Determinants and clinical correlates of the duration of untreated psychosis in schizophrenia: evidence from a Moroccan cross-sectional study

Worldwide, 71% of individuals with psychosis do not receive mental health care. Duration of untreated psychosis (DUP) refers to the time interval elapsing between the onset of psychotic symptoms until the first treatment initiation. This study aimed to estimate DUP, identify its associated factors, and evaluate its clinical impact among patients with schizophrenia in southeastern and southern Morocco. We conducted a cross-sectional study from July 2024 to June 2025, including 630 patients with schizophrenia diagnosed according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. They were recruited from the Drâa-Tafilalet, Guelmim-Oued Noun, Laâyoune – Sakia El Hamra, and Dakhla-Oued-Eddahab regions. Data were collected using a structured questionnaire, and the Arabic version of the Positive and Negative Syndrome Scale (PANSS) was used to assess symptom severity and insight into the illness. The median DUP among patients was 12[interquartile range (IQR) 3-15.8] months. Patients with prolonged DUP also exhibited higher rates of relapse and more severe schizophrenia symptoms. Longer DUP was significantly associated with multiple cultural, patient and illness-related factors, including initial consultation of traditional healers, insidious onset of psychosis, low educational level, and lack of judgement and insight. Long DUP remains prevalent in Morocco and is associated with worse clinical outcomes. Identifying the predictive factors of schizophrenia is necessary for targeted interventions able to reduce this duration and thus improve the prognosis of schizophrenia.