A total of 252 caregivers and patients participated in the present study. Most of the caregivers were women, without a partner and with a poor schooling. In contrast, patients were primarily middle-aged, unemployed, and Aymara men (46.2%). The severity of symptoms was generally moderate, with an average PANSS score of 71.3 (SD = 28.2). Participant details are presented in Table 1.

Table 1 Note.

SD: Standard deviation; PANSS: Positive and Negative Syndrome Scale for Schizophrenia. *PANSS total score 58 = Mildly ill, PANSS total score 75 = Moderately ill, PANSS total score 95 = Markedly ill, and PANSS total score 116 = Severely ill. **The monthly family income accounts for the economic contribution of all family members.

Data concerning which kind of provider patients first visited following the experience of the initial signs of schizophrenia are displayed in Table 2.

Table 2

As shown in Table 2, most of the patients contacted a general practitioner. The differences are highly significant regarding general practitioners as patients’ choice (Chi-squared = 213.7; p = 0.000).

Additionally, statistical analyses of the variables were performed using appropriate tests based on the type of variable. All variables were non-significant. A 3 x 2 x 2 analysis of variance was, therefore, performed with country x ethnic group x first visit.

The results displayed in Tables 3 and 4 show that patients' psychosocial beliefs differed significantly between countries, with Bolivia’s scores being the lowest and Peru’s the highest.

In all three countries, there were significant differences in the biological beliefs of caregivers, finding in Bolivia the lowest and in Peru the highest. In Peru, caregivers scored higher in terms of psychosocial beliefs than did caregivers in Chile and Bolivia.

By analyzing DUP according to ethnicity, country of origin, and first professional visited and with all interactions between the variables, significant differences were obtained only for country of origin (F = 4.77, p = 0.009). DUP was significantly lower in Peru than in Bolivia. Chile was not significantly different from the other two countries.

Table 3 Note.

PANSS: Positive and Negative Syndrome Scale for Schizophrenia; DUP: Duration of untreated psychosis (years). Bold remarks p value significant at 0.05 or 0.005.

Table 4 Note.

Beliefs scores are presented in Z scores.

Table 5 shows that in Chile, the magical-religious beliefs of Aymara patients who first visited a yatiri were higher than those of non-Aymara patients or those who visited health professionals.

In Peru, the average magical-religious belief scores of caregivers who consult healthcare professionals are higher than among those who consult yatiri. In Chile, the average magical-religious belief scores are lower among caregivers who consult health professionals than those who consult yatiri.

Table 5

This study sought to both describe the behavior related to the healthcare pathways of patients who have experienced a first episode of psychosis and determine whether these behaviors are significantly affected by ethnicity and causal beliefs concerning the disorder.

Our results indicated that 64.7% of patients in the study went to see a general practitioner at first, while 14% sought help from a psychologist and 12% from traditional healers (yatiri). These results are consistent with those from Gater & Goldberg (1991), Amaddeo et al. (2001) and Lincoln et al. (1998) who reported that 76%, 50%, and 40% of their samples, respectively, contacted a general practitioner at first. Nevertheless, contact with a traditional healer was more evident in our sample as compared to that of other studies, but it occurred at a lower rate than that reported in Africa, Singapore, and India (Burns, & Tomita, 2015; Chong et al., 2005; Lahariya et al., 2010).

Furthermore, our results on help-seeking behavior suggested that the time interval between patients’ first prodromal symptoms and their first help-seeking contact was approximately 2.7 years (SD = 4.9), which is longer than that found in another study that reported an average delay of approximately one year before receiving psychiatric treatments (Penttilä et al., 2014). In this study, the average delay of 140 weeks was positively correlated with negative long-term results. Patients experienced an average of 1.3 hospitalizations in the past three years and had average PANSS scores of 71 points. Furthermore, negative symptoms that are difficult to recognize and treat promptly were predominantly observed in this sample. This finding suggests that information campaigns about the negative and nonspecific symptoms of schizophrenia are necessary and quite important.

Although a difference between patients with either long or short DUPs in terms of their healthcare pathways was not found prior to psychiatric admission, patients with a longer DUP sought help after a longer period of time. However, differences in the time interval between the first healthcare contact and admission were not observed. Also, in this study, DUP was not associated with causal beliefs as was expected. Therefore, a longer DUP does not necessarily relate to the delayed reaction of patients contacts; rather, it is more likely the result of a belated visit. Melle et al. (2004) found that factors such as poor support networks to be associated with quite longer DUP and delayed help-seeking.

Notably, among the 252 patients, only 31 initially contacted a traditional healer (yatiri). Therefore, it appears that the role of yatiri does not involve the early recognition of psychosis in the Andean population of Chile, Peru, and Bolivia. Furthermore, given that in the past decade, public health services have made a concerted effort to avoid discrimination against indigenous populations and to achieve greater levels of contact with indigenous populations through health centers, patients’ contact with traditional faith healers may have been impacted (Ministerio de Salud de Chile [MINSAL], 2006; Ministerio de Salud de Perú [MINSA], 2004).

In this study, as in research conducted in Africa, regional differences were observed (Burns, & Tomita, 2015). In this study, Bolivia had a higher percentage of patients who first contacted a traditional healer. Similarly, it has been observed in Canada that nonnative youth living in rural regions sometimes seek help from informal and traditional supporters, such as counsellors and traditional healers. Difficulties with acculturation and identity can increase the impact of stigma and can impair patients’ use of mental health services (Archie et al., 2008; Boydell et al., 2006; Cauce et al., 2002; Duran et al., 2005).

Our study has some limitations. Given that only patients who received treatment at the mental health centers could be interviewed, potential bias may have existed in the sample selection. Additionally, data concerning both the number and the symptoms of those patients who either were not admitted to mental health centers or did not contact a mental health professional were not available. Future research should include more specific fieldwork in the Andes region involving those patients who are outside of the mental health system.

Despite the abovementioned limitations, this study provides initial insights into the help-seeking behaviors of patients with a first episode of psychosis that considers their ethnicity and the availability of services in this Latin-American context. Our findings may reflect some changes in Aymara cultural values, including a transformation in conceptions of mental disorders, which opposes the previous conceptions involving magical-religious forces (Caqueo-Urízar et al., 2015) as well as the novel reliance on doctors rather than traditional healers (i.e., the yatiri).

These changes likely reflect the large-scale migration of Aymara families from rural to urbanized areas, which is associated with the increased acceptance of the biomedical model of mental disorders and the assimilation of Western culture (Gundermann, 2000; Gundermann et al., 2007).

Greater attention should be devoted to factors that determine the pathways through which people who have experienced a first episode of psychosis initially contact the healthcare system. In particular, more studies on the specific needs of minority ethnic groups are required to develop interventions aimed at preventing secondary damage that may result from either extensive DUPs or negative first experiences with psychiatric care services.

Furthermore, general practitioners and psychologists should be highly involved in disorder detection, the adequate referral of people who have experienced a first episode of psychosis, and the planning of care programs for these patients. Finally, the healthcare system should devote more attention to those patients lacking a social-support network to minimize the additional risk of delayed treatment and the associated adverse outcomes.