“TIME BETWEEN ONSET OF ILLNESS AND CONTACT WITH PSYCHIATRIST IN RURAL VS URBAN PATIENTS”
Main Article Content
Keywords
Psychiatric care delay, rural–urban disparity, mental illness, Pakistan, mental health services
Abstract
Background: Late access to psychiatric services is one of the significant health issues in society, especially in low- and middle-income nations. The disparities in the rural-urban access to mental health services, stigma, and accessibility may be a major factor contributing to the interval between the development of a psychiatric illness and the initial encounter with a psychiatrist.
Objective: The purpose of the study is to compare the gap between the onset of the psychiatric illness and the first psychiatric consultation of the rural and urban patients.
Methods and Materials: It was a cross-sectional study that was done at Department of Psychiatry, Khyber Teaching Hospital, Peshawar from January, 2025 to June, 2025. Patients in the first psychiatric visit were included as adults. A structured proforma was used to collect sociodemographic and clinical data, and the length of untreated illness was determined in months. The comparison between rural and urban groups was done by applying relevant statistical tests.
Results: Rural patients took a much longer period to seek psychiatric care than urban patients (14.8 vs 7.9 months, p<0.001). Delay was also longer with rural living, distance to hospital, and low educational level.
Conclusion: The delays in referral to psychiatric care are significant among rural patients, and special measures should be taken to increase the early use of mental health services.
References
2. Hung P, Probst JC, Shih Y, Ranganathan R, Brown MJ, Crouch E, Eberth JM. Rural–urban disparities in quality of inpatient psychiatric care. Psychiatric Services. 2023;74(5):446–454.
3. Sun CF, Correll CU, Trestman RL, Lin Y, Xie H, Hankey MS, Uymatiao RP, Patel RT, Metsutnan VL, McDaid EC, Saha A. Low availability, long wait times, and high geographic disparity of psychiatric outpatient care in the US. General Hospital Psychiatry. 2023;84:12–17.
4. Maxwell JM, Coleman JR, Breen G, Vassos E. Association between genetic risk for psychiatric disorders and the probability of living in urban settings. JAMA Psychiatry. 2021;78(12):1355–1364.
5. Lankila T, Laatikainen T, Wikström K, Linna M, Antikainen H. Association of travel time with mental health service use in primary health care according to contact type: a register-based study in Kainuu, Finland. BMC Health Services Research. 2022;22(1):1458.
6. Yang LH, Phillips MR, Li X, Yu G, Grivel MM, Zhang J, Shi Q, Ding Z, Pang S, Susser E. Determinants of never-treated status in rural versus urban contexts for individuals with schizophrenia in a population-based study in China. BMC Psychiatry. 2022;22(1):128.
7. Kvello-Alme M, Bråthen G, White LR, Sando SB. Time to diagnosis in young-onset Alzheimer’s disease: a population-based study from central Norway. Journal of Alzheimer’s Disease. 2021;82(3):965–974.
8. Lin L, Zhang L, Kim HM, Frost MC. Impact of COVID-19 telehealth policy changes on buprenorphine treatment for opioid use disorder. American Journal of Psychiatry. 2022;179(10):740–747.
9. Newbury JB, Stewart R, Fisher HL, Beevers S, Dajnak D, Broadbent M, Pritchard M, Shiode N, Heslin M, Hammoud R, Hotopf M. Association between air pollution exposure and mental health service use among individuals with first presentations of psychotic and mood disorders: a retrospective cohort study. The British Journal of Psychiatry. 2021;219(6):678–685.
10. Kaur A, Kallakuri S, Mukherjee A, Wahid SS, Kohrt BA, Thornicroft G, Maulik PK. Mental health-related stigma, service provision, and utilization in Northern India: a situational analysis. International Journal of Mental Health Systems. 2023;17(1):10.
11. Deng M, Zhai S, Ouyang X, Liu Z, Ross B. Factors influencing medication adherence among patients with severe mental disorders from the perspective of mental health professionals. BMC Psychiatry. 2022;22(1):22.
12. Raghavan R, Brown B, Horne F, Kumar S, Parameswaran U, Ali AB, Raghu A, Wilson A, Svirydzenka N, Venkateswaran C, Kumar M. Stigma and mental health problems in an Indian context: perceptions of people with mental disorders in urban, rural, and tribal areas of Kerala. International Journal of Social Psychiatry. 2023;69(2):362–369.
13. Babicki M, Małecka M, Kowalski K, Bogudzińska B, Piotrowski P. Stigma levels toward psychiatric patients among medical students: a worldwide online survey across 65 countries. Frontiers in Psychiatry. 2021;12:798909.
14. Moulaei K, Sheikhtaheri A, Fatehi F, Shanbehzadeh M, Bahaadinbeigy K. Patients’ perspectives and preferences toward telemedicine versus in-person visits: a mixed-methods study on 1226 patients. BMC Medical Informatics and Decision Making. 2023;23(1):261.
15. Kurdyak P, Gandhi S, Holder L, Rashid M, Saunders N, Chiu M, Guttmann A, Vigod S. Incidence of access to ambulatory mental health care prior to a psychiatric emergency department visit among adults in Ontario, 2010–2018. JAMA Network Open. 2021;4(4):e215902.
16. Fonseca Barbosa J, Gama Marques J. The revolving door phenomenon in severe psychiatric disorders: a systematic review. International Journal of Social Psychiatry. 2023;69(5):1075–1089.
17. Elsayed Ahmed B, Ibrahim Elmaleky M, Mahmoud Zaki M. Relationship between suicidal thoughts and positive symptoms among schizophrenic patients. Journal of Nursing Science Benha University. 2022;3(1):966–980.
18. Ghosh P, Balasundaram S, Sankaran A, Chandrasekaran V, Sarkar S, Choudhury S. Factors associated with medication non-adherence among patients with severe mental disorder: a cross-sectional study in a tertiary care centre. Exploratory Research in Clinical and Social Pharmacy. 2022;7:100178.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr Aziz Muhammad
Assistant Professor of Psychiatry, KMC/ KTH Peshawar
Dr Fatima
Senior Registrar, Jinnah Medical College & Jinnah Teaching Hospital, Peshawar
Dr Osama Akhtar
Postgraduate Resident, Hayatabad Medical Complex, Peshawar
Dr Muhammad Aamir Khan
Postgraduate Resident, Hayatabad Medical Complex, Peshawar
Dr Ala Orakzai
Postgraduate Resident, Hayatabad Medical Complex, Peshawar
