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Social Psychiatry and Psychiatric Epidemiology
Published in: Social Psychiatry and Psychiatric Epidemiology 8/2019

01-08-2019 | Schizophrenia | Original Paper

The rates and determinants of disengagement and subsequent re-engagement in young people with first-episode psychosis

Authors: Da Jung Kim, Ellie Brown, Siobhan Reynolds, Hellen Geros, Holly Sizer, Rachel Tindall, Patrick McGorry, Brian O’Donoghue

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 8/2019

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Abstract

Background

A core component of treatment provided by early intervention for psychosis (EI) services is ensuring individuals remain successfully engaged with the service. This ensures they can receive the care they may need at this critical early stage of illness. Unfortunately, rates of disengagement are high in individuals with a first episode of psychosis (FEP), representing a major barrier to effective treatment. This study aimed to ascertain the rates and determinants of disengagement and subsequent re-engagement of young people with FEP in a well-established EI service in Melbourne, Australia.

Method

This cohort study involved all young people, aged 15–24, who presented to the Early Psychosis Prevention and Intervention Centre (EPPIC) service with FEP between 1st January 2011 and 1st September 2014. Data were collected retrospectively from clinical files and electronic records. Cox regression analysis was used to identify determinants of disengagement and re-engagement.

Results

A total of 707 young people presented with FEP during the study period, of which complete data were available for 700. Over half of the cohort (56.3%, N = 394) disengaged at least once during their treatment period, however, the majority of these individuals (85.5%, N = 337) subsequently re-engaged following the initial episode of disengagement. Of those who disengaged from the service, 54 never re-engaged, representing 7.6% of the total cohort. Not being in employment, education or training, not having a family history of psychosis in second degree relatives and using cannabis were found to be significant predictors of disengagement. No significant predictors of re-engagement were identified.

Conclusion

In this study, the rate of disengagement in young people with first-episode psychosis was higher than found previously. Encouragingly, rates of re-engagement were also high. The concept of disengagement from services might be more complex than previously thought with individuals disengaging and re-engaging a number of times during their episode of care. What prompts individuals to re-engage with services needs to be better understood.
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Metadata
Title
The rates and determinants of disengagement and subsequent re-engagement in young people with first-episode psychosis
Authors
Da Jung Kim
Ellie Brown
Siobhan Reynolds
Hellen Geros
Holly Sizer
Rachel Tindall
Patrick McGorry
Brian O’Donoghue
Publication date
01-08-2019
Publisher
Springer Berlin Heidelberg
Keyword
Schizophrenia
Published in
Social Psychiatry and Psychiatric Epidemiology / Issue 8/2019
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI
https://doi.org/10.1007/s00127-019-01698-7

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