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

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Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

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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Authors and Affiliations

  1. Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia

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

  2. Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia

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

  3. Orygen Youth Health, 35 Poplar Road, Parkville, VIC, 3052, Australia

    Brian O’Donoghue

  4. Deakin University, IMPACT Strategic Research Centre, School of Medicine, Geelong, 3220, Australia

    Ellie Brown

Authors
  1. Da Jung Kim
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  2. Ellie Brown
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  3. Siobhan Reynolds
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  4. Hellen Geros
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  5. Holly Sizer
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  6. Rachel Tindall
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  7. Patrick McGorry
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  8. Brian O’Donoghue
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Corresponding author

Correspondence to Brian O’Donoghue.

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Kim, D.J., Brown, E., Reynolds, S. et al. The rates and determinants of disengagement and subsequent re-engagement in young people with first-episode psychosis. Soc Psychiatry Psychiatr Epidemiol 54, 945–953 (2019). https://doi.org/10.1007/s00127-019-01698-7

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  • DOI: https://doi.org/10.1007/s00127-019-01698-7

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