Understanding the influence of childhood adversity on pathways to care in first episode psychosis.

Canny, Hannah (2023) Understanding the influence of childhood adversity on pathways to care in first episode psychosis. Doctoral thesis, University of East Anglia.

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Abstract

Background
Early intervention is vital to improve treatment outcomes in individuals experiencing mental health difficulties (MHD), and particularly in those experiencing first episode psychosis (FEP). Research has sought to identify factors that impact upon pathways to care (PtC) to reduce barriers that result in treatment delays. Childhood adversity (CA) is a factor widely associated with increased risks of experiencing MHD, yet its impact on PtC is less known. This thesis aimed to explore the impact of CA on PtC and help-seeking behaviours for MHD and more specifically in FEP.

Methods
A systematic review exploring the relationship between CA and help-seeking for different MHD was conducted, analysed using narrative analysis. A quantitative study to examine associations between CA and PtC during FEP was carried out using data collected from adults presenting to services in two London boroughs between 2010-2012 (N=558). Data were analysed using Chi-square, t- and Kruskal-Wallis tests, and regression analyses.

Results
Twelve studies were included in the systematic review. Overall findings suggested links between CA and help-seeking behaviours, but mixed evidence of the direction of impact. Some studies reported CA as a barrier to help-seeking, while others suggested that it increased help-seeking behaviours. The impact of CA was not shown to vary across differing mental health presentations. Findings of this review were cautioned due to the heterogeneity of the papers included. The empirical study findings indicated that individuals with records of CA were more likely to experience longer duration of untreated psychosis (DUP), insidious onset of psychosis and have previous service use. These factors were also associated with number of CAs experienced. Younger and female individuals were found as more likely to have CA records.

Conclusions
The findings indicated that experiences of CA can influence PtC, in FEP and MHD more widely. It remains unclear as to whether CA acts as a facilitator or barrier to help-seeking during MHD, although in FEP, the results showed that it can lead to delays to receiving care and higher service use. Research in these areas was found to be limited, warranting further exploration of the role CA plays in PtC for MHD to help inform care pathways and increase opportunities for early intervention.

Item Type:	Thesis (Doctoral)
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User:	Chris White
Date Deposited:	07 Nov 2023 09:29
Last Modified:	07 Nov 2023 09:29
URI:	https://ueaeprints.uea.ac.uk/id/eprint/93585
DOI:

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