In Psychosis Time From Onset to Treatment Differs by Ethnoracial Group

Close up of young woman struggling from mental breakdown
Researchers investigated whether time from psychosis onset to treatment differs on the basis of ethnicity.

Time from psychosis onset to treatment differs on the basis of ethnicity, according to the results of a study published in JAMA Psychiatry.

Data for this study were sourced from the OnTrackNY database which comprises coordinated specialty care (CSC) information about patients with recent onset nonaffective psychosis who were cared for at 21 sites between 2013 and 2020 in the state of New York. Time from symptom onset to first contact and CSC initiation were evaluated on the basis of ethnicity.

The study cohort comprised 1726 individuals who were aged 16 to 30 years of which 73.2% were boys or men, 82.0% were living with their parents, 5.2% were homeless within 90 days of admission, and 61.2% lived in a metropolitan area. The patients were Black (n=604), Latinx (n=454), White (n=420), Asian (n=153), unknown (n=62), and multiracial (n=33).

Overall, the median time from onset to first contact was 28.0 days. Stratified by ethnicity, the shortest time to first contact was for White individuals (median, 17.0 days), followed by unknown (median, 28.5 days), Black (median, 30.0 days), Latinx (median, 30.0 days), multiracial (median, 32.0 days), and Asian (median, 34.0 days) individuals (P =.007).

The median time from first contact to CSC was 75.0 days. Stratified by ethnicity, the shortest time from first contact to CSC was for Asian individuals (median, 57.0 days), followed by Latinx (median, 62.0 days), multiracial (median, 71.0 days), Black (median, 76.0 days), unknown (median, 89.5 days), and White (median, 102.5 days) individuals (P <.001).

Stratified by time from symptom onset to CSC, 5 clusters of individuals were formulated. Cluster 1 had the shortest time from onset to CSC (median, 140.0 days) and comprised 34.6% of all patients who were Black (51%), Latinx (33%), Asian (12%), and White (0.2%). These patients tended to live in metropolitan areas and had the highest proportion of family referrals (78%), and psychiatric hospitalization as first contact (75.9%).

Cluster 5 (7.3%) had the longest latency time (median, 201.0 days) and was the oldest and had the highest proportion of Black individuals (63%) and those with homeless status (49%). This cluster was most likely to have the first encounter with law enforcement (11%) or referral from the criminal justice system (4%).

In general, the most advantaged clusters (2 and 3) had the shortest time between onset and first contact but the longest time from first contact to CSC. More disadvantaged clusters (4 and 5) had the longest time from onset to first contact.

This study may have included recall bias as data about symptom onset relied on family and patient recollection.

Study authors concluded, “In this cohort study of individuals with recent-onset psychosis, time-to-treatment outcomes differed by ethnoracial group and by empirically derived clusters combining multiple factors of social and clinical context. These findings underscore greater depth of understanding that may be gained through intersectional approaches. We demonstrated that onset to first contact and first contact to CSC pathways differed across ethnoracial group and intersectional clusters, supporting the position that future studies should include multiple time-to-treatment factors.”


van der Ven E, Jones N, Bareis N, et al. An intersectional approach to ethnoracial disparities in pathways to care among individuals with psychosis in coordinated specialty care. JAMA Psychiatry. 2022;79(8):790-798. doi:10.1001/jamapsychiatry.2022.1640