Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-08T00:32:09.016Z Has data issue: false hasContentIssue false
  • English
  • Français

Socioeconomic inequalities in duration of untreated psychosis: evidence from administrative data in England

Published online by Cambridge University Press:  14 August 2017

A. Reichert  and
R. Jacobs
A. Reichert*
Affiliation:
Centre for Health Economics, University of York, York YO105DD, UK
R. Jacobs
Affiliation:
Centre for Health Economics, University of York, York YO105DD, UK
*
*Address for correspondence: A. Reichert, Centre for Health Economics, University of York, Alcuin College Block A, York YO105DD, UK. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Duration of untreated psychosis (DUP) is an important measure of access to care as it predicts prognosis and treatment outcomes. Little is known about potential socioeconomic inequalities in DUP. The aim of this study was to investigate inequalities in DUP associated with socioeconomic deprivation in a national cohort in England.

Method

We analysed a cohort of 887 patients with a first-episode in psychosis using the administrative Mental Health Services Dataset in England for 2012/13-2014/15. We used a Generalised Linear Model to account for non-linearity in DUP and looked at inequalities across the whole distribution of DUP using quantile regression.

Results

The median DUP was 22 days (mean = 74 days) with considerable variations between and within the 31 hospital providers. We found evidence of significant inequalities regarding the level of socioeconomic deprivation. Patients living in the second, third and fourth deprived neighbourhood quintiles faced a 36, 24 and 31 day longer DUP than patients from the least deprived neighbourhoods. Inequalities were more prevalent in higher quantiles of the DUP distribution. Unemployment prolonged DUP by 40 days. Having been in contact with mental health care services prior to the psychosis start significantly reduced the DUP by up to 53 days.

Conclusions

Socioeconomic deprivation is an important factor in explaining inequalities in DUP. Policies to improve equitable access to care should particularly focus on preventing very long delays in treatment and target unemployed patients as well as people that have not been in contact with any mental health professional in the past.

Keywords

Duration of untreated psychosisDUPsocioeconomic inequalitiesaccess to careadministrative data
Type
Original Articles
Information
Psychological Medicine , Volume 48 , Issue 5 , April 2018 , pp. 822 - 833
Copyright
Copyright © Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Apeldoorn, SY, Sterk, B, van den Heuvel, ER, Schoevers, RA, Islam, MA, Bruggeman, R, Cahn, W, deHaan, L, Kahn, RS, Meijer, CJ, Myin-Germeys, I, van Os, J, Wiersma, D (2014). Factors contributing to the duration of untreated psychosis. Schizophrenia Research 158, 76–81.CrossRefGoogle Scholar
Behan, C, Cullinan, J, Kennelly, B, Turner, N, Owens, E, Lau, A, Kinsella, A, Clarke, M (2015). Estimating the cost and effect of early intervention on in-patient admission in first episode psychosis. The Journal of Mental Health Policy and Economics 18, 57–61.Google ScholarPubMed
Birchwood, M, Connor, C, Lester, H, Patterson, P, Freemantle, N, Marshall, M, Fowler, D, Lewis, S, Jones, P, Amos, T, Everard, L, Singh, SP (2013). Reducing duration of untreated psychosis: care pathways to early intervention in psychosis services. The British Journal of Psychiatry 203, 58–64.CrossRefGoogle ScholarPubMed
Breitborde, NJK, Srihari, VH, Woods, SW (2009). Review of the operational definition for first-episode psychosis. Early Intervention in Psychiatry 3, 259–265.CrossRefGoogle ScholarPubMed
Broussard, B, Kelley, ME, Wan, CR, Cristofaro, SL, Crisafio, A, Haggard, PJ, Myers, NL, Reed, T, Compton, MT (2013). Demographic, socio-environmental, and substance-related predictors of duration of untreated psychosis (DUP). Schizophrenia Research 148, 93–98.CrossRefGoogle ScholarPubMed
Cascio, MT, Cella, M, Preti, A, Meneghelli, A, Cocchi, A (2012). Gender and duration of untreated psychosis: a systematic review and meta-analysis. Early Intervention in Psychiatry 6, 115–127.CrossRefGoogle ScholarPubMed
Compton, MT, Gordon, TL, Weiss, PS, Walker, EF (2011). The ‘doses’ of initial, untreated hallucinations and delusions: a proof-of-concept study of enhanced predictors of first-episode symptomatology and functioning relative to duration of untreated psychosis. The Journal of Clinical Psychiatry 72, 1487–1493.CrossRefGoogle ScholarPubMed
Department of Health (2014). Achieving Better Access to Mental Health Services by 2020. Department of Health (https://www.gov.uk/government/publications/mental-health-services-achieving-better-access-by-2020). Accessed 21 March 2017.Google Scholar
Donoghue, K, Doody, GA, Murray, RM, Jones, PB, Morgan, C, Dazzan, P, Hart, J, Mazzoncini, R, MacCabe, JH (2014). Cannabis use, gender and age of onset of schizophrenia: data from the ÆSOP study. Psychiatry Research 215, 528–532.CrossRefGoogle ScholarPubMed
Doyle, R, Turner, N, Fanning, F, Brennan, D, Renwick, L, Lawlor, E, Clarke, M (2014). First-episode psychosis and disengagement from treatment: a systematic review. Psychiatric Services 65, 603–611.CrossRefGoogle ScholarPubMed
Drake, RJ, Haley, CJ, Akhtar, S, Lewis, SW (2000). Causes and consequences of duration of untreated psychosis in schizophrenia. The British Journal of Psychiatry 177, 511–515.CrossRefGoogle ScholarPubMed
Fridgen, GJ, Aston, J, Gschwandtner, U, Pflueger, M, Zimmermann, R, Studerus, E, Stieglitz, R-D, Riecher-Rössler, A (2013). Help-seeking and pathways to care in the early stages of psychosis. Social Psychiatry and Psychiatric Epidemiology 48, 1033–1043.CrossRefGoogle ScholarPubMed
Ghali, S, Fisher, HL, Joyce, J, Major, B, Hobbs, L, Soni, S, Chisholm, B, Rahaman, N, Papada, P, Lawrence, J, Bloy, S, Marlowe, K, Aitchison, KJ, Power, P, Johnson, S (2013). Ethnic variations in pathways into early intervention services for psychosis. The British Journal of Psychiatry 202, 277–283.CrossRefGoogle ScholarPubMed
Gronholm, PC, Thornicroft, G, Laurens, KR, Evans-Lacko, S (2017). Mental health-related stigma and pathways to care for people at risk of psychotic disorders or experiencing first-episode psychosis: a systematic review. Psychological Medicine 15, 1–13.Google Scholar
Guloksuz, S, Li, F, Tek, C, Woods, SW, McGlashan, TH, Frii, S, Srihari, VH (2016). Analyzing the duration of untreated psychosis: quantile regression. JAMA Psychiatry 73, 1094–1095.CrossRefGoogle ScholarPubMed
Gutacker, N, Cookson, R, Siciliani, L (2015). Waiting time prioritisation: evidence from England. CHE Research Paper 114, Centre For Health Economics, University of York.Google Scholar
Hosmer, DW, Lemeshow, S (2005). Assessing the fit of the model. In Applied Logistic Regression (ed. Hosmer, D. W., Lemeshow, S., Sturdivant, R. X.), pp. 143–202. New Jersey: John Wiley & Sons, Inc.Google Scholar
Johar, M, Jones, G, Keane, MP, Savage, E, Stavrunova, O (2013). Discrimination in a universal health system: explaining socioeconomic waiting time gaps. Journal of Health Economics 32, 181–194.CrossRefGoogle Scholar
Kaarboe, O, Carlsen, F (2014). Waiting times and socioeconomic status. Evidence from Norway. Health Economics 23, 93–107.CrossRefGoogle ScholarPubMed
Kirkbride, JB, Stubbins, C, Jones, PB (2012). Psychosis incidence through the prism of early intervention services. The British Journal of Psychiatry 200, 156–157.CrossRefGoogle ScholarPubMed
Large, M, Nielssen, O, Slade, T, Harris, A (2008). Measurement and reporting of the duration of untreated psychosis. Early Intervention in Psychiatry 2, 201–211.CrossRefGoogle ScholarPubMed
Larsen, TK, Melle, I, Auestad, B, Haahr, U, Joa, I, Johannessen, JO, Opjordsmoen, S, Rund, BR, Rossberg, JI, Simonsen, E, Vaglum, P, Friis, S, McGlashan, T (2011). Early detection of psychosis: positive effects on 5-year outcome. Psychological Medicine 41, 1461–1469.CrossRefGoogle Scholar
Laudicella, M, Siciliani, L, Cookson, R (2012). Waiting times and socioeconomic status: evidence from England. Social Science and Medicine 74, 1331–1341.CrossRefGoogle ScholarPubMed
Lindsay, CM, Feigenbaum, B (1984). Rationing by waiting lists. American Economic Review 74, 404–417.Google ScholarPubMed
Lloyd-Evans, B, Crosby, M, Stockton, S, Pilling, S, Hobbs, L, Hinton, M, Johnson, S (2011). Initiatives to shorten duration of untreated psychosis: systematic review. The British Journal of Psychiatry 198, 256–263.CrossRefGoogle ScholarPubMed
Marques, E, Noble, S, Blom, AW, Hollingworth, W (2014). Disclosing total waiting times for joint replacement: evidence from the English NHS using linked HES data. Health Economics 23, 806–820.CrossRefGoogle ScholarPubMed
Marshall, M, Lewis, S, Lockwood, A, Drake, R, Jones, P, Croudace, T (2005). Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Archives of General Psychiatry 62, 975–983.CrossRefGoogle ScholarPubMed
McLennan, D, Barnes, H, Noble, M, Davies, J, Garratt, E, Dibben, C (2011). The English Indices of Deprivation 2010. Department for Communities and Local Government (https://www.gov.uk/government/statistics/english-indices-of-deprivation-2010). Accessed 21 March 2017.Google Scholar
Morgan, C, Abdul-al, R, Lappin, JM, Jones, P, Fearon, P, Leese, M, Croudace, TIM, Morgan, K, Dazzan, P, Craig, TOM, Leff, J, Murray, R (2006). Clinical and social determinants of duration of untreated psychosis in the ÆSOP first-episode psychosis study. The British Journal of Psychiatry 189, 446–452.CrossRefGoogle ScholarPubMed
Nelder, JA, Wedderburn, RWM (1972). Generalized linear models. Journal of the Royal Statistical Society Series A 135, 370–384.CrossRefGoogle Scholar
NHS Digital (2017). Mental Health Services Data Set. NHS Digital (http://content.digital.nhs.uk/mhsds). Accessed 21 March 2017.Google Scholar
NHS England, NICE (2016). Implementing the Early Intervention in Psychosis Access and Waiting Time Standard: Guidance. NHS England, NICE (https://www.england.nhs.uk/mental-health/resources/access-waiting-time/). Accessed 21 March 2017.Google Scholar
Norman, RM, Malla, AK (2001). Duration of untreated psychosis: a critical examination of the concept and its importance. Psychological Medicine 31, 381–400.CrossRefGoogle ScholarPubMed
O'Donoghue, B, Lyne, JP, Renwick, L, Lane, A, Madigan, K, Staines, A, O'Callaghan, E, Clarke, M (2016). Neighbourhood characteristics and the incidence of first-episode psychosis and duration of untreated psychosis. Psychological Medicine 46, 1367–1378.CrossRefGoogle ScholarPubMed
Orrell, M, Yard, P, Handysides, J, Schapira, R (1999). Validity and reliability of the Health of the Nation Outcome Scales in psychiatric patients in the community. The British Journal of Psychiatry 174, 409–412.CrossRefGoogle ScholarPubMed
Penttilä, M, Jääskeläinen, E, Hirvonen, N, Isohanni, M, Miettunen, J (2014). Duration of untreated psychosis as predictor of long-term outcome in schizophrenia: systematic review and meta-analysis. The British Journal of Psychiatry 205, 88–94.CrossRefGoogle ScholarPubMed
Perkins, DO, Gu, H, Boteva, K, Lieberman, JA (2005). Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. The American Journal of Psychiatry 162, 1785–1804.CrossRefGoogle ScholarPubMed
Pregibon, D (1980). Goodness of link tests for generalized linear models. Journal of the Royal Statistical Society Series C 29, 15–14.Google Scholar
Propper, C (1995). The disutility of time spent on the United Kingdom's National Health Service waiting lists. The Journal of Human Resources 30, 677–700.CrossRefGoogle Scholar
Ramsey, JB (1969). Tests for specification errors in classical linear least-squares regression analysis. Journal of the Royal Statistical Society Series B 31, 350–371.Google Scholar
Register-Brown, K, Hong, LE (2014). Reliability and validity of methods for measuring the duration of untreated psychosis: a quantitative review and meta-analysis. Schizophrenia Research 160, 20–26.CrossRefGoogle ScholarPubMed
Revier, CJ, Reininghaus, U, Dutta, R, Fearon, P, Murray, RM, Doody, GA, Croudace, T, Dazzan, P, Heslin, M, Onyejiaka, A, Kravariti, E, Lappin, J, Lomas, B, Kirkbride, JB, Donoghue, K, Morgan, C, Jones, PB (2015). Ten-year outcomes of first-episode psychoses in the MRC ÆSOP-10 study. The Journal of Nervous and Mental Disease 203, 379–386.CrossRefGoogle ScholarPubMed
Shapiro, SS, Francia, RS (1972). An approximate analysis of variance test for normality. Journal of American Statistical Association 67, 215–216.CrossRefGoogle Scholar
Shapiro, SS, Wilk, MB (1965). An analysis of variance test for normality (complete samples). Biometrika 52, 591–611.CrossRefGoogle Scholar
Sharma, A, Siciliani, L, Harris, A (2013). Waiting times and socioeconomic status: does sample selection matter? Economic Modelling 33, 659–667.CrossRefGoogle Scholar
Siciliani, L (2016). Waiting times: evidence of social inequalities in access for care. In Data and Measures in Health Services Research (ed. Sobolev, B., Levy, A., Goring, S.), pp. 1–17. Springer US: Boston, MA, USA.Google Scholar
Singh, SP (2007). Outcome measures in early psychosis: relevance of duration of untreated psychosis. The British Journal of Psychiatry 191, s58–s63.CrossRefGoogle Scholar
Singh, SP, Cooper, JE, Fisher, HL, Tarrant, CJ, Lloyd, T, Banjo, J, Corfe, S, Jones, P (2005). Determining the chronology and components of psychosis onset: The Nottingham Onset Schedule (NOS). Schizophrenia Research 80, 117–130.CrossRefGoogle ScholarPubMed
Tang, JY, Chang, WC, Hui, CL, Wong, GH, Chan, SK, Lee, EH, Yeung, WS, Wong, CK, Tang, WN, Chan, WF, Pang, EP, Tso, S, Ng, RM, Hung, SF, Dunn, EL, Sham, PC, Chen, EY (2014). Prospective relationship between duration of untreated psychosis and 13-year clinical outcome: a first-episode psychosis study. Schizophrenia Research 153, 1–8.CrossRefGoogle ScholarPubMed
Tsiachristas, A, Thomas, T, Leal, J, Lennox, BR (2016). Economic impact of early intervention in psychosis services: results from a longitudinal retrospective controlled study in England. BMJ Open 6, e012611.CrossRefGoogle ScholarPubMed
Valmaggia, LR, Byrne, M, Day, F, Broome, MR, Johns, L, Howes, O, Power, P, Badger, S, Fusar-Poli, P, McGuire, PK (2015). Duration of untreated psychosis and need for admission in patients who engage with mental health services in the prodromal phase. The British Journal of Psychiatry 207, 130–134.CrossRefGoogle ScholarPubMed
White, C, Stirling, J, Hopkins, R, Morris, J, Montague, L, Tantam, D, Lewis, S (2009). Predictors of 10-year outcome of first-episode psychosis. Psychological Medicine 39, 1447–1456.CrossRefGoogle ScholarPubMed
Wing, JK, Beevor, AS, Curtis, RH, Park, SB, Hadden, S, Burns, A (1998). Health of the Nation Outcome Scales (HoNOS). Research and development. The British Journal of Psychiatry 172, 11–18.CrossRefGoogle ScholarPubMed
Supplementary material: File

Reichert and Jacobs supplementary material

Appendices 1-8

Download Reichert and Jacobs supplementary material(File)
File 57.3 KB