{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T15:01:21Z","timestamp":1788447681113,"version":"build-2803163510"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,9,4]],"date-time":"2023-09-04T00:00:00Z","timestamp":1693785600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007048","name":"Mayo Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007048","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>There is evidence suggesting racial disparities in diagnosis and treatment in bipolar disorder (BD) and schizophrenia (SZ). The purpose of this study is to compare psychiatric diagnoses and psychotropic use preceding a first episode of mania (FEM) or psychosis (FEP) in racially diverse patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using a comprehensive medical records linkage system (Rochester Epidemiology Project, REP), we retrospectively identified individuals diagnosed with BD or SZ and a documented first episode of mania or psychosis. Illness trajectory before FEP\/FEM were characterized as the time from first visit for a mental health complaint to incident case. Pathways to care and clinical events preceding FEP\/FEM were compared based on subsequent incident case diagnosis (BD or SZ) and self-reported race (White vs. non-White).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 205 (FEM\u2009=\u200974; FEP\u2009=\u2009131) incident cases were identified in the REP. Duration of psychiatric antecedents was significantly shorter in non-White patients, compared to White patients (2.2\u2009\u00b1\u20094.3 vs. 7.4\u2009\u00b1\u20096.6\u2009years; <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001) with an older age at time of first visit for a mental health complaint (15.7\u2009\u00b1\u20096.3 vs. 11.1\u2009\u00b1\u20096.0\u2009years; <jats:italic>p<\/jats:italic>\u2009=\u20090.005). There were no significant differences by race in FEM pathway to care or age of first seeking mental health. Overall non-White patients had lower rates of psychotropic use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>These data are unable to ascertain reasons for shorter duration of psychiatric antecedents and later age of seeking care, and more broadly first age of initial symptom presentation. If symptoms are confirmed to be earlier than first time seeking care in both groups, it would be important to identify barriers that racial minorities face to access timely psychiatric care and optimize early intervention strategies.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpsyt.2023.1241071","type":"journal-article","created":{"date-parts":[[2023,9,4]],"date-time":"2023-09-04T15:04:41Z","timestamp":1693839881000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Racial differences in pathways to care preceding first episode mania or psychosis: a historical cohort prodromal study"],"prefix":"10.3389","volume":"14","author":[{"given":"Manuel","family":"Gardea-Resendez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Ortiz-Orendain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Miola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Fuentes Salgado","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mete","family":"Ercis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon J.","family":"Coombes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peggy M.","family":"Gruhlke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Michael","family":"Bostwick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Michel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Vande Voort","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aysegul","family":"Ozerdem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alastair","family":"McKean","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark A.","family":"Frye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Taylor-Desir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,9,4]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1186\/s12888-020-2483-y","article-title":"Exploring factors of diagnostic delay for patients with bipolar disorder: a population-based cohort study","volume":"20","author":"Lubl\u00f3y","year":"2020","journal-title":"BMC Psychiatry"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"161","DOI":"10.4088\/JCP.v64n0209","article-title":"Perceptions and impact of bipolar disorder: how far have we really come? Results of the National Depressive and Manic-Depressive Association 2000 survey of individuals with bipolar disorder","volume":"64","author":"Hirschfeld","year":"2003","journal-title":"J Clin Psychiatry"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1038\/s41537-022-00256-6","article-title":"Multidimensional analysis of adult patients\u2019 care trajectories before a first diagnosis of schizophrenia","volume":"8","author":"Vanasse","year":"2022","journal-title":"Schizophrenia"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1056\/NEJMra1906193","article-title":"Bipolar disorder","volume":"383","author":"Carvalho","year":"2020","journal-title":"N Engl J Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"18008","DOI":"10.1038\/nrdp.2018.8","article-title":"Bipolar disorders","volume":"4","author":"Vieta","year":"2018","journal-title":"Nature"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1186\/s40345-017-0077-5","article-title":"Prodrome or risk syndrome: what\u2019s in a name?","volume":"5","author":"Geoffroy","year":"2017","journal-title":"Int J Bipolar Disord"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"478","DOI":"10.1111\/bdi.12194","article-title":"Type and duration of sybsyndromal symptoms in youth with bipolar I disorder prior to their first manic episode","volume":"16","author":"Correll","year":"2014","journal-title":"Bipolar Disord"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"720","DOI":"10.1111\/bdi.12831","article-title":"An International Society of Bipolar Disorders task force report: precursors and prodromes of bipolar disorder","volume":"21","author":"Faedda","year":"2019","journal-title":"Bipolar Disord"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3389\/fpsyt.2019.00774","article-title":"Improving the detection of individuals at clinical risk for psychosis in the community, primary and secondary care: an integrated evidence-based approach","volume":"10","author":"Fusar-Poli","year":"2019","journal-title":"Front Psychiatry"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1176\/appi.ajp.2015.15040414","article-title":"Toward the definition of a bipolar prodrome: dimensional predictors of bipolar spectrum disorders in at-risk youths","volume":"173","author":"Hafeman","year":"2016","journal-title":"Am J Psychiatry"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1038\/s41537-021-00185-w","article-title":"Systematic review of pathways to care in the U.S. for Black individuals with early psychosis","volume":"7","author":"Oluwoye","year":"2021","journal-title":"NPJ Schizophr"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1001\/jamapsychiatry.2020.3995","article-title":"Association between race\/ethnicity and disparities in health care use before first-episode psychosis among privately insured young patients","volume":"78","author":"Heun-Johnson","year":"2021","journal-title":"JAMA Psychiatry"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1016\/0165-0327(96)00028-6","article-title":"Racial influence on diagnosis in psychotic mania","volume":"39","author":"Strakowski","year":"1996","journal-title":"J Affect Disord"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1571","DOI":"10.1176\/ajp.140.12.1571","article-title":"Misdiagnosis of schizophrenia in bipolar patients: a multiethnic comparison","volume":"140","author":"Mukherjee","year":"1983","journal-title":"Am J Psychiatry"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1097\/JCP.0000000000001532","article-title":"Clinical phenotype of tardive dyskinesia in bipolar disorder","volume":"42","author":"Gardea-Resendez","year":"2022","journal-title":"J Ciln Psychopharmacol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1016\/j.jad.2019.09.022","article-title":"Decreased core symptoms of mania and utilization of lithium\/mood stabilizing anticonvulsants in U.S. bipolar I patients of African vs European ancestry","volume":"260","author":"Akinhanmi","year":"2020","journal-title":"J Affect Disord"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1111\/bdi.12638","article-title":"Racial disparities in bipolar disorder treatment and research: a call to action","volume":"20","author":"Akinhanmi","year":"2018","journal-title":"Bipolar Disord"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1098292","DOI":"10.3389\/fpsyt.2023.1098292","article-title":"The weaponization of medicine: early psychosis in the Black community and the need for racially informed mental healthcare","volume":"14","author":"Faber","year":"2023","journal-title":"Front Psychiatry"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"747","DOI":"10.4088\/JCP.v64n0702","article-title":"Ethnicity and diagnosis in patients with affective disorders","volume":"64","author":"Strakowski","year":"2003","journal-title":"J Clin Psychiatry"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1007\/s40615-016-0236-x","article-title":"Disparities in treatment and service utilization among Hispanics and non-Hispanic Whites with bipolar disorder","volume":"4","author":"Salcedo","year":"2017","journal-title":"J Racial Ethn Health Disparities"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"677","DOI":"10.1176\/appi.ps.55.6.677","article-title":"Variations in use of second-generation antipsychotic medication by race among adult psychiatric patients","volume":"55","author":"Herbeck","year":"2004","journal-title":"Psychiatr Serv"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1016\/j.mayocp.2011.11.009","article-title":"Generalizability of epidemiological findings and public health decisions: an illustration from the Rochester Epidemiology Project","volume":"87","author":"St Sauver","year":"2012","journal-title":"Mayo Clin Proc"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1016\/j.schres.2007.10.005","article-title":"Mortality in schizophrenia and schizoaffective disorder: an Olmsted County, Minnesota cohort: 1950\u20132005","volume":"98","author":"Capasso","year":"2008","journal-title":"Schizophr Res"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1097\/PSY.0000000000001017","article-title":"Association of bipolar disorder with major adverse cardiovascular events: a population-based historical cohort study","volume":"84","author":"Foroughi","year":"2021","journal-title":"Psychosom Med"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1001\/archpsyc.62.3.247","article-title":"The lifetime risk of suicide in schizophrenia: a reexamination","volume":"62","author":"Palmer","year":"2005","journal-title":"Arch Gen Psychiatry"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1016\/j.jad.2016.01.015","article-title":"Long-term risk of myocardial infarction and stroke in bipolar I disorder: a population-based cohort study","volume":"194","author":"Prieto","year":"2016","journal-title":"J Affect Disord"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.jad.2023.07.106","article-title":"Antecedents to first episode psychosis and mania: comparing the prodromes of schizophrenia and bipolar disorder in a retrospective population cohort: antecedents of schizophrenia and bipolar disorder","volume":"340","author":"Ortiz-Orendain","year":"2023","journal-title":"J Affect Disord"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1093\/ije\/dyx268","article-title":"Data resource profile: expansion of the Rochester Epidemiology Project medical records-linkage system (E-REP)","volume":"47","author":"Rocca","year":"2018","journal-title":"Int J Epidemiol"},{"key":"ref29","volume-title":"NIH policy on reporting race and ethnicity data: subjects in clinical research (NOT-OD-01-053)","year":"2001"},{"key":"ref30","article-title":"United States Census: Olmsted County, Minnesota","year":"2020"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.1007\/s00787-023-02196-7","article-title":"Prodromal symptoms and the duration of untreated psychosis in first episode of psychosis patients: what differences are there between early vs. adult onset and between schizophrenia vs. bipolar disorder?","author":"Baeza","year":"2023","journal-title":"Eur Child Adolesc Psychiatry"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1192\/bjp.bp.105.014068","article-title":"Untreated illness and outcome of psychosis","volume":"189","author":"Clarke","year":"2006","journal-title":"Br J Psychiatry"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"592","DOI":"10.1176\/appi.ajp.2021.21060558","article-title":"Dismantling structural racism in psychiatry: a path to mental health equity","volume":"178","author":"Shim","year":"2021","journal-title":"Am J Psychiatry"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3389\/fpsyt.2020.00500","article-title":"Depression preceding diagnosis of bipolar disorder","volume":"11","author":"O\u2019Donovan","year":"2020","journal-title":"Front Psychiatry"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1111\/eip.13158","article-title":"Antipsychotics are related to psychometric conversion to psychosis in ultra-high-risk youth","volume":"16","author":"Preti","year":"2022","journal-title":"Early Interv Psychiatry"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"21m14092","DOI":"10.4088\/JCP.21m14092","article-title":"Antipsychotic exposure in clinical high risk of psychosis: empirical insights from a large cohort study","volume":"83","author":"Zeng","year":"2022","journal-title":"J Clin Psychiatry"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1016\/j.genhosppsych.2016.12.004","article-title":"Examining psychotropic medication use among youth in the U.S. by race\/ethnicity and psychological impairment","volume":"45","author":"Cook","year":"2017","journal-title":"Gen Hosp Psychiatry"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1016\/j.jaac.2010.11.004","article-title":"Racial\/ethnic differences in mental health service use among adolescents with major depression","volume":"50","author":"Cummings","year":"2011","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1177\/1077558709350884","article-title":"Explaining racial and ethnic differences in antidepressant use among adolescents","volume":"67","author":"Kirby","year":"2010","journal-title":"Med Care Res Rev"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"1197","DOI":"10.1002\/pds.3819","article-title":"Persistence of racial disparities in prescription of first-generation antipsychotics in the USA: racial disparities in prescription of antipsychotics","volume":"24","author":"Cook","year":"2015","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1007\/s40615-022-01228-3","article-title":"Comparison of demographic and clinical features of bipolar disorder in persons of African and European ancestry","volume":"10","author":"Taylor-Desir","year":"2022","journal-title":"J Racial Ethn Health Disparities"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"100101","DOI":"10.1016\/j.pmip.2023.100101","article-title":"Health disparities in the treatment of bipolar disorder","author":"Tchikrizov","year":"2023","journal-title":"Pers Med Psychiatry"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1097\/HRP.0000000000000353","article-title":"Psychotic misdiagnosis of racially minoritized patients: a case-based ethics, equity, and educational exploration","volume":"31","author":"Jegarl","year":"2023","journal-title":"Harv Rev Psychiatry"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1093\/rheumatology\/keq199","article-title":"The Rochester epidemiology project: exploiting the capabilities for population-based research in rheumatic diseases","volume":"50","author":"Kremers","year":"2011","journal-title":"Rheumatology"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1176\/appi.ajp.2020.20071091","article-title":"From womb to neighborhood: a racial analysis of social determinants of psychosis in the United States","volume":"178","author":"Anglin","year":"2021","journal-title":"Am J Psychiatry"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1007\/s44192-022-00010-5","article-title":"Social and environmental variables as predictors of mania: a review of longitudinal research findings","volume":"2","author":"Johnson","year":"2022","journal-title":"Discov Ment Health"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2023.1241071\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,4]],"date-time":"2023-09-04T15:04:44Z","timestamp":1693839884000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2023.1241071\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,4]]},"references-count":46,"alternative-id":["10.3389\/fpsyt.2023.1241071"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2023.1241071","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,4]]},"article-number":"1241071"}}