First-Episode Psychosis and Disengagement From Treatment: A Systematic Review

Abstract

Given the importance of continuity of care for FEP, there is a need for a clearly defined and agreed measurement of service engagement and disengagement across FEP services. In particular, those who enter an FEP program without family involvement and support as well as those who maintain persistent substance abuse are at higher risk of disengagement. Early identification of such individuals and the development of approaches to reduce risk of service disengagement are likely to increase the effectiveness of these services.

Correlates of attendance in mental health services for individuals with psychotic disorders: A critical review

“…Some of these variables are also largely driven by consumers (i.e., satisfaction, past history of missed appointments), indicating they could be particularly salient predictors of future attendance patterns and key areas for interventions to increase attendance. Another understudied variable, family involvement in treatment, predicted better attendance in both studies which examined it; this is consistent with past reviews (Doyle et al, 2014;O'Brien et al, 2009), and points to social support as an important place for future study and potential intervention.…”

“…Not surprisingly, few variables emerged as having clear, consistent relationships (i.e., ongoing substance use). This finding echoed that of a recent review of the attendance literature in first-episode psychosis, in which substance use was the most robust predictor of dropout, and demographic variables were of little value (Doyle et al, 2014). In the current review, diagnosis also seems to be of some utility, in that multiple studies found those diagnosed with psychosis not otherwise specified (as compared to schizophrenia) tend to have poorer attendance.…”

“…Studies also frequently did not clearly operationalize their attendance terms (Operationalized dropout/attendance terms in Table 2), making it difficult first for readers to understand exactly what is being measured, and second, for researchers to replicate the research design. As has been discussed before (Doyle et al, 2014;Mitchell & Selmes, 2007;Nose et al, 2003;O'Brien et al, 2009), this issue runs rampant in the attendance literature, and presents a barrier to furthering this research in a replicable, robust manner.…”

“…While variable, dropout rates appear high among outpatients with psychotic disorders, ranging from 17% to 64% (Dworkin, Adams, & Telschow, 1986;Ucok et al, 2007). A recent review of attendance to services for individuals with first-episode psychosis found an average dropout rate across 10 studies of about 30% (Doyle et al, 2014). With such high dropout rates, mental health agencies lose money and resources invested in missed appointments and under-attended groups, providers lose valuable time, and consumers do not receive recommended levels of services.…”

“…As Mitchell and Selmes (2007) note, attendance is often not measured in a nuanced fashion, but evidence indicates there may be distinctions in what predicts attendance for patients at varied levels of engagement (e.g., disengaged, low attendance, good attendance, etc.). O'Brien and colleagues (2009) discussed the difficulty in defining disengagement in general, and that terminology is often used interchangeably (such as attendance and engagement) when there may be important nuanced differences in what these terms imply; this issue is also of concern in the growing literature on treatment for first-episode psychosis (Doyle et al, 2014). Nose et al (2003) acknowledged that they chose not to assess how adherence was measured in their review, in part because "the majority of included studies did not explicitly state how adherence was measured" (pg.…”