Factors Associated with Delayed Presentation Among Patients with First-Episode Psychosis in Bangladesh

Open Access

Abstract

Introduction: First-episode psychosis is a critical stage in the course of psychotic disorders, and timely initiation of treatment is associated with better clinical and functional outcomes. In Bangladesh, evidence regarding the determinants of delayed presentation in first-episode psychosis remains limited. Therefore, this study aims to assess the factors associated with delayed presentation among patients with first-episode psychosis in Bangladesh. Methods & Materials: This observational analytical cross-sectional study was conducted among patients with first-episode psychosis attending the Department of Psychiatry in Combined Military Hospital, Dhaka, Bangladesh, from January 2022 to December 2022. A total of 104 patients fulfilling the diagnostic criteria for first-episode psychosis were included using purposive sampling. Data were analyzed using SPSS version 26.0. Results: 64 (61.5%) had delayed presentation to psychiatric services, with a median duration of untreated psychosis of 9 months (IQR 4-16 months). Most patients were 25-34 years old (44.2%), male (59.6%), from rural areas (63.5%), and had schizophrenia-spectrum disorders (71.2%). Traditional or religious healers were the most common first source of help (40.4%), while stigma (34.6%) and lack of awareness (28.8%) were the leading perceived barriers. Delayed presentation was significantly associated with rural residence (75.8% vs 36.8%, p=0.001), primary or lower education (76.5%, p=0.015), unemployment (73.1%, p=0.026), insidious onset of symptoms (85.0%, p<0.001), first consultation with traditional or religious healers (81.0%, p<0.001), and perceived stigma (83.3% vs 50.0%, p=0.002), whereas substance use showed no significant association (p=0.397). Conclusion: This study found that delayed presentation was frequent among patients with first-episode psychosis in Bangladesh, with almost two-thirds not receiving treatment within six months of symptom onset. Longer delays were significantly linked to rural residence, lower levels of education, unemployment, gradual onset of symptoms, first seeking care from traditional or religious healers, and the presence of stigma related to mental illness.