Disengagement from early psychosis intervention services: an observational study informed by a survey of patient and family perspectives

Abstract

Approximately one-third of patients with early psychosis disengage from services before the end of treatment. We sought to understand patient and family perspectives on early psychosis intervention (EPI) service engagement and use these findings to elucidate factors associated with early disengagement, defined as dropout from EPI in the first 9 months. Patients aged 16–29 referred to a large EPI program between July 2018-February 2020 and their family members were invited to complete a survey exploring facilitators and barriers to service engagement. A prospective chart review was conducted for 225 patients consecutively enrolled in the same EPI program, receiving the NAVIGATE model of coordinated specialty care, between July 2018-May 2019. We conducted a survival analysis, generating Kaplan–Meier curves depicting time to disengagement and Cox proportional hazards models to determine rate of disengagement controlling for demographic, clinical, and program factors. The survey was completed by 167 patients and 79 family members. The top endorsed engagement facilitator was related to the therapeutic relationship in both patients (36.5%) and families (43.0%). The top endorsed barrier to engagement was medication side effects in both patients (28.7%) and families (39.2%). In Cox proportional hazards models, medication nonadherence (HR = 2.37, 95% CI = 1.17–4.80) and use of individual psychotherapy (HR = .460, 95% CI = 0.220–0.962) were associated with early disengagement, but some of the health equity factors expected to affect engagement were not. Findings suggest that delivery of standardized treatment may buffer the effects of health disparities on service disengagement in early psychosis.

Care Pathways and Initial Engagement in Early Psychosis Intervention Services Among Youths and Young Adults

“…Interestingly, equity-related factors did not emerge as associated with initial engagement in our study or later disengagement in other EPI studies, 16,30 with problem substance use, medication nonadherence, and a lack of family support associated with disengagement later in EPI treatment. 16 Although we were not able to test the association between these factors and initial engagement as these data were not available at the time of EPI referral, referral from the ED or bridging clinic was found to be associated with nonattendance at the initial appointment and may act as a proxy for acuity or decreased social support.…”

Short-term disengagement from early intervention service for first-episode psychosis: findings from the “Parma Early Psychosis” program

“…Finally, a “reactive disengagement” in response to individual circumstances (such as medication side effects or a quick returning to work or school) may also exist. In the last case, engagement with EIP service becomes a second priority that young people would follow through with if it does not impact on their primary priority (i.e., the return to work/school) [ 74 , 75 ].…”

Rates and predictors of service disengagement in adolescents with first episode psychosis: results from the 2-year follow-up of the Pr-EP program

“…Finally, there could be a “reactive disengagement” in response to individual circumstances (such as the appearance of medication side effects or a quick returning to school or work). In the last case, engagement with EIP service becomes a second priority that FEP adolescents would follow through with if it does not impact on their primary priority [ 52 ]. However, it is also important to acknowledge that the age range of our FEP participants was lower than early psychosis studies in other countries (such as the North American context).…”