Association of an Early Intervention Service for Psychosis With Suicide Rate Among Patients With First-Episode Schizophrenia-Spectrum Disorders

Chan, Sherry Kit Wa; Chan, Stephanie W. Y.; Pang, Herbert; Yan, Kang K.; Hui, Christy Lai Ming; Chang, Wing Chung; H, Lee; Chen, Eric

doi:10.1001/jamapsychiatry.2018.0185

Cited by 64 publications

(52 citation statements)

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“…Early relapse in patients with first-episode psychosis has been suggested as an important factor relating to long-term clinical outcomes 32 and mortality. 11 This study further suggests that a greater number of relapses during the first 3 years is associated with worse longitudinal vocational outcomes in patients who received the early intervention. The results of a detailed exploration of relapse patterns suggest that relapses in years 2 and 3 are particularly important.…”

Section: Discussionmentioning

confidence: 61%

“…9 Other studies reported that patients continued to show better outcomes including clinical remission, number of hospital admissions and suicide mortality at a follow-up period of between 5 and 10 years. [10][11][12] In addition to the sustainability of the benefits of early intervention, another important policyrelated question concerns the optimal duration of the early intervention service. 13 Most early intervention services are delivered for between 1 and 3 years.…”

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confidence: 99%

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Ten-year employment patterns of patients with first-episode schizophrenia-spectrum disorders: comparison of early intervention and standard care services

et al. 2019

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BackgroundLittle is known about long-term employment outcomes for patients with first-episode schizophrenia-spectrum (FES) disorders who received early intervention services.AimsWe compared the 10-year employment trajectory of patients with FES who received early intervention services with those who received standard care. Factors differentiating the employment trajectories were explored.MethodPatients with FES (N = 145) who received early intervention services in Hong Kong between 1 July 2001 and 30 June 2002 were matched with those who entered standard care 1 year previously. We used hierarchical clustering analysis to explore the 10-year employment clusters for both groups. We used the mixed model test to compare cluster memberships and piecewise regression analysis to compare the employment trajectories of the two groups.ResultsThere were significantly more patients who received the early intervention service in the good employment cluster (early intervention: N = 98 [67.6%]; standard care: N = 76 [52.4%]; P = 0.009). In the poor employment cluster, there was a significant difference in the longitudinal pattern between early intervention and standard care for years 1–5 (P < 0.0001). The number of relapses during the first 3 years, months of full-time employment during the first year and years of education were significant in differentiating the clusters of the early intervention group.ConclusionsResults suggest there was an overall long-term benefit of early intervention services on employment. However, the benefit was not sustained for all patients. Personalisation of the duration of the early intervention service with a focus on relapse prevention and early vocational reintegration should be considered for service enhancement.Declaration of interestsNo relevant conflicts of interests reported by C.L.M.H., Y.N.S., P.S., H.H.P. and K.K.Y. S.K.W.C., W.C.C. and E.H.M.L. report that they are members of the working group of the Early Assessment Service for Young People with Psychosis (EASY) programme of the Hospital Authority in Hong Kong. E.Y.H.C. is the convener of the working group of the EASY programme of the Hospital Authority in Hong Kong.

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Section: Discussionmentioning

confidence: 61%

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confidence: 99%

Ten-year employment patterns of patients with first-episode schizophrenia-spectrum disorders: comparison of early intervention and standard care services

et al. 2019

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“…clozapine) in rural China. 16 Severe self-stigma and lack of appropriate treatment during the first onset of illness, especially in rural China where the availability and accessibility of mental health services are limited, 10 , 13 , 15 may be significant factors in suicide among the younger participants. 12 , 20 The results of this study further address the importance of developing suicide prevention strategies through community-based mental healthcare to provide earlier diagnosis, antipsychotic treatment, anti-stigma intervention, family support and social functioning rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

“… 8 Approximately 5% of persons with schizophrenia die by suicide, with elevated rates near illness onset. 9 , 10 However, studies examining mortality and suicide among persons with schizophrenia over a long period (i.e. over 20 years) remain scarce.…”

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Mortality and suicide in schizophrenia: 21-year follow-up in rural China

et al. 2020

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Background Little is known about the trend and predictors of 21-year mortality and suicide patterns in persons with schizophrenia. Aims To explore the trend and predictors of 21-year mortality and suicide in persons with schizophrenia in rural China. Method This longitudinal follow-up study included 510 persons with schizophrenia who were identified in a mental health survey of individuals (≥15 years old) in 1994 in six townships of Xinjin County, Chengdu, China, and followed up in three waves until 2015. Kaplan–Meier survival analysis and Cox hazard regressions were conducted. Results Of the 510 participants, 196 died (38.4% mortality) between 1994 and 2015; 13.8% of the deaths (n = 27) were due to suicide. Life expectancy was lower for men than for women (50.6 v. 58.5 years). Males consistently showed higher rates of mortality and suicide than females. Older participants had higher mortality (hazard ratio HR = 1.03, 95% CI 1.01–1.05) but lower suicide rates (HR = 0.95, 95% CI 0.93–0.98) than their younger counterparts. Poor family attitudes were associated with all-cause mortality and death due to other causes; no previous hospital admission and a history of suicide attempts independently predicted death by suicide. Conclusions Our findings suggest there is a high mortality and suicide rate in persons with schizophrenia in rural China, with different predictive factors for mortality and suicide. It is important to develop culture-specific, demographically tailored and community-based mental healthcare and to strengthen family intervention to improve the long-term outcome of persons with schizophrenia.

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“…Moreover, in these four studies, some important service user and family outcomes were not assessed (either as primary or as secondary outcomes). A few more outcomes commonly reported in the literature, such as knowledge about mental illness (Chan et al, ), perceived care burden (Chien et al, ) and suicide rate (Chan et al, ), should be considered as additional outcomes in future CBFI studies to comprehensively evaluate the treatment effect on families and service users. The addition of these outcomes would also enable direct comparisons of the benefits of CBFI with those from CBT or other psychosocial intervention studies.…”

Section: Discussionmentioning

confidence: 99%

Cognitive behavioural family intervention for people diagnosed with severe mental illness and their families: A systematic review and meta‐analysis of randomized controlled trials

Fai

Chan

Chien

et al. 2019

Psychiatric Ment Health Nurs

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Accessible Summary What is known on the subject? Cognitive behavioural therapy for psychosis (CBTp) and family intervention (FI) for psychosis are effective evidence‐based interventions, but they are practically difficult to be implemented in many clinical settings. The CBTp and FI approaches have been integrated to form cognitive behavioural family intervention (CBFI). This brief intervention may be more feasible to implement in clinical practice. A few individual studies reported the effectiveness of CBFI, but no systematic review and meta‐analysis have been conducted. What the paper adds to existing knowledge CBFI was effective for reducing overall positive and negative symptoms immediately following the intervention. Compared to CBTp, the intervention seems to be more effective to reduce delusions. What are the implications for practice? The results of this review suggest that the brief CBFI is an effective family‐inclusive intervention that could be integrated into clinical practice. Mental health nurses with adequate training and support may implement and develop CBFI to improve the recovery of people diagnosed with SMI and support their families. AbstractIntroductionCognitive behavioural family intervention (CBFI) may be an effective brief psychosocial intervention for people diagnosed with severe mental illness (SMI) and their families. No systematic review has summarized the effectiveness of CBFI.AimThis review aimed to systematically examine the trial evidence of the effectiveness of CBFI versus treatment as usual (TAU) on improving the outcomes of people diagnosed with SMI and their families.MethodEligible randomized controlled trials were identified from nine databases. Three investigators independently took part in selection of articles, data extraction and risk assessment. Pooled treatment effects were computed using random‐effects models.ResultsFour studies consisting of 524 participants were included. The risk of bias was low–unclear in most areas. The pooled CBFI effect on four service user outcomes including overall positive symptoms, delusions, overall negative symptoms and general psychopathology was significantly improved at post‐treatment, compared with TAU, whereas effects on hallucinations and insight were equivocal.DiscussionThe findings reveal that CBFI is superior to TAU in treating positive and negative symptoms immediately following the intervention.Implications for PracticeMental health nurses may practise CBFI to enrich the psychiatric nursing service and promote nurse‐led intervention. However, there is currently no substantial evidence that the intervention is effective over the longer term.

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Association of an Early Intervention Service for Psychosis With Suicide Rate Among Patients With First-Episode Schizophrenia-Spectrum Disorders

Abstract: This study suggests that the EI service may be associated with reductions in the long-term suicide rate. Suicide at different stages of schizophrenia was associated with unique risk factors, highlighting the importance of a phase-specific service.

Cited by 64 publications

References 46 publications

Ten-year employment patterns of patients with first-episode schizophrenia-spectrum disorders: comparison of early intervention and standard care services

Ten-year employment patterns of patients with first-episode schizophrenia-spectrum disorders: comparison of early intervention and standard care services

Mortality and suicide in schizophrenia: 21-year follow-up in rural China

Cognitive behavioural family intervention for people diagnosed with severe mental illness and their families: A systematic review and meta‐analysis of randomized controlled trials

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