Return to College After a First Episode of Psychosis

Abstract

A first episode of psychosis (FEP) can derail a patient’s educational goals, including attainment of a college education, and this can have lasting ramifications for socioeconomic and health outcomes. Despite this, few studies have examined return to college or other indices of real-world educational success after a FEP. In this study, we conducted a longitudinal medical record review of patients in a transdiagnostic outpatient FEP program and performed survival analysis, setting return to college as the endpoint, among the subset of patients whose college education was interrupted. We found that 82% (93/114) of college-enrolled FEP individuals experienced disruptions to their education after FEP, but that return to college also occurred in a substantial proportion (49/88, 56%) among those on leave who had follow-up data. In this sample, the median time to college return was 18 months. When separated by baseline diagnostic category, FEP patients with affective psychotic disorders (FEAP, n=45) showed faster time to college return than those with primary psychotic disorders (FEPP, n=43) (median 12 vs. 24 months; p=0.024, unadjusted). When adjusted for having no more than one psychiatric hospitalization at intake and absence of cannabis use in the 6 months prior to intake (which were also significant predictors), differences by diagnostic category were more significant (hazard ratio 2.66, 95% CI 1.43-4.94, p=0.002). Participation in education is an important outcome for stakeholders, and students with FEP can be successful in accomplishing this goal.

Moving from risk to resilience in psychosis research

“…Research in psychosis prevention and recovery has traditionally focused on the absence of clinical psychotic symptoms and identifying the factors that prevent, delay, or reduce psychosis. This narrow definition diverges from the richer qualitative and psychosocial descriptors of well-being in individuals with psychotic disorders, whereby personal recovery is not necessarily contingent on clinical recovery [98][99][100][101] . To individuals seeking treatment, symptom remission alone might be insufficient to achieving a positive outcome.…”

Demographic predictors of lack of current mental health treatment among university students with a schizophrenia spectrum disorder

“…Although an estimated 56% of university students return to school following a first episode of psychosis, patterns of MH care use in this vulnerable population are poorly understood (Pedrelli et al, 2015; Shinn et al, 2020). The social environment of university campuses may make university a particularly high‐risk time for MH treatment interruptions (Pedrelli et al, 2015).…”

How early stigmatizing experiences, peer connections, and peer spaces influenced pathways to employment or education after a first-episode of psychosis.

“…It is common for young adults to experience unemployment in the months preceding the FEP as well as for prolonged periods while stabilizing from the illness (Ramsay et al, 2012). Educational disruption is also common, with college drop-out rates between 80% and 90% (Shinn et al, 2020) during the initial FEP period. Finally, the diagnostic labeling process can produce self-stigma, negatively impacting self-concept and personal aspirations (Ahmedani, 2011; Crocker, 1999; Goffman, 1959; Lauber et al, 2005), and further hindering pursuit of employment and education.…”