Duration of Untreated Psychosis in the United States: A Scoping Review Focused on Equity

Background: Although many studies have assessed the relationship between duration of untreated psychosis (DUP) and schizophrenia outcomes, the relationship between sociodemographic variables and DUP remains unclear. Methods: I conducted a scoping review of research based in the United States that reported any measure of DUP in addition to at least one sociodemographic variable with the aim of describing deficiencies in the documentation of the role of structural racism in the context of DUP. A systematic search of PubMed, PsycInfo, and Cochrane Library from 1975 to April 2023 was performed. Results: Of 465 studies identified, 20 met inclusion criteria. Operationalization of DUP varied between studies in terms of both criteria for psychosis onset and DUP end point. Of 17 studies reporting racial/ethnic data, only 5 gathered the information using participant self-report. Sixteen studies included a measure of socioeconomic status. Ten studies analyzed for an association between any sociodemographic variable and DUP. Five studies subdivided DUP into “help-seeking” and “referral delay” components in order to ascertain effects of both individual behaviors and the systems-level service delivery on pathways to care. Conclusions: Current practices in early psychosis research are missing significant opportunities to examine and understand known disparities in mental health care access in the US. Recommendations for future research include: a focus on recruitment of ethnically and socioeconomically diverse study participants; collection of race/ethnicity data by participant self-report; clearly defining operationalization of DUP; and adoption of “help-seeking” and “referral delay” DUP classifications.Master of Public Healt