title: Rate and predictors of service disengagement in an epidemiological first-episode psychosis cohort.
abstract: OBJECTIVE
  To assess the prevalence and predictors of service disengagement in a treated epidemiological cohort of first-episode psychosis (FEP) patients.
  
  
  METHODS
  The Early Psychosis Prevention and Intervention Centre (EPPIC) in Australia admitted 786 FEP patients from January 1998 to December 2000. Treatment at EPPIC is scheduled for 18 months. Data were collected from patients' files using a standardized questionnaire. Seven hundred four files were available; 44 were excluded, because of a non-psychotic diagnosis at endpoint (n=43) or missing data on service disengagement (n=1). Rate of service disengagement was the outcome of interest, as well as pre-treatment, baseline, and treatment predictors of service disengagement, which were examined via Cox proportional hazards models.
  
  
  RESULTS
  154 patients (23.3%) disengaged from service. A past forensic history (Hazard ratio [HR]=1.69; 95%CI 1.17-2.45), lower severity of illness at baseline (HR=0.59; 95%CI 0.48-0.72), living without family at discharge (HR=1.75; 95%CI 1.22-2.50) and persistence of substance use disorder during treatment (HR=2.30; 95%CI 1.45-3.66) were significant predictors of disengagement from service.
  
  
  CONCLUSIONS
  While engagement strategies are a core element in the treatment of first-episode psychosis, particular attention should be paid to these factors associated with disengagement. Involvement of the family in the treatment process, and focusing on reduction of substance use, need to be pursued in early intervention services.
authors.affiliation: Département Universitaire de Psychiatrie Adulte, Université de Lausanne, Clinique de Cery, Switzerland. philippe.conus@chuv.ch
authors.forename: Philippe
authors.initials: P
authors.lastname: Conus
authors.forename: Martin
authors.initials: M
authors.lastname: Lambert
authors.forename: Sue
authors.initials: S
authors.lastname: Cotton
authors.forename: Charles
authors.initials: C
authors.lastname: Bonsack
authors.forename: Patrick D
authors.initials: PD
authors.lastname: McGorry
authors.forename: Benno G
authors.initials: BG
authors.lastname: Schimmelmann
mesh_terms: D000293:Adolescent; D015331:Cohort Studies; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D010349:Patient Compliance; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D012189:Retrospective Studies; D012565:Schizophrenic Psychology; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult