Predictors of Service Disengagement in First-Admitted Adolescents With Psychosis

doi:10.1097/01.chi.0000223015.29530.65

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 45, Issue 8, August 2006, Pages 990-999

https://doi.org/10.1097/01.chi.0000223015.29530.65 Get rights and content

ABSTRACT

Objective:

To assess the risk and predictors of service disengagement in adolescents with first-episode psychosis (FEP) receiving their first treatment in a long-standing early intervention and prevention centre.

Method:

The Early Psychosis Prevention and Intervention Centre (EPPIC) in Australia admitted 157 adolescents, ages 15 to 18, with FEP from January 1998 to December 2000. Treatment at EPPIC spans an average of 18-months. Data were collected from patients' charts using a standardized questionnaire; 134 charts were available. Time to service disengagement was the outcome of interest. Baseline and treatment predictors of service disengagement were examined via Cox proportional hazards model.

Results:

Kaplan-Meier 18-month risk of service disengagement was 0.28. A lower severity of illness at baseline (hazard ratio [HR] = 0.2; 95% confidence interval [CI] 0.1-0.4), living without family during treatment (HR = 4.8; 95% CI 2.1-11.2), and persistent substance use during treatment (HR = 2.6; 95% CI 1.1-5.9) contributed significantly to predicting service disengagement. Neither initial substance use nor insight at baseline was related to service disengagement.

Conclusions:

Clinicians should focus on treating substance use and establishing a social network if family support is missing in adolescents with FEP. In addition, clinicians should apply strategies to keep in touch with those adolescents who might not see the necessity of continuous treatment because of a moderate severity of illness.

Section snippets

Setting and Sample

The Early Psychosis Prevention and Intervention Centre (EPPIC) in Melbourne, Australia, covered, at the time of the study, a catchment area of approximately 880,000 people and had a mandate to offer initial treatment to all patients aged 15 to 29 with FEP. In this catchment area, EPPIC is the only facility for the target population, with virtually no private psychiatrists and little, if any, movement into private facilities outside the area; as such, the study sample represents an

Sample Characteristics

Table 1 shows premorbid, baseline, and treatment variables of the 134 subjects. The mean age of the complete sample was 16.9 (SD = 1.1) years; 71% were male. The majority of patients were diagnosed with schizophreniform disorder (45.5%) and schizophrenia (21.6%), followed by bipolar affective disorder (12.7%), schizoaffective disorder (5.2%), and major depressive episode with psychotic symptoms (3.7%); 11.2% were diagnosed with other psychotic disorders.

Rate of Service Disengagement

Based on the raw data, 33 (23.4%) of 134

DISCUSSION

Worldwide, a growing number of specialised first-episode services treat adolescents with psychotic disorders together with young adults to overcome barriers to continuity of care. To our knowledge, the present investigation is the first on disengagement in adolescent patients with FEP. Service disengagement obviously is the most severe form of nonadherence with treatment; the latter being a broad concept including inconsistent or intermittent involvement in treatment sessions and medication

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Citation Excerpt :
Individuals with psychosis may lack awareness regarding their symptoms or mental illness (Pini et al., 2001). Although not all studies have found an association (Lecomte et al., 2008; Perivoliotis et al., 2010; Schimmelmann et al., 2006; Stowkowy et al., 2012; Tait et al., 2003), limited insight into illness has been associated with non-attendance of treatments amongst individuals with FEP (Alvarez-Jimenez et al., 2009; Fanning et al., 2012; Turner et al., 2007) and persisting psychosis (Fung et al., 2008; Lincoln et al., 2014). Additionally, clinicians have qualitatively identified a lack of insight into illness as a barrier to engagement with CBTp (Hazell et al., 2017).
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Online databases were searched for studies relevant to predictors of engagement with online interventions for psychosis; predictors of Internet use amongst individuals with psychosis; and predictors of engagement with traditional psychosocial treatments for psychosis. Data were synthesised into a conceptual model highlighting factors relevant to engagement with online interventions for psychosis.
Sixty-one studies were identified. Factors relevant to engagement related directly to the impact of psychosis, response to psychosis, integration of technology into daily lives and intervention aspects.
While several candidate predictors were identified, there is minimal research specifically investigated predictors of engagement with online interventions for psychosis. Further investigation examining both individual- and intervention-related factors is required to inform effective design and dissemination of online interventions for psychosis.
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328 early psychosis patients were assessed at baseline on a large set of socio-demographic and clinical variables and were followed-up over 36 months. Patients who left the program for reasons related to engagement with care were compared to patients who completed the program.
Rates of disengagement were low (6.3%). Patients with lower socio-economic status, who committed offences during the program or with a diagnosis of Schizophreniform/brief psychotic disorder were more likely to disengage from the program.
The engagement strategies implemented in the context of our early intervention programs have allowed to keep disengagements to a relatively low level. In this context, only 3 variables emerged to guide adaptation of the intervention in order to improve this already good engagement rate.
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The acquisition of data was in part supported by the Colonial Foundation of National Health and Medical Research Council and Eli Lilly Australia. The authors acknowledge HokPan Yuen, M.Sc., EPPIC statistician, for database design.

Disclosure: Drs. Schimmelmann, Conus, McGorry, and Lambert have received research funding from and/or served as paid speakers for Eli Lilly. Ms. Schacht has no financial relationships to disclose.

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ARTICLESPredictors of Service Disengagement in First-Admitted Adolescents With Psychosis

ABSTRACT

Objective:

Method:

Results:

Conclusions:

Section snippets

Setting and Sample

Sample Characteristics

Rate of Service Disengagement

DISCUSSION

J Am Acad Child Adolesc Psychiatry

Schizophr Res

Diagnostic Criteria from DSM-IV

Adolescents who drop out of psychotherapy at a community-based psychotherapy centre: a preliminary investigation of the characteristics of early drop-outs, late drop-outs and those who continue treatment

Br J Med Psychol

Measurement of premorbid adjustment in chronic schizophrenia

Schizophr Bull

The Analysis of Binary Data

The Lambeth Early Onset (LEO) Team: Randomised controlled trial of the effectiveness of specialised care for early psychosis

BMJ

Multi-component early intervention - models of good practice

Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I)-Clinician Version

Does duration of untreated psychosis bias study samples of first-episode psychosis?

Acta Psychiatr Scand

From compliance to concordance: a review of the literature on interventions to enhance compliance with antipsychotic medication

J Psychiatr Ment Health Nurs

ECDEU Assessment Manual for Psychopharmacology, Revised

ARTICLES
Predictors of Service Disengagement in First-Admitted Adolescents With Psychosis