The period of untreated psychosis before treatment initiation: A qualitative study of family members' perspectives

Bergner, Erin; Leiner, Amy S.; Carter, Tandrea; Franz, Lauren; Thompson, Nancy J.; Compton, Michael T.

doi:10.1016/j.comppsych.2008.02.010

« Previous Next »Comprehensive Psychiatry
Volume 49, Issue 6 , Pages 530-536, November 2008

The period of untreated psychosis before treatment initiation:

A qualitative study of family members' perspectives

Erin Bergner
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health of Emory University, Atlanta, GA 30322, USA
Amy S. Leiner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA
Tandrea Carter
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA
Lauren Franz
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health of Emory University, Atlanta, GA 30322, USA
Nancy J. Thompson
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health of Emory University, Atlanta, GA 30322, USA
Michael T. Compton
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health of Emory University, Atlanta, GA 30322, USA
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA
- Corresponding author. Tel.: +1 404 778 1486; fax: +1 404 616 3241.

published online 18 April 2008.

Abstract

Aim

This study used a qualitative research methodology to explore common themes pertaining to the period of untreated psychosis before treatment initiation in hospitalized, urban, African American, first-episode psychosis patients.

Methods

Twelve family members of 10 patients were interviewed at length to gather detailed narrative accounts of factors related to untreated psychosis and treatment delay. Using qualitative analysis, verbatim transcripts were reviewed by 2 researchers to identify prominent themes useful for generating future research hypotheses.

Results

Four themes emerged as informative of the period of untreated psychosis before treatment initiation: (1) misattribution of symptoms or problem behaviors (eg, depression, drug use, and adolescent rebellion), (2) positive symptoms causing unusual or dangerous behaviors that served as a catalyst for initiating treatment, (3) views about personal autonomy of an adult or nearly adult patient, and (4) system-level factors (eg, unaffordability of health care and inefficiency on the part of health care providers).

Conclusions

Family members encountered numerous barriers when seeking treatment, including their own misattributions, the nature of the patient's symptoms, financial issues, and system-level delays. The themes uncovered in this formative analysis merit further exploration with additional qualitative and quantitative research.