Predictors of disengagement from Early Intervention in Psychosis services.
The British journal of psychiatry : the journal of mental science
Royal College of Psychiatrists
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Solmi, F., Mohammadi, A., Perez, J., Hameed, Y., Jones, P., & Kirkbride, J. B. (2018). Predictors of disengagement from Early Intervention in Psychosis services.. The British journal of psychiatry : the journal of mental science, 213 (2), 477-483. https://doi.org/10.1192/bjp.2018.91
Background Early intervention in Psychosis (EIP) services offer phase-specific pharmacological, psychological, social, occupational, and educational support to individuals with early or prodromal symptoms of psychosis for up to three years.1 In England, EIP services typically consist of a multi-disciplinary team of experts, including psychiatrists, care coordinators, clinical psychologists, psychological therapists and employment and educational specialists.2 They were introduced following demonstration that longer duration of untreated psychosis (DUP) was associated with adverse clinical, functional and social outcomes.3 Over the past 15 years, they have gained increased traction worldwide.4 In the UK, studies suggest that EIP services can be effective in halting transition to psychosis5 as well as cost-effective.6,7 Nevertheless, concerns exist that high rates of early disengagement from EIP services – estimated to range from 13% to 31%8–11 – could hamper their effectiveness, particularly with respect to sustaining long-term positive outcomes. Although studies evaluating the optimal length of EIP service provision have yielded conflicting results12–15, there is some evidence that longer time spent in EIP is associated with better long-term outcomes.14 It is therefore important to identify potential factors – positive or negative – that predict discharge from EIP services before receipt of a full package of care. Two recent literature reviews found that male gender, unemployment, substance use, not having a family member involved in treatment, and belonging to an ethnic minority are the most consistently-reported predictors of patient disengagement from EIP services.16,17 However, the evidence is mixed for other factors such as age, symptom severity, and social functioning, as they appear to be associated differently with disengagement from pharmacological therapy versus psychosocial services. For example, studies have shown that lower social functioning and symptom severity, and older age, are associated with disengagement from psychosocial services, whilst the reverse is true for pharmacological treatments.16,17 In this study, we sought to investigate socio-demographic and clinical factors which predicted early discharge due to disengagement from six EIP services in the UK region of East Anglia, using a large, longitudinal dataset from the Social Epidemiology of Psychosis in East Anglia (SEPEA) study. Based on findings from the previous literature, we hypothesised that participants with greater substance use, fewer symptoms and who were male, older, and from an ethnic minority background would be more likely to disengage from EIP services.
Humans, Early Diagnosis, Treatment Outcome, Severity of Illness Index, Multivariate Analysis, Logistic Models, Proportional Hazards Models, Cohort Studies, Predictive Value of Tests, Patient Compliance, Psychotic Disorders, Psychiatric Status Rating Scales, Schizophrenic Psychology, Adolescent, Adult, Female, Male, Young Adult, Early Medical Intervention, United Kingdom
Wellcome Trust (085540/Z/08/Z)
Embargo Lift Date
External DOI: https://doi.org/10.1192/bjp.2018.91
This record's URL: https://www.repository.cam.ac.uk/handle/1810/278340
Attribution 4.0 International
Licence URL: http://creativecommons.org/licenses/by/4.0/
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