{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T05:44:42Z","timestamp":1792215882950,"version":"4.4.0"},"reference-count":39,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/T040378\/1"],"award-info":[{"award-number":["MR\/T040378\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100020171","name":"Foreign, Commonwealth and Development Office","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100020171","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Early Intervention Psych"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Prolonged delay between the onset of the first episode of psychosis (FEP) and initiation of treatment is common in lower\u2010 and middle\u2010income countries (LMICs), including Pakistan. This qualitative study explored perspectives of young persons with FEP, carers, healthcare professionals, and traditional and spiritual healers (TSHs) on drivers of delayed diagnosis and treatment of FEP, to suggest interventions aimed at addressing factors contributing to prolonged duration of untreated psychosis (DUP) in Pakistan and similar contexts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a qualitative study in Peshawar, Pakistan using focused ethnography as a research design. We first conducted focused ethnography using participant observation with 15 TSHs. Subsequently, data was collected through semi\u2010structured interviews (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200926) and focus group discussions (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20096) with FEP individuals (age 14\u201325), their carers, and healthcare professionals. We used framework analysis, combining inductive and deductive thematic approaches to analyse the data.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Three themes emerged from the analysis in relation to care pathways in psychosis: (1) moral\u2010spiritual explanations legitimise spiritual healings; (2) stigma renders psychiatric disclosure socially risky; and (3) structural exclusion of inaccessibility of mental health from primary care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Psychosis remains untreated for a prolonged time as families navigate a moral\u2010spiritual landscape that makes TSHs the only legitimate healers, stigma makes psychiatric disclosure a threat to family honour, and absent or dismissive services make biomedical care unreachable. Engagement with TSHs represents an underutilised opportunity to develop collaborative care models that reduce the duration of untreated psychosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/eip.70233","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T09:33:59Z","timestamp":1785836039000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Untreated Psychosis and Healthcare\u2010Seeking Behaviour in Pakistan: A Qualitative Study With Young People, Carers, Traditional Healers, and Healthcare Professionals"],"prefix":"10.1111","volume":"20","author":[{"given":"Noor","family":"Sanauddin","sequence":"first","affiliation":[{"name":"Department of Sociology University of Peshawar  Peshawar Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Dikomitis","sequence":"additional","affiliation":[{"name":"Warwick Medical School, University of Warwick  Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdul Jalil","family":"Khan","sequence":"additional","affiliation":[{"name":"Institute of Public Health &amp; Social Sciences, Khyber Medical University  Peshawar Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mian Mukhtar ul Haq","family":"Azeemi","sequence":"additional","affiliation":[{"name":"Lady Reading Hospital  Peshawar Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Firaz","family":"Khan","sequence":"additional","affiliation":[{"name":"Institute of Mental Health and Behavioural Sciences, Khyber Medical University  Peshawar Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saima","family":"Sheikh","sequence":"additional","affiliation":[{"name":"Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nishani","family":"Fonseka","sequence":"additional","affiliation":[{"name":"School of Medicine, Keele University  Newcastle\u2010under\u2010Lyme UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abbie","family":"Milner","sequence":"additional","affiliation":[{"name":"School of Medicine, Keele University  Newcastle\u2010under\u2010Lyme UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syed Muhammad Uzair","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Sociology University of Peshawar  Peshawar Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ishfaq Tariq","family":"Azeemi","sequence":"additional","affiliation":[{"name":"Institute of Public Health &amp; Social Sciences, Khyber Medical University  Peshawar Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shumaila","family":"Hamid","sequence":"additional","affiliation":[{"name":"Institute of Public Health &amp; Social Sciences, Khyber Medical University  Peshawar Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syeda Fatima","family":"Jamal","sequence":"additional","affiliation":[{"name":"Institute of Public Health &amp; Social Sciences, Khyber Medical University  Peshawar Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aimee","family":"Sargeant","sequence":"additional","affiliation":[{"name":"University Hospitals of North Midlands NHS Trust  Stoke\u2010on\u2010Trent UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saeed","family":"Farooq","sequence":"additional","affiliation":[{"name":"School of Medicine, Keele University  Newcastle\u2010under\u2010Lyme UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"Ahmad S.2018.\u201cUnleashing the Potential of a Young Pakistan. Retrieved From Human Development Reports.\u201dJuly 24.http:\/\/hdr.undp.org\/en\/content\/unleashing\u2010potential\u2010young\u2010pakistan."},{"issue":"1","key":"e_1_2_10_3_1","first-page":"28","article-title":"From Hostage to Host: The Spirit Possession, Mediumship, and Gender Relations in Chitral, Pakistan","volume":"4","author":"Ahmad Z.","year":"2023","journal-title":"Journal of Humanities, Social and Management Sciences"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amsu.2022.104755"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.55737\/qjss.717809184"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00127-014-0989-7"},{"key":"e_1_2_10_7_1","first-page":"108","volume-title":"Advancing Ethnography in Corporate Environments: Challenges and Emerging Opportunities","author":"Cefkin M.","year":"2013"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.3946\/kjme.2017.53"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.7748\/nr2013.03.20.4.36.e305"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/eip.12279"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbae025"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2009.01.008"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2023-072471"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1207\/s15327019eb0904_5"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.46743\/2160\u20103715\/2021.5011"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0277\u20109536(98)00163"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.5040\/9798216422891"},{"key":"e_1_2_10_18_1","first-page":"937","article-title":"Schizophrenia Diagnosis and Treatment by General Practitioners: A Cross\u2010Sectional Study in District Peshawar, Pakistan","volume":"65","author":"Irfan M.","year":"2015","journal-title":"Journal of the Pakistan Medical Association"},{"key":"e_1_2_10_19_1","first-page":"92","volume-title":"Advancing Ethnography in Corporate Environments: Challenges and Emerging Opportunities","author":"Isaacs E.","year":"2013"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.17169\/fqs\u201022.2.3811"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0273286"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0277\u20109536(78)80014\u20108"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.17169\/fqs\u20106.3.20"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.107.041863"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajp.2020.102237"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/0147-1767(85)90062-8"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.4135\/9781529716689"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.62.9.975"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.29271\/jcpsp.2026.03.346"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbx166"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1080\/10872981.2019.1624133"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.150.4.554"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-023-09294-x"},{"key":"e_1_2_10_34_1","unstructured":"Sahai\u2010Siddiqui V.2025.\u201cMental Health and Matchmaking: How Stigma Affects South Asian Marriage Prospects.\u201dMarch 12th. Accessed April 28 2026. Available.https:\/\/behavioralhealthnews.org\/mental\u2010health\u2010and\u2010matchmaking\u2010how\u2010stigma\u2010affects\u2010south\u2010asian\u2010marriage\u2010prospects\/."},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(20)30387-4"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2005.04.018"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1002\/wps.20708"},{"issue":"3","key":"e_1_2_10_38_1","first-page":"89","article-title":"Healers and Healing Practices of Mental Illness in India: The Role of Proposed Eclectic Healing Model","volume":"4","author":"Subudhi C.","year":"2017","journal-title":"Journal of Health Research and Reviews"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2023.116108"},{"issue":"4","key":"e_1_2_10_40_1","first-page":"321","article-title":"Quick and Dirty? 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