Table 2: Clinical Characteristics Treatment Delay and Pathways to Psychiatric Care among People with schizophrenia: Data from a Rural Psychiatric Center Anish V. Cherian1, Shishir Kumar1, Aneesh Bhat1, Santosh Prabhu1, Praveen A2, Divya Prabha D’Souza1, Shrinivasa Bhat U. 1, Naveen Chandra Shetty 3, Satheesh Rao1 1 K. S. Hegde Medical Academy, Nitte University, Mangalore, India, 2 Kasturba Medical College, Manipal, India 3 Nitte Rural Psychiatric Center, Nitte University, Nitte, India Email: anishvcherian@gmail.com INTRODUCTION METHODS ‘Duration of untreated psychosis’ (DUP) remains a major predictor of poor outcome among people with schizophrenia. Hence, reducing DUP remains a significant public health concern. There are studies from various low-middle income countries, demonstrating that large number of people with schizophrenia remain untreated in the community for a long time. However, there is paucity of data from rural India on DUP and its association with clinical factors and pathways to care. Sample: n = 106 Source of data: Nitte Rural Psychiatric Center, Nitte, Karnataka, Jan 2014 – Apr 2015 Criteria: Primary diagnosis of International Classification of Disorders (ICD-10) criteria for schizophrenia Assessment Tools: Socio-demographic proforma, World Health Organization (WHO) Encounter Form, Positive and Negative Symptom Scale (PANSS) and Indian Disability Evaluation and Assessment Scale (IDEAS) Outcome measures: ‘Duration of Untreated Psychosis’ was evaluated by measuring duration between onset of first psychotic symptom to the first contact of psychiatrist. RESULTS Table 3: onset related information Table 1: Demographic characteristics Variable Mean (SD) Age of onset of illness (in years) 27.09 ± 12.25 Age of first psychiatric consultation (in years) 31.34 ± 12.76 Duration of Illness (in years) 10.93 ± 9.59 Duration of Untreated Psychosis (DUP) (in years) Mean Median Minimum – maximum DUP 4.44 ± 6.87 2 15 Days to 34 years First gateway of care provider Native/religious healer Medical Practitioner Psychiatrist 91 (85.8) 5 (4.7) 10 (9.4) Variable Mean (SD) / N (%) Age (in years) 38.73 ± 13.08 Female 57 (53.8) Education (in years) 7.03 ± 4.32 Marital status Single Married Widow/er Separated 44 (41.5) 48 (45.3) 7 (6.6) Hindu 94 (88.7) Rural background 99 (93.4) Nuclear family structure 74 (69.8) Employment Homemaker Employed (full time or part time) Unemployed 46 (43.4) 22 (20.8) 37 (35.0) Monthly family income Rs. 1000-2500 Rs. 2500-5000 Rs. 5000-10000 21 (19.8) Table 4: Linear Regression Analyses to identify predictors of longer duration of untreated psychosis (DUP) Predictor Variable Beta t p 95%CI (OR) Age of onset of illness -1.883 0.859 0.03 -3.597 – (-0.168) Summary of Results : The patients were predominantly young adults, female, from a rural and low-middle income background. The mean DUP was 4.44 ± 6.87 years. The longest time to contact was 34 years but 80% had a DUP shorter than 5 years. Earlier onset of illness was associated with longer DUP. It was seen that there were three gateways to care, with native/ faith healers being the most popular gateway of care (85.8%). Table 2: Clinical Characteristics Variable Mean (SD) PANSS Score Positive Negative Score General Score 72.02 ± 26.06 17.24 ± 7.17 19.02 ± 8.47 35.76 ± 13.40 IDEAS Score 8.69 ± 3.5 WHODAS Score 62.16 ± 29.30 Insight Score 10.29 ± 4.22 CONCLUSIONS In rural India, the people with schizophrenia usually takes longer time to seek psychiatric help after their first psychotic episodes compared with their urban counterparts. The results emphasize the essentiality of developing culturally acceptable early identification strategies such as improving mental health literacy and community based intervention for people with schizophrenia which has been found to be effective in reducing delay in reducing untreated duration of schizophrenia. in developed countries ACKNOLEDGEMENT This study was funded by the Nitte University Seed Grant to Dr. Anish V. Cherian. Dr. Anish V. Cherian also been support by Public Health Research Initiative (PHRI) Fellowship jointly awarded by Public Health Foundation of India, New Delhi and Department of Science & Technology (DST), New Delhi. REFERENCES 1. Mishra N, Nagpal SS, Chadda RK, Sood M. Help-seeking behavior of patients with mental health problems visiting a tertiary care centre in north India. Indian J Psychiatry 2011;53(3):234-8. 2. Al Fayez H, Lappin J, Murray R, Boydell J. Duration of untreated psychosis and pathway to care in Riyadh, Saudi Arabia. Early Interv Psychiatry. 2015 [Epub ahead of print]