Reasons for Discharge in a National Network of Early Psychosis Intervention Programs

Abstract

Background. Discharge from early psychosis intervention is a critical stage of treatment that may occur for a variety of reasons. This study characterizes reasons for discharge among participants in early psychosis intervention programs participating in the Early Psychosis Intervention Network (EPINET) which comprises >100 programs organized under eight academic hubs. Study Design. We analyzed 1,787 discharges with a focus on program completion, unilateral termination by the client/family, and lost contact with the client/family. We performed exploratory analyses of demographic, clinical, and functional predictors of discharge reason. Variables predictive of discharge type were included in multilevel logistic regressions, allowing for estimation of predictors of discharge reason and variability in rates by program and hub.Study Results. An estimated 20-30% of enrolled patients completed the program. Program completion rates were higher among participants who were older on admission, had lower negative symptoms severity, spent more time in education, employment or training, and were covered by private insurance (a close proxy for socioeconomic status). Programs were more likely to lose contact with male participants, black participants, and participants who were never covered by private insurance. After accounting for patient-level factors, there was substantial program-level variation on all three discharge outcomes, and hub-level variability on the proportion of participants who completed the program. The impact of race on program completion varied substantially by program.Conclusions. Participants discharged from early psychosis intervention services for diverse reasons, some of which were associated with sociocultural factors. Disengagement is a widespread problem affecting all hubs.