{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T20:46:48Z","timestamp":1789246008693,"version":"build-2803163510"},"reference-count":43,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-017"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-037"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-012"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-029"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-004"}],"funder":[{"DOI":"10.13039\/100012775","name":"Royal Melbourne Hospital","doi-asserted-by":"publisher","award":["PG-016-2015"],"award-info":[{"award-number":["PG-016-2015"]}],"id":[{"id":"10.13039\/100012775","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","epilepsybehavior.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Epilepsy & Behavior"],"published-print":{"date-parts":[[2026,3]]},"DOI":"10.1016\/j.yebeh.2025.110864","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T17:10:47Z","timestamp":1769101847000},"page":"110864","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":1,"special_numbering":"C","title":["Delay to diagnosis of epilepsy: A history of a psychiatric disorder and substance use is associated with prior seizures"],"prefix":"10.1016","volume":"176","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5532-9327","authenticated-orcid":false,"given":"Honor","family":"Coleman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0747-3877","authenticated-orcid":false,"given":"Genevieve","family":"Rayner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5799-5534","authenticated-orcid":false,"given":"K.Meng","family":"Tan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7518-564X","authenticated-orcid":false,"given":"Patrick W.","family":"Carney","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piero","family":"Perucca","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Kwan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7198-8621","authenticated-orcid":false,"given":"Terence J.","family":"O\u2019Brien","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4580-841X","authenticated-orcid":false,"given":"Samuel F.","family":"Berkovic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne M.","family":"McIntosh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.yebeh.2025.110864_b0005","doi-asserted-by":"crossref","first-page":"1494","DOI":"10.1111\/epi.16929","article-title":"Missed, mistaken, stalled: Identifying components of delay to diagnosis in epilepsy","volume":"62","author":"Alessi","year":"2021","journal-title":"Epilepsia"},{"issue":"1","key":"10.1016\/j.yebeh.2025.110864_b0010","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1111\/epi.12479","article-title":"Diagnostic delays in children with early onset epilepsy: impact, reasons, and opportunities to improve care","volume":"55","author":"Berg","year":"2014","journal-title":"Epilepsia"},{"issue":"4","key":"10.1016\/j.yebeh.2025.110864_b0015","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1046\/j.1528-1157.2001.31400.x","article-title":"Newly diagnosed unprovoked epileptic seizures: presentation at diagnosis in CAROLE study. Coordination active du Reseau Observatoire Longitudinal de l' Epilepsie","volume":"42","author":"Jallon","year":"2001","journal-title":"Epilepsia"},{"issue":"10","key":"10.1016\/j.yebeh.2025.110864_b0020","doi-asserted-by":"crossref","first-page":"1534","DOI":"10.1111\/epi.13127","article-title":"Mind the gap: Multiple events and lengthy delays before presentation with a \u201cfirst seizure\u201d","volume":"56","author":"Firkin","year":"2015","journal-title":"Epilepsia"},{"issue":"12","key":"10.1016\/j.yebeh.2025.110864_b0025","doi-asserted-by":"crossref","first-page":"2643","DOI":"10.1111\/epi.16707","article-title":"Focal nonmotor versus motor seizures: the impact on diagnostic delay in focal epilepsy","volume":"61","author":"Pellinen","year":"2020","journal-title":"Epilepsia"},{"issue":"6","key":"10.1016\/j.yebeh.2025.110864_b0030","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.1111\/j.1528-1167.2007.01018.x","article-title":"Diagnostic inaccuracy in children referred with \u201cfirst seizure\u201d: role for a first seizure clinic","volume":"48","author":"Hamiwka","year":"2007","journal-title":"Epilepsia"},{"issue":"4","key":"10.1016\/j.yebeh.2025.110864_b0035","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1002\/epi4.12443","article-title":"Impact of diagnostic delay on seizure outcome in newly diagnosed focal epilepsy","volume":"5","author":"Parviainen","year":"2020","journal-title":"Epilepsia Open"},{"key":"10.1016\/j.yebeh.2025.110864_b0040","doi-asserted-by":"crossref","DOI":"10.1016\/j.yebeh.2022.108960","article-title":"Comorbidities in newly diagnosed epilepsy: Pre-existing health conditions are common and complex across age groups","volume":"138","author":"McIntosh","year":"2023","journal-title":"Epilepsy Behav"},{"key":"10.1016\/j.yebeh.2025.110864_b0045","unstructured":"Royal Australian and New Zealand College of Psychiatrists (RANZCP). Keeping body and mind together. Improving the physical health and life expectancy of people with serious mental illness; 2015."},{"issue":"2","key":"10.1016\/j.yebeh.2025.110864_b0050","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1080\/09595230500102434","article-title":"Stigma, social inequality and alcohol and drug use","volume":"24","author":"Room","year":"2005","journal-title":"Drug Alcohol Rev"},{"key":"10.1016\/j.yebeh.2025.110864_b0055","series-title":"Evidence Review: the social determinents of inequities in alcohol consumption and alcohol-related health outcomes","author":"Roche","year":"2015"},{"issue":"1","key":"10.1016\/j.yebeh.2025.110864_b0060","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1002\/epi4.12460","article-title":"Newly diagnosed seizures assessed at two established first seizure clinics: Clinic characteristics, investigations, and findings over 11 years","volume":"6","author":"McIntosh","year":"2021","journal-title":"Epilepsia Open"},{"key":"10.1016\/j.yebeh.2025.110864_b0065","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.seizure.2022.02.004","article-title":"Diagnostic delay in focal epilepsy: Association with brain pathology and age","volume":"96","author":"Yang","year":"2022","journal-title":"Seizure"},{"issue":"4","key":"10.1016\/j.yebeh.2025.110864_b0070","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1111\/j.1528-1167.2009.02285.x","article-title":"Recommendation for a definition of acute symptomatic seizure","volume":"51","author":"Beghi","year":"2010","journal-title":"Epilepsia"},{"key":"10.1016\/j.yebeh.2025.110864_b0075","unstructured":"World Health Organisation (WHO). International Classification of Diseases and Related Health Problems 10th Revision. Chapter V Mental and behavioral disorders due to psychoactive substance use. 2019."},{"key":"10.1016\/j.yebeh.2025.110864_b0080","unstructured":"Australian Bureau of Statistics. Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA), Australia, Data only, 2006. In: Statistics ABo, editor.: Australian Bureau of Statistics; 2006."},{"key":"10.1016\/j.yebeh.2025.110864_b0085","unstructured":"StataCorp. Stata Statistical Software: Release 16. College Station, Texas: StataCorp LLC; 2019."},{"key":"10.1016\/j.yebeh.2025.110864_b0090","series-title":"Applied Logistic Regression","author":"Hosmer","year":"2000"},{"issue":"5","key":"10.1016\/j.yebeh.2025.110864_b0095","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1080\/09602010500231875","article-title":"Traumatic brain injury and substance misuse: a systematic review of prevalence and outcomes research (1994\u20132004)","volume":"16","author":"Parry-Jones","year":"2006","journal-title":"Neuropsychol Rehabil"},{"issue":"4","key":"10.1016\/j.yebeh.2025.110864_b0100","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1093\/alcalc\/agh159","article-title":"Alcohol intake and the pattern of trauma in young adults and working aged people admitted after trauma","volume":"40","author":"Savola","year":"2005","journal-title":"Alcohol and Acoholism"},{"issue":"7","key":"10.1016\/j.yebeh.2025.110864_b0105","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1111\/j.1528-1167.2009.02426.x","article-title":"Alcohol consumption, unprovoked seizures, and epilepsy: a systematic review and meta-analysis","volume":"51","author":"Samokhvalov","year":"2010","journal-title":"Epilepsia"},{"issue":"2","key":"10.1016\/j.yebeh.2025.110864_b0110","first-page":"135","article-title":"The risks associated with alcohol use and alcoholism","volume":"34","author":"Rehm","year":"2011","journal-title":"Alcohol Res Health"},{"issue":"1","key":"10.1016\/j.yebeh.2025.110864_b0115","doi-asserted-by":"crossref","first-page":"18","DOI":"10.3174\/ng.1800018","article-title":"Neuroimaging of substance abuse","volume":"9","author":"Naveed","year":"2019","journal-title":"Neurographics"},{"issue":"1","key":"10.1016\/j.yebeh.2025.110864_b0120","first-page":"13","article-title":"Alcoholic epilepsy: a unified and dynamic classification","volume":"37","author":"Bartolomei","year":"1997","journal-title":"Eur Neurol"},{"issue":"20","key":"10.1016\/j.yebeh.2025.110864_b0125","doi-asserted-by":"crossref","DOI":"10.1212\/WNL.0000000000207212","article-title":"Premature Mortality and Causes of death among people with Epilepsy: a Nationwide Population-based Incident Cohort Study","volume":"100","author":"Moon","year":"2023","journal-title":"Neurology"},{"issue":"7","key":"10.1016\/j.yebeh.2025.110864_b0130","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1097\/MLR.0000000000001541","article-title":"Markers of Quality Care for Newly Diagnosed People with Epilepsy on Medicaid","volume":"59","author":"Bensken","year":"2021","journal-title":"Med Care"},{"issue":"9","key":"10.1016\/j.yebeh.2025.110864_b0135","doi-asserted-by":"crossref","first-page":"2036","DOI":"10.1111\/epi.16996","article-title":"Adult onset epilepsy is defined by phenotypic clusters with unique comorbidities and risks of death","volume":"62","author":"Josephson","year":"2021","journal-title":"Epilepsia"},{"key":"10.1016\/j.yebeh.2025.110864_b0140","article-title":"Alcohol-specific Mortality in people with Epilepsy: Cohort Studies in two Independent Population-based Datasets","volume":"11","author":"Gorton","year":"2020","journal-title":"Front Neurol"},{"issue":"1","key":"10.1016\/j.yebeh.2025.110864_b0145","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.ijcard.2003.04.059","article-title":"Prehospital delay in acute coronary syndrome\u2013an analysis of the components of delay","volume":"96","author":"Ottesen","year":"2004","journal-title":"Int J Cardiol"},{"issue":"4","key":"10.1016\/j.yebeh.2025.110864_b0150","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1111\/acem.14114","article-title":"The Impact of Clinical Seizure Characteristics on Recognition and Treatment of New-onset Focal Epilepsy in Emergency Departments","volume":"28","author":"Pellinen","year":"2021","journal-title":"Acad Emerg Med"},{"issue":"10","key":"10.1016\/j.yebeh.2025.110864_b0155","doi-asserted-by":"crossref","DOI":"10.1212\/WNL.0000000000209389","article-title":"Unrecognized Focal Nonmotor Seizures in Adolescents Presenting to Emergency Departments","volume":"102","author":"Jandhyala","year":"2024","journal-title":"Neurology"},{"issue":"Suppl 1","key":"10.1016\/j.yebeh.2025.110864_b0160","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1111\/j.1528-1167.2008.01444.x","article-title":"Risk of recurrence after a first unprovoked seizure","volume":"49","author":"Berg","year":"2008","journal-title":"Epilepsia"},{"issue":"9905","key":"10.1016\/j.yebeh.2025.110864_b0165","doi-asserted-by":"crossref","first-page":"1646","DOI":"10.1016\/S0140-6736(13)60899-5","article-title":"Premature mortality in epilepsy and the role of psychiatric comorbidity: a total population study","volume":"382","author":"Fazel","year":"2013","journal-title":"Lancet"},{"issue":"1","key":"10.1016\/j.yebeh.2025.110864_b0170","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1093\/brain\/awac042","article-title":"Cause-specific mortality and life years lost in people with epilepsy: a danish cohort study","volume":"146","author":"Dreier","year":"2023","journal-title":"Brain"},{"issue":"8","key":"10.1016\/j.yebeh.2025.110864_b0175","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1212\/WNL.0000000000002390","article-title":"Cause of death and predictors of mortality in a community-based cohort of people with epilepsy","volume":"86","author":"Keezer","year":"2016","journal-title":"Neurology"},{"issue":"4","key":"10.1016\/j.yebeh.2025.110864_b0180","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1590\/S0004-282X2009000600008","article-title":"Alcohol consumption and sudden unexpected death in epilepsy: experimental approach","volume":"67","author":"Scorza","year":"2009","journal-title":"Arq Neuropsiquiatr"},{"issue":"4","key":"10.1016\/j.yebeh.2025.110864_b0185","doi-asserted-by":"crossref","DOI":"10.1212\/WNL.0000000000008741","article-title":"Clinical risk factors in SUDEP: a nationwide population-based case-control study","volume":"94","author":"Sveinsson","year":"2020","journal-title":"Neurology"},{"issue":"12","key":"10.1016\/j.yebeh.2025.110864_b0190","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1111\/j.1528-1157.1999.tb01587.x","article-title":"Incidence of epileptic syndromes in Rochester, Minnesota: 1980-1984","volume":"40","author":"Zarrelli","year":"1999","journal-title":"Epilepsia"},{"issue":"1","key":"10.1016\/j.yebeh.2025.110864_b0195","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.1528-1157.1975.tb04721.x","article-title":"The epidemiology of epilepsy in Rochester, Minnesota, 1935 through 1967","volume":"16","author":"Hauser","year":"1975","journal-title":"Epilepsia"},{"issue":"6","key":"10.1016\/j.yebeh.2025.110864_b0200","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1111\/j.1528-1167.2005.51204.x","article-title":"Gender differences in epilepsy","volume":"46","author":"Christensen","year":"2005","journal-title":"Epilepsia"},{"issue":"8","key":"10.1016\/j.yebeh.2025.110864_b0205","doi-asserted-by":"crossref","first-page":"2144","DOI":"10.1093\/brain\/awx129","volume":"140","year":"2017","journal-title":"Brain"},{"issue":"11","key":"10.1016\/j.yebeh.2025.110864_b0210","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1056\/NEJM198809153191102","article-title":"Alcohol consumption and withdrawal in new-onset seizures","volume":"319","author":"Stephen","year":"1988","journal-title":"N Engl J Med"},{"issue":"4","key":"10.1016\/j.yebeh.2025.110864_b0215","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/heapro\/dap037","article-title":"Alcohol use and related harms in school students in the USA and Australia","volume":"24","author":"Toumbourou","year":"2009","journal-title":"Health Promot Int"}],"container-title":["Epilepsy & Behavior"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1525505025006043?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1525505025006043?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,6,21]],"date-time":"2026-06-21T11:32:40Z","timestamp":1782041560000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1525505025006043"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":43,"alternative-id":["S1525505025006043"],"URL":"https:\/\/doi.org\/10.1016\/j.yebeh.2025.110864","relation":{},"ISSN":["1525-5050"],"issn-type":[{"value":"1525-5050","type":"print"}],"subject":[],"published":{"date-parts":[[2026,3]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Delay to diagnosis of epilepsy: A history of a psychiatric disorder and substance use is associated with prior seizures","name":"articletitle","label":"Article Title"},{"value":"Epilepsy & Behavior","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.yebeh.2025.110864","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.","name":"copyright","label":"Copyright"}],"article-number":"110864"}}