Mental health-related stigma and pathways to care for people at risk of psychotic disorders or experiencing first-episode psychosis: a systematic review

Abstract

Background. Stigma associated with mental illness can delay or prevent help-seeking and service contact. Stigmarelated influences on pathways to care in the early stages of psychotic disorders have not been systematically examined.Method. This review systematically assessed findings from qualitative, quantitative and mixed-methods research studies on the relationship between stigma and pathways to care (i.e. processes associated with help-seeking and health service contact) among people experiencing first-episode psychosis or at clinically defined increased risk of developing psychotic disorder. Forty studies were identified through searches of electronic databases (CINAHL, EMBASE, Medline, PsycINFO, Sociological Abstracts) from 1996 to 2016, supplemented by reference searches and expert consultations. Data synthesis involved thematic analysis of qualitative findings, narrative synthesis of quantitative findings, and a meta-synthesis combining these results.Results. The meta-synthesis identified six themes in relation to stigma on pathways to care among the target population: 'sense of difference', 'characterizing difference negatively', 'negative reactions (anticipated and experienced)', 'strategies', 'lack of knowledge and understanding', and 'service-related factors'. This synthesis constitutes a comprehensive overview of the current evidence regarding stigma and pathways to care at early stages of psychotic disorders, and illustrates the complex manner in which stigma-related processes can influence help-seeking and service contact among first-episode psychosis and at-risk groups.Conclusions. Our findings can serve as a foundation for future research in the area, and inform early intervention efforts and approaches to mitigate stigma-related concerns that currently influence recognition of early difficulties and contribute to delayed help-seeking and access to care.

The impact of waiting time on patient outcomes: Evidence from early intervention in psychosis services in England

“…DUP has been criticised in its suitability to measure service effectiveness as definitions vary considerably across studies and are prone to a self-report bias by patients (Norman & Malla, 2001;Register-Brown & Hong, 2014;Singh, 2007). Our waiting time measure allows us to investigate the impact of delays within the care system rather than the help-seeking behaviour of patients (Gronholm, Thornicroft, , & Evans-Lacko, 2017). Second, we consider treatment intensity during the time of follow-up.…”

Stigma and access to care in first‐episode psychosis

“…A small number of studies have assessed this relationship specifically in first-episode psychosis (FEP), with a substantial proportion of literature being qualitative (Anderson, Fuhrer, & Malla, 2013;Chen, Gearing, DeVylder, & Oh, 2014;Connor et al, 2016;Ferrari et al, 2015;Stewart, 2013;Welsh & Tiffin, 2012). A recent systematic review of mental-health stigma and pathways to care in FEP or at-risk populations revealed only nine quantitative articles with no study exploring the relationship between stigma and help-seeking from a patient perspective in FEP (Gronholm, Thornicroft, Laurens, & Evans-Lacko, 2017). Much of the literature was found to focus on family members or carers viewpoints (Compton & Esterberg, 2005) or on atrisk populations (Rüsch & Thornicroft, 2014;Xu et al, 2016).…”

Altered States of Consciousness: Evaluation of a voice‐hearing simulation during an immersive art exhibition

“…A cross-national analysis of over 30 000 people found 1 in 20 adults report "psychotic-like" experiences, such as hearing voices (McGrath et al, 2015) while, in children, a larger proportion have such subclinical experiences (Fisher et al, 2013;Garralda, 2016). Data from mental health campaigns in England reveal that psychosis is challenging to destigmatize (Evans-Lacko, Corker, Williams, Henderson, & Thornicroft, 2014) and stigma is associated with poor outcomes for individuals with psychosis (Gronholm, Thornicroft, Laurens, & Evans-Lacko, 2017). However, a recent systematic review of definitions and assessments revealed psychotic experiences to be variously defined (Lee et al, 2016), and a recent British Psychological Society report aimed to normalize otherwise pathologized experiences such as voice hearing by highlighting a continuum of culturally varied ways that people interpret human experiences (Cooke, 2014).…”