The rates and determinants of disengagement and subsequent re-engagement in young people with first-episode psychosis
Open accessAbstract
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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Young individuals who do establish contact with mental health services show high rates of disengagement.
“When they do, they show high rates of disengagement [20]”
From Prevention and early intervention in youth mental health: is it time for a multidisciplinary and trans-diagnostic model for care? (2020) · cites this paper as [20]
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“28 Of particular note were the stories of participants who made sudden changes, such as taking on significant work or study commitments, and who simultaneously reduced their contact with their EIPS, culminating in challenges coping with stressors or a subsequent period of relapse.”
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- Authors
- Kim, D. J., Brown, E., Reynolds, S., Geros, H., Sizer, H., Tindall, R., McGorry, P., & O’Donoghue, B.
- Affiliations
- The University of Melbourne (AU)
- Deakin University (AU)
- Venue
- Social Psychiatry and Psychiatric Epidemiology
- Published
- 2019-03-28
- Volume
- 54
- Issue
- 8
- Pages
- 945-953
- ISSN
- 0933-7954 (ISSN-L)
- 1433-9285
- OpenAlex
- W2926999082
- Cited by
- 42
- References
- 31
- Citations by year
- 2026: 1 · 2025: 9 · 2024: 7 · 2023: 1 · 2022: 7 · 2021: 5 · 2020: 10 · 2019: 2
- FWCI
- 4.80
- Type
- journal article
- Language
- en
- Open access
- green
- figshare.com
- Licence
- Locations
- Social Psychiatry and Psychiatric Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- Figshare (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- first-episode psychosis, service disengagement, re-engagement, early intervention in psychosis, youth, cannabis use, education and employment, family history of psychosis
- MeSH terms
- Adolescent, Adult, Australia, Female, Humans, Male, Patient Participation, Psychotic Disorders, Retrospective Studies, Treatment Outcome, Young Adult, Early Medical Intervention
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