Barriers to Professional Care Among Adults with Schizophrenia Spectrum Disorders

Background and Purpose: Suicide is a leading public health concern, with individuals diagnosed with schizophrenia spectrum disorders (SSDs) experiencing disproportionately elevated risk for suicidal ideation, attempts, and death. Despite this heightened risk, suicide prevention efforts tailored to this population remain limited. Engagement in mental health care is a key protective factor, yet individuals with SSDs encounter numerous barriers that interfere with access to and sustained participation in treatment. Emerging work has identified patient-reported barriers such as time constraints, stigma-related concerns, financial limitations, doubts about treatment usefulness, logistical challenges, and lack of cultural responsiveness. However, limited research has examined how these barriers relate to suicide-related outcomes. Within community mental health (CMH) settings where most individuals with SSDs receive care, these challenges can disrupt treatment initiation, continuity, and retention. This study examined associations between multiple domains of barriers to care and suicide-related and clinical outcomes among adults with SSDs receiving services in CMH settings.

Methods: Adults (n=19) with SSDs receiving CMH services completed measures assessing perceived barriers to care (problem severity, time, stigma, financial, questioning, logistical, and cultural sensitivity domains) and clinical outcomes, including suicidal ideation, depressive symptoms, and psychosis symptoms. Regression analyses were conducted to examine associations between barrier domains and outcomes. Both unadjusted results and results corrected for multiple comparisons using false discovery rate (FDR) procedures were evaluated.

Results: Stigma-related barriers emerged as the most consistent correlate of suicide risk. Greater fear of stigma was significantly associated with higher suicidal ideation severity (β = .37, p = .007) and remained the only barrier significant after FDR correction. Questioning (p = .041) and cultural sensitivity barriers (p = .050) showed nominal associations with ideation but did not persist after adjustment. Several barriers were associated with depressive symptoms at the unadjusted level, including financial (β ≈ .34, p = .016), logistical (β ≈ .31, p = .028), and cultural sensitivity barriers (β ≈ .32, p = .021), with questioning barriers approaching significance (p = .061). However, none remained significant following FDR correction. Associations between barriers and psychosis symptoms were limited. Fear of stigma and logistical barriers were linked to greater positive and general psychosis symptoms at the unadjusted level, with additional trend-level associations for questioning and cultural sensitivity barriers. No barriers were associated with PANSS Negative symptoms.

Conclusions and Implications: Findings suggest that stigma-related barriers may be particularly relevant for suicide risk among adults with SSDs, even after accounting for multiple comparisons. While several barriers were associated with depression and psychosis outcomes at the unadjusted level, these relationships were not robust after correction. Interventions that directly address stigma and enhance treatment engagement may be especially important for reducing suicide risk in CMH settings. Larger studies are needed to further clarify these relationships and inform targeted intervention strategies.