Time to integrated care and social and clinical determinants: secondary analysis of a multicenter study in persons with dual diagnosis

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Purpose This study explores the time to integrated care contact (TICC) and its determinants among individuals with dual diagnosis (DD) in a multicenter study across India. By examining sociodemographic and clinical factors, this study aims to identify barriers and facilitators for timely integrated care (IC) access. Design/methodology/approach This secondary analysis included 558 adults diagnosed with substance dependence and co-occurring psychiatric disorders, recruited from nine centers. Sociodemographic and clinical data were analyzed using descriptive and inferential statistics, with generalized linear modeling used to identify predictors of TICC. Findings The mean TICC was 30.7 months, with delays influenced by marital status, income, education and substance use duration. Separated individuals and those with prolonged substance use histories experienced longer delays. Married individuals with higher incomes accessed care sooner, while common mental disorders were associated with extended TICC compared to severe mental illnesses. The final model explained 30.9% of the variance in TICC, emphasizing the interplay of multiple factors. Research limitations/implications The cross-sectional design limits causal inferences, and unmeasured variables like health-care accessibility and stigma may influence TICC. Future research should incorporate longitudinal designs to address these gaps. Practical implications These findings highlight the need for targeted interventions, such as stigma reduction and family-oriented approaches, to reduce delays in accessing IC for vulnerable populations. Social implications Improved access to IC can enhance social functioning and health outcomes, reducing the societal burden of untreated DD. Originality/value This study provides novel insights into the determinants of IC utilization in low-resource settings, addressing critical gaps in understanding the health-care pathways of individuals with DD in India.