Importance Intersecting factors of social position including ethnoracial background may provide meaningful ways to understand disparities in pathways to care for people with a first episode of psychosis. Objective To examine differences in pathways to care by ethnoracial groups and by empirically derived clusters combining multiple factors of social and clinical context in an ethnoracially diverse multisite early-intervention service program for first-episode psychosis. Design, Setting, and Participants This cohort study used data collected on individuals with recent-onset psychosis (<2 years) by clinicians with standardized forms from October 2013 to January 2020 from a network of 21 coordinated specialty care (CSC) programs in New York State providing recovery-oriented, evidence-based psychosocial interventions and medications to young people experiencing early psychosis. Exposures Ethnoracial group and other factors of social position (eg, insurance status, living situation, English fluency, geographic region) intersecting with first-contact experiences (ie, type of first service, referral source, and symptoms at referral). Main Outcomes and Measures Outcome measures were time from onset to first contact, first contact to CSC, and onset to CSC. Results The total study sample consists of 1726 individuals aged 16 to 30 years and included 452 women (26%), 1263 men (73%), and 11 (<1%) with another gender enrolled in the network of CSC programs. The total sample consisted of 153 Asian (9%), 599 Black (35%), 454 Latinx (26%), and 417 White individuals (24%). White individuals had a significantly shorter time from onset to first contact (median [IQR], 17 [0-80] days) than Asian (median [IQR], 34 [7-94] days) and Black (median [IQR], 30 [1-108] days) individuals but had the longest period from first contact to CSC (median [IQR], 102.5 [45-258] days). Five distinct clusters of individuals emerged that cut across ethnoracial groups. The more disadvantaged clusters in terms of both social position and first-contact experiences had the longest time from onset to first contact, which were longer than for any single ethnoracial group. Conclusions and Relevance 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. The examination of disparities in durations to treatment through an intersectional, ethnoracial lens may improve understanding of the inequities resulting from the various intersecting factors that may compound delays in treatment initiation.

中文翻译：

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协调专业护理中精神病患者护理途径中种族差异的交叉方法。


重要性 包括民族背景在内的社会地位的交叉因素可能提供有意义的方法来理解照顾首次精神病患者的途径差异。目的 在针对首发精神病的种族多样化多地点早期干预服务计划中，研究不同种族群体和结合社会和临床背景多种因素的经验得出的集群在护理途径上的差异。设计、设置和参与者 这项队列研究使用了临床医生从 2013 年 10 月至 2020 年 1 月从纽约 21 个协调专科护理 (CSC) 项目网络中以标准化表格收集的新发精神病患者（<2 年）的数据。国家为经历早期精神病的年轻人提供以康复为导向、基于证据的心理社会干预和药物治疗。暴露民族群体和其他社会地位因素（例如，保险状况、生活状况、英语流利程度、地理区域）与首次接触经历（即首次服务类型、转诊来源和转诊时的症状）的交叉。主要结果和措施 结果措施是从发病到首次接触的时间、首次接触 CSC 的时间以及发病到 CSC 的时间。结果 总研究样本由 1726 名 16 至 30 岁的个体组成，其中包括 452 名女性 (26%)、1263 名男性 (73%) 和 11 名 (<1%) 加入 CSC 项目网络的其他性别。总样本包括 153 名亚洲人 (9%)、599 名黑人 (35%)、454 名拉丁裔 (26%) 和 417 名白人 (24%)。 白人从发病到首次接触的时间（中位 [IQR]，17 [0-80] 天）明显短于亚洲人（中位 [IQR]，34 [7-94] 天）和黑人（中位 [IQR]， 30 [1-108] 天）个体，但从第一次接触到 CSC 的时间最长（中位 [IQR]，102.5 [45-258] 天）。出现了跨越种族群体的五个不同的个体群体。在社会地位和首次接触经历方面处于不利地位的群体从发病到首次接触的时间最长，比任何单一种族群体都要长。结论和相关性 在这项针对新发精神病患者的队列研究中，治疗时间结果因种族群体和结合社会和临床背景多种因素的经验得出的群体而异。通过交叉、民族的视角来检查治疗持续时间的差异，可以提高对各种交叉因素造成的不平等的理解，这些因素可能会导致治疗开始的延迟。