Association of an Early Intervention Service for Psychosis With Suicide Rate Among Patients With First-Episode Schizophrenia-Spectrum Disorders
Open accessAbstract
Importance: Patients with schizophrenia have a substantially higher suicide rate than the general public. Early intervention (EI) services improve short-term outcomes. However, little is known about the association of EI with suicide reduction in the long term. Objective: To examine the association of a 2-year EI service with suicide reduction in patients with first-episode schizophrenia-spectrum (FES) disorders during 12 years and the risk factors for early and late suicide. Design, Setting, and Participants: This historical control study compared 617 consecutive patients with FES who received the 2-year EI service in Hong Kong between July 1, 2001, and June 30, 2003, with 617 patients with FES who received standard care (SC) between July 1, 1998, and June 30, 2001, matched individually. Clinical information was systematically retrieved for the first 3 years of clinical care for both groups. The details of death were collected up to 12 years from presentation to the services. Data analysis was performed from October 30, 2016, to August 18, 2017. Main Outcomes and Measures: Suicide rate during 12 years was the primary measure. The association of the EI service with the suicide rates during years 1 through 3 and years 4 through 12 were explored separately. Results: The main analysis included 1234 patients, with 617 in each group (mean [SD] age at baseline, 21.2 [3.4] years in the EI group and 21.3 [3.4] years in the SC group; 318 male [51.5%] in the EI group and 322 [52.2%] in the SC group). The suicide rates were 7.5% in the SC group and 4.4% in the EI group (McNemar χ2 = 5.55, P = .02). Patients in the EI group had significantly better survival (propensity score-adjusted hazard ratio, 0.57; 95% CI, 0.36-0.91; P = .02), with the maximum association observed in the first 3 years. The number of suicide attempts was an indicator of early suicide (1-3 years). Premorbid occupational impairment, number of relapses, and poor adherence during the initial 3 years were indicators of late suicide (4-12 years). Conclusions and Relevance: This study suggests that the EI service may be associated with reductions in the long-term suicide rate. Suicide at different stages of schizophrenia was associated with unique risk factors, highlighting the importance of a phase-specific service.
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Introduction of early intervention services for psychosis reduced suicides in Hong Kong.
“The introduction of early intervention services for psychosis reduced suicides in Hong Kong.60”
From Suicide (2020) · cites this paper as [60]
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The Lancet Psychiatry Commission on youth mental health
McGorry, P. D., Mei, C., Dalal, N., Alvarez-Jimenez, M., Blakemore, S.-J., Browne, V., Dooley, B., Hickie, I. B., Jones, P. B., McDaid, D., et al. (2024) · The Lancet Psychiatry · doi:10.1016/s2215-0366(24)00163-9 · Cited by 663 · see citing works
Self-citationFazel, S., & Runeson, B. (2020) · New England Journal of Medicine · doi:10.1056/nejmra1902944 · Cited by 502 · see citing works
- Authors
- Chan, S. K. W., Chan, S. W. Y., Pang, H. H., Yan, K. K., Hui, C. L. M., Chang, W. C., Lee, E. H. M., & Chen, E. Y. H.
- Affiliations
- University of Hong Kong (HK)
- Corresponding author
- Chan, Sherry Kit Wa
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2018-05-01
- Volume
- 75
- Issue
- 5
- Pages
- 458
- ISSN
- 2168-622X (ISSN-L)
- PMC
- PMC6145768
- OpenAlex
- W2795864754
- Cited by
- 95
- References
- 46
- Citations by year
- 2026: 9 · 2025: 11 · 2024: 14 · 2023: 10 · 2022: 10 · 2021: 14 · 2020: 16 · 2019: 8 · 2018: 2
- FWCI
- 7.81
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Psychiatry (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- The HKU Scholars Hub (University of Hong Kong) (submittedVersion)
- Funders
- Health and Medical Research Fund (03040141, 11121721)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- early intervention, psychosis, suicide, suicide attempts, suicide risk factors, relapse, medication adherence, long-term survival, Hong Kong, standard of care comparison, suicide prevention programs
- MeSH terms
- Suicide Prevention, Adult, Cause of Death, Cross-Sectional Studies, Female, Hong Kong, Humans, Male, Risk Factors, Schizophrenia, Suicide, Survival Analysis, Young Adult, Early Medical Intervention, Historically Controlled Study
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