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Opie JE, Vuong A, Welsh ET, Esler TB, Khan UR, Khalil H. Outcomes of Best-Practice Guided Digital Mental Health Interventions for Youth and Young Adults with Emerging Symptoms: Part II. A Systematic Review of User Experience Outcomes. Clin Child Fam Psychol Rev 2024; 27:476-508. [PMID: 38634939 PMCID: PMC11222193 DOI: 10.1007/s10567-024-00468-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2024] [Indexed: 04/19/2024]
Abstract
Although many young people demonstrate resilience and strength, research and clinical evidence highlight an upward trend in mental health concerns among those aged 12 to 25 years. Youth-specific digital mental health interventions (DMHIs) aim to address this trend by providing timely access to mental health support for young people (12-25 years). However, there is a considerable gap in understanding young people user experiences with digital interventions. This review, co-designed with Australia's leading mental health organization Beyond Blue, utilizes a systematic methodology to synthesize evidence on user experience in youth-oriented digital mental health interventions that are fully or partially guided. Five relevant online databases were searched for articles published from 2018 to 2023, yielding 22,482 articles for screening and 22 studies were included in the present analysis. User experience outcomes relating to satisfaction and engagement were assessed for each included intervention, with experience indicators relating to usefulness, usability, value, credibility, and desirability being examined. Elements associated with positive/negative outcomes were extracted. Elements shown to positively influence user experience included peer engagement, modern app-based delivery, asynchronous support, and personalized content. In contrast, users disliked static content, homework/log-keeping, the requirement for multiple devices, and social media integration. Asynchronous interventions showed high satisfaction but faced engagement issues, with combined asynchronous/synchronous interventions reporting better completion rates. DMHIs offer a promising platform for youth mental health support and has the potential to dramatically increase the reach of interventions through the adoption of technological and user experience best practices. While young people respond positively to many aspects of intervention modernization, such as interactive, app-based design, other concepts, such as social media integration, they need to be adopted by the field more cautiously to ensure trust and engagement.Trial Registration CRD42023405812.
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Affiliation(s)
- Jessica E Opie
- The Bouverie Centre, La Trobe University, Melbourne, 3056, Australia.
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, 3000, Australia.
| | - An Vuong
- The Bouverie Centre, La Trobe University, Melbourne, 3056, Australia
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, 3000, Australia
| | - Ellen T Welsh
- The Bouverie Centre, La Trobe University, Melbourne, 3056, Australia
| | - Timothy B Esler
- The Bouverie Centre, La Trobe University, Melbourne, 3056, Australia
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, 3000, Australia
| | - Urooj Raza Khan
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, 3000, Australia
| | - Hanan Khalil
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, 3000, Australia
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Meyer-Kalos P, Owens G, Fisher M, Wininger L, Williams-Wengerd A, Breen K, Abate J, Currie A, Olinger N, Vinogradov S. Putting measurement-based care into action: A mixed methods study of the benefits of integrating routine client feedback in coordinated specialty care programs for early psychosis. RESEARCH SQUARE 2024:rs.3.rs-3918063. [PMID: 38405727 PMCID: PMC10889084 DOI: 10.21203/rs.3.rs-3918063/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Background Measurement-based care (MBC) is an effective tool in the delivery of evidence-based practices (EBPs). MBC utilizes feedback loops to share information and drive changes throughout a learning healthcare system. Few studies have demonstrated this practice in team-based care for people with early psychosis. This paper describes the development of a personalized feedback report derived from routine assessments that is shared with clients and clinicians as part of a MBC process. Methods We used a quasi pre-post comparison design with mixed methods to evaluate the implementation of a personalized feedback report at 5 early psychosis coordinated specialty care programs (CSC). We compared clients enrolled in CSC who did and did not receive a feedback report over the first 6 months of treatment. The sample included 204 clients: 146 who did not receive the feedback report and were enrolled over 2 years, and 58 who received the feedback report. A subset of 67 clients completed measures at both intake and 6-month follow-up, including 42 who received the report and 25 who did not. We compared the two groups with regard to self-reported symptoms, likelihood of completing treatment, and perception of shared decision making. We conducted qualitative interviews with 5 clients and 5 clinicians to identify the benefits and challenges associated with the personalized feedback report. Results People who received a personalized feedback report reported significant improvements in shared decision-making and had greater improvements over time in their intent to attend future treatment sessions. They engaged in more sessions for Supported Employment and Education (SEE), case management, and peer support, and fewer medication visits over the first 6 months of treatment. Both groups showed significant improvement in symptoms and functioning. Results from the qualitative analysis indicated that the experience of receiving the reports was valuable and validating for both patients and clinicians. Conclusions A personalized feedback report was integrated into standard of care for early psychosis programs. This process may improve shared decision-making, strengthen the likelihood to stay in treatment, and increase engagement in psychosocial interventions. We posit that this process facilitates strengths-focused discussions, enhances intrinsic motivation, and strengthens the therapeutic alliance.
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Pelosi AJ, Arulnathan V. Neglecting the care of people with schizophrenia: here we go again. Psychol Med 2023; 53:1-6. [PMID: 36804942 PMCID: PMC10009396 DOI: 10.1017/s0033291723000247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/11/2023] [Accepted: 01/23/2023] [Indexed: 02/22/2023]
Abstract
Specialist early intervention teams consider clinician-patient engagement and continuity of care to be a driving philosophy behind the treatment they provide to people who have developed schizophrenia or a related psychotic illness. In almost all countries where this service model has been implemented there is a dearth of available data about what is happening to patients following time-limited treatment. Information on discharge pathways in England indicates that some early intervention specialists are discharging most of their patients from all psychiatric services after only 2 or 3 years of input. Some ex-patients will be living in a state of torment and neglect due to an untreated psychosis. In the UK, general practitioners should refuse to accept these discharge pathways for patients with insight-impairing mental illnesses.
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A Scoping and Systematic Review of Employment Processes and Outcomes for Young Adults Experiencing Psychosis. Community Ment Health J 2022; 59:728-755. [PMID: 36463531 DOI: 10.1007/s10597-022-01056-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 11/11/2022] [Indexed: 12/07/2022]
Abstract
Young adults who experience psychosis want to work but are less likely to be employed than their peers. Sixty two studies relating to young adults with psychosis and employment were reviewed following a systematic search of five databases: CINAHL, PsycINFO, MEDLINE, SCOPUS and EMBASE. Publication date ranged from 1973 to 2019 with > 70% between 2010 and 2019. Intervention was considered in 29 papers; critical appraisal revealed 90% of these had moderate to good methodological quality with only three RCTs. Of 11 intervention types "Early Intervention" and "Individual Placement and Support" were most common; both demonstrating positive impact on obtaining employment. The review identified minimal participant perspectives and great variability in: terminology used; the reporting of participant attributes; intervention characteristics and ways employment outcomes were measured. Employment processes identified were preparing for, seeking, obtaining, keeping and re-obtaining employment, with current research efforts focused on obtaining work. More focus is required on keeping and re-obtaining employment.
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Thomas EC, Jones N, Shern DL, Salzer MS. Identifying indicators of community participation-promoting efforts within coordinated specialty care: A modified e-Delphi study of stakeholder perspectives. Early Interv Psychiatry 2022; 16:1376-1390. [PMID: 35322565 DOI: 10.1111/eip.13282] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 11/02/2021] [Accepted: 03/13/2022] [Indexed: 01/15/2023]
Abstract
AIM Community participation in occupational, social, recreational, and other domains is critically important during young adulthood. Coordinated Specialty Care (CSC) programs provide developmentally tailored care to young adults experiencing early psychosis within the United States, but little is known about the breadth of efforts to promote community participation. This study aimed to develop and evaluate indicators of these efforts based on the perspectives of a national multi-stakeholder group. METHODS Seventeen stakeholders (i.e., young adults with early psychosis, family members, experts by profession) participated in a modified e-Delphi study, conducted in two rounds. The purpose of round one was to generate a comprehensive list of community participation-promoting indicators. During round two, stakeholders rated the importance and feasibility of the implementation of each indicator. Descriptive statistics and percentage of agreement regarding round two ratings were assessed. RESULTS During round one, 186 indicators of activities and/or practices designed to promote community participation were identified; this list was reduced to 44 by eliminating redundancies or indicators not related to community participation. In round two, we found broad agreement regarding the importance, but significant variation in perceived feasibility of indicators. The highest-rated indicators in both categories pertained to staff knowledge (regarding barriers and supports to participation and the importance of participation to health) and strategies for addressing participation barriers. CONCLUSIONS This study is expected to facilitate the identification and development of promising CSC activities and practices designed to promote community participation among young adults while potentially also enhancing engagement in services and improving clinical outcomes.
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Affiliation(s)
- Elizabeth C Thomas
- College of Public Health, Temple University, Philadelphia, Pennsylvania, USA
| | - Nev Jones
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David L Shern
- National Association of State Mental Health Program Directors Research Institute, Falls Church, VA, USA
| | - Mark S Salzer
- College of Public Health, Temple University, Philadelphia, Pennsylvania, USA
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Munson MR, Jaccard J, Moore KL, Rodwin AH, Shimizu R, Cole AR, Scott LD, Narendorf SC, Davis M, Gilmer T, Stanhope V. Impact of a brief intervention to improve engagement in a recovery program for young adults with serious mental illness. Schizophr Res 2022; 250:104-111. [PMID: 36399899 PMCID: PMC9742319 DOI: 10.1016/j.schres.2022.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 10/03/2022] [Accepted: 11/06/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Serious mental illnesses (SMI) commonly emerge during young adulthood. Effective treatments for this population exist; however, engagement in treatment is a persistent challenge. This study examines the impact of Just Do You (JDY), an innovative intake-focused intervention designed to improve engagement in treatment and enhance personal recovery. METHODS The study used a parallel group randomized trial to examine if and how JDY improved recovery among 121 young adults with SMI from low-resourced communities referred to personalized recovery-oriented services (PROS). Measures of engagement (buy-in and attendance) and personal recovery in this pilot study were assessed at baseline and 3-month follow-up. RESULTS Participants in JDY reported more positive engagement outcomes; that is, relative to the control group they reported higher past two week attendance (b = 0.72, p < 0.05, Cohen's d = 0.56) and higher levels of buy-in to treatment (b = 2.42, p < 0.05, Cohen's d = 0.50). JDY also impacted young adults' personal recovery (b = 0.99, p < 0.05, Cohen's d = 1.15) and did so largely by increasing their level of buy-in to the treatment program. CONCLUSION This study suggests that an engagement intervention for young adults that orients, prepares, and empowers them to be active and involved in the larger treatment program makes a difference by improving engagement and enhancing recovery. Data also support conceptualizing and examining engagement beyond treatment attendance; in this study what mattered most for recovery was the level of buy-in to treatment among young adults.
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Affiliation(s)
- Michelle R Munson
- New York University, Silver School of Social Work, 1 Washington Sq. N, 10003 New York, NY, USA.
| | - James Jaccard
- New York University, Silver School of Social Work, 1 Washington Sq. N, 10003 New York, NY, USA
| | - Kiara L Moore
- New York University, Silver School of Social Work, 1 Washington Sq. N, 10003 New York, NY, USA
| | - Aaron H Rodwin
- New York University, Silver School of Social Work, 1 Washington Sq. N, 10003 New York, NY, USA
| | - Rei Shimizu
- University of Alaska, School of Social Work, 3211 Providence Drive, Anchorage, AK 99508, USA
| | - Andrea R Cole
- Fairleigh Dickinson University, 1000 River Rd, Teaneck, NJ 07666, USA
| | - Lionel D Scott
- Georgia State University, School of Social Work, 55 Park Pl, Atlanta, GA 3030, USA
| | - Sarah C Narendorf
- University of Houston, Graduate College of Social Work, 3511 Cullen Blvd, Houston, TX 77204, USA
| | - Maryann Davis
- University of Massachusetts, Chan Medical School, 55 Lake Avenue North, Worcester, MA, USA
| | - Todd Gilmer
- University of California San Diego, Department of Family Medicine and Public Health, 9500 Gilman Drive, San Diego, CA, USA
| | - Victoria Stanhope
- New York University, Silver School of Social Work, 1 Washington Sq. N, 10003 New York, NY, USA
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Brooke LE, Gucciardi DF, Ntoumanis N, Chapman MT, Lines RLJ, Perry Y, Gilbey D, Formby T, Phillips T, Lin A. Enhancing functional recovery for young people recovering from first episode psychosis via sport-based life skills training: outcomes of a feasibility and pilot study. Health Psychol Behav Med 2022; 10:1136-1158. [PMID: 36437870 PMCID: PMC9683043 DOI: 10.1080/21642850.2022.2147073] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 11/02/2022] [Indexed: 11/22/2022] Open
Abstract
Early intervention within First Episode Psychosis (FEP) recovery efforts support functional recovery in several ways, including increasing levels of (1) physical activity (2) life skills, and (3) social connectivity. Sport has been proposed as an ideal platform to target these three goals simultaneously. The primary aims were to assess the feasibility of utilising sport-based life skills within FEP recovery efforts and test intervention components. The secondary aim was to evaluate the potential recovery benefits. Seven young people (aged 15-25 years) with FEP participated in a six-week sport programme alongside their support workers (community and peer workers) from the service, including peer workers with a lived experience of psychosis. The programme consisted of various sporting activities, which were designed to promote physical activity, maximise social connectivity, and teach life-skills (e.g. motivation, emotional regulation, and goal-setting) that are relevant and transferrable to other contexts (e.g. school, employment, independent living). The support participants engaged with the programme at the same level as the young people, with the role of providing support and normalising/modelling engagement. The young and support participants provided feedback during and after the programme via questionnaires and interviews. Young participants self-reported physical activity levels, psychological needs, recovery dimensions, and life skills pre- and post- intervention using established psychometric tools. We used thematic analysis to analyse the qualitative data and compared this information with other data collected (e.g. attendance, feedback, quantitative measurements). The study culminated with a process evaluation. The results indicated that, despite challenges with engagement for young people with FEP, sport-based life skills programming may be a feasible and useful recovery outlet. In addition, the results highlighted specific intervention components that were useful to promote engagement and recovery benefits. This study serves as a critical foundation for future sport-based work within FEP recovery.
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Affiliation(s)
- Lauren E. Brooke
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Daniel F. Gucciardi
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Nikos Ntoumanis
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
| | | | - Robin L. J. Lines
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Yael Perry
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Dylan Gilbey
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | | | | | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
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Qi W, Marx J, Zingman M, Li Y, Petkova E, Blessing E, Ardekani B, Sakalli Kani A, Cather C, Freudenreich O, Holt D, Zhao J, Wang J, Goff DC. Hippocampal Subfield Volumes Predict Disengagement from Maintenance Treatment in First Episode Schizophrenia. Schizophr Bull 2022; 49:34-42. [PMID: 36370124 PMCID: PMC9810017 DOI: 10.1093/schbul/sbac043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Disengagement from treatment is common in first episode schizophrenia (FES) and is associated with poor outcomes. Our aim was to determine whether hippocampal subfield volumes predict disengagement during maintenance treatment of FES. METHODS FES patients were recruited from sites in Boston, New York, Shanghai, and Changsha. After stabilization on antipsychotic medication, participants were randomized to add-on citalopram or placebo and followed for 12 months. Demographic, clinical and cognitive factors at baseline were compared between completers and disengagers in addition to volumes of hippocampal subfields. RESULTS Baseline data were available for 95 randomized participants. Disengagers (n = 38, 40%) differed from completers (n = 57, 60%) by race (more likely Black; less likely Asian) and in more alcohol use, parkinsonism, negative symptoms and more impairment in visual learning and working memory. Bilateral dentate gyrus (DG), CA1, CA2/3 and whole hippocampal volumes were significantly smaller in disengagers compared to completers. When all the eight volumes were entered into the model simultaneously, only left DG volume significantly predicted disengagement status and remained significant after adjusting for age, sex, race, intracranial volume, antipsychotic dose, duration of untreated psychosis, citalopram status, alcohol status, and smoking status (P < .01). Left DG volume predicted disengagement with 57% sensitivity and 83% specificity. CONCLUSIONS Smaller left DG was significantly associated with disengagement status over 12 months of maintenance treatment in patients with FES participating in a randomized clinical trial. If replicated, these findings may provide a biomarker to identify patients at risk for disengagement and a potential target for interventions.
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Affiliation(s)
| | | | - Michael Zingman
- Department of Psychiatry, NYU Langone Health, 1 Park Avenue, New York, NY, USA
| | - Yi Li
- Department of Population Health, Division of Biostatistics, NYU School of Medicine, 180 Madison Avenue, New York, NY, USA
| | - Eva Petkova
- Department of Population Health, Division of Biostatistics, NYU School of Medicine, 180 Madison Avenue, New York, NY, USA,Nathan Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY, USA
| | - Esther Blessing
- Department of Psychiatry, NYU Langone Health, 1 Park Avenue, New York, NY, USA
| | - Babak Ardekani
- Department of Psychiatry, NYU Langone Health, 1 Park Avenue, New York, NY, USA,Nathan Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY, USA
| | - Ayse Sakalli Kani
- Department of Psychiatry, NYU Langone Health, 1 Park Avenue, New York, NY, USA,4New York State Psychiatric Institute, Columbia University Medical Center, 601 West 168th St., New York, NY, USA
| | - Corinne Cather
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, USA
| | - Oliver Freudenreich
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, USA
| | - Daphne Holt
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, USA
| | - Jingping Zhao
- National Clinical Research Center for Mental Disorders, Mental Health Institute, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jijun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Donald C Goff
- To whom correspondence should be addressed; Psychiatry Department, NYU Langone Health, One Park Ave, New York, NY 10016, USA; tel: 646-754-4843, e-mail:
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Brown E, Gao CX, Staveley H, Williams G, Farrelly S, Rickwood D, Telford N, Papanastasiou C, McGorry P, Thompson A. The clinical and functional outcomes of a large naturalistic cohort of young people accessing national early psychosis services. Aust N Z J Psychiatry 2022; 56:1265-1276. [PMID: 34845922 DOI: 10.1177/00048674211061285] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS Services for individuals with a first episode of psychosis or at ultra-high risk of psychosis have become a treatment model of choice in mental health care. The longitudinal changes in clinical and functional outcomes as a result of real-world treatment remain under-reported. METHODS We analysed data from first episode of psychosis and ultra-high risk services delivered across Australian primary youth mental health care services known as headspace between 19 June 2017 and 30 September 2019. Outcome measures were completed and entered into a minimum dataset every 90 days a participant was receiving treatment and included psychiatric symptomatology (Brief Psychiatric Rating Scale and psychological distress, K10) and psychosocial functioning (Social and Occupational Functioning Assessment Scale and My Life Tracker). Linear mixed-effects models were used to evaluate changes in outcome over time. RESULTS Outcome data from a total of 1252 young people were evaluated (643 first episode of psychosis, 609 ultra-high risk). Of those who entered ultra-high risk services, 11.8% transitioned to first episode of psychosis services. Overall, substantial improvement in clinical (Brief Psychiatric Rating Scale, K10) and functional (Social and Occupational Functioning Assessment Scale, My Life Tracker) outcomes were seen across groups and outcomes. Ultra-high risk patients showed a greater reduction in distress symptoms, while first episode of psychosis patients experienced a greater reduction in positive psychosis symptoms. Although clinical outcomes showed a plateau effect after approximately 3 months of care, improvement in functional outcomes (Social and Occupational Functioning Assessment Scale, My Life Tracker) continued later in treatment. CONCLUSION These findings support the use of real-time, real-world and low-cost administrative data to rigorously evaluate symptomatic and functional outcomes in early psychosis treatment settings. Findings that functional outcomes improve past the remittance of clinical outcomes also support the functional recovery focus of early psychosis services and remaining high levels of distress suggest the need for ultra-high risk services to extend beyond 6 months of care.
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Affiliation(s)
- Ellie Brown
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, Parkville, VIC, Australia
| | - Caroline X Gao
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, Parkville, VIC, Australia
| | - Heather Staveley
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, Parkville, VIC, Australia
| | - Georgia Williams
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, Parkville, VIC, Australia
| | - Simone Farrelly
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Debra Rickwood
- Headspace National, Melbourne, VIC, Australia.,University of Canberra, Canberra, ACT, Australia
| | - Nic Telford
- Headspace National, Melbourne, VIC, Australia
| | | | - Pat McGorry
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, Parkville, VIC, Australia
| | - Andrew Thompson
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, Parkville, VIC, Australia
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Iyer SN, Malla A, Taksal A, Maraj A, Mohan G, Ramachandran P, Margolese HC, Schmitz N, Joober R, Rangaswamy T. Context and contact: a comparison of patient and family engagement with early intervention services for psychosis in India and Canada. Psychol Med 2022; 52:1538-1547. [PMID: 32981550 DOI: 10.1017/s0033291720003359] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND It is unknown whether patient disengagement from early intervention services for psychosis is as prevalent in low- and middle-income countries (LMICs) like India, as it is in high-income countries (HICs). Addressing this gap, we studied two first-episode psychosis programs in Montreal, Canada and Chennai, India. We hypothesized lower service disengagement among patients and higher engagement among families in Chennai, and that family engagement would mediate cross-site differences in patient disengagement. METHODS Sites were compared on their 2-year patient disengagement and family engagement rates conducting time-to-event analyses and independent samples t tests on monthly contact data. Along with site and family involvement, Cox proportional hazards regression included known predictors of patient disengagement (e.g. gender). RESULTS The study included data about 333 patients (165 in Montreal, 168 in Chennai) and their family members (156 in Montreal, 168 in Chennai). More Montreal patients (19%) disengaged before 24 months than Chennai patients (1%), χ2(1, N = 333) = 28.87, p < 0.001. Chennai families had more contact with clinicians throughout treatment (Cohen's d = -1.28). Family contact significantly predicted patient disengagement in Montreal (HR = 0.87, 95% CI 0.81-0.93). Unlike in Chennai, family contact declined over time in Montreal, with clinicians perceiving such contact as not necessary (Cohen's d = 1.73). CONCLUSIONS This is the first investigation of early psychosis service engagement across a HIC and an LMIC. Patient and family engagement was strikingly higher in Chennai. Maintaining family contact may benefit patient engagement, irrespective of context. Findings also suggest that differential service utilization may underpin cross-cultural variations in psychosis outcomes.
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Affiliation(s)
- Srividya N Iyer
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Ashok Malla
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Aarati Taksal
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Anika Maraj
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Greeshma Mohan
- Schizophrenia Research Foundation (SCARF), Chennai, Tamil Nadu, India
| | | | - Howard C Margolese
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Prevention and Early Intervention Program for Psychosis- McGill University Health Centre (PEPP-MUHC), Montreal, Quebec, Canada
| | - Norbert Schmitz
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Thara Rangaswamy
- Schizophrenia Research Foundation (SCARF), Chennai, Tamil Nadu, India
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11
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Westfall MBE, Kohler CG, Hurford I, Abegunde C, Agosti D, Brinen A, Cadman ML, Conroy C, Ered A, Fooks A, Franco O, Huque ZM, Namowicz D, O'Connor S, Oross M, Payne E, Sarpal DK, Schmidt LR, Swigart A, Wenzel RM, Calkins ME. Pennsylvania coordinated specialty care programs for first-episode psychosis: 6- and 12-month outcomes. Early Interv Psychiatry 2021; 15:1395-1408. [PMID: 33283472 DOI: 10.1111/eip.13084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/16/2020] [Accepted: 11/14/2020] [Indexed: 01/21/2023]
Abstract
AIM Pennsylvania (PA) first-episode psychosis (FEP) program evaluation is a statewide initiative, supported by the PA Office of Mental Health and Substance Abuse Services (PA-OMHSAS) and administered by PA Early Intervention Center/Heads Up, which evaluates fidelity and outcomes of PA Coordinated Specialty Care (CSC) programs. Programs participate in standard computerized measures of CSC outcomes using centralized informatics. The aims of the current report are to describe implementation of this core battery for program evaluation in PA and to present 6- and 12-month outcomes. METHODS Participants (n = 697) from nine PA CSC programs completed the core battery at admission. The battery was re-administered at 6- and 12-month follow-up, and data were analysed for individuals (n = 230) who had completed 12-months of treatment. Domains assessed via clinician report and/or self-report included symptoms, role and social functioning, self-perceived recovery and service utilization. RESULTS PA FEP CSC participants showed improvement over time in several domains, including decreased symptoms, higher role and social functioning, decreased hospitalizations, and improved self-perception of recovery, quality of life, and services satisfaction. Trends towards improvements were observed for participant happiness, hopelessness, and school-enrolment. Nearly all improvements were observed at 6-month follow-up, with earlier gains maintained at 12-months. CONCLUSIONS PA FEP CSC programs demonstrate the ability to assess and improve critical outcomes of coordinated specialty care in PA. Improved outcomes by 12 months in treatment provides evidence of an effective treatment model and supports the continuation of these programs in pursuit of our goal of reducing schizophrenia disease burden on individuals and society.
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Affiliation(s)
- Megan B E Westfall
- Pennsylvania Early Intervention Center (PEIC)/Heads Up, Psychosis and Neurodevelopment Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christian G Kohler
- Pennsylvania Early Intervention Center (PEIC)/Heads Up, Psychosis and Neurodevelopment Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Psychosis Evaluation and Recovery Center (PERC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Irene Hurford
- Pennsylvania Early Intervention Center (PEIC)/Heads Up, Psychosis and Neurodevelopment Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Courtney Abegunde
- STEP Clinic, UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA
| | - Dominick Agosti
- Connect 2 Empower, CMSU Behavioral Health Services, Danville, Pennsylvania, USA
| | - Aaron Brinen
- Department of Psychiatry, Drexel College of Medicine, Philadelphia, Pennsylvania, USA
| | - Mary Lyn Cadman
- Connect 2 Empower, CMSU Behavioral Health Services, Danville, Pennsylvania, USA
| | - Catherine Conroy
- Pennsylvania Early Intervention Center (PEIC)/Heads Up, Psychosis and Neurodevelopment Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Arielle Ered
- Psychosis Evaluation and Recovery Center (PERC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA
| | - Amanda Fooks
- CAPSTONE, Pennsylvania Psychiatric Institute, Harrisburg, Pennsylvania, USA
| | - Olivia Franco
- Psychosis Evaluation and Recovery Center (PERC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zeeshan M Huque
- Psychosis Evaluation and Recovery Center (PERC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Denise Namowicz
- Helping to Overcome Psychosis Early (HOPE), Children's Service Center, Wilks-Barre, Pennsylvania, USA
| | - Seamus O'Connor
- On My Way, Child and Family Focus, Inc., Broomall, Pennsylvania, USA
| | - Molly Oross
- ENGAGE, Wesley Family Services, Pittsburgh, Pennsylvania, USA
| | - Elisa Payne
- Psychosis Evaluation and Recovery Center (PERC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Deepak K Sarpal
- STEP Clinic, UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA
| | - Lyndsay R Schmidt
- Psychosis Evaluation and Recovery Center (PERC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alison Swigart
- CAPSTONE, Pennsylvania Psychiatric Institute, Harrisburg, Pennsylvania, USA
| | | | - Monica E Calkins
- Pennsylvania Early Intervention Center (PEIC)/Heads Up, Psychosis and Neurodevelopment Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Psychosis Evaluation and Recovery Center (PERC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Symptomatic, functional and service utilization outcomes of migrants with a first episode of psychosis. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1389-1397. [PMID: 33399882 DOI: 10.1007/s00127-020-02011-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Certain migrant groups have been identified as being at increased risk of developing a psychotic disorder, but there is limited research on the outcomes for migrants who develop a first episode of psychosis (FEP). We investigated symptomatic outcomes (remission and relapse rates), functional outcomes (occupational status and relationships) and service utilization (hospital admission and engagement). METHODS Young people, aged between 15 and 24, who presented with FEP to the Early Psychosis Prevention and Intervention Centre (EPPIC) at Orygen between 01.01.11 and 31.12.16 were included. Place of birth was recorded at the time of presentation. To determine remission, symptoms were scored at three-month intervals using the short-form Scale for the Assessment of Positive Symptoms. RESULTS A total of 1220 young people presented with FEP over the six-year period (mean age = 19.6 ± 2.8). Of these, 58.1% were male and 24.0% were first-generation migrants. While there was no difference in overall rates of admission after presentation, migrants were more likely to have an involuntary admission after presentation (31.4% vs. 24.6%, aHR = 1.54, 95% CI [1.19, 2.01]) and this risk was greatest for African migrants (HR = 1.98, 95% C.I. [1.37, 2.86]. The rates of remission and relapse were similar in migrants and those born in Australia and there was no difference in functional outcomes, such as employment rates at follow-up. DISCUSSION The outcomes for migrants who experience FEP appear to be largely similar to those for the Australian-born population. Our finding that a greater rate of involuntary admission for migrants at presentation supports existing literature and needs further exploration to improve clinical care.
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13
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Engagement with online psychosocial interventions for psychosis: A review and synthesis of relevant factors. Internet Interv 2021; 25:100411. [PMID: 34401370 PMCID: PMC8350605 DOI: 10.1016/j.invent.2021.100411] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 05/27/2021] [Accepted: 06/02/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Little is known about factors associated with engagement with online interventions for psychosis. This review aimed to synthesise existing data from relevant literature to develop a working model of potential variables that may impact on engagement with online interventions for psychosis. METHODS Online databases were searched for studies relevant to predictors of engagement with online interventions for psychosis; predictors of Internet use amongst individuals with psychosis; and predictors of engagement with traditional psychosocial treatments for psychosis. Data were synthesised into a conceptual model highlighting factors relevant to engagement with online interventions for psychosis. RESULTS Sixty-one studies were identified. Factors relevant to engagement related directly to the impact of psychosis, response to psychosis, integration of technology into daily lives and intervention aspects. CONCLUSION While several candidate predictors were identified, there is minimal research specifically investigated predictors of engagement with online interventions for psychosis. Further investigation examining both individual- and intervention-related factors is required to inform effective design and dissemination of online interventions for psychosis.
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14
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Incidence of catastrophic healthcare expenditure and its main determinants in Mexican households caring for a person with a mental disorder. Glob Ment Health (Camb) 2021; 8:e2. [PMID: 33889419 PMCID: PMC8057364 DOI: 10.1017/gmh.2020.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 11/14/2020] [Accepted: 12/03/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND There are few studies on the impact of out-of-pocket mental health care expenditures and sociodemographic factors on the probability of Mexican households to incur catastrophic healthcare expenditures (CHE). OBJECTIVE The goal of the present study was to estimate the incidence of CHE and its main determinants among the households of persons with mental disorders (MD) in Mexico. METHODS A cross-sectional survey was conducted, including 387 households of persons with MD. The estimation of the CHE was obtained by the health expenditure distribution method. A Logistic Regression (LR) was used to identify the determinants of probability variation of CHE occurrence. Since we expected a proportion of CHE between 20% and 80%, we assume linearity in the probability function, therefore we additionally used an Ordinary Least Squares (OLS) model. RESULTS In our sample, the incidence of CHE was 34.8%. The two mental illnesses most frequently associated with CHE were schizophrenia and hyperactive disorder (35.5% and 32.6% of CHE cases, respectively). The regression coefficients showed that for each unit (US$53.77) increase in income, the probability of CHE was reduced by 8.6%, while for each unit increase in hospitalization or medication expenditures, the probability of CHE increased by 12.9% or 19%, respectively. For each additional household member, the probability of CHE increased by 3%, and households with a male patient had a 7% greater probability of CHE. CONCLUSION Household income, household size, hospitalization and medication expenses, and sex of the patient were significant predictors of CHE for households caring for a person with MD.
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15
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Mascayano F, van der Ven E, Martinez-Ales G, Henao AR, Zambrano J, Jones N, Cabassa LJ, Smith TE, Yang LH, Susser E, Dixon LB. Disengagement From Early Intervention Services for Psychosis: A Systematic Review. Psychiatr Serv 2021; 72:49-60. [PMID: 33234052 DOI: 10.1176/appi.ps.201900375] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Therapeutic benefits associated with early services for psychosis are influenced by the degree to which participants engage in treatment. The main objective of this review was to analyze rates of disengagement in early psychosis services and identify predictors of disengagement in these settings. METHODS A systematic search for studies published in the 1966-2019 period was conducted in PubMed, Google Scholar, EBSCO, Ovid, and Embase. The Observational Cohort and Cross-Sectional Studies scale was used to assess the methodological quality of reports identified in this search. A revised version of the behavioral model of health service use was employed to evaluate and understand predictors of disengagement (categorized as predisposing, enabling, and need factors) identified in the studies with the highest quality. RESULTS Twenty studies met the inclusion criteria. Disengagement rates (12% to 53%) and definitions of disengagement varied widely across these studies. Most did not find a compelling association between predisposing factors (e.g., age) and disengagement. Enabling factors, such as lack of family support and living alone, were consistently found to be related to increased disengagement across studies. Finally, need factors, such as lower medication adherence and higher drug misuse, were associated with higher risk for disengagement. CONCLUSIONS Enabling and need factors seemed to be the most predictive of disengagement from early psychosis services. Substantial between-study variation in identified predictors of disengagement may be addressed by developing and applying a consensus definition of disengagement in future research.
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Affiliation(s)
- Franco Mascayano
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Mascayano, van der Ven, Martinez-Ales, Restrepo Henao, Zambrano, Yang, Susser); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Mascayano, Smith, Susser, Dixon); School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands (van der Ven); Epidemiology Group, National School of Public Health, Universidad of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Mental Health Law and Policy, Louis de la Parte Florida Mental Health Institute, University of South Florida, Tampa (Jones); George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis (Cabassa); Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York City (Yang)
| | - Els van der Ven
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Mascayano, van der Ven, Martinez-Ales, Restrepo Henao, Zambrano, Yang, Susser); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Mascayano, Smith, Susser, Dixon); School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands (van der Ven); Epidemiology Group, National School of Public Health, Universidad of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Mental Health Law and Policy, Louis de la Parte Florida Mental Health Institute, University of South Florida, Tampa (Jones); George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis (Cabassa); Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York City (Yang)
| | - Gonzalo Martinez-Ales
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Mascayano, van der Ven, Martinez-Ales, Restrepo Henao, Zambrano, Yang, Susser); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Mascayano, Smith, Susser, Dixon); School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands (van der Ven); Epidemiology Group, National School of Public Health, Universidad of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Mental Health Law and Policy, Louis de la Parte Florida Mental Health Institute, University of South Florida, Tampa (Jones); George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis (Cabassa); Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York City (Yang)
| | - Alexandra Restrepo Henao
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Mascayano, van der Ven, Martinez-Ales, Restrepo Henao, Zambrano, Yang, Susser); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Mascayano, Smith, Susser, Dixon); School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands (van der Ven); Epidemiology Group, National School of Public Health, Universidad of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Mental Health Law and Policy, Louis de la Parte Florida Mental Health Institute, University of South Florida, Tampa (Jones); George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis (Cabassa); Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York City (Yang)
| | - Juliana Zambrano
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Mascayano, van der Ven, Martinez-Ales, Restrepo Henao, Zambrano, Yang, Susser); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Mascayano, Smith, Susser, Dixon); School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands (van der Ven); Epidemiology Group, National School of Public Health, Universidad of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Mental Health Law and Policy, Louis de la Parte Florida Mental Health Institute, University of South Florida, Tampa (Jones); George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis (Cabassa); Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York City (Yang)
| | - Nev Jones
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Mascayano, van der Ven, Martinez-Ales, Restrepo Henao, Zambrano, Yang, Susser); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Mascayano, Smith, Susser, Dixon); School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands (van der Ven); Epidemiology Group, National School of Public Health, Universidad of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Mental Health Law and Policy, Louis de la Parte Florida Mental Health Institute, University of South Florida, Tampa (Jones); George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis (Cabassa); Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York City (Yang)
| | - Leopoldo J Cabassa
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Mascayano, van der Ven, Martinez-Ales, Restrepo Henao, Zambrano, Yang, Susser); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Mascayano, Smith, Susser, Dixon); School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands (van der Ven); Epidemiology Group, National School of Public Health, Universidad of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Mental Health Law and Policy, Louis de la Parte Florida Mental Health Institute, University of South Florida, Tampa (Jones); George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis (Cabassa); Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York City (Yang)
| | - Thomas E Smith
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Mascayano, van der Ven, Martinez-Ales, Restrepo Henao, Zambrano, Yang, Susser); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Mascayano, Smith, Susser, Dixon); School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands (van der Ven); Epidemiology Group, National School of Public Health, Universidad of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Mental Health Law and Policy, Louis de la Parte Florida Mental Health Institute, University of South Florida, Tampa (Jones); George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis (Cabassa); Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York City (Yang)
| | - Lawrence H Yang
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Mascayano, van der Ven, Martinez-Ales, Restrepo Henao, Zambrano, Yang, Susser); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Mascayano, Smith, Susser, Dixon); School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands (van der Ven); Epidemiology Group, National School of Public Health, Universidad of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Mental Health Law and Policy, Louis de la Parte Florida Mental Health Institute, University of South Florida, Tampa (Jones); George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis (Cabassa); Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York City (Yang)
| | - Ezra Susser
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Mascayano, van der Ven, Martinez-Ales, Restrepo Henao, Zambrano, Yang, Susser); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Mascayano, Smith, Susser, Dixon); School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands (van der Ven); Epidemiology Group, National School of Public Health, Universidad of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Mental Health Law and Policy, Louis de la Parte Florida Mental Health Institute, University of South Florida, Tampa (Jones); George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis (Cabassa); Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York City (Yang)
| | - Lisa B Dixon
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Mascayano, van der Ven, Martinez-Ales, Restrepo Henao, Zambrano, Yang, Susser); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Mascayano, Smith, Susser, Dixon); School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands (van der Ven); Epidemiology Group, National School of Public Health, Universidad of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Mental Health Law and Policy, Louis de la Parte Florida Mental Health Institute, University of South Florida, Tampa (Jones); George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis (Cabassa); Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York City (Yang)
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Guitter M, Laprevote V, Lala A, Sturzu L, Dobre D, Schwan R. Rate and predictors of interrupted patient follow-up after first-episode psychosis - a retrospective cohort study in France. Early Interv Psychiatry 2020; 15:1551-1563. [PMID: 33350169 DOI: 10.1111/eip.13093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 09/28/2020] [Accepted: 11/14/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patient adherence to follow-up after a first episode of psychosis (FEP) is currently a major challenge. Patient's early adherence reduces the risk of relapse and improves their prognosis in the short and long term. The primary goal of our study was to determine the incidence of treatment disengagement at 1-year follow-up in patients with first-episode schizophrenia, schizophreniform or schizoaffective disorder. The secondary goal was to assess the factors associated with treatment disengagement in this patient population. METHODS We conducted a monocentric retrospective study of 136 patients in France. Relevant information was collected on sociodemographic, pre-morbidities and co-morbidities data, as well as the management and treatment characteristics at 1.3 and 12 months. Survival analysis was used to assess the association between clinical variables, management and treatment disengagement. RESULTS Eighty-four patients (62%) have interrupted their medical follow-up at 1 year, 16% at 1 month and 34% at 3 months. A higher number of out-patient appointments after a FEP was associated with better adherence (HR:0.85 p < .0001 95% IC = [0.0-0.9]). Initial management seems to play an important role. Involuntary admissions (HR:7.14 p = .015 95% IC = [1.48-34.52]) and total number of admissions (HR:6.86 p < .0001 95% IC = [2.47-19.05]) predict disengagement at 1 month while an increased number of out-patient appointments at 3 months predicts adherence (HR:0.60 p < .0001 95% IC = [0.00-0.74]). Being a single parent is associated with disengagement at 3 months (HR:15.51 p = .022 95% IC = [1.49-161.65]). CONCLUSIONS Incidence of disengagement is high. It might be necessary to change our management in order to develop out-patient or day-admission care and intensify care for patients at risk.
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Affiliation(s)
- Marie Guitter
- Faculté de Médecine, Université de Lorraine, Vandoeuvre les Nancy, France
| | - Vincent Laprevote
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France
| | - Adrian Lala
- Emergency Medicine Unit, 'Robert PAX' Hospital, Sarreguemines, France
| | - Livia Sturzu
- Faculté de Médecine, Université de Lorraine, Vandoeuvre les Nancy, France
| | - Daniela Dobre
- Unité de Recherche et d'Investigation Clinique, Centre Psychothérapique de Nancy, Laxou, France
| | - Raymund Schwan
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France
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Jones N, Gius B, Daley T, George P, Rosenblatt A, Shern D. Coordinated Specialty Care Discharge, Transition, and Step-Down Policies, Practices, and Concerns: Staff and Client Perspectives. Psychiatr Serv 2020; 71:487-497. [PMID: 32188363 DOI: 10.1176/appi.ps.201900514] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In recent years, optimizing the process of transition and discharge from coordinated specialty care (CSC), a program that provides early intervention in psychosis, has emerged as an important focus area for program administrators, clinicians, and policy makers. To explore existing CSC policies and practices and to understand frontline provider and client views on discharge, the authors conducted a comprehensive analysis of staff and client interview data from the Mental Health Block Grant 10% Set-Aside Study. METHODS Data from 66 interviews with groups of CSC providers and administrators representing 36 sites and 22 states were analyzed, as well as data from interviews with 82 CSC clients at 34 sites. Transcripts were coded by using systematic content analyses. RESULTS Analyses of data from providers and administrators showed the heterogeneity of CSC program practices and strategies regarding discharge and highlighted a range of concerns related to postdischarge service accessibility and quality. Analysis of data from client interviews reflected the heterogeneity of transition challenges that clients confront. A significant number of participants reported concerns about their readiness for discharge. CONCLUSIONS CSC discharge policies and practices vary across CSC programs and states. Frequent clinician and client concerns about optimal program length, transition, and postdischarge services highlight the importance of sustained policy and research efforts to develop evidence-informed practice guidelines and possible modifications to the time-limited CSC model that currently dominates the field.
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Affiliation(s)
- Nev Jones
- Department of Psychiatry and Behavioral Neurosciences (Jones) and Department of Psychology (Gius), University of South Florida, Tampa; Westat, Inc., Rockville, Maryland (Daley, George, Rosenblatt); National Association of State Mental Health Program Directors, Alexandria, Virginia (Shern)
| | - Becky Gius
- Department of Psychiatry and Behavioral Neurosciences (Jones) and Department of Psychology (Gius), University of South Florida, Tampa; Westat, Inc., Rockville, Maryland (Daley, George, Rosenblatt); National Association of State Mental Health Program Directors, Alexandria, Virginia (Shern)
| | - Tamara Daley
- Department of Psychiatry and Behavioral Neurosciences (Jones) and Department of Psychology (Gius), University of South Florida, Tampa; Westat, Inc., Rockville, Maryland (Daley, George, Rosenblatt); National Association of State Mental Health Program Directors, Alexandria, Virginia (Shern)
| | - Preethy George
- Department of Psychiatry and Behavioral Neurosciences (Jones) and Department of Psychology (Gius), University of South Florida, Tampa; Westat, Inc., Rockville, Maryland (Daley, George, Rosenblatt); National Association of State Mental Health Program Directors, Alexandria, Virginia (Shern)
| | - Abram Rosenblatt
- Department of Psychiatry and Behavioral Neurosciences (Jones) and Department of Psychology (Gius), University of South Florida, Tampa; Westat, Inc., Rockville, Maryland (Daley, George, Rosenblatt); National Association of State Mental Health Program Directors, Alexandria, Virginia (Shern)
| | - David Shern
- Department of Psychiatry and Behavioral Neurosciences (Jones) and Department of Psychology (Gius), University of South Florida, Tampa; Westat, Inc., Rockville, Maryland (Daley, George, Rosenblatt); National Association of State Mental Health Program Directors, Alexandria, Virginia (Shern)
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18
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Brown E, Bedi G, McGorry P, O’Donoghue B. Rates and Predictors of Relapse in First-Episode Psychosis: An Australian Cohort Study. ACTA ACUST UNITED AC 2020. [DOI: 10.1093/schizbullopen/sgaa017] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Abstract
Background
Clinical and functional recovery is usually achieved after treatment for a first episode of psychosis (FEP). Unfortunately, subsequent relapse remains common, occurring within a year for approximately 30% of individuals and up to 80% over 5 years. Factors that make relapse more likely in any given individual remain poorly understood.
Methods
This article presents a naturalistic cohort study of young people (15–24 years old) accessing an early intervention in psychosis service in Melbourne, Australia between January 1, 2011 and December 31, 2016. Demographic and clinical predictors of relapse were collected and analyzed using Cox regression analysis.
Results
A total of 1220 young people presented with an FEP during the study period; 37.7% (N = 460) experienced at least 1 relapse during their episode of care. Over half of all relapses resulted in an admission to hospital. Non-adherence to medication, substance use, and psychosocial stressors were commonly noted as clinical precipitants of relapse. Significant predictors of relapse (vs no relapse) were a diagnosis of schizophrenia spectrum disorder (adjusted hazard ratio [aHR] = 1.62) or affective psychotic disorder (aHR = 1.37), lifetime amphetamine use (aHR = 1.48), and any substance use during treatment (aHR = 1.63).
Conclusion
These findings suggest that relapse occurs frequently for young people who have experienced FEP. This is one of the first studies to report that amphetamine use (predominantly illicit methamphetamine) increases the risk of relapse. Clinical services, especially in Australasia, need to consider how best to manage this comorbidity in young people with FEP.
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Affiliation(s)
- Ellie Brown
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Gillinder Bedi
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Pat McGorry
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Brian O’Donoghue
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
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Colizzi M, Lasalvia A, Ruggeri M. Prevention and early intervention in youth mental health: is it time for a multidisciplinary and trans-diagnostic model for care? Int J Ment Health Syst 2020; 14:23. [PMID: 32226481 PMCID: PMC7092613 DOI: 10.1186/s13033-020-00356-9] [Citation(s) in RCA: 138] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 03/16/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Similar to other health care sectors, mental health has moved towards the secondary prevention, with the effort to detect and treat mental disorders as early as possible. However, converging evidence sheds new light on the potential of primary preventive and promotion strategies for mental health of young people. We aimed to reappraise such evidence. METHODS We reviewed the current state of knowledge on delivering promotion and preventive interventions addressing youth mental health. RESULTS Half of all mental disorders start by 14 years and are usually preceded by non-specific psychosocial disturbances potentially evolving in any major mental disorder and accounting for 45% of the global burden of disease across the 0-25 age span. While some action has been taken to promote the implementation of services dedicated to young people, mental health needs during this critical period are still largely unmet. This urges redesigning preventive strategies in a youth-focused multidisciplinary and trans-diagnostic framework which might early modify possible psychopathological trajectories. CONCLUSIONS Evidence suggests that it would be unrealistic to consider promotion and prevention in mental health responsibility of mental health professionals alone. Integrated and multidisciplinary services are needed to increase the range of possible interventions and limit the risk of poor long-term outcome, with also potential benefits in terms of healthcare system costs. However, mental health professionals have the scientific, ethical, and moral responsibility to indicate the direction to all social, political, and other health care bodies involved in the process of meeting mental health needs during youth years.
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Affiliation(s)
- Marco Colizzi
- 1Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
- 2Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF UK
| | - Antonio Lasalvia
- 1Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
| | - Mirella Ruggeri
- 1Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
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Reynolds S, Kim DJ, Brown E, Tindall R, O'Donoghue B. Defining disengagement from mental health services for individuals experiencing first episode psychosis: a systematic review. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1325-1335. [PMID: 31321451 DOI: 10.1007/s00127-019-01750-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 07/10/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Individuals affected by psychotic disorders frequently disengage from mental health services, although reports of this rate in the literature have ranged from 6 to 60%. One of the potential explanations for the large variation is that studies have adopted different definitions. Without a universal definition it is challenging to compare rates and factors leading to disengagement across studies. This systematic review aims to identify and compare how disengagement from psychosis services has been defined, measured and operationalised in the literature to date. METHODS A systemic literature search of the PubMed, PsycINFO and CINAHL databases was completed following the PRISMA guidelines for systematic reviews. RESULTS 1506 Studies were identified, of which 30 were eligible to be included. It was found that disengagement was operationalized as either a categorical or continuous variable across studies, with 18 studies classifying it as a categorical, binary variable. Only four studies applied a time period over which disengagement was said to occur, and only four studies used an instrument to measure or predict disengagement. Few studies considered similar factors in their definition, when this occurred it was because the papers came from the same research group. DISCUSSION To truly understand the phenomenon of disengagement, studies need to have a comparable outcome variable. The need for consensus on a gold standard definition of disengagement that considers the full breadth of its complexity remains. A potential process for establishing a definition that includes set parameters, agreed upon terminology and time periods of assessment is discussed.
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Affiliation(s)
- Siobhan Reynolds
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia
| | - Da Jung Kim
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia
| | - Ellie Brown
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia
| | - Rachel Tindall
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia
| | - Brian O'Donoghue
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia.
- Orygen Youth Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.
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