Pathways to care: Source of referral at first-episode psychosis, a cross-country comparison between Bologna and South London

Pathways to Care (PtC) are useful indicators of how patients access mental healthcare, especially in the context of first-episode psychosis (FEP). We explored how PtC: source of referral, is associated with patients' characteristics and clinical presentation and assessed the cross-country differences of the PtC predictors between South London and Bologna. This study included 427 FEP individuals in the context of the European Union Gene-Environment Interactions (EU-GEI) study. We performed multinomial logistic regression to test the associations between our outcome variables (PtC) and the independent study variables. In London, patients were more likely to be referred by GPs or specialists, while in Bologna, most patients followed the emergency route. Despite the study centre differences, older patients were more likely to be referred by GPs; patients referred informally and via specialist services were more likely to be single. Compared with emergency referrals, patients referred by GPs and specialists experienced a longer DUP. We found insufficient evidence of an association between symptoms profile and PtC. PtC characteristics of FEP patients were associated with several sociodemographic and DUP in both study centres. Our results highlight the importance of social networks and social services and public engagement, and public health initiatives (such as psychoeducation in schools and leisure centres) in easing help-seeking behaviours.