Help-seeking in people with early psychosis: a systematic review of the qualitative literature and novel model of facilitators and barriers

Abstract

Background: Reducing duration of untreated psychosis (DUP) is a priority for mental health services worldwide. Delayed help-seeking leads to prolonged DUP which is associated with poorer healthcare outcomes. Methods: Most of the research in this area is qualitative. We conducted an electronic search of relevant databases (MEDLINE, APA PsycArticles, APA PsycINFO, and CINAHL) using terms for early psychosis, help-seeking and qualitative analyses. Following best practice guidelines for reviews of qualitative research, we extracted and thematically synthesised data from all included articles. Results: The search yielded thirty papers. Synthesis of the results generated five domains of facilitators and barriers to help-seeking: (a) knowledge of psychosis and services; (b) role of family and friends; (c) stigma of psychosis and help-seeking; (d) relationship with clinicians; and (e) experience of services. Conclusion: This is the first systematic review of the qualitative research examining first person accounts of help-seeking in high risk and first episode psychosis. We integrate these findings with an established theory of help-seeking to generate a novel model of help-seeking in early psychosis that can now be used to predict engagement and disengagement from services, and shape routine clinical practice to reduce DUP.

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