Rate and predictors of service disengagement among patients with first-episode psychosis

Psychiatr Serv. 2013 Aug 1;64(8):812-5. doi: 10.1176/appi.ps.201200199.

Abstract

Objective: This study determined the rate of service disengagement among patients in the Early Psychosis Intervention Program (EPIP) in Singapore and predictors of disengagement.

Methods: EPIP is a two-year multidisciplinary program targeting first-episode psychosis. The sample comprised patients consecutively accepted (2001-2009) who had two years of follow-up data. Disengagement was assessed with a semistructured scale. Sociodemographic and clinical variables were assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders, the Positive and Negative Syndrome Scale, and the Global Assessment of Functioning. Regression analyses were conducted.

Results: Among 775 patients, 109 (14%) disengaged from EPIP within two years. Significant baseline predictors included Malay ethnicity (odds ratio [OR]=1.93, 95% confidence interval [CI]=1.12-3.29) and less than six years of education (OR=2.30, CI=1.23-4.29).

Conclusions: EPIP's engagement strategy should focus on patients of Malay ethnicity and of low educational attainment. Further studies should examine how these factors affect service disengagement.

MeSH terms

  • Adolescent
  • Adult
  • Female
  • Humans
  • Male
  • Patient Compliance* / ethnology
  • Patient Compliance* / statistics & numerical data
  • Psychotic Disorders / diagnosis
  • Psychotic Disorders / therapy*
  • Refusal to Participate* / ethnology
  • Refusal to Participate* / statistics & numerical data
  • Singapore
  • Time Factors
  • Young Adult