Beyond Duration of Untreated Psychosis: Understanding Help-Seeking Pathways to First-Episode Psychosis Care in a Coordinated Specialty Clinic 

Beyond Duration of Untreated Psychosis: Understanding Help-Seeking Pathways to First-Episode Psychosis Care in a Coordinated Specialty Clinic | 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 Short Report Beyond Duration of Untreated Psychosis: Understanding Help-Seeking Pathways to First-Episode Psychosis Care in a Coordinated Specialty Clinic Mack Guillory III, B.A, Mackenzie Banchik, B.S, Anna Yee, M.D, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6710866/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 14 You are reading this latest preprint version Abstract Background: Duration of untreated psychosis (DUP) is often used to assess early psychosis intervention programs, with shorter DUPs historically associated with better outcomes. However, using DUP as a primary proxy minimizes individual experiences during help-seeking. Objective: To examine specific help-seeking episodes (HSEs) among patients accessing first-episode psychosis (FEP) care, with a focus on a subset whose first HSE led directly to specialized treatment. Methods: Patients at the Early Psychosis Intervention Clinic – New Orleans (EPIC-NOLA) completed the Pathways to Care (PTC) assessment, which included both structured items and narrative responses. Thematic analysis was conducted on patient responses to identify common barriers to care. A subgroup of patients whose first HSE resulted in direct intake at EPIC-NOLA (“EPIC First”) was examined. Results: Among 79 participants, 32 were classified as “EPIC First.” The mean DUP for this group was 18 weeks. Entry into care was most commonly through hospitalization and/or emergency services (n=26). The majority (75%) reported patient distress as a primary motivator for initiating help-seeking. Thematic analysis revealed recurring barriers such as stigma, inadequate provider knowledge of FEP symptoms, and limited awareness of available resources. Conclusion: While patients in the “EPIC First” subgroup had shorter DUPs compared to the national average (72 weeks), they still experienced aversive and stigmatizing pathways to care. Help-seeking episodes offer a more individualized lens to understand how structural and interpersonal dynamics shape access to early psychosis treatment. Community education and upstream referral strategies may support more positive pathways to care. first-episode psychosis help-seeking episodes duration of untreated psychosis barriers to care stigma Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 25 Jun, 2025 Reviews received at journal 16 Jun, 2025 Reviews received at journal 12 Jun, 2025 Reviews received at journal 09 Jun, 2025 Reviews received at journal 08 Jun, 2025 Reviewers agreed at journal 06 Jun, 2025 Reviewers agreed at journal 05 Jun, 2025 Reviewers agreed at journal 05 Jun, 2025 Reviewers agreed at journal 03 Jun, 2025 Reviewers invited by journal 03 Jun, 2025 Editor invited by journal 30 May, 2025 Editor assigned by journal 22 May, 2025 Submission checks completed at journal 22 May, 2025 First submitted to journal 20 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6710866","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":466015296,"identity":"4f9f647e-6543-4fa3-92d3-952c25fb1792","order_by":0,"name":"Mack Guillory III, 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help-seeking episodes, duration of untreated psychosis, barriers to care, stigma","lastPublishedDoi":"10.21203/rs.3.rs-6710866/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6710866/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: Duration of untreated psychosis (DUP) is often used to assess early psychosis intervention programs, with shorter DUPs historically associated with better outcomes. However, using DUP as a primary proxy minimizes individual experiences during help-seeking.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eObjective: To examine specific help-seeking episodes (HSEs) among patients accessing first-episode psychosis (FEP) care, with a focus on a subset whose first HSE led directly to specialized treatment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMethods: Patients at the Early Psychosis Intervention Clinic – New Orleans (EPIC-NOLA) completed the Pathways to Care (PTC) assessment, which included both structured items and narrative responses. Thematic analysis was conducted on patient responses to identify common barriers to care. A subgroup of patients whose first HSE resulted in direct intake at EPIC-NOLA (“EPIC First”) was examined.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults: Among 79 participants, 32 were classified as “EPIC First.” The mean DUP for this group was 18 weeks. 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Community education and upstream referral strategies may support more positive pathways to care.\u003c/p\u003e","manuscriptTitle":"Beyond Duration of Untreated Psychosis: Understanding Help-Seeking Pathways to First-Episode Psychosis Care in a Coordinated Specialty Clinic ","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-05 23:17:04","doi":"10.21203/rs.3.rs-6710866/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-25T11:50:48+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-16T16:58:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-12T16:22:23+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-09T09:01:12+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-09T03:52:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"194489662365594374543546007121010600238","date":"2025-06-06T13:24:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"204610882320959336510128974232507685471","date":"2025-06-05T18:55:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"333848467057842581390002273364265697972","date":"2025-06-05T18:11:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"247858903222219705363844322116577162710","date":"2025-06-03T17:35:22+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-03T17:21:15+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-30T20:00:28+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-22T09:18:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-22T09:15:59+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Mental Health","date":"2025-05-20T21:06:53+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-mental-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"dimh","sideBox":"Learn more about [Discover Mental Health](https://www.springer.com/44192)","snPcode":"","submissionUrl":"","title":"Discover Mental Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b502e68b-79f3-41ef-bba4-f69aad9529b8","owner":[],"postedDate":"June 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-10T08:38:27+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-05 23:17:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6710866","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6710866","identity":"rs-6710866","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}