incorporated demographic variables selected based on univariate results and clinical expertise. This model explained 21.1% of variance in diagnostic delay. Block 2 added perceived social support, stigma, and help-seeking motivation, significantly increasing variance explanation(△\u003cem\u003eR\u003c/em\u003e\u0026sup2;=0.31). These psychological constructs emerged as core predictors of diagnostic delay. Complete regression results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eHierarchical binary logistic regression of diagnostic delay in patients with schizophrenia\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"11\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eWald X\u0026sup2;\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003eOR\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003e95%\u003cem\u003eCI\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cem\u003eR\u003c/em\u003e\u0026sup2;\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003e△\u003cem\u003eR\u003c/em\u003e\u0026sup2;\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eBlock 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e(Constant)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.811\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.445\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e16.544\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e6.115\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.211\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMode of initial onset\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSlow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAcute\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-1.405\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.238\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e34.787\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.245\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.154\u0026ndash;0.391\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003eBlock 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e(Constant)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.408\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.913\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e13.928\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e30.198\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003e0.521\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003e0.310\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMode of initial onset\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSlow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAcute\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-1.167\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.290\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e16.178\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.311\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.176\u0026ndash;0.550\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePerceived social support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.009\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6.252\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.012\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.979\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.962\u0026ndash;0.995\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStigma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.052\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9.690\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.054\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e1.020\u0026ndash;1.089\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHelp-seeking motivation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.057\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e47.738\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.945\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.929\u0026ndash;0.960\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section3\"\u003e\u003ch2\u003e3.1.5. The mediating effect of stigma and help-seeking motivation on perceived social support and diagnostic delay\u003c/h2\u003e\u003cp\u003eStructural equation modeling was employed to examine the mediating roles of stigma and help-seeking motivation. Perceived social support significantly predicted diagnostic delay (\u003cem\u003eβ\u003c/em\u003e=-0.522, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), stigma (\u003cem\u003eβ\u003c/em\u003e=-0.484, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and help-seeking motivation (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.487, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while stigma directly influenced help-seeking motivation (\u003cem\u003eβ\u003c/em\u003e=-0.217, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and diagnostic delay (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.169, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and help-seeking motivation exerted significant effects on diagnostic delay (\u003cem\u003eβ\u003c/em\u003e=-0.493, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Complete regression statistics are presented in Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e and visualized path coefficients in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The results of the mediation analysis indicated that the 95% confidence intervals for all paths excluded zero, establishing mediation effects. Perceived social support's indirect influence on diagnostic delay can be through three paths: (1) Perceived social support\u0026rarr; Stigma\u0026rarr; Diagnostic delay; (2) Perceived social support\u0026rarr; Help-seeking motivation\u0026rarr; Diagnostic delay; (3) Perceived social support\u0026rarr; Stigma\u0026rarr; Help-seeking motivation\u0026rarr; Diagnostic delay. The total indirect effect accounts for 71.65%, including 15.71% for mediation path 1, 45.98% for mediation path 2, and 9.96% for mediation path 3. Table\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e for details. Consequently, Hypothesis 1\u0026ndash;6 were validated through these findings.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRegression analysis of the variables\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDependent variable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIndependent variable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStigma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePerceived social support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.484\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.035\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-13.965\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.234\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e158.240***\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eHelp-seeking motivation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePerceived social support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.487\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.039\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e12.478\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.387\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e163.197***\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStigma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.217\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.043\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-5.020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eDiagnostic delay\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePerceived social support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.148\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.061\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-2.419\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.016\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.479\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e158.134***\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStigma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.169\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.062\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.736\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.006\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHelp-seeking motivation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.493\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.050\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-9.898\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003cb\u003e***P\u0026lt;0.001\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eChain mediating effect on perceived social support, stigma, help-seeking motivation and diagnostic delay\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eModel pathways\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eEffect\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eBootstrap95%CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eRelative effect\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLLCI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eULCI\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDirect effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.374\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.039\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.451\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.298\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e71.65%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerceived social support\u0026rarr; Stigma\u0026rarr; Diagnostic delay\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.082\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.030\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.141\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e15.71%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerceived social support\u0026rarr; Help-seeking motivation\u0026rarr; Diagnostic delay\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.240\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.030\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.302\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.185\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e45.98%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerceived social support\u0026rarr; Stigma\u0026rarr; Help-seeking motivation\u0026rarr; Diagnostic delay\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.052\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.013\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.081\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9.96%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal indirect effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.148\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.061\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.264\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.026\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e28.35%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.522\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.043\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.601\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.431\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e**P\u0026lt;0.001\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003e3.2. Qualitative research\u003c/h2\u003e\u003cp\u003eParticipants included 12 patients and 11 family caregivers. The total interview duration was 644 min, averaging about 28 min per interview. (Demographic characteristics of participants detailed in Document S5). Thematic analysis identified patients and caregivers as a collaborative unit during diagnostic-seeking, demonstrating shared experiential patterns across multiple dimensions. Two themes with five subthemes emerged, revealing near-identical help-seeking experiences except for divergence within the \u0026ldquo;Family emotional support\u0026rdquo; subtheme, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab9\" class=\"InternalRef\"\u003e9\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab9\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 9\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eTheme, subtheme and encode\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTheme\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSubtheme\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEncode\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMultifaceted barriers in the process of seeking diagnosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDeficient illness insight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLack of knowledge about the concept of diseases,\u003c/p\u003e\u003cp\u003eMisunderstanding of disease symptoms\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInadequate medical information\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMisconceptions about the choice of medical treatment locations,\u003c/p\u003e\u003cp\u003eLack of control over the timing of seeking medical treatment\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInaccessible psychiatric services\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNegative experiences due to insufficient services\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMultifaceted collaboration to mitigate diagnostic delay\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFamily emotional support(patients)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDesire for family tolerance and understanding, Family support reduces the sense of stigma\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCommunity informational support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDesire for the popularization of knowledge in society to change the public's stereotypical impression of mental illness.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003eNotes: Parentheses are marked as only the help-seeking experience of patients, and the rest are the common help-seeking experience of patients and caregivers.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThematic analysis revealed that patients with schizophrenia encountered multifaceted barriers in the process of seeking diagnosis, severely diminishing motivation levels and contributing to varying degrees of diagnostic delay. Crucially, family emotional support and community informational support counterbalanced these effects, elevating help-seeking motivation and ultimately mitigating diagnostic delay occurrence. Figure\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the frame diagram.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec21\" class=\"Section3\"\u003e\u003ch2\u003e3.2.1. Multifaceted Barriers in the process of seeking diagnosis\u003c/h2\u003e\u003cp\u003ePatients will face multiple barriers in the process of seeking diagnosis, including deficient illness insight, inadequate medical information, inaccessible psychiatric services, which weakens patients' help-seeking motivation and causes diagnostic delay.\u003c/p\u003e\u003cp\u003e\u003cem\u003eDeficient illness insight\u003c/em\u003e\u003c/p\u003e\u003cp\u003ePatients demonstrated limited mental health literacy, with one-third unaware of schizophrenia concepts and consequences of untreated psychosis, directly undermining help-seeking motivation:\u003c/p\u003e\u003cp\u003e\u003cem\u003eP4: \"I'd never heard of schizophrenia before diagnosis\u0026mdash;only searched online afterward.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003eAlthough most patients described experiencing various psychological symptoms, they often denied any connection to schizophrenia. Early, subtle symptoms were frequently misinterpreted by patients and caregivers as supernatural phenomena rather than signs of mental illness requiring professional attention:\u003c/p\u003e\u003cp\u003e\u003cem\u003eP1: \"I thought it was depression after losing my child, never considered schizophrenia.\" C11: \"We believed she was possessed, constantly muttering (incoherent speech)\u0026mdash;never considered hospitalization.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003eAbnormal emotions or behaviors in the early stage of the disease are usually ignored by patients and their caregivers, and only when the illness gets worse and affects their daily work and life will they try to seek professional help:\u003c/p\u003e\u003cp\u003e\u003cem\u003eP1: \" At first, I thought it would get better on its own. After half a year without improvement, I couldn't bear it anymore and went to the hospital.\" C6: \" My brother didn't think it was serious, and I didn't understand. We delayed... only seeking help when it became very severe. We never imagined it was this illness.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eInadequate medical information\u003c/em\u003e\u003c/p\u003e\u003cp\u003eGeographic and economic constraints restricted access to treatment information sources, causing confusion about care pathways:\u003c/p\u003e\u003cp\u003e\u003cem\u003eP8: \" I didn't know how to treat my illness or where to find effective treatment.\" C10: \" We were completely lost at the time, unsure what medication he needed or where to get treatment. So, he just stayed home.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003eConsequently, many relied on non-specialized interventions through social networks, despite questionable efficacy:\u003c/p\u003e\u003cp\u003e\u003cem\u003eP6: \" I used traditional Chinese medicine from a local healer in my town for almost half a year. I felt it worked well, so I stopped considering the hospital.\" C2: \" I heard many people with my wife's condition were cured by witch doctors, so I took her to them.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003eFurthermore, determining when to seek professional help proved challenging for most participants. This uncertainty eroded confidence in initiating contact with specialized psychiatric services:\u003c/p\u003e\u003cp\u003e\u003cem\u003eP9: \" I never knew when to go to the hospital. I only realized when things got bad, but by then it was often too late. This made me reluctant to seek help proactively; I just waited until it worsened.\" C3: \" Neither my husband nor I understood the illness. After each visit, the doctor said it wasn't serious, so we stopped going... we didn't anticipate it worsening so much later.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eInaccessible psychiatric services\u003c/em\u003e\u003c/p\u003e\u003cp\u003ePoor accessibility to mental healthcare was the most frequently cited barrier. Participants identified the substantial time and financial burdens associated with accessing care as major deterrents:\u003c/p\u003e\u003cp\u003eP11:\"\u003cem\u003eThe hospital is 30 kilometers away. Each trip is incredibly time-consuming and draining. I simply couldn't manage it regularly, leading to delay.\u003c/em\u003e\" C1:\u003cem\u003e\"Beyond the hospitalization and treatment costs, just the travel and accommodation expenses placed a huge strain on our family.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003eAdditionally, services at local primary care levels often failed to meet treatment expectations. Some families reported losing confidence in the available care and developing skepticism towards local healthcare quality, further reducing help-seeking motivation and causing delay:\u003c/p\u003e\u003cp\u003e\u003cem\u003eP10:\"Our town hospital lacks equipment like ECT machines and has limited medication. I wanted proper treatment but couldn't get it there, so I eventually gave up going.\" C8:\"We went to the county hospital, but it felt pointless. The level of care wasn't reassuring at all.\"\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section3\"\u003e\u003ch2\u003e3.2.2. Multifaceted collaboration to mitigate diagnostic delay\u003c/h2\u003e\u003cp\u003eLow levels of help-seeking motivation among schizophrenia patients were linked to insufficient emotional support and unmet informational needs. Addressing diagnostic delay requires collaborative efforts involving family emotional support, and community informational support to strengthen help-seeking motivation.\u003c/p\u003e\u003cp\u003e\u003cem\u003eFamily emotional support.\u003c/em\u003e\u003c/p\u003e\u003cp\u003eUpon suspecting illness, patients reported experiencing significant psychological burdens, including denial, anger, and depression. Adequate emotional support from family members was identified as crucial for alleviating this distress, boosting help-seeking motivation, and reducing delay. Participants expressed a desire for comfort and encouragement from family to facilitate seeking help:\u003c/p\u003e\u003cp\u003e\u003cem\u003eP1:\"I was hesitant about going to the hospital. I wished my husband would discuss it with me and offer reassurance. That would have given me more motivation to seek help earlier, preventing this delay.\" P7:\"People outside have negative views about this illness, but my father constantly encouraged me. This helped me gradually ignore the stigma. Feeling motivated to seek help allowed me to get treatment early.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003eDiscussions with family members also enhanced patients' understanding of their illness and fostered positive beliefs about recovery. This process encouraged proactive consideration of sustained treatment and more adaptive coping strategies:\u003c/p\u003e\u003cp\u003e\u003cem\u003eP12:\"My family and I frequently discussed the illness, which increased my understanding. This gave me confidence and the desire to continue treatment consistently.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eCommunity informational support\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe level of disease knowledge among patients and their caregivers significantly influenced adherence to standardized treatment. Most interviewees reported very limited understanding of schizophrenia and expressed a strong need for accessible disease-related information. They indicated that receiving such information through community/social channels would promote accurate illness perception, restore confidence in recovery:\u003c/p\u003e\u003cp\u003e\u003cem\u003eP9:\"I wish healthcare providers would explain the illness more. Better understanding that it's manageable would motivate me to keep taking medication.\" C7:\"Ordinary people like us previously knew nothing about schizophrenia, let alone whether lifelong medication is needed. If someone had informed us, we certainly wouldn't have stopped the medication.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003cp\u003eSeveral participants emphasized that broader societal dissemination of mental health knowledge could effectively reduce public stigma. An environment perceived as free from discrimination and prejudice would foster stronger motivation to seek professional care and decrease diagnostic delay:\u003c/p\u003e\u003cp\u003eP7:\u003cem\u003e\"Public awareness campaigns are essential. Even we patients sometimes view mental illness as abnormal. This stigma makes us afraid to acknowledge our illness or go to the hospital.\"\u003c/em\u003e C5:\u003cem\u003e\"People instantly distance themselves upon hearing 'mental illness.' Who dares to let others know there's someone with mental illness in their family?... Once public education improves and people are less afraid of discrimination and isolation, families will be more willing to seek hospital care.\"\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec23\" class=\"Section2\"\u003e\u003ch2\u003e3.3. Integration of Quantitative and Qualitative Findings\u003c/h2\u003e\u003cp\u003eThis study collected and analyzed quantitative and qualitative data independently, subsequently integrating findings through methodological triangulation. The analysis revealed complementarity and expansion between quantitative results and qualitative interview data. The specific analytical procedures are detailed below.\u003c/p\u003e\u003cdiv id=\"Sec24\" class=\"Section3\"\u003e\u003ch2\u003e3.3.1. Analysis of factors influencing diagnostic delay in patients with schizophrenia\u003c/h2\u003e\u003cp\u003eQuantitative and qualitative analyses demonstrated complementarity in identifying diagnostic delay influencing factors: hierarchical binary logistic regression confirmed perceived social support, stigma, and help-seeking motivation as core psychological predictors, while qualitative findings revealed multifaceted barriers in the process of seeking diagnosis - specifically deficient illness insight, inadequate medical information, and inaccessible psychiatric services. Methodological triangulation established that the mode of initial onset, perceived social support, stigma, help-seeking motivation, illness insight, medical information accessibility, and psychiatric service availability collectively constitute primary determinants of diagnostic delay.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec25\" class=\"Section3\"\u003e\u003ch2\u003e3.3.2. Analysis of the role of help-seeking motivation in diagnostic delay\u003c/h2\u003e\u003cp\u003eQuantitative analysis mapped the pathways through which help-seeking motivation functions within diagnostic delay, while qualitative inquiry illuminated its contextual processes. The overlapping components between quantitative and qualitative findings expanded the scope of research outcomes, demonstrating the property of expansion: Mediation analysis confirmed that perceived social support directly affects diagnostic delay and operates indirectly through the chain mediation of stigma and help-seeking motivation. Qualitative findings demonstrated that seeking help during the diagnostic process involves encountering multifaceted barriers which compromise patients' help-seeking motivation and contribute to diagnostic delay. In this context, family emotional support and community informational support synergistically elevate perceived social support and mitigate stigma, thereby fortifying help-seeking motivation and ultimately reducing diagnostic delay. Integration revealed that multifaceted barriers compromise patients' help-seeking motivation, and the relationship between help-seeking motivation and diagnostic delay is not a singular linear relationship, but follows a core pathway: perceived social support\u0026rarr; stigma\u0026rarr; help-seeking motivation\u0026rarr; diagnostic delay. These factors require multifaceted collaboration to primarily reduce diagnostic delay. The conceptual framework is presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eQualitative analysis revealed that deficient illness insight was a primary contributor to diagnostic delay in schizophrenia. Insight forms the basis of behavior, low levels of illness insight prevent accurate self-assessment of symptoms, leading to diagnostic delay[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. This can be attributed, in part, to mental illness's sensitivity in China, patients often refrain from consulting clinicians despite having disease-related questions[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Our study further revealed inadequate medical information among patients and caregivers, causing confusion regarding whether, when, and where to seek treatment. Prior studies indicate that without scientific medical information guidance, initial symptom management typically involves folk remedies or informal consultations rather than psychiatric care[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Significantly, we observed psychiatric service availability inversely correlates with delay occurrence. Currently, China's mental health system faces insufficient service provision and uneven quality, significantly diminishing treatment engagement among patients with schizophrenia[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. These challenges may stem from two primary causes: First, inadequate compensation and challenging work environments for community mental health workers, coupled with limited specialized training access, result in suboptimal identification and management of mental disorders at the primary care level[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Second, disproportionate allocation of governmental resources toward large psychiatric institutions and research academies, rather than grassroots mental health services, further constrains community capacity[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Interviews highlighted that patients strongly desired family emotional support, recognizing family members as primary sources for problem-solving guidance and decision-making assistance, making families their consistent first choice for help-seeking[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Furthermore, patients expressed needs for community informational support, specifically advocating intensified public mental health education to foster social acceptance and alleviate their psychological distress and self-stigma. In light of these findings, healthcare authorities and clinicians should implement enhanced public education campaigns and psychological support services to mitigate barriers' negative impact on help-seeking motivation and treatment initiation, thereby facilitating timely diagnosis.\u003c/p\u003e\u003cp\u003eIn quantitative analysis, our study indicated that acute initial onset reduced diagnostic delay likelihood compared to insidious presentations. The mode of initial onset critically influences help-seeking decisions, acute manifestations facilitate prompt recognition and treatment initiation, whereas negative symptoms (e.g., apathy, social withdrawal) are frequently misattributed to laziness or low mood by families, consequently delaying diagnosis[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Low perceived social support independently predicted diagnostic delay. Individuals with heightened support perception employ proactive coping strategies. Consequently, reinforcing positive reinforcement of perceived social support is essential to help patients effectively mobilize internal and external resources, thereby reducing diagnostic delay[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. This study additionally identified elevated stigma as a significant risk factor for diagnostic delay, aligning with findings from Vally et al[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. The rationale behind this is rooted in the public labeling of mental disorders as \"pathological\" or \"neurotic\", driving patients to conceal conditions to avoid mockery and discrimination. Furthermore, since initial onset often coincides with critical phases of career establishment and romantic relationship formation, intense shame compels prioritization of occupational/familial stability over treatment, resulting in deliberate care avoidance[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Notably, stronger help-seeking motivation predicted more proactive treatment-seeking behaviors and significantly lower delay likelihood. Motivation uniquely activates care-engagement behaviors, serving as a catalyst distinct from other psychological variables[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Thus, interventions targeting motivation enhancement represent a pivotal strategy, clinicians can guide patients toward timely psychiatric consultation by elevating help-seeking motivation.\u003c/p\u003e\u003cp\u003eOur findings robustly confirm stigma's partial mediating role in the relationship between perceived social support and diagnostic delay among patients with schizophrenia. Specifically, perceived social support directly influences diagnostic delay while also exerting indirect effects through stigma, corroborating previous research[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Stigma, conceptualized as a negative emotional response to public discrimination and exclusion, drives treatment avoidance through concealment behaviors when patients anticipate isolation and marginalization due to mental illness stereotypes[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. In contrast, perceived social support positively modulates behavioral responses. Patients with stronger perceived support demonstrate greater resilience against prejudice and more adaptive coping during adverse events, exhibiting reduced stigma levels and consequently reducing delays[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Furthermore, perceived social support also indirectly influences delay through help-seeking motivation. Help-seeking motivation, an internal psychological process activating professional help-seeking, interacts bidirectionally with external support resources. Robust external support strengthens patients' propensity for professional help-seeking, enhancing psychiatric service utilization. Consequently, heightened perceived support correlates with increased motivation during health crises. This occurs because feeling supported profoundly reinforces problem-solving resolve and provides actionable information pathways, collectively intensifying their drive to seek help[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. This validates our hypothesis that accessible support systems promote timely engagement with professional healthcare, mitigating diagnostic delay.\u003c/p\u003e\u003cp\u003eIn the chain mediation model, stigma and help-seeking motivation partially mediated the relationship between perceived social support and diagnostic delay, accounting for 9.96% of the total effect. Patients with higher perceived social support cognitively reframe negative public attitudes toward mental illness, thereby reducing self-stigma and its demotivating effects on help-seeking. Additionally, stigma serves as a key psychological factor impeding help-seeking motivation, as evidenced by multiple studies and confirmed here, patients experiencing heightened stigma demonstrate reduced motivation to seek professional help, substantially increasing delay risk when confronting psychiatric symptoms[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In summary, stigma and help-seeking motivation constitute pivotal mediating factors linking perceived social support to diagnostic delay, establishing them as essential intervention targets for future delay-reduction strategies.\u003c/p\u003e\u003cp\u003eThrough qualitative interviews, this study explored influencing factors from patient/caregiver perspectives and elucidated help-seeking motivation's functional process in diagnostic delay. Quantitative analysis validated our hypotheses, revealing motivation's pathway effects. Methodological triangulation integrated these findings, enriching evidence from multiple angles and effectively clarifying the role of help-seeking motivation in diagnostic delay among patients with schizophrenia. This convergence strengthens result generalizability. Diagnostic delay fundamentally stems from the interplay between external barriers and internal psychological conflicts. Consequently, enhancing help-seeking motivation to reduce diagnostic delay requires tripartite collaboration: mobilizing family emotional support to build robust networks, enhancing clinician-patient communication to increase disease knowledge access, and implementing stigma-reduction strategies to counter negative emotions. These approaches will establish standardized delay-mitigation protocols, ultimately improving prognostic outcomes.\u003c/p\u003e"},{"header":"5. Strengths and limitations","content":"\u003cp\u003eThis study, like any other, encompasses both strengths and limitations. Notably, our research adopted a mixed-method approach, analyzing risk factors for diagnostic delay among patients with schizophrenia and examining the role of help-seeking motivation in diagnostic delay. The integration of these diverse analytical methods stands as a clear strength of this study, and provides new directions for future family, hospital and community intervention. Nevertheless, the survey has several limitations. Primarily, retrospective assessment of help-seeking motivation during initial onset carries recall bias risks. This necessitates extending future research to validate these findings in first-episode cohorts. Moreover, potential selection bias may exist as participants were exclusively recruited from three psychiatric hospitals, expand recruitment to diverse healthcare settings in future studies could enhance applicability. Finally, help-seeking motivation and other psychological variables may exhibit dynamic fluctuations over time. Future studies should implement longitudinal designs to examine changing patterns of these variables and analyze causal relationships between time-specific influencing factors and diagnostic delay.\u003c/p\u003e"},{"header":"6. Conclusions","content":"\u003cp\u003eThis study enriched the existing theoretical literature on risk factors for diagnostic delay among patients with schizophrenia. And building upon this, we confirmed that diagnostic delay originates from complex interactions between multifaceted barriers and psychological mechanisms, broadening understanding of the role of help-seeking motivation in diagnostic delay. Finally, we propose a tripartite intervention strategy, namely, mobilizing family emotional networks, enhancing clinician-patient knowledge dissemination, and implementing community anti-stigma programs, hereby effectively elevates help-seeking motivation levels to reduce diagnostic delay.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFootnote\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJin Songand Chong-Wen Wu contributed equally to this work and should be considered co-first authors.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eChong-Wen Wu: Writing \u0026ndash; original draft, Visualization, Supervision, Methodology, Investigation, Formal analysis, Conceptualization, Data curation, Funding acquisition.\u0026nbsp;Min Chen: Writing \u0026ndash; original draft, Funding acquisition, Conceptualization. Yu-Xin Zhang: Writing \u0026ndash; original draft, Conceptualization. Jing-Jing Dai: Writing \u0026ndash; review \u0026amp; editing, Project administration, Investigation, Data curation. Qin-Xue Zhou: Writing \u0026ndash; review \u0026amp; editing, Project administration, Investigation, Data curation. Quan-hui Guo: Writing \u0026ndash; review \u0026amp; editing, Supervision, Conceptualization. Yu-Qiu Zhou: Writing \u0026ndash; review \u0026amp; editing. Jin Song: Writing \u0026ndash; review \u0026amp; editing, Supervision, Project administration, Methodology, Conceptualization.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was partially supported by the National Natural Science Foundation of China (72074063) and Huzhou natural science foundation(2022YZ42).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analysed during the current study are not publicly available due to concerns about the privacy of people diagnosed with schizophrenia, but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eThe study conformed to the ethical guidelines of the Helsinki Declaration. The study received ethical approval from the Ethics Review Committee of Harbin Medical University (Institutional Review Board: HMUDQ20230726003). After explaining the study purpose, data confidentiality, and data processing to the participants, we obtained written consent for voluntary participation. Participants were enrolled in the study during stable disease and signed an informed consent form.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003eDeclaration of informed consent\u003c/p\u003e\n\u003cp\u003eParticipants were enrolled in the study during stable disease and signed an informed consent form.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declared that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eClinical trial number: not applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization (WHO). 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Lepr Rev. 2014;85(1):36\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChen X, Wang S, Liao X, Li Y, Leung SF, Bressington DT. Interventions to decrease health students' stigma toward schizophrenia: A scoping review. Int J Nurs Stud. 2024;158:104837.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYarborough BJ, Yarborough MT, Cavese JC. Factors that hindered care seeking among people with a first diagnosis of psychosis. Early Interv Psychiatry. 2019;13(5):1220\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Schizophrenia, Perceived social support, Stigma, Help-seeking motivation, Diagnostic delay, Mixed-methods","lastPublishedDoi":"10.21203/rs.3.rs-7518536/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7518536/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eSchizophrenia exhibits the most prolonged diagnostic delay among mental disorders. Deficits or misalignment in help-seeking motivation contributes to delayed help-seeking behaviors and missed critical intervention windows. Nevertheless, research gaps persist regarding the systematic investigation of diagnostic delay, and the mechanistic role of help-seeking motivation within the diagnostic process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e: This study adopted a convergent mixed study design. During the quantitative phase, 520 clinically stable individuals with schizophrenia were consecutively recruited from outpatient and inpatient psychiatric settings across three specialized psychiatric hospitals in China. Standardized instruments assessed help-seeking motivation, perceived social support, stigma, diagnostic delay. Data analysis utilized SPSS26.0 and Mplus8.0 for measurement modeling and path validation. Concurrently, in-depth interviews explored help-seeking experiences during diagnostic processes with 12 patients and 11 caregivers. Final integration applied methodological triangulation to converge findings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy results: \u003c/strong\u003eQuantitative and qualitative analyses identified distinct correlates of diagnostic delay, with quantitative findings revealing mode of initial onset (\u003cem\u003eOR\u003c/em\u003e = 0.311, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001), perceived social support (\u003cem\u003eOR\u003c/em\u003e = 0.979, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001), stigma (\u003cem\u003eOR\u003c/em\u003e = 1.054, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001), and help-seeking motivation (\u003cem\u003eOR\u003c/em\u003e = 0.945, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001) as core predictors of diagnostic delay, while qualitative thematic analysis identified three barriers in the process of seeking diagnosis: deficient illness insight, inadequate medical information, and inaccessible psychiatric services. Path modeling confirmed that perceived social support could negatively affect diagnostic delay through stigma and help-seeking motivation, accounting for 15.71% and 45.98% of the total effect. Perceived social support could also affect diagnostic delay through the chain-mediated effect of stigma and help-seeking motivation, accounting for 9.96%. Qualitative evidence synergistically showed that multifaceted collaboration (family emotional support and community informational support) jointly elevated perceived support levels while concurrently diminishing stigma and fortifying help-seeking motivation, thereby mitigating diagnostic delay. Integration revealed that multifaceted barriers compromise patients' help-seeking motivation, and the relationship between help-seeking motivation and diagnostic delay is not a singular linear, but follows a core pathway: perceived social support→ stigma→ help-seeking motivation→ diagnostic delay. These factors require multifaceted collaboration to primarily reduce diagnostic delay.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eDiminishing stigma and fortifying help-seeking motivation are essential for enhancing perceived social support and reducing diagnostic delay in schizophrenia. Moreover, this study highlights the critical need to focusing on providing patients with schizophrenia with family emotional support and community informational support, thereby increasing their help-seeking motivation to effectively address delay in diagnosis.\u003c/p\u003e","manuscriptTitle":"The Role of Help-Seeking Motivation in Diagnostic Delay Among Patients with Schizophrenia: A Mixed-Methods Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-03 01:07:01","doi":"10.21203/rs.3.rs-7518536/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2025-09-21T05:10:14+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-03T19:02:30+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-03T03:00:13+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-03T02:59:21+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychiatry","date":"2025-09-02T13:54:52+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b4b4904b-5ad0-482b-b81a-5e4e361ade3c","owner":[],"postedDate":"October 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-03T01:07:02+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-03 01:07:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7518536","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7518536","identity":"rs-7518536","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}