Ethnic Variations in Pathways to Care in North Carolina, United States 
Creators: name: Ojo, Enioluwafe
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2020

description: Background 
“Pathway to Care (PtC)” is the term used to describe the onset of psychiatric illness until the initiation of treatment or defined endpoint. Mapping patients’ PtC is critical for understanding how to improve early recognition and treatment of mental disorders. However, little is known about the pathways to care among individuals experiencing first-episode psychosis in the United States. The few studies that have investigated pathways in the United States have not commented on ethnic variations within pathways. 
Objective 
This study's objective was to describe the ethnic variations in the pathway to care among first-episode psychosis individuals by using patients’ narratives as elicited by interviews with them. My hypotheses were that self-reported race is associated with differences in number of help-seeking events prior to psychotic diagnosis and specific differences in external (i.e. not self-motivated) pathways to care for patients experiencing psychotic episodes. 
Methods
All interviews were conducted by two masters-level clinicians who had clinical experience treating first-episode psychosis under the supervision of the second reader of this paper. The duration of undiagnosed psychosis was calculated from the date of the onset of psychosis to time of diagnosis. The subject was given a psychotic disorder diagnosis. Here, I am conducting a secondary analysis of these data.
Results
The study comprised 167 patients, 108 identified as Caucasian, 33 identified as African American, and 7 identified as interracial. Nine participants identified as Asian: East Asian, Southeast Asia, and South Asian. Three participants identified as First Nations, 1 was Central/South American, and 1 was Native Hawaiian or Pacific Islander. Each ethnic group was assigned a numerical label. I performed a statistical analysis that showed that the Black group (Ethnic group 5) had significantly more “reported events, ” (i.e. help-seeking episodes motivated by the patient or others) than did the Caucasian group (Ethnic group 8), but I found no other difference in means between ethnic groups was statically significant (p < 0.05). I report that Black participants were noticed by peers at half the expected rate via chi-squared analysis assuming equal likelihood of report across races. Black participants had a total of 3 “noted events” by peers compared to the statistically expected 7, while white patients were reported by their peers at twice the expected rate. Additionally, I report that black patients were reported by the general public 10 times, though 4 were expected statistically, while white patients were reported 6 times despite an expected 11 reports.
Significance 
Black patients were more likely to have increased help-seeking events but were less likely to have those events initiated by close peers while being more likely to be noticed by the general public for those events than were their white counterparts. However, black individuals both have less access to care and are less likely to seek it. These may indicate inherent biases that may influence the access to and quality of care that black patients may receive if further biases are found as it relates to how care is administered based on differing pathways.