Rural-urban differences in accessing mental health treatment in patients with psychosis

Background: Delay in accessing psychiatric treatment has considerable influence on the outcome of psychoses. Systematic studies examining the source of the delay are lacking in India. In this article, we examine rural-urban differences regarding delay in accessing psychiatric care in patients with psychosis, an issue which was hitherto not studied. Aims: To evaluate the rural-urban differences in treatment seeking among patients with psychosis. Methods: Patients with psychotic disorders who presented to the outpatient department of an academic psychiatric institute for the first time (n=551) were interviewed using a semi-structured interview tool to assess the date of onset of illness. Results: Families in urban areas had significantly higher level of education and greater income than their rural counterparts. However, there was no difference in urban and rural patients in the duration of untreated illness (DUI). There was no correlation between average years of education of the family members and DUI (spearman's rho=-0.01; p=.77). Conclusions: Despite the proximity to psychiatric centers, better education and greater income, patients in urban areas do not access psychiatric care earlier than patients in rural areas. So, mere presence of services would not make patients access them early.