Predictors of Early Discharge From Early Intervention Services for Psychosis in New York State [2020]

Objective:
Although specialized early intervention services (EISs) for psychosis promote engagement in care, a substantial number of individuals who receive these services are discharged from care earlier than expected. The main goal of this study was to examine predictors of early discharge in a large sample of individuals enrolled in an EIS program in the United States.

Methods:
This cohort study (N=1,349) used programmatic data from OnTrackNY, an EIS program that delivers evidence-based interventions to youths across New York State experiencing a first episode of nonaffective psychosis. The main outcome was “early discharge,” which was operationalized as discharge prior to completing 12 months of treatment. Cox proportional hazard regression models were used to assess the association between sociodemographic, clinical, and support system predictors and early discharge.

Results:
The estimated probability of discharge before 1 year was 32%. Participants who at baseline had poor medication adherence, had no health insurance, were living alone or with nonparental family, or were using cannabis were at higher risk of leaving services within the first 12 months after enrollment. Individuals with higher social functioning were at lower risk of being discharged early from OnTrackNY, but those with higher occupational functioning were at a higher risk.

Conclusions:
Predictors of early discharge from EISs largely overlapped with previously identified predictors of poor prognosis in early psychosis. However, the association between early discharge and high occupational functioning indicates that trajectories leading up to discharge are heterogeneous.

Franco Mascayano, M.P.H., Els van der Ven, Ph.D., Gonzalo Martinez-Ales, M.D., Cale Basaraba, M.P.H., Nev Jones, Ph.D., Rufina Lee, Ph.D., Iruma Bello, Ph.D., Ilana Nossel, M.D., Stephen Smith, Ph.D., Thomas E. Smith, M.D., Melanie Wall, Ph.D., Ezra Susser, Ph.D., Lisa B. Dixon, M.D., M.P.H.
Psychiatric Services, 16 Sep 2020
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