Socio-Cultural Predictors of First-Episode Psychosis and Symptom Severity

OBJECTIVE: To examine the sociodemographic and clinical characteristics of patients with first-episode psychosis (FEP) and to explore their associations with symptom severity, length of hospital stay, and PANSS symptom clusters. STUDY DESIGN: A cross-sectional study. Place and Duration of the Study: Department of Psychiatry, Khyber Medical College, Peshawar, Pakistan, from January 2021 to December 2024. METHODOLOGY: A total of 104 inpatients with FEP were recruited. Sociodemographic and clinical data were collected, and symptom severity was assessed using the Positive and Negative Syndrome Scale (PANSS). Chi-square test, Fisher's exact test, ANOVA, and logistic regression identified associations and predictors of symptom severity and hospitalisation. RESULTS: Of 104 patients, 77.9% were male (mean age 23.4 years). Females were more likely to be married (p = 0.002), while substance misuse occurred only among males (28.7%, p = 0.001). Patients aged ≤18 years had significantly higher PANSS total scores (p = 0.013). Multiple regression revealed that younger age, lower socioeconomic status (SES), fewer years of education and unawareness or cultural barriers to referral predicted higher total PANSS severity (all p < 0.05). Longer duration of untreated psychosis (DUP) and tribal residence predicted elevated positive symptoms, whereas low education and tribal origin predicted thought disturbance. PANSS severity correlated strongly with longer hospital stay (p < 0.001). Age and gender were not significant predictors, and no major gender differences were observed across subscales. CONCLUSION: Younger age, limited education, low SES, and sociocultural barriers were associated with more severe FEP. Enhancing community awareness and early referral pathways may improve outcomes in low-resource settings. KEY WORDS: Acute psychosis, First-episode psychosis, Acute and transient psychotic disorder, PANSS.